Improved Adipocyte Viability in Autologous Fat Grafting With Ascorbic Acid-Supplemented Tumescent Solution.

INTRODUCTION: In reconstructive surgery, fat volume augmentation is often necessary for esthetic or functional reasons. As an alternative to synthetic and xenogeneic materials, autologous fat grafting (AFG) based on liposuction is gaining popularity, yet successful transplantation and long-term volume maintenance are difficult. Standard tumescent solution formulations neglect adipocyte and stromal vascular fraction (SVF) cell survival during extraction, as well as SVF differentiation into adipocytes thereafter, all of which are crucial for the success of AFG. Here we hypothesized that addition of ascorbic acid (AA) to the tumescent solution could prevent liposuction-induced cell damage. MATERIALS AND METHODS: The effect of 0.1 mmol/L AA in tumescent solution was investigated in a previously described ex vivo model of AFG. Briefly, excision fat was infiltrated with tumescent solution, with or without AA, and incubated for 20 minutes at 37°C. Hand-assisted liposuction was then performed with a blunt cannula. Total cell viability, clonogenicity, and differentiation capacity of the SVF cells were assessed. RESULTS: With AA, 10.3% more cells and in particular 14.9% more adipocytes survived liposuction. Clonogenicity, adipocyte and osteoblast differentiation by SVF cells remained unchanged. CONCLUSIONS: Addition of AA successfully improved survival of adipocytes during liposuction without affecting SVF growth and differentiation. This study therefore identified a useful supplement to the tumescent solution which may lead to improving AFG success.

Functional fat injection under local anesthesia to treat severe postsurgical dysphagia, case report.

BACKGROUND: In this study, we present the first application of functional fat injection performed under local anesthesia in the treatment of severe dysphagia secondary to head and neck cancer surgery. METHODS: Functional fat injection was performed using a transcervical approach. Control of injection depth and site was performed through a transnasal flexible endoscope. The effect of surgery was evaluated through videofluoroscopy (VFS), Fiberendoscopic Evaluation of Swallowing (FEES), Functional Oral Intake Scale (FOIS), and Eating Assessment Tool-10 (EAT-10). RESULTS: Before the functional fat injection, the patient was dependent on permanent tube feeding; the VFS and FEES revealed a severe impairment of swallowing abilities. The EAT-10 scored 26. Twelve months after surgery, the patient was on oral diet, the VFS demonstrated mild to moderate dysphagia, the FEES demonstrated aspiration only with liquids and the EAT-10 improved. CONCLUSION: Functional fat injection under local anesthesia could be useful in the treatment of chronic dysphagia in selected patients.

Necrose facial após enxerto de gordura e tratamento com oxigenioterapia hiperbárica / Facial necrosis after fat grafting and treatment with hyperbaric oxygen therapy

A lipoenxertia de face, apesar de consagrada, não é isenta de riscos e complicações. Neste relato de caso, descrevemos de forma inédita uma complicação isquêmica local, causada por enxerto de gordura. Simultaneamente, propomos a terapêutica com Oxigenioterapia Hiperbárica para o tratamento desta situação, não se limitando exclusivamente à gordura, mas principalmente ao PMMA, em que esta complicação é muito mais frequente.

Facial fat grafting is not devoid of risks and complications, despite being a widely practiced procedure. In this case report, we describe a novel form of local ischemic complication that occurred secondary to fat grafting. Simultaneously, we propose Hyperbaric Oxygen therapy for the treatment of this situation. We propose that Hyperbaric Oxygen therapy should not be limited solely to fat graft-related ischemia, but should be effective in the management of the more frequently encountered complications associated with polymethylmethacrylate fillers.

Effect of local, long-term delivery of platelet-derived growth factor (PDGF) on injected fat graft survival in severe combined immunodeficient (SCID) mice.

SUMMARY BACKGROUND: Autogenous fat injection is widely used for the correction of acquired and congenital soft tissue defects. However, the high absorption rate results in the need for over-correction of the defect and repeat procedures. We hypothesised that platelet-derived growth factor (PDGF), a potent mitogen and known stimulant for murine preadipocytes, would improve fat graft survival when concentrations were sustained with a gelatine microsphere delivery system. METHODS: Abdominal fat was harvested from an otherwise healthy 43-year-old woman during a breast reconstruction. Prior to subdermal injection into severe combined immunodeficient (SCID) mice, the fat grafts were divided into 1-ml aliquots, mixed with microspheres bound to PDGF, free PDGF, or nothing depending on its experimental group, and weighed. The following experimental groups were thus created (minimum n=8 per group): (1) fat graft control, (2) fat graft with free PDGF, (3) fat graft with blank microspheres, and (4) fat graft with microspheres bound to PDGF. After 12 weeks, the fat xenografts were harvested for analysis of weight maintenance and histological and morphometric evaluation. RESULTS: The addition of PDGF bound to gelatine microspheres was effective in improving xenograft weight maintenance (P=0.018) and preservation of adipose tissue architecture (P<0.0005) compared to controls at 3 months. The microspheres were completely absorbed at 12 weeks. CONCLUSIONS: Sustained, local delivery of PDGF via a gelatine microsphere delivery system resulted in improved weight maintenance of the xenografts with greater preservation of adipose tissue architecture at 3 months compared to controls.