CC BY-NC-ND 4.0 · Indian J Plast Surg 2016; 49(02): 151-158
DOI: 10.4103/0970-0358.191322
Original Article
Association of Plastic Surgeons of India

Effect of external volume expansion on the survival of fat grafts

Raghuveer Reddy
Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Subramania Iyer
Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Mohit Sharma
Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Sundeep Vijayaraghavan
Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
P. Kishore
Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Jimmy Mathew
Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
A. K. K. Unni
1   Department of Animal Research Facility, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
P. Reshmi
1   Department of Animal Research Facility, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Rakesh Sharma
2   Department of Oral Pathology, Amrita Institute of Dental Sciences, Kochi, Kerala, India
,
Chaya Prasad
3   Department of Clinical Pathology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
› Author Affiliations
Further Information

Address for correspondence:

Dr. Raghuveer Reddy
Department of Plastic and Reconstructive Surgery, Tower 1, Floor 4, Amrita Institute of Medical Sciences
AIMS Ponekkara, Kochi - 682 024, Kerala
India   

Publication History

Publication Date:
13 August 2019 (online)

 

ABSTRACT

Introduction: External volume expansion (EVE) is one method, which has been utilised for increasing the survival of adipose tissue grafts. EVE releases positive pressure from the graft and also induces intense levels of edema that decreases diffusion of metabolites essential for graft survival initially. The ideal timing of external volume expansion in relation to the injection of the fat to facilitate survival is not yet clear. Aims and Objectives: This study was undertaken to evaluate and compare the efficacy of external volume expansion applied at variable time points in relation to the injection of the fat. Materials and Methods: Athymic mouse was the animal model and human lipo-aspirate mixed with PRP was used as graft. An indigenous dome shaped silicone device was fabricated to deliver a negative pressure of -30 mm of Hg. The EVE was applied at variable time intervals. At the end of 4 weeks visual, histological and radiological features of the injected fat were compared. The adipose tissue was stained with human vimentin to ascertain the origin of the retained fat. Results: All the grafts, which had EVE, had significantly better volume retention and vascularity. The groups which underwent a delayed EVE or prior expansion followed by concomitant graft injection and expansion showed the most optimal vascularity and graft retention. Conclusions: A delayed EVE or prior expansion followed by concomitant graft injection and expansion may be the most ideal combinations to optimize graft take. However, on account of the relatively small sample size, there was a limitation in drawing statistically significant conclusions for certain variables.


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Conflicts of interest

There are no conflicts of interest.

  • REFERENCES

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Address for correspondence:

Dr. Raghuveer Reddy
Department of Plastic and Reconstructive Surgery, Tower 1, Floor 4, Amrita Institute of Medical Sciences
AIMS Ponekkara, Kochi - 682 024, Kerala
India   

  • REFERENCES

  • 1 Carpaneda CA, Ribeiro MT. Percentage of graft viability versus injected volume in adipose autotransplants. Aesthetic Plast Surg 1994; 18: 17-9
  • 2 Niechajev I, Sevcuk O. Long-term results of fat transplantation: Clinical and histologic studies. Plast Reconstr Surg 1994; 94: 496-506
  • 3 Gir P, Brown SA, Oni G, Kashefi N, Mojallal A, Rohrich RJ. Fat grafting: Evidence-based review on autologous fat harvesting, processing, reinjection, and storage. Plast Reconstr Surg 2012; 130: 249-58
  • 4 Ersek RA. Transplantation of purified autologous fat: A 3-year follow-up is disappointing. Plast Reconstr Surg 1991; 87: 219-27
  • 5 Coleman SR, Saboeiro AP. Fat grafting to the breast revisited: Safety and efficacy. Plast Reconstr Surg 2007; 119: 775-85
  • 6 Paletta CE, Pokorny JJ, Rumbolo P. Skin grafts. In: Mathes SJ. editor. Plastic Surgery. Vol. 1. Philadelphia: Saunders Elsevier; 2006: p. 293-316
  • 7 Lancerotto L, Chin MS, Freniere B, Lujan-Hernandez JR, Li Q, Valderrama Vasquez A. et al. Mechanisms of action of external volume expansion devices. Plast Reconstr Surg 2013; 132: 569-78
  • 8 Wilhelmi BJ, Blackwell SJ, Mancoll JS, Phillips LG. Creep vs stretch: A review of the viscoelastic properties of skin. Ann Plast Surg 1998; 41: 215-9
  • 9 Ingber D. How cells (might) sense microgravity. FASEB J 1999; 13 Suppl: S3-15
  • 10 Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP. Vacuum-assisted closure: Microdeformations of wounds and cell proliferation. Plast Reconstr Surg 2004; 114: 1086-96
  • 11 Chin MS, Ogawa R, Lancerotto L, Pietramaggiori G, Schomacker KT, Mathews JC. et al. In vivo acceleration of skin growth using a servo-controlled stretching device. Tissue Eng Part C Methods 2010; 16: 397-405
  • 12 Saxena V, Orgill D, Kohane I. A set of genes previously implicated in the hypoxia response might be an important modulator in the rat ear tissue response to mechanical stretch. BMC Genomics 2007; 8: 430
  • 13 Chin MS, Lancerotto L, Helm DL, Dastouri P, Prsa MJ, Ottensmeyer M. et al. Analysis of neuropeptides in stretched skin. Plast Reconstr Surg 2009; 124: 102-13
  • 14 Lujan-Hernandez J, Lancerotto L, Nabzdyk C, Hassan KZ, Giatsidis G, Khouri Jr. RK. et al. Induction of adipogenesis by external volume expansion. Plast Reconstr Surg 2016; 137: 122-31
  • 15 Zocchi ML, Zuliani F. Bicompartmental breast lipostructuring. Aesthetic Plast Surg 2008; 32: 313-28
  • 16 Del Vecchio D. Breast reconstruction for breast asymmetry using recipient site pre-expansion and autologous fat grafting: A case report. Ann Plast Surg 2009; 62: 523-7
  • 17 Stillaert F, Findlay M, Palmer J, Idrizi R, Cheang S, Messina A. et al. Host rather than graft origin of matrigel-induced adipose tissue in the murine tissue-engineering chamber. Tissue Eng 2007; 13: 2291-300
  • 18 Jin R, Zhang L, Zhang YG. Does platelet-rich plasma enhance the survival of grafted fat? An update review. Int J Clin Exp Med 2013; 6: 252-8
  • 19 Modarressi A. Platlet rich plasma (PRP) improves fat grafting outcomes. World J Plast Surg 2013; 2: 6-13
  • 20 Lee JW, Han YS, Kim SR, Kim HK, Kim H, Park JH. A rabbit model of fat graft recipient site preconditioning using external negative pressure. Arch Plast Surg 2015; 42: 150-8
  • 21 Cronin KJ, Messina A, Knight KR, Cooper-White JJ, Stevens GW, Penington AJ. et al. New murine model of spontaneous autologous tissue engineering, combining an arteriovenous pedicle with matrix materials. Plast Reconstr Surg 2004; 113: 260-9
  • 22 Dolderer JH, Abberton KM, Thompson EW, Slavin JL, Stevens GW, Penington AJ. et al. Spontaneous large volume adipose tissue generation from a vascularized pedicled fat flap inside a chamber space. Tissue Eng 2007; 13: 673-81
  • 23 Dolderer JH, Thompson EW, Slavin J, Trost N, Cooper-White JJ, Cao Y. et al. Long-term stability of adipose tissue generated from a vascularized pedicled fat flap inside a chamber. Plast Reconstr Surg 2011; 127: 2283-92
  • 24 Abberton KM, Bortolotto SK, Woods AA, Findlay M, Morrison WA, Thompson EW. et al. Myogel, a novel, basement membrane-rich, extracellular matrix derived from skeletal muscle, is highly adipogenic in vivo and in vitro . Cells Tissues Organs 2008; 188: 347-58
  • 25 Kelly JL, Findlay MW, Knight KR, Penington A, Thompson EW, Messina A. et al. Contact with existing adipose tissue is inductive for adipogenesis in matrigel. Tissue Eng 2006; 12: 2041-7
  • 26 Stillaert FB, Abberton KM, Keramidaris E, Thompson EW, Blondeel PN, Morrison WA. Intrinsics and dynamics of fat grafts: An in vitro study. Plast Reconstr Surg 2010; 126: 1155-62
  • 27 Heit YI, Lancerotto L, Mesteri I. et al. External volume expansion increases subcutaneous thickness, cell prolif- eration, and vascular remodeling in a murine model. Plast Reconstr Surg. 2012; 130: 541-547