Microautologous Fat Transplantation (MAFT) sebagai Rekonstruksi Lanjutan pada Kasus Deformitas Maksilofasial Pasca Trauma

Latar Belakang: Teknik Microautologous Fat Transplantation (MAFT) merupakan sebuah metode yang relatif baru untuk memindahkan lemak dari lokasi tubuh tertentu ke lokasi tubuh yang diinginkan dengan suatu alat khusus. Teknik transfer lemak sebenarnya sudah dilakukan sejak tahun 1893 namun terkendala dengan masih banyaknya lemak yang diresorpsi sehingga memerlukan beberapa kali tindakan ulangan. Teknik Microatutologus Fat Transplantation menggunakan MAFT Gun pertama kali dilakukan oleh Lin et al. pada tahun 2006. Teknik ini telah menunjukkan hasil yang baik dalam bidang estetik maupun rekonstruksi menggantikan teknik dermofat graft yang bersifat lebih invasive. Deformitas pada wajah akibat dari hilangnya sejumlah volume lemak dapat diatasi dengan MAFT Gun yang bersifat minimal invasif. Pada tulisan ini dilaporkan satu kasus penanganan deformitas maksilofasial pasca reposisi dan fiksasi fraktur tulang wajah dengan Microautologous Fat Transplantation sebagai salah satu modalitas. Pasien dan Metode: Jaringan lemak diambil dengan spuit 60 cc tekanan negatif kemudian dilakukan sentrifugasi dengan kecepatan 3000 rpm selama 10 menit untuk memisahkan komponen lemak dan plasma. Lapisan lemak murni selanjutnya ditransplantasikan pada area wajah menggunakan MAFT Gun di bawah mata 3.5 ml, pipi 20.5 ml, dagu 3 ml, dan pelipis 1 ml. Hasil: Lama tindakan 2 jam 30 menit, prosedur anestesi sedasi sedang dan blok nervus infraorbitalis, nervus mentalis, dan nervus supraorbitalis, dan nervus supratrochealis ipsilateral. Deformitas dapat teratasi, longterm follow up 3 bulan pasca operasi tidak banyak jaringan lemak yang diresorpsi, sehingga penampilan masih baik. Kesimpulan: Teknik MAFT Gun merupakan prosedur yang efektif untuk memperbaiki kontur wajah, peremajaan wajah, memperbaiki area yang cekung, dan mengembalikan volume termasuk mengoreksi deformitas wajah akibat fraktur maksilofasial pasca reposisi fraktur maksilofasial yang kurang sempurna. Prosedur yang dilakukan relatif tidak invasif. Jaringan lemak dapat diambil dari berbagai area tubuh yang memiliki jaringan lemak berlebih. Menggunakan MAFT Gun yang telah tersertifikasi, proses transfer lemak dapat dilakukan secara akurat dan konsisten. Hasil MAFT cukup memuaskan bagi pasien, sehingga memungkinkan prosedur MAFT menjadi alternatif solusi untuk mengoreksi deformitas maksilofasial pasca reposisi dan fiksasi yang mungkin hanya memerlukan tindakan touch up satu sampai dua kali saja

Dedifferentiation of Human Adipocytes After Fat Transplantation

Background Fat transplantation is a common method employed to treat soft-tissue defects. The dedifferentiation of mature adipocytes has been well documented, but whether it occurs after fat transplantation remains unclear. Objectives The major purpose of this project was to investigate the dedifferentiation of mature adipocytes after fat transplantation. Methods Human lipoaspirate tissue was obtained from 6 female patients who underwent esthetic liposuction. Mature adipocytes were extracted and labeled with PKH26, mixed with lipoaspirate, and injected into nude mice. In addition, PKH26+ adipocytes were subjected to a ceiling culture. Grafted fat was harvested from nude mice, and stromal vascular fragment cells were isolated. The immunophenotype of PKH26+ cells was detected by flow cytometry analysis at 2 days and 1 week. The PKH26+ cells were sorted and counted at 2 and 4 weeks to verify their proliferation and multilineage differentiation abilities. Results Two days after transplantation, almost no PKH26+ cells were found in the stromal vascular fragment cells. The PKH26+ cells found 1 week after transplantation showed a positive expression of cluster of differentiation (CD) 90 (CD90) and CD105 and a negative expression of CD45. This indicates that the labeled adipocytes were dedifferentiated. Its pluripotency was further demonstrated by fluorescent cell sorting and differentiation culture in vitro. In addition, the number of live PKH26+ cells at week 4 [(6.83 ± 1.67) × 104] was similar with that at week 2 [(7.11 ± 1.82) × 104]. Conclusions Human mature adipocytes can dedifferentiate into stem cell-like cells in vivo after fat transplantation.

Salvianolic Acid B Improves the Effect of Fat Grafts by Inhibiting the NF-kB Signalling Pathway in Macrophages

Background Autologous fat grafting (AFG), although an appealing approach to repair soft tissue defects, has various complications. Excessive inflammation at the transplant site is one of the main reasons for the poor effect of fat transplantation and occurrence of complications. Our previous study proved that Salvia miltiorrhiza can enhance fat graft survival. Salvianolic acid B (Sal-B) is the most abundant and bioactive water-soluble compound in Salvia miltiorrhiza and has anti-inflammatory effects on other diseases. Therefore, we hypothesized that salvianolic acid B could improve the effect of fat grafts by inhibiting inflammation. Methods In vivo, 0.2 ml of Coleman fat was transplanted into nude mice with salvianolic acid B. The grafts were evaluated by HE and IF at 2, 4 and 12 weeks posttransplantation and by micro-CT at 4 weeks posttransplantation. In vitro, the proliferative and anti-inflammatory activities of salvianolic acid B were analyzed in cultured RAW264.7 cells to detect the mechanism by which salvianolic acid B affects graft survival by inhibiting inflammation. Results In vivo, the degree of adipose tissue fibrosis and inflammatory cell infiltration in the salvianolic acid B treatment group was lower, and the infiltration of M1 macrophages in fat grafts was also less than that in the control group. In vitro, salvianolic acid B inhibited the proliferation and activation of inflammatory pathways in RAW264.7 cells. Conclusions This study demonstrates the use of salvianolic acid B as a possible treatment to improve the effect of fat transplantation.

Salvianolic acid-B improves fat graft survival by promoting proliferation and adipogenesis

Background Our previous study proved that Salvia miltiorrhiza could enhance fat graft survival by promoting adipogenesis. However, the effect of salvianolic acid B (Sal-B), the most abundant and bioactive water-soluble compound in Salvia miltiorrhiza, on fat graft survival has not yet been investigated. Objective This study aims to investigate whether salvianolic acid B could improve fat graft survival and promote preadipocyte differentiation. The underlying mechanism has also been studied. Methods In vivo, 0.2 ml of Coleman fat was transplanted into nude mice with salvianolic acid B. The grafts were evaluated by HE and IF at 2 and 4 weeks posttransplantation and by micro-CT at 4 weeks posttransplantation. In vitro, the adipogenesis and proliferative activities of salvianolic acid B were analyzed in cultured human adipose-derived stem cells (h-ADSCs) and 3T3-L1 cells to detect the mechanism by which salvianolic acid B affects graft survival. Results In vivo, the weights and volumes of the fat grafts in the Sal-B-treated groups were significantly higher than those of the fat grafts in the control group. In addition, higher fat integrity and more viable adipocytes were observed in the Sal-B-treated groups. In vitro, salvianolic acid B showed the ability to promote 3T3-L1 and h-ADSC proliferation and adipogenesis. Conclusions Our in vitro experiments demonstrated that salvianolic acid B can promote the proliferation of adipose stem cells and enhance the differentiation of adipose stem cells. Simultaneously, in vivo experiments showed that salvianolic acid B can improve the survival rate of fat transplantation. Therefore, our research shed light on the potential therapeutic usage of salvianolic acid B in improving the survival rate of fat transplantation.

The Versatility of Autologous Fat Grafting in Facial Volumetric Restoration

Deformities in the craniofacial region are of great social and functional importance. Several surgical techniques have been used to treat such pathologies often with high morbidity and lacking the ability to address smaller contour defects. The minimally invasive technique of fat transplantation has evolved rapidly within the last few decades. The objective of this paper is to present the versatility and applicability of fat transplantation in a wide range of contour deformities in the craniofacial region. We share our experiences in treating 24 patients with autoimmune disorders, congenital malformations, and acquired defects.

Hybrid mastopexy: improving outcomes on implant-based augmentation mastopexy with fat

Background Autologous fat transplantation for breast augmentation represents an increasingly interesting technique in plastic surgery. Only a few standardized procedures are available. Hybrid augmentation mastopexy combines the benefits of autologous fat transplantation and implant-based breast augmentation mastopexy, reducing implant-related complications and prothesis size. Herein, we describe our surgical approach as a “hybrid aesthetic surgery.” Methods A retrospective analysis of all patients who underwent hybrid breast augmentation and lifting with simultaneous fat grafting was carried out. Clinical outcomes, ultrasound evaluation of upper pole fullness, aesthetic postoperative results, and complications were examined. Results Eighteen patients with a mean age of 33 years (range: 24–52 years) and mean BMI of 25.8 kg/m2 (range: 21.4–32.1 kg/m2) were included in this study. Mean injected fat volume per breast was 115 cc (range: 78–144 cc). Patients were followed up for a mean of 9.4 months (range: 6–24 months). No fat necrosis or major complications were encountered during the follow-up. Patient satisfaction was high in terms of breast shape, size, and coverage of the breast implant. No recurrence of ptosis was observed yet and no secondary revision surgery was performed. Conclusions Hybrid mastopexy augmentation is an effective and safe procedure that combines the benefits of autologous fat grafting and implant-based breast augmentation. The transfer of autologous soft tissue allows obtaining a natural breast shape, reducing the onset of rippling and prothesis size. The reduction of prothesis size prevents ptosis recurrence but provides the desired projection. This reliable option improves long-term breast shape with elevated patient’s satisfaction. Level of evidence: Level IV, therapeutic study.