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제목 [논문] ADHESIOLYSIS AND FAT GRAFT IN AESTHETIC AND RECONSTRUCTIVE BREAST…
조회수 70 등록일 2020-01-29
내용

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 Concept of adhesiolysis and fat grafting​ 

 

1. scars will probably become adherent again when only adhesiolysis is performed

 

2.  expect the possible effect of adipose-derived stem cells 

 

3.  provide a small functional layer of subcutaneous fat

 

4.  recipient site plays a key role in success of a fat graft

 

 

GRAFT TAKE IS LARGELY DICTATED BY INTERSTITIAL PRESSURES 

 

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1. percentage survival (black curve) remains very high until the recipient reaches its maximal capacity. 

 

​2. the added grafts will increase the interstitial fluid pressure to levels that choke capillary perfusion. 

 

​3. percentage augmentation increases until maximal capacity is reached. Beyond this capacity, additional grafting is counterproductive. 

 

​4. preexpansion can increase the maximal capacity.

 

 

 

 Microneedling (Sezgin)

 

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1. to induce a woundhealing process through mechanical microtraumatization, resulting in beneficial effects for fat transplantation 

 

​2. creating a multitude of microchannels leading to the activation of the inflammatory cascade (normal wound healing process) 

 

​3. fibroblast growth factor, VEGF, platelet-derived growth factor, and transforming growth factor alpha and beta are endogenously induced, resulting in the stimulation of fibroblasts and collagen production within the skin

 

4. expecting a restrictive cicatrix transforming into a regenerative matrix

 

 

 

 

Indications of adhesiolysis+fat graft in breast surgery  

· DEPRESSED SCAR

 

· VOLUME DEFICIT 

 

· constricted breast

 

· tuberous breast

 

· double fold

 

· post-radiation deformity

 

· asymmetry

 

· Poland syndrome, Pectus excavatum etc

 

· contour enhancement in primary augmentaton

 

 

 

 

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PROCEDURE
ADHESIOLYSIS AND FAT GRAFT


ADHESIOLYSIS AND FAT GRAFT
· HARVEST FAT ( L’handle, saddle back)

· CENTRIFUGE 3,000 rpm for 1-3 min

· ADHESIOLYSIS BY 18G NEEDLE, RIGOTTOMY KNIFE

· INFILTRATE FAT BY 16-18G CANNULA (1cc syringe)

· AVOID OVERGRAFTING

· POSTOP. HYPERBARIC OXYGEN THERAPY (within 5days)

 

 

 

HBOT (O2ONE-H810) 

 

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1. Assumption: the hyperbaric oxygen-mediated decrement in endothelial leukocyte adhesion will decrease cytokine release, thereby reducing edema and inflammatory responses.=> increased viability of fat graft within 5 days. (Shoshani, PRS 2000 Nov;106(6):1390-6)

2. The normobaric hyperoxygenation protocol using 60% oxygen can be safely applied to enhance adipocyte survival, regeneration, and final engraftment after fat grafting. (Kato, PRS 2014 Nov;134(5):951-9)

 




517584369ea7dd3abf222e17c1743e59_1580310
Microneedling for double folds which originated from preexisting creases.



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Fat could be harvested from abdomen, thoghs and buttocks and transferred to breast recipient sites.



517584369ea7dd3abf222e17c1743e59_1580310
CASES
ADHESIOLYSIS AND FAT GRAFT


MOST COMMONLY FOR SIMPLE AUGMENTATION TO IMPROVE RESULTS
517584369ea7dd3abf222e17c1743e59_1580310

TUBEROUS BREAST [RIGO+AFI 5 ml Rt]
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DELAYED RECONSTRUCTION RT [RIGO+AFI 36 ml Rt] 
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EFFECTS OF FAT GRAFT IN RECONSTRUCTION (Mullender 2016)

· fat graft has a volume-increasing effect and improves skin quality by stimulating the neosynthesis of collagen fibers. 

· alleviating effect on pain was postulated to be a result of changes in the microenvironment and secretion of substances by mesenchymal cells of the graft (Khouri)

· regenerative potential of ADSC could reverse radiation damage (Rigotti) 

· absorption rate 44-47%

· oncological follow-up after fat transfer showed no increased risk of local recurrence or development of a new cancer (Delay, Krastev, Dale, Khouri)




CONCLUSION
· Small volume fat grafting is no longer controversial and provides beneficial effects with limited side effects.

· Combined adhesiolysis and fat grafting could mitigate variable aesthethic and reconstructive breast defects as a simple and effective adjunctive therapy.


[본문 내용의 무단 복제 혹은 도용할 경우 법률적 제재를 받을 수 있습니다.]


 


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