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Enhancement of autologous fat graft survival by recipient site preparation

Oranges, Carlo M.. Enhancement of autologous fat graft survival by recipient site preparation. 2019, Doctoral Thesis, University of Basel, Faculty of Medicine.

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Official URL: http://edoc.unibas.ch/diss/DissB_13490

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Abstract

Fat grafting has emerged as a very powerful tool, largely used in plastic surgery for a multitude of indications, including correction of contour abnormalities, breast reconstruction, and cosmetic procedures. However, the variability in terms of volumetric stability of the grafted fat and the lack of methods to measure outcomes in a reliable, easy and reproducible manner represent relevant limitations. To improve outcomes, the majority of the investigations has focused on three of the four steps of the fat grafting process, namely harvesting, processing, and re-injection. The preparation of the recipient site has instead received less attention, despite several reports suggesting an ability of determining higher fat survival rates, mainly through induction of cell proliferation, neo-vascularization and neo-adipogenesis. It is therefore of utmost clinical relevance to determine whether the preparation of the recipient site prior to fat grafting leads to more favorable results. The aim of the present work is to collect and review all existing pre-clinical and clinical evidence regarding all methods to prepare the recipient site, to introduce a new preparation technique and to validate a new three-dimensional method to assess outcomes objectively.
Four publications are included. The first manuscript provides a comprehensive overview of the different techniques to prepare the recipient site for fat grafting as they were investigated in pre-clinical studies, including external volume expansion, implantation of alloplastic material, administration of cell-proliferation factors, ischemia, and microneedling. The resulting outcomes are analyzed and the underlying mechanisms of action clarified. The second paper reviews all clinical studies investigating the most used preparation technique, external volume expansion, examining different indications, treatment protocols, outcomes, and complications. The third article presents an innovative and simple intraoperative external expansion system which applies a strong cycling negative pressure of -550 mmHg to enhance small-volume autologous fat grafting (40–80 mL) and discusses its background and its mechanism of action. In particular, this article examines our experience with recipient sites in the breast characterized by restrictive cicatrix or pre-irradiated tissues. Finally, the fourth study validates the use of a novel, inexpensive and handheld three-dimensional scanning process to perform an easy and precise measurement of breast volumes and surfaces, extremely useful to evaluate fat grafting outcomes, especially in case of small volume transplantation.
Advisors:Schaefer, Dirk J. and Kalbermatten, Daniel Felix and Horch, Raymund
Faculties and Departments:03 Faculty of Medicine > Bereich Operative Fächer (Klinik) > Bewegungsapparat und Integument > Plastische, rekonstruktive, ästhetische und Handchirurgie (Schaefer)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Operative Fächer (Klinik) > Bewegungsapparat und Integument > Plastische, rekonstruktive, ästhetische und Handchirurgie (Schaefer)
Item Type:Thesis
Thesis Subtype:Doctoral Thesis
Thesis no:13490
Thesis status:Complete
Number of Pages:1 Online-Ressource (1 Band)
Language:English
Identification Number:
Last Modified:14 Feb 2020 09:10
Deposited On:14 Feb 2020 09:09

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