Assessing the Long-Term Viability of Facial Fat Grafts: An Objective Measure Using Computed Tomography

Fontdevila, Joan; Serra-Renom, José María; Raigosa, Mauricio; Berenguer, Joan; Guisantes, Eva; Prades, Eduard; Benito-Ruiz, Jesús; Martínez, Estebán

doi:10.1016/j.asj.2008.05.002

Cited by 74 publications

(54 citation statements)

References 58 publications

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“…Sí es su objeto la comparación de nuestra supervivencia con la comunicada por otros autores utilizando otros métodos de valoración (17), o bien, de la supervivencia de los injertos grasos comparada con la otros materiales de relleno en la cara (18), lo cual sería ilustrativo y necesario para encuadrar la relevancia de nuestro trabajo. Destacan los recientes estudios éticos en humanos de Yoshimura, Llull o Fontdevila (19), pero que no son extrapolables por enriquecer los injertos con cé-lulas madre derivadas del tejido adiposo el primero o por seleccionar una muestra-modelo de observación muy distinta, extraer el injerto de diversas zonas donantes y utilizar un método volumétrico basado en tomografías computerizadas los segundos. Además, incurren en una reiterada diferencia y divergencia fundamental: realizan estimaciones de supervivencia o prendimiento de los injertos a partir de medidas entre lo que había y lo que hallan en una localización anatómica o función fisiológica después de la lipoinyección, es decir, indirectamente; no de lo que sucede con la propia grasa y sus propiedades y valores desde que se inyecta hasta que se extrae para estudio histológico, es decir, datos directamente emanados del estudio de los injertos.…”

Section: Discussionunclassified

¿Cuál es la supervivencia de los injertos de grasa en la cara? ¿Cómo cuantificarla?: medicina basada en la evidencia

Serna-Cuéllar

Santamaría-Solís²

2013

Cir. plást. iberolatinoam.

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ResumenMuchos de los artículos publicados acerca del éxito de los injertos autólogos de grasa (IAG) en humanos son muy subjetivos o, en el mejor de los casos, semicuantitativos Hasta hoy, se necesitan estudios adicionales, tanto clínicos como básicos, antes de que podamos llegar a precisar el valor de esta técnica.Diseñamos un estudio prospectivo y randomizado con el objetivo de cuantificar la supervivencia de los autoinjertos de grasa en cara, en una serie seleccionada de 71 pacientes con defectos subcutáneos de partes blandas faciales que cumplieron criterios de inclusión, en dos grupos, según fueran casos de Cirugía Reconstructiva o de Cirugía Estética. El procedimiento quirúrgico estándar empleado fue la técnica de lipoestructura facial; se tomó biopsia del tejido adiposo injertado a los 14 meses de seguimiento. Empleamos el método estereológico para medir los parámetros volumétricos cuantitativos de la grasa en el momento de la inyección y en el momento de la biopsia. Por medio de simples ecuaciones matemáticas, pudimos extraer las tasas de prendimiento tanto volumétrica como numérica. También se practicaron análisis estadísticos descriptivos y cuantitativos de todos los datos.Los injertos de grasa autólogos en la cara sobreviven en dos tercios del volumen inyectado a los 14 meses de seguimiento. La única prueba confirmatoria de supervivencia de los autoinjertos de grasa es la evidencia y demostración histológica de tejido adiposo viable en las zonas receptoras y su cuantificación mediante un método de evaluación volumétrico, preciso y objetivo, como el que permite la Estereología.Palabras clave Tejido adiposo, Injertos de tejido adiposo, Estereología, Supervivencia de la grasa Código numérico 19-104-15841 AbstractMany reports concerning the success of fat auto-grafts in humans are widely subjective or semi-quantitative in best of cases. Even today, additional studies, clinical or basic, are necessary before the value of this technique can be calculated. With the aim of quantifying the survival of fat auto-grafts on the face, a prospective randomized study was designed, selecting 71 patients suffering facial soft tissue subcutaneous defects fulfilling the inclusion criteria. Two groups were described according to reconstructive and aesthetic surgery. Facial lipostructure technique was used as the standard surgical procedure and a biopsy of the grafted adipose tissue was taken at 14 months follow-up. The stereological method was used to measure the quantitative volumetric parameters of the fat at the injection time and at the biopsy time. By means of simple mathematical equations, the volumetric and numerical take rate could be obtained. Descriptive and quantitative statistical analyses of all data were performed.Fat auto-grafts on the face survive two thirds of the injected volume at 14 months follow-up. The unique confirmation proof of survival of fat auto-grafts is the histological evidence and demonstration of viable adipose tissue in recipient sites and its quantification by a volumetric, accurate and o...

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Section: Discussionunclassified

¿Cuál es la supervivencia de los injertos de grasa en la cara? ¿Cómo cuantificarla?: medicina basada en la evidencia

Serna-Cuéllar

Santamaría-Solís²

2013

Cir. plást. iberolatinoam.

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“…Arthralgia, erythema and pruritis at site of injection; abdominal pain, swelling, myalgia; worsening glycaemic control (207) Lipid-lowering drugs Statins Pharmacokinetic interaction with PI (209,210,215) Niacin Glucose intolerance; transient increases in insulin resistance (248) Anti-diabetic drugs Metformin Increased risk of lactic acidosis when taken with NRTI (213,214) Rosiglitazone Increased postprandial lipaemia; increased risk of myocardial infarction (214,218) Pioglitazone Pharmacokinetic interaction with PI (214) Surgical Lipohypertrophy Ultrasonic liposuction Relapse/recurrence of abdominal lipohypertrophy common (219) Excisional lipectomy High rate of recurrence of dorsocervical fat pad (220) Lipoatrophy Silicone gluteal prostheses Painful postoperative period (221) Facial fillers Granuloma formation; local migration of particles (90) Fat transplantation Operative risks and facial fat hypertrophy (225) Facial grafting Fat resorption (96) PI, protease inhibitor; NRTI, nucleoside RT inhibitor.…”

Section: Interventionmentioning

confidence: 99%

“…Subsequently, Carr & Law (95) developed a severity grading scale based on their objective case definition of HALS; however, in the same paper they recommended abandoning the assessment of lipodystrophy severity, and suggested the lipodystrophy case definition score provided the best objective measure of severity. Recently, Fontdevila et al (96) have developed a CT-validated grading system for determining the severity of facial LA based on the loss of facial bone and muscle structures. This grading system is recommended for use when comparing the efficacy of fat grafting procedures and, therefore, may not be ideal in routine clinical practice.…”

Section: Prevalence and Definitionmentioning

confidence: 99%

“…To correct the morphological abnormalities associated with HALS, patients often undergo surgical procedures. These include liposuction (223) and excisional lipectomy (224) for LH and silicone gluteal prostheses (225) , facial fillers (226 -228) , facial grafting (96) and fat transplantation (229) for LA. Surgical interventions such as these are radical interventions and are associated with numerous adverse events, which often offset their success ( Table 2).…”

Section: Pharmacological and Surgical Managementmentioning

confidence: 99%

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Nutrition and the HIV-associated lipodystrophy syndrome

Loonam

Mullen

2012

Nutr. Res. Rev.

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HIV-associated lipodystrophy syndrome (HALS), comprising metabolic and morphological alterations, is a known side effect of highly active antiretroviral therapy (HAART). Evidence for the role of nutrition in the management of the systemic parameters of HALS is currently limited. In the present paper we review the current knowledge base surrounding HALS, focusing particularly on the role of nutrition in mitigating the systemic parameters of the syndrome. Reported prevalence of HALS was found to vary from 9 to 83 % due to lack of a standardised definition, as well as variations in assessment methods and in the study population used. HALS is associated with both morphological (lipoatrophy, lipohypertrophy) and metabolic (dyslipidaemia, glucose intolerance, diabetes, hypertension, endothelial dysfunction and atherosclerosis) alterations, which may occur singly or in combination, and are associated with an increased risk of CVD. HAART-induced adipocyte inflammation, oxidative stress and macrophage infiltration, as well as altered adipocyte function and mitochondrial toxicity, have been shown to be central to the development of HALS. The adipocyte, therefore, represents a plausible target for treatment. Pharmacological and surgical treatment interventions have shown effect. However, their use is associated with numerous adverse effects and complications. Targeted lifestyle interventions may provide a useful alternative for managing HALS owing to their safety and tolerability. A Mediterranean-style diet has been found to be effective in improving the systemic parameters of HALS. Furthermore, the effects of n-3 PUFA supplementation are encouraging and future randomised controlled trials investigating the beneficial effects of n-3 PUFA in HALS are justified.

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“…Além disto, novos programas computadorizados adicionados às estações de trabalho têm sido muito úteis em oferecer imagens com alto grau de precisão e por permitirem a obtenção de imagens comparáveis ao longo do tempo (144,145) .…”

Section: Análise Objetiva De Resultados Por Meio De Ctunclassified

Ensaio clínico randomizado sobre o uso de enxerto autógeno de gordura suplementado com células estromais derivadas do tecido adiposo para a reconstrução de partes moles faciais em pacientes portadores de microssomia craniofacial

Tanikawa¹

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Assessing the Long-Term Viability of Facial Fat Grafts: An Objective Measure Using Computed Tomography

Abstract: Using objective measurement, this study demonstrates that with one fat grafting procedure a durable result can be achieved, persisting for a minimum of 12 months without any trend towards reabsorption.

Cited by 74 publications

References 58 publications

¿Cuál es la supervivencia de los injertos de grasa en la cara? ¿Cómo cuantificarla?: medicina basada en la evidencia

¿Cuál es la supervivencia de los injertos de grasa en la cara? ¿Cómo cuantificarla?: medicina basada en la evidencia

Nutrition and the HIV-associated lipodystrophy syndrome

Ensaio clínico randomizado sobre o uso de enxerto autógeno de gordura suplementado com células estromais derivadas do tecido adiposo para a reconstrução de partes moles faciais em pacientes portadores de microssomia craniofacial

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