|제목||ADHESIOLYSIS AND FAT GRAFT IN AESTHETIC AND RECONSTRUCTIVE BREAST…|
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
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.
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
· Poland syndrome, Pectus excavatum etc
· contour enhancement in primary augmentaton
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)
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)
Microneedling for double folds which originated from preexisting creases.
Fat could be harvested from abdomen, thoghs and buttocks and transferred to breast recipient sites.
ADHESIOLYSIS AND FAT GRAFT
· 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)
· 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.