Document Detail

Diffusion and Perfusion: The Keys to Fat Grafting.
MedLine Citation:
PMID:  25426403     Owner:  NLM     Status:  Publisher    
BACKGROUND: Fat grafting is now widely used in plastic surgery. Long-term graft retention can be unpredictable. Fat grafts must obtain oxygen via diffusion until neovascularization occurs, so oxygen delivery may be the overarching variable in graft retention.
METHODS: We studied the peer-reviewed literature to determine which aspects of a fat graft and the microenvironment surrounding a fat graft affect oxygen delivery and created 3 models relating distinct variables to oxygen delivery and graft retention.
RESULTS: Our models confirm that thin microribbons of fat maximize oxygen transport when injected into a large, compliant, well-vascularized recipient site. The "Microribbon Model" predicts that, in a typical human, fat injections larger than 0.16 cm in radius will have a region of central necrosis. Our "Fluid Accommodation Model" predicts that once grafted tissues approach a critical interstitial fluid pressure of 9 mm Hg, any additional fluid will drastically increase interstitial fluid pressure and reduce capillary perfusion and oxygen delivery. Our "External Volume Expansion Effect Model" predicts the effect of vascular changes induced by preoperative external volume expansion that allow for greater volumes of fat to be successfully grafted.
CONCLUSIONS: These models confirm that initial fat grafting survival is limited by oxygen diffusion. Preoperative expansion increases oxygen diffusion capacity allowing for additional graft retention. These models provide a scientific framework for testing the current fat grafting theories.
Roger K Khouri; Raoul-Emil R Khouri; Jorge R Lujan-Hernandez; Khalil R Khouri; Luca Lancerotto; Dennis P Orgill
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-10-07
Journal Detail:
Title:  Plastic and reconstructive surgery. Global open     Volume:  2     ISSN:  2169-7574     ISO Abbreviation:  Plast Reconstr Surg Glob Open     Publication Date:  2014 Sep 
Date Detail:
Created Date:  2014-11-26     Completed Date:  -     Revised Date:  2014-11-27    
Medline Journal Info:
Nlm Unique ID:  101622231     Medline TA:  Plast Reconstr Surg Glob Open     Country:  -    
Other Details:
Languages:  ENG     Pagination:  e220     Citation Subset:  -    
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