Carbon Dioxide versus Saline Tissue Expanders

Ascherman, Jeffrey A.; Zeidler, Kamakshi R.; Jacoby, Adam; Appel, James Z.; Berkowitz, Richard L.; Castle, John; Colwell, Amy S.; Chun, Yoon S.; Johnson, Debra; Mohebali, Khashayar

doi:10.1097/prs.0000000000001865

Cited by 18 publications

(14 citation statements)

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“…In autologous fat grafting, fat is harvested, processed, and transplanted to different parts of the body. It has proven a valuable treatment regimen in patients suffering from multiply determined chronic pain [1314]. In previous studies, a significant reduction of pain was reported after treatment with AFG for patients with post-mastectomy pain syndrome [67] or painful scars with a mean follow-up ranging from 10 to 14 months [5678].…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, a significant reduction of pain was reported after treatment with AFG for patients with post-mastectomy pain syndrome [67] or painful scars with a mean follow-up ranging from 10 to 14 months [5678]. The mesenchymal cells of the fat graft are thought to give prolonged analgesia by changing the microenvironment and the secretion of substances [671314]. In the literature, a resorption rate of 17% to 82% of the injected fat is reported [15], which could explain why repeated treatment is required.…”

Section: Discussionmentioning

confidence: 99%

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Autologous Fat Grafting as a Last Resort for Unsustainable Pain in a Woman with Multiple Osteochondromas

2017

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Multiple osteochondromas (MO) is characterized by the formation of osteochondromas throughout the entire body. Although the evidence regarding its pathogenesis is well understood, no curative treatment for the disorder is available. Patients can be treated symptomatically by surgical removal of painful osteochondromas. Unfortunately, some patients still suffer from severe pain, even after surgery. We report on a case concerning a 48-year-old woman with a history of MO who presented with persistent pain after surgical removal of a symptomatic osteochondroma of the left scapula and multiple symptomatic osteochondromas of the left foot and trochanteric region. Several interventions to reduce the pain did not have any lasting effect. Subsequently, she was treated with autologous fat grafting (AFG). After each session she was pain-free for at least one year and reported only partial recurrence of the pain. This is the first case report describing AFG for the treatment of pain after both surgical removal of an osteochondroma and symptomatic osteochondromas in a patient suffering MO with promising results. The treatment is more effective and clearly continues to remain active longer than injection therapy or pain medication. Future studies are necessary to confirm our results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Autologous Fat Grafting as a Last Resort for Unsustainable Pain in a Woman with Multiple Osteochondromas

2017

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“…Patients receive weekly injections, over the course of 6-8 weeks. 7,8 The AeroForm TE (AirXpanders, Palo Alto, CA, USA) consists of a silicon shell containing a stainless steel reservoir of compressed CO 2 .…”

Section: Introductionmentioning

confidence: 99%

“…If radiation is indicated, the patient is typically simulated and treated after expansion is complete. 8,9 Tissue expanders pose particular challenges in a radiation oncology setting. The high-density metallic components of both types of TE cause artifacts in treatment planning CT images.…”

Section: Introductionmentioning

confidence: 99%

Modeling AeroForm tissue expander for postmastectomy radiation therapy

Dziemianowicz

Gardner

Snyder

et al. 2019

J Applied Clin Med Phys

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The AeroForm chest wall tissue expander (TE) is a silicon shell containing a metallic CO 2 reservoir, placed surgically after mastectomy. The patient uses a remote control to release compressed CO 2 from the reservoir to inflate the expander. AeroForm poses challenges in a radiation therapy setting: The high density of the metallic reservoir causes imaging artifacts on the planning CT, which encumber structure definition and cause misrepresentation of density information, in turn affecting dose calculation. Additionally, convolution‐based dose calculation algorithms may not be well‐suited to calculate dose in and around high‐density materials. In this study, a model of the AeroForm TE was created in Eclipse treatment planning system (TPS). The TPS model was validated by comparing measured to calculated transmission through the AeroForm. Transmission was measured with various geometries using radiochromic film. Dose was calculated with both Varian’s Anisotropic Analytical Algorithm (AAA) and Acuros External Beam (AXB) algorithms. AAA and AXB were compared using dose profile and gamma analyses. While both algorithms modeled direct transmission well, AXB better modeled lateral scatter from the AeroForm TE. Clinical significance was evaluated using clinical data from four patients with AeroForm TEs. The AeroForm TPS model was applied, and RT plans were optimized using AAA, then re‐calculated with AXB. Structures of clinical significance were defined and dose volume histogram analysis was performed. Compared to AXB, AAA overestimates dose in the AeroForm device. Changes in clinically significant regions were patient‐ and plan‐specific. This study proposes a clinical procedure for modeling the AeroForm in a commercial TPS, and discusses the limitations of dose calculation in and around the device. An understanding of dose calculation accuracy in the vicinity of the AeroForm is critical for assessing individual plan quality, appropriateness of different planning techniques and dose calculation algorithms, and even the decision to use the AeroForm in a postmastectomy radiation therapy setting.

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“…In addition, the proven regenerative potential expressed by its stromal vascular fraction, has been applied for the treatment of scars, scar-related conditions and burns. 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes

Oranges

Striebel

Tremp

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:The fat grafting process includes the 4 phases of tissue harvesting, processing, recipient-site preparation, and reinjection. Among them, the preparation of the recipient site has never been exhaustively reviewed. We aim to provide a comprehensive overview of the methods to prepare the recipient site through external expansion with the resulting outcomes.Methods:PubMed/Medline database was searched for studies on fat grafting recipient site preparation by applying the following algorithm: ((fat grafting) OR (lipofilling) OR (lipograft) AND (recipient site)). A priori criteria were used to review the resulting articles and identify those dealing with external expansion.Results:Fourteen studies published from 2008 through 2016 met inclusion criteria (4 case reports, 6 retrospective, and 4 prospective studies), representing 1,274 treated patients. Two devices for preexpansion were used with different protocols: BRAVA system and Kiwi VAC-6000M with a PalmPump. The 13 studies that applied the BRAVA system reported large fat volume transplantation to the breast (average > 200 cc). The most common complications were localized edema (14.2%), temporary bruising, and superficial skin blisters (11.3%), while the most serious was pneumothorax (0.5%). The majority of the studies reported enhancement of fat graft survival, which ranged between 53% and 82% at 6 months to 1 year follow-up, and high satisfaction of patients and surgeon.Conclusions:External expansion and fat grafting is a promising technique for breast reconstruction and augmentation. However, due to the overall low level of evidence of the available studies, further research is needed to validate the procedure.

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Carbon Dioxide versus Saline Tissue Expanders

Abstract: The authors believe that carbon dioxide-based devices may play a significant role in the future of implant-based breast reconstruction, and may be widely applicable to other areas of plastic surgery that also involve tissue expansion.

Cited by 18 publications

References 14 publications

Autologous Fat Grafting as a Last Resort for Unsustainable Pain in a Woman with Multiple Osteochondromas

Autologous Fat Grafting as a Last Resort for Unsustainable Pain in a Woman with Multiple Osteochondromas

Modeling AeroForm tissue expander for postmastectomy radiation therapy

The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes

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