Effects of Lidocaine Plus Epinephrine and Prilocaine on Autologous Fat Graft Survival

Abstract

Although fat grafting is frequently used in plastic surgery practice, debate about the viability of the graft still persists owing to its questionable long-term success. The ultimate aim is to obtain long-term graft viability. Vascularization of the graft is essential for this purpose. The effects of 2 different local anesthetic preparations frequently used during harvesting of fat grafts on long-term graft survival were compared with angiogenesis and volumetric measurements. Twenty-four male Wistar rats were divided into 3 groups. The inguinal region was selected as the fat graft donor site. The first group was injected with isotonic saline, the second was injected with lidocaine plus epinephrine, and the third was injected with prilocaine. Fat grafts were implanted into the dorsal regions of rats, and volumetric measurements were performed initially and on days 30 and 180 at which microvascular angiogenesis were also analyzed. Microvascular angiogenesis was assessed both with the reverse transcription-polymerase chain reaction and immunohistochemistry through determination of vessels stained with factor VIII. No significant difference was obtained between the 3 groups in graft volume or microvascular angiogenesis at any stage of the study. Results from this experimental study indicate that there is no negative effect of lidocaine plus epinephrine or prilocaine on microangiogenesis and the survival of fat grafts.

The Current State of Fat Grafting

“…28,29 Furthermore, the implantation of adipose tissue pretreated with saline or lidocaine and epinephrine demonstrated no significant effect on fat graft volumes or histologic architecture. 30,31 Analysis of different anesthesia drugs demonstrated greater adipose stem cell viability within adipose tissue treated with bupivacaine, mepivacaine, ropivacaine, and lidocaine compared with combined treatment with articaine and epinephrine. 32 Although one would not expect variability between amides, epinephrine may affect the α 1 receptors on the surrounding tissues supporting the implanted cells.…”

Effects of Tumescent Solution on Fat Survival

“…There are only a few experimental or clinical studies focused on this subject, and mostly some expert opinion was reported in the literature. 1,[13][14][15][16] In this article, long-term clinical and histopathologic effects of the tumescent solutions containing different combinations of lidocaine and adrenaline were investigated in a rat model.…”

“…The inguinal fat pad is a big subcutaneous fat source considering the size of the rats' body and can be harvested without causing significant damage to the rat. However, the fat pad is actually very small, and the whole fat pad weights approximately 1 g. 16 It is extremely difficult to harvest it with routine liposuction procedure, and most of the inguinal fat pad spreads over the neighboring tissues or gets stuck in the cannula. Therefore, in many studies, the inguinal fat pad was harvested surgically in en bloc fashion and trimmed into small pieces before the reimplantation process.…”

The Discordant Histology of Grafted Fat

“…Time from grafting also varied widely, clearly affecting the tissue reaction seen on biopsy results. Although fat apoptosis has been shown to reach a maximum at 30 days after transfer, 27 the articles examined harvested fat over a range of 1 day to 65 months after transfer. This variable period prevents direct comparison, as the inflammatory and survival response is unequivocally time dependent.…”