Dermal fat graft from simultaneous abdominoplasty as an adjunct to revision aesthetic and reconstructive breast surgery: A poor man's acellular dermal matrix?

INTRODUCTION: The global use of acellular dermal matrices as an adjunct to tissue expander or implant-based breast reconstruction, by surgeons wishing to cover and support the inferior breast pole, has increased in frequency in the last two decades. However despite the reported enhanced cosmetic outcomes, issues regarding their cost effectiveness have led to their infrequent use within the UK National Health Service and the need for an equally efficacious but cheaper alternative. PRESENTATION OF CASE: We report two patients requiring bilateral revision breast surgery for severely asymmetrical, tender, ptotic breasts and cosmetically poor abdomens. Both were denied assisted acellular dermal matrix reconstructive surgery on the state NHS system and unable to afford the private costs. We therefore utilised free dermal fat grafts, harvested from concomitant abdominoplasties to extend the pectoralis major muscle and smoothen surface irregularities. DISCUSSION: Both patients achieved excellent cosmetic outcomes and aside from a small, spontaneously resolving abdominal site seroma in one patient, have remained free of any complications for over two years. This cost effective procedure is only feasible in patients with an adequate pannus who are amenable to the extra surgery and resultant scarring. CONCLUSION: We herein report the use of free dermal fat graft in revision aesthetic and reconstructive surgery in a manner akin to recent acellular dermal matrix use. The comparable enhanced aesthetic outcomes, minimal complication rate and substantial cost savings merit dissemination to a global audience and encourage surgeons to consider this economic alternative.

Successful use of a gastrocnemius flap for an exposed PTFE femorodistal graft: a case report.

Peripheral vascular disease (PVD) is a condition requiring aggressive management to minimise the associated increased morbidity and mortality. Femoro-distal bypass grafting is used in patients with extensive occlusion affecting the crural arteries and poor limb function, but is associated with infection, wound dehiscence and graft exposure. We report a case of a 73-year-old male with history of PVD and occluded ipsilateral femoro-distal bypass graft who underwent limb salvage surgery with a left 6 mm heparin-bonded polytetrafluoroethylene femoro-distal bypass graft in September 2011. He later presented with exposure of the graft over the lateral aspect of the knee following wound dehiscence. During surgery, the exposed portion of the graft was covered by a lateral gastrocnemius muscle flap with an overlying split thickness skin graft. Minor donor site healing problems were noted, but he otherwise made an excellent recovery. While gastrocnemius muscle flaps have been used to cover soft tissue tibial defects secondary to sarcoma and exposed knee joint prostheses, our case adds to the limited literature demonstrating successful salvage of an exposed synthetic graft as a viable alternative to amputation. We therefore recommend prompt referral to plastic services for the management of these complex wounds.