Lee L.Q. Pu

Autologous fat grafts harvested and refined by the Coleman technique: a comparative study.

Background: The viability of fat grafts obtained by even a well-established technique remains poorly studied and unknown. This study was designed to determine the viability of fat grafts harvested and refined by the Coleman technique. Methods: Sixteen adult white women were enrolled in this study. In group 1 (n = 8), fat grafts were harvested and processed with the Coleman technique by a single surgeon from the abdomen of each patient according to his standardized method. In group 2 (n = 8), fat grafts were harvested with the conventional liposuction by another surgeon. After centrifugation, the resulting middle layer of tissue was collected. All fat graft samples were analyzed for the following studies: trypan blue vital staining for viable adipocyte counts, glycerol-3-phophatase dehydrogenase assay, and routine histologic examination. Results: The higher viable adipocyte counts were found in group 1 compared with group 2 (4.11 ± 1.11 versus 2.57 ± 0.56 × 106 cells/ml; p < 0.004). The level of glycerol-3-phophatase dehydrogenase activity was significantly higher in group 1 compared with group 2 (0.66 ± 0.09 versus 0.34 ± 0.13 U/ml; p < 0.0001). Histologic examination showed normal structure of fragmented fatty tissues in both groups. Conclusions: Although fat grafts obtained by both methods maintain normal histologic structure, the Coleman technique yields a greater number of viable adipocytes and sustains a more optimal level of cellular function within fat grafts and should be considered superior to conventional liposuction as a preferred method of choice for fat graft harvesting.

Autologous fat grafting to the breast for cosmetic enhancement: experience in 66 patients with long-term follow up.

BACKGROUND Autologous fat grafting to the breast for cosmetic enhancement remains controversial because the efficacy and fate of fat grafting to the breast are primarily unknown. In this report, we present our retrospective study in 66 patients who underwent autologous fat grafting to the breast for various cosmetic reasons and who were followed with sonography, mammography, or magnetic resonance imaging (MRI). METHODS Sixty-six patients who desired cosmetic enhancement of the breast for various reasons underwent autologous fat transplantation between August 2000 and March 2005 in our institution. The cosmetic outcome was assessed by the plastic surgeons as well as the patients. The imaging features of fat necrosis, cyst formation, and calcification in these patients were carefully studied and biopsies of palpable lumps were evaluated histologically. RESULTS All patients were followed from 13 to 61 months with an average of 37 months. Breast cosmetic contour was significantly improved in 28 patients (42.4%), improved in 24 patients (36.4%), and not improved in 14 patients (21.2%) as judged by the plastic surgeons. Twenty-seven patients (40.9%) were very satisfied, 26 patients (39.4%) were satisfied, and 13 patients (19.7%) were unsatisfied. Eleven patients (16.7%) developed liponecrotic cysts but only two patients elected to have the breast lump surgically removed. CONCLUSION Autologous fat grafting to the breast can be a useful procedure for cosmetic enhancement in many patients who desire such a procedure. Patients with breast contour deformities after removal of silicon implants were found to be the best candidates for fat grafting. The primary long-term complication is the formation of liponecrotic cysts which have characteristically benign appearances in sonography, mammography or MRI.

The effect of centrifugation on viability of fat grafts: an evaluation with the glucose transport test.

BACKGROUND An up-to-date, simple, but useful technique to evaluate the viability of fat grafts prior to transplant is lacking. The purpose of this study is to introduce the glucose transport test - a new method to evaluate the viability of fat grafts after they are subjected to different centrifugal forces in vitro. METHOD Fat grafts were harvested from healthy patients who underwent liposuction for body contouring. The glucose transport test was performed to evaluate the viability of fat grafts after centrifugation with different forces (1000-4000 rpm). An MTT assay was also performed with the same experimental protocol for comparison. Routine histological examination was done in all groups to examine possible structural destruction after centrifugation. RESULTS When compared with the group not subjected to centrifugation, the glucose transport test showed a significant decrease in viability of fat grafts in all of the other four groups (all p<0.001). There was a linear reduction of viability in fat grafts with the increase in centrifugal force (all p<0.03). MTT assay showed similar findings on the viability of fat grafts in all five groups and correlated well with the glucose transport test (r=0.9870). Histology showed significantly distorted and fractured adipocytes when the centrifugal force reached 4000 rpm. CONCLUSION Our study demonstrates the harmful effect on the viability of fat grafts with an increase in centrifugal force and, for the first time, that the glucose transport test may be an effective and potentially useful method to evaluate the viability of fat grafts in a clinical setting.

Towards more rationalized approach to autologous fat grafting

BACKGROUND Even though fat grafting has become widely used by plastic surgeons, most surgeons choose their method of fat grafting based almost entirely on anecdotal evidence. As more and more scientific studies appear in the literature, we now may have more objective, scientific evidence to support the use of specific techniques. METHODS The author critically reviewed all studies related to fat grafting research in the last 20 years in the English literature. To better summarize the findings of the studies, the fat grafting procedure was arbitrarily divided into 4 essential parts to determine the best donor sites and how the fat grafts should be harvested, processed, and placed. RESULTS While most studies show no difference in the viability of fat grafts harvested from different donor sites, one study shows that more adipose-derived stem cells (ADSCs) are found within the fat grafts harvested from the lower abdomen or inner thigh. Fat grafts harvested with syringe aspiration and processed with centrifugation at 1200 g for 3 min clearly have better viability. In addition, viable adipocytes and ADSCs as well as growth factors can be concentrated within the fat grafts after proper centrifugation. The studies also reinforce the principle that fat grafts, once placed, should have a maximal amount of contact with the vascularized tissue in the recipient site for better survival. CONCLUSIONS Most scientific studies in fat grafting research support a more rationalized technique that should be selected by surgeons for fat grafting. The technique includes proper selection of donor sites, proper harvest and process of fat grafts, and proper placement of fat grafts.

Autologous fat grafting for primary breast augmentation: A systematic review

As the technique of autologous fat grafting is being refined and perfected, its clinical applications are expanding. The use of autologous fat grafting for primary breast augmentation is controversial due to a lack of clarity regarding its safety and efficacy. Most notably, concerns about interference with the detection of breast cancer have been raised, but these have not been clearly addressed in the literature. To help surgeons gain further insight, the authors conducted a systematic review of the literature, carefully comparing technique, clinical outcome, radiologic impact, and complications in all available data on this subject. Although an optimal method of autologous fat grafting for primary breast augmentation is yet to be standardized, further strong evidence-based studies are necessary to confirm the findings of this approach.

Correction of hemifacial atrophy with autologous fat transplantation.

Background:Autologous fat transplantation has frequently been used by many surgeons for facial recontouring in esthetic patients, with good long-term results. However, this technique has not been used primarily in treating patients with hemifacial atrophy, and its efficacy and long-term outcome remain unknown. Methods:In a 7-year period, 31 patients with hemifacial atrophy were treated with autologous fat transplantation in our institution. All patients had been in their stable phase of the disease for at least 1 year. Autologous fat grafts were harvested from the lower abdomen or thigh with our preferred low-pressure syringe technique and then spun at the lower speed. The fat grafts were injected into multiple areas in multiple tissue planes and tunnels to the diseased side of the face. The same procedure was repeated once or twice as necessary after each injection in at least 3 months. All patients were followed up to 5 years, and their outcomes were evaluated by the patients, plastic surgeons, and laypersons separately. Results:Obviously improved facial contour was evident in most patients after autologous fat transplantations. More than 65% of the patients in this series were assessed as satisfactory by all 3 groups. Between 10% and 30% of the patients were mostly satisfactory. Only less than 7% of the patients were unsatisfactory. No complications were seen in either donor sites or recipient sites in this series. Conclusions:Autologous fat transplantation can be a good treatment of choice for patients with hemifacial atrophy.

Cryopreservation of autologous fat grafts harvested with the Coleman technique.

The viability of fat grafts harvested with an established technique after cryopreservation remains unknown. This study was conducted in vitro to evaluate the viability of autologous fat grafts harvested with the Coleman technique and subsequently preserved with our preferred cryopreservation method. Eight adult females were enrolled in this study. In each patient, 10 mL of fat grafts were harvested with the Coleman technique by a single surgeon from the lower abdomen. In group 1, 5 mL of fresh fat grafts were mixed with cryoprotective agents and underwent cryopreservation with controlled slow cooling and fast rewarming. In group 2, 5 mL of fresh fat grafts without cryopreservation from the same patient served as a control. The fat graft samples from both groups were evaluated with trypan blue vital staining, glycerol-3-phophatase dehydrogenase assay, and routine histology. Viable adipocyte counts were found similar in both group 1 and group 2 (3.46 ± 0.91 vs. 4.12 ± 1.11 × 106/mL, P = 0.22). However, glycerol-3-phophatase dehydrogenase activity was significantly lower in group 1 compared with group 2 (0.47 ± 0.09 vs. 0.66 ± 0.09 u/mL, P < 0.001). Histologically, the normal structure of fragmented fatty tissues was found primarily in both groups. Our results indicate that autologous fat grafts harvested with the Coleman technique and preserved with our preferred cryopreservation method have a normal histology with near the same number of viable adipocytes as compared with the fresh fat grafts. However, those cryopreserved fat grafts appear to have a less optimal level of adipocyte specific enzyme activity compared with the fresh ones and thus may not survive well after they are transplanted without being optimized.

Future Perspectives of Fat Grafting

Autologous fat grafting is an exciting part of plastic and reconstructive surgery. Fat serves as a filler and its role in tissue regeneration will likely play a more important role in our specialty. As we learn more about the basic science of fat grafting and the standardized techniques and instruments used for fat grafting, this procedure alone or in conjunction with invasive procedures may be able to replace many operations that we perform currently. Its minimally invasive nature will benefit greatly our cosmetic and reconstructive patients, and may even achieve better clinical outcomes.

Can We Standardize the Techniques for Fat Grafting

Fat grafting still remains technique dependent with possible less favorable long-term results because there are no standardized techniques used by the surgeon to perform the procedure. In this article, the authors have tried to standardize the techniques for fat grafting as first proposed and popularized by Coleman. These techniques, supported by the most recent scientific studies and understandings of clinical course following autologous fat transplantation, emphasize proper fat harvesting, processing, and placement so that a predictable long-lasting result can be achieved.

Soft-tissue coverage of an extensive mid-tibial wound with the combined medial gastrocnemius and medial hemisoleus muscle flaps: The role of local muscle flaps revisited

The proper soft-tissue management for an extensive mid-tibial wound of the leg with a less aggressive surgical approach has rarely been discussed in the literature and the reliability and the usefulness of such an approach to this challenging clinical problem remains uncertain. In this series, four patients with an extensive mid-tibial wound (12x3 to 22x6 cm) of the leg underwent the combined medial gastrocnemius and medial hemisoleus muscle flaps for soft-tissue reconstruction. Both muscle flaps were elevated with emphasis on the preservation of the critical perforators from the posterior tibial vessels to the medial hemisoleus muscle flap as possible and on the possible preservation of foot planter flexion by reconstruction of the proximal Achilles tendon to minimise functional loss. All patients except one had primary healing of their tibial wounds. One patient developed insignificant distal flap necrosis of the medial soleus flap and was treated with debridement and flap re-advancement. Three patients with tibial fracture also had evidenced healing of their tibial fractures. Limb salvage was achieved in all four patients during follow-up. Thus, the combined medial gastrocnemius and medial hemisoleus muscle flaps can be a valid option for soft-tissue coverage of an extensive mid-tibial wound of the leg when both local muscle flaps are not traumatised. Such an approach offers relatively simple but more cost-effective way to manage this complex clinical problem and should be revisited by reconstructive surgeons.