A Randomized Prospective Time and Motion Comparison of Techniques to Process Autologous Fat Grafts

Hanson, Summer E.; Garvey, Patrick B.; Chang, Edward I.; Reece, Gregory P.; Li, Jun; Baumann, Donald P.; Butler, Charles E.

doi:10.1097/prs.0000000000007827

Cited by 9 publications

(8 citation statements)

References 33 publications

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“…A total of 46 patients were enrolled in the parent study. 14 Fifteen were randomized to active filtration, 15 were randomized to passive filtration, and 16 were randomized to centrifugation, with one failing the initial screen. There were no statistical differences in patient characteristics among the three groups (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The source time and motion study was powered to demonstrate a statistical difference in techniques based on time and motion methodology and clearly favored the active filtration system. 14 Given that reported rates of fat necrosis are low in autologous fat grafting, one would need to enroll nearly 1000 patients to achieve adequate statistical power to demonstrate a significant difference. Although the focus of this study was objective clinical outcomes, another limitation may be the lack of a validated patient-reported outcome survey.…”

Section: Discussionmentioning

confidence: 99%

“…The authors conducted a randomized, prospective parent study to compare outcomes in processing techniques for fat grafting. 14 The protocol was approved by the authors' institutional review board (P2015-0006) as well as the Clinical Oncology Research system (CORe) and registered with the U.S. National Library of Medicine at ClinicalTrials.gov (no. NCT02677012).…”

Section: Methodsmentioning

confidence: 99%

“…We previously performed a prospective, randomized time and motion study comparing the operative outcomes of three commonly used processing techniques. 14 There was significant difference in the rate of processing the tissue graft in each system, favoring the active filtration device. The purpose of the current study is to compare short-term and 1-year clinical outcomes of the three commonly used systems for graft preparation.…”

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confidence: 99%

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A Prospective, Randomized Comparison of Clinical Outcomes with Different Processing Techniques in Autologous Fat Grafting

Hanson¹,

Garvey²,

Chang³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Autologous fat grafting is a useful tool in breast reconstruction. The authors have previously demonstrated a difference in the rate of processing adipose grafts in a randomized time and motion clinical trial. The purpose of this study was to compare clinical outcomes in commonly used grafting systems. Methods: Three methods to prepare adipose grafts were compared: a passive washing filtration system (Puregraft system), an active washing filtration system (Revolve system), and centrifugation (Coleman technique). Postoperative complications, rates of fat necrosis, revision procedures, and additional imaging were recorded. Results: Forty-six patients were included in the prospective, randomized study (15 active filtration, 15 passive filtration, and 16 centrifugation). Their mean age was 54 years and mean body mass index was 28.6 kg/m2. The mean length of follow-up was 16.9 ± 4 months. The overall complication rate was 12.1 percent. The probability of fat necrosis was no different between the groups (active filtration, 15 percent versus passive filtration, 14.3 percent] versus centrifugation, 8 percent; p = 0.72). Fat necrosis was highest in patients with breast conservation before grafting (60 percent; p = 0.011). There was no significant difference in contour irregularity (active filtration, 40 percent versus passive filtration, 38 percent versus centrifugation, 36 percent; p = 0.96) or additional grafting (active filtration, 40 percent versus passive filtration, 24 percent versus centrifugation, 32 percent; p = 0.34). Conclusions: This is the first prospective, randomized study to compare clinical outcomes of adipose graft preparation. There was no significant difference in early complications, fat necrosis, or rates of additional grafting among the study groups. There was significantly higher risk of fat necrosis in patients with previous breast conservation treatment regardless of processing technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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A Prospective, Randomized Comparison of Clinical Outcomes with Different Processing Techniques in Autologous Fat Grafting

Hanson¹,

Garvey²,

Chang³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Autologous fat grafting (AFG) after breast reconstruction and cosmetic breast augmentation has recently gained attention in the scientific literature 1 . It is most often performed for volume enhancement but has also been used for other indications, including soft tissue deficits, contour irregularities, and volume augmentation 2 . Autologous fat grafting is a procedure that entails harvesting fat from one part of the body, processing or purifying the tissue, and delivering it to a different location.…”

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confidence: 99%

Postoperative Antibiotics Confer No Protective Association After Fat Grafting for Breast Reconstruction

et al. 2023

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Introduction Autologous fat grafting after breast reconstruction is a commonly used technique to address asymmetry and irregularities in breast contour. While many studies have attempted to optimize patient outcomes after fat grafting, a key postoperative protocol that lacks consensus is the optimal use of perioperative and postoperative antibiotics. Reports suggest that complication rates for fat grafting are low relative to rates after reconstruction and have been shown to not be correlated to antibiotic protocol. Studies have additionally demonstrated that the use of prolonged prophylactic antibiotics do not lower the complication rates, stressing the need for a more conservative, standardized antibiotic protocol. This study aims to identify the optimal use of perioperative and postoperative antibiotics that optimizes patient outcomes. Methods Patients in the Optum Clinformatics Data Mart who underwent all billable forms of breast reconstruction followed by fat grafting were identified via Current Procedural Terminology codes. Patients meeting inclusion criteria had an index reconstructive procedure at least 90 days before fat grafting. Data concerning these patient's demographics, comorbidities, breast reconstructions, perioperative and postoperative antibiotics, and outcomes were collected via querying relevant reports of Current Procedural Terminology; International Classification of Diseases, Ninth Revision; International Classification of Diseases, Tenth Revision; National Drug Code Directory, and Healthcare Common Procedure Coding System codes. Antibiotics were classified by type and temporal delivery: perioperatively or postoperatively. If a patient received postoperative antibiotics, the duration of antibiotic exposure was recorded. Outcomes analysis was limited to the 90-day postoperative period. Multivariable logistic regression was performed to ascertain the effects of age, coexisting conditions, reconstruction type (autologous or implant-based), perioperative antibiotic class, postoperative antibiotic class, and postoperative antibiotic duration on the likelihood of any common postoperative complication occurring. All statistical assumptions made by logistic regression were met successfully. Odds ratios and corresponding 95% confidence intervals were calculated. Results From more than 86 million longitudinal patient records between March 2004 and June 2019, our study population included 7456 unique records of reconstruction-fat grafting pairs, with 4661 of those pairs receiving some form of prophylactic antibiotics. Age, prior radiation, and perioperative antibiotic administration were consistent independent predictors of increased all-cause complication likelihood. However, administration of perioperative antibiotics approached a statistically significant protective association against infection likelihood. No postoperative antibiotics of any duration or class conferred a protective association against infections or all-cause complications. Conclusions This study provides national, claims-level support for antibiotic stewardship during and after fat grafting procedures. Postoperative antibiotics did not confer a protective benefit association against infection or all-cause complication likelihood, while administering perioperative antibiotics conferred a statistically significant increase in the likelihood that a patient experienced postoperative complication. However, perioperative antibiotics approach a significant protective association against postoperative infection likelihood, in line with current guidelines for infection prevention. These findings may encourage the adoption of more conservative postoperative prescription practices for clinicians who perform breast reconstruction, followed by fat grafting, reducing the nonindicated use of antibiotics.

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A one year follow-up on quality of adherent scars after autologous fat grafting processed by a filtration technique

Rijpma,

Jaspers,

Pijpe

et al. 2024

Burns

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A Randomized Prospective Time and Motion Comparison of Techniques to Process Autologous Fat Grafts

Cited by 9 publications

References 33 publications

A Prospective, Randomized Comparison of Clinical Outcomes with Different Processing Techniques in Autologous Fat Grafting

A Prospective, Randomized Comparison of Clinical Outcomes with Different Processing Techniques in Autologous Fat Grafting

Postoperative Antibiotics Confer No Protective Association After Fat Grafting for Breast Reconstruction

A one year follow-up on quality of adherent scars after autologous fat grafting processed by a filtration technique

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