An integrated approach for increasing the survival of autologous fat grafts in the treatment of contour defects

Autologous fat grafting as a technique to correct soft-tissue defects is a controversial subject. The high percentage of fat resorption and the result ing need for additional grafting considerably reduce the value of this meth od. The purpose of this study was to evaluate the clinical application of t issue-culturing methodology in the handling of the lipocyte aspirate in an endeavor to improve the survival rate and therefore the take of the grafted lipocytes. The method consists of syringe aspiration of the lipocytes from the donor site, isolation of intact lipocytes by gentle centrifugation, su spension of the aspirate in an enriched cell culture medium, and injection of the cell suspension into preformed subdermal tunnels. A number of media were tested and shown to prolong the survival of lipocytes ex vivo using fl uorescent acridine orange stain. Implementing the integrated cell culture t echniques increased the lipocytes' viability, as indicated in clinical eval uation in which the amount of graft take ranged between 50 and 90 percent. The results of 15 patients with varied types of cases who were operated on using this new methodology show that the tissue defect was filled and remai ned so in postoperative follow-ups of 6 to 24 months. A three-dimensional C AT scan-aided evaluation method was developed and used in one of four case histories presented herein.