Autologous Fat Grafting – A Step Forward in Wound Management

Autologous fat grafting (AFG) is an emerging therapeutic option for wounds that are not ready for grafting. The regenerative potential of autologous fat lies in the adipose derived stem cells (ADSCs) contained within the stromal vascular fraction (SVF), which are capable of differentiating into multiple cell lineages. However to date, there has been no comprehensive evaluation of its efficacy in acute complicated wounds. This study aims to critically evaluate the efficacy and safety of AFG in cutaneous wound healing. Materials and Methods: This prospective, quasi experimental study was conducted in the Department Of Plastic Surgery, SIMS, Lahore, between June 2020 and June 2021. Thirty patients with pale granulation, not ready for grafting with no vital structure exposed were included in the study after detailed history, examination and were photographed pre and postoperatively. The procedure was performed under local anaesthesia. 40 to 80 ml fat was harvested from lower abdomen and after emulsification, placed over the wound wrapped in sufra tulle dressing. The dressing was changed on third postoperative day and outcome was assessed on clinical grounds. Results: Thirty patients (M:F Ratio 1.75:1) with mean age 30 years (Range 13-45 years) were included in this study with post traumatic (n = 23) and post infective (n = 7). Of 27 patients who completed their follow up, all had healthy granulation tissue which was later on grafted. Mean number of fat dressing sessions were 2 (Range 1-3). Conclusion: Autologous fat grafting has shown promising results for cutaneous wounds without any unacceptably high complication rates reported so far. Randomised controlled trials should be done on a larger scale to prove its efficacy in the management of complicated wounds.

The Effect of Locally Delivered Apocynin on Fat Graft Survival in an Experimental Rat Animal Model

Objectives: We aimed to investigate the efficacy of locally delivered apocynin on fat graft survival in an experimental autologous fat grafting (AFG) model created in rats. Methods: Twenty-one Wistar albino male rats were included in this study. The 0.647 g mean weight grafts were harvested from the inguinal region and transferred to the nape of every rat. The subjects were randomly separated into three groups. Saline, dimethyl sulfoxide (DMSO) and apocynin, a dose of 20 mg/kg, solutions were applied once a day for 2 weeks. After 3 months, the rats were sacrificed. The evaluation of physical measurements (weight and volume) and survival rates of the grafts for volume (SRV) and weight (SRW), the viable cell count (VC) with the MTT assay, and histopathological parameters were done. Results: All biophysical parameters were found to be significantly higher in the apocynin group compared to other groups (p < .05). In the MTT test, the saline group was normalized to 100%. According to this, DMSO and apocynin groups’ means were 106% and 163%, respectively. The VC was significantly higher in the apocynin group than the other groups (p < .05). The VC was significantly higher in the DMSO group than in the saline group (p < .05). No significant difference was found in other comparisons performed according to biophysical and histopathological parameters (p > .05). Conclusion: The locally delivered apocynin decreases fat graft volume loss in an experimental AFG model. Consequently, apocynin can be used as an effective substance to increase graft survival.

Adipose Tissue Uses in Peripheral Nerve Surgery

Currently, many different techniques exist for the surgical repair of peripheral nerves. The degree of injury dictates the repair and, depending on the defect or injury of the peripheral nerve, plastic surgeons can perform nerve repairs, grafts, and transfers. All the previously listed techniques are routinely performed in human patients, but a novel addition to these peripheral nerve surgeries involves concomitant fat grafting to the repair site at the time of surgery. Fat grafting provides adipose-derived stem cells to the injury site. Though fat grafting is performed as an adjunct to some peripheral nerve surgeries, there is no clear evidence as to which procedures have improved outcomes resultant from concomitant fat grafting. This review explores the evidence presented in various animal studies regarding outcomes of fat grafting at the time of various types of peripheral nerve surgery.