Abstract
Background
Fat grafting is a practice with prior successful outcomes that is frequently used to improve tissue regeneration as well as to add volume to the subcutaneous tissue. The literature review in this study provided references to the information that the survival of a fat graft is related to the duration of its stay and the recipient site to which it is transplanted. Our study aimed to examine the effects of the recipient site of fat grafting on graft survival.
Methods
This study was conducted using a prospective and experimental design. Our sample consisted of three groups, each including 9 Wistar albino rats. Skin incision was made in the right inguinal region of the rats in group 1 (control group), and the incision was closed without any dissection to the fat pad. The fat pads extracted from the right inguinal region of the rats in groups 2 and 3 were transformed into chopped fat grafts by the fine cutting method. Micropipettes (Isolab 100 µL, Germany) were used during the fat graft transfer process. Grafts were placed subcutaneously on the right inguinal region in group 2 and on the sternum in group 3. The wounds of the incision areas in all groups were closed with simple sutures. Three months later, the fat pads in group 1 and grafts in groups 2 and 3 were removed for histopathological and stereological evaluations.
Results
Our study revealed a statistically significant decrease in the volume of the adipose tissue placed in group 3, compared to groups 1 and 2 (p ≤ 0.01). However, no statistically significant difference (p > 0.05) was observed in the comparison of the volume of adipose tissue placed in the rats in group 1 and those in group 2. In group 3, an intense cellular infiltration developed in the fat grafts placed in the subcutaneous tissue above the sternum, the fat cells could not maintain their normal structure, and there were areas of dense cystic cells and calcification.
Conclusions
It was concluded that recipient site differences are effective in maintaining the volume and survival of fat grafts. It is recommended that the volume and survival of the fat graft be supported by effective therapeutic interventions following the application of the fat graft.
Level of evidence: Not ratable
Similar content being viewed by others
Data availability
The datasets generated and/or analyzed during this study are available from the corresponding author on reasonable request.
References
Khouri RK, Rigotti G, Khouri RK Jr, Cardoso E, Marchi A, Rotemberg SC et al (2015) Tissue-engineered breast reconstruction with Brava-assisted fat grafting: a 7-year, 488-patient, multicenter experience. Plast Reconstr Surg 135(3):643–658
Cai J, Feng J, Liu K, Zhou S, Lu F (2018) Early macrophage infiltration improves fat graft survival by inducing angiogenesis and hematopoietic stem cell recruitment. Plast Reconstr Surg 141(2):376–386
Guerrerosantos J (1996) Autologous fat grafting for body contouring. Clin Plast Surg 23(4):619–631
Mineda K, Kuno S, Kato H, Kinoshita K, Doi K, Hashimoto I et al (2014) Chronic inflammation and progressive calcification as a result of fat necrosis: the worst outcome in fat grafting. Plast Reconstr Surg 133(5):1064–1072
Kato H, Araki J, Doi K, Kuno S, Kinoshita K, Mineda K et al (2014) Normobaric hyperoxygenation enhances initial survival, regeneration, and final retention in fat grafting. Plast Reconstr Surg 134(5):951–959
Kato H, Mineda K, Eto H, Doi K, Kuno S, Kinoshita K et al (2014) Degeneration, regeneration, and cicatrization after fat grafting: dynamic total tissue remodeling during the first 3 months. Plast Reconstr Surg 133(3):303e–313e
Sica A, Mantovani A (2012) Macrophage plasticity and polarization: in vivo veritas. J Clin Investig 122(3):787–795
Choi M, Small K, Levovitz C, Lee C, Fadl A, Karp NS (2013) The volumetric analysis of fat graft survival in breast reconstruction. Plast Reconstr Surg 131:185–191
Sommeling CE, Heyneman A, Hoeksema H, Verbelen J, Stillaert FB, Monstrey S (2013) The use of platelet-rich plasma in plastic surgery: a systematic review. J Plast Reconstr Aesthet Surg 66:301–311
Kim YC, Mungunsukh O, McCart EA, Roehrich PJ, Yee DK, Day RM (2014) Mechanism of erythropoietin regulation by angiotensin II. Mol Pharmacol 85:898–908
Madrigal M, Rao KS, Riordan NHA (2014) Review of therapeutic effects of mesenchymal stem cell secretions and induction of secretory modification by different culture methods. J Transl Med 12:260
Guerrerosantos J, Gonzalez-Mendoza A, Masmela Y, Gonzalez MA, Deos M, Diaz P (1996) Long-term survival of free fat grafts in muscle: an experimental study in rats. Aesthet Plast Surg 20(5):403–408
Del Vecchio DA, Del Vecchio SJ (2014) The graft-to-capacity ratio: volumetric planning in large-volume fat transplantation. Plast Reconstr Surg 133:561–569
Illouz YG, Sterodimas A (2009) Autologous fat transplantation to the breast: a personal technique with 25 years of experience. Aesthet Plast Surg 33:706–715
Khouri RK, Eisenmann-Klein M, Cardoso E et al (2012) Brava and autologous fat transfer is a safe and effective breast augmentation alternative: results of a 6-year, 81-patient, prospective multicenter study. Plast Reconstr Surg 129:1173–1187
Rubin JP, Coon D, Zuley M et al (2012) Mammographic changes after fat transfer to the breast compared with changes after breast reduction: a blinded study. Plast Reconstr Surg 129:1029–1038
Veber M, Tourasse C, Toussoun G et al (2011) Radiographic findings after breast augmentation by autologous fat transfer. Plast Reconstr Surg 127:1289–1299
Zocchi ML, Zuliani F (2008) Bicompartmental breast lipostructuring. Aesthet Plast Surg 32:313–328
Gosset J, Guerin N, Toussoun G et al (2008) Radiological evaluation after lipomodelling for correction of breast conservative treatment sequelae (in French). Ann Chir Plast Esthet 53:178–189
Sahin B, Elfaki A (2012) Estimation of the volume and volume fraction of brain and brain structures on radiological images. Neuroquantology 10:87–97
Howard CV, Reed MG (2005) Unbiased stereology: three-dimensional measurement in microscopy, 2nd edn. Liv-erpool Bios, Oxford, pp 55–68
Altunkaynak M, Özbek E, Altunkaynak BZ, Can I, Unal D, Unal B (2008) The effects of high-fat diet on the renal structure and morphometric parametric of kidneys in rats. J Anat 212:845–852
Deniz OG, Kıvrak EG, Kaplan AA, Altunkaynak BZ (2017) Effects of folic acid on rat kidney expose to 900 MHz electromagnetic radiation. J Microsc Ultrastruct 5:198–205
Gundersen HJ, Jensen EB (1987) The efficiency of systematic sampling in stereology and its prediction. J Microsc 147:229–263
Abramov Y, Golden B, Sullivan M, Botros SM, Miller JJR, Alshahrour A et al (2007) Histologic characterization of vaginal vs. abdominal surgical wound healing in a rabbit model. Wound Repair Regen 15(1):80–86
Kalidasan V, Yang X, Xiong Z et al (2021) Wirelessly operated bioelectronic sutures for the monitoring of deep surgical wounds. Nat Biomed Eng 5:1217–1227
Zocchi ML, Vindigni V, Pagani A, Pirro O, Conti G, Sbarbati A, Bassetto F (2019) Regulatory, ethical, and technical considerations on regenerative technologies and adipose-derived mesenchymal stem cells. Eur J Plast Surg 42(6):531–548
Zocchi ML, Facchin F, Pagani A, Bonino C, Sbarbati A, Conti G et al (2022) New perspectives in regenerative medicine and surgery: the bioactive composite therapies (BACTs). Eur J Plast Surg 45(1):1–25
Mashiko T, Yoshimura K (2015) How does fat survive and remodel after grafting? Clin Plast Surg 42(2):181–190
Nissinen LM, Kahari VM (2015) Collagen turnover in wound repair–a macrophage connection. J Invest Dermatol 135(10):2350–2352
Kim MH, Curry FR, Simon SI (2009) Dynamics of neutrophil extravasation and vascular permeability are uncoupled during aseptic cutaneous wounding. Am J Physiol Cell Physiol 296(4):848–856
Allen RJ, Canizares O, Scharf C et al (2009) Spinning into control: centrifugation creates an optimal density for fat grafting. Plast Reconstr Surg 124:35S-36S
Butala P, Hazen A, Szpalsk C, Sultan SM, Coleman SR, Warren SM (2012) Endogenous stem cell therapy enhances fat graft survival. Plast Reconstr Surg 130(2):293–306
Suga H, Eto H, Shigeura T, Inoue K, Aoi N, Kato H et al (2009) IFATS collection: fibroblast growth factor-2-induced hepatocyte growth factor secretion by adipose-derived stromal cells inhibits postinjury fibrogenesis through ac-Jun N-terminal kinase-dependent mechanism. Stem Cells 27(1):238–249
Kato H, Suga H, Eto H, Araki J, Aoi N, Doi K et al (2010) Reversible adipose tissue enlargement induced by external tissue suspension: possible contribution of basic fibroblast growth factor in the preservation of enlarged tissue. Tissue Eng A 16(6):2029–2040
Sthijns M, van Blitterswijk CA (2018) LaPointe VLS Redox regulation in regenerative medicine and tissue engineering: the paradox of oxygen. J Tissue Eng Regen Med 12(10):2013–2020
Eto H, Kato H, Suga H, Aoi N, Doi K, Kuno S, Yoshimura K (2012) The fate of adipocytes after nonvascularized fat grafting: evidence of early death and replacement of adipocytes. Plast Reconstr Surg 129(5):1081–92
Kato H, Mineda K, Eto H, Doi K, Kuno S, Kinoshita K et al (2014) Degeneration, regeneration, and cicatrization after fat grafting: dynamic total tissue remodeling during the first 3 months. Plast Reconstr Surg 133(3):303e–313e
Zhu M, Zhou Z, Chen Y et al (2010) Supplementation of fat grafts with adipose-derived regenerative cells improves long-term graft retention. Ann Plast Surg 64:222–228
Tutak FN, Kıvrak EG (2022) The effect of human umbilical cord-derived lyophilized stem cells on fat graft viability: an experimental study. Aesthet Plast Surg 1–10
Seyhan N, Alhan D, Ural AU, Gunal A, Avunduk MC, Savaci N (2015) The effect of combined use of platelet-rich plasma and adipose-derived stem cells on fat graft survival. Ann Plast Surg 74(5):615–620
Kim SK, Yang JY, Kim CW, Baek SH, Kim U, Hwang E (2020) The effect of hyaluronidase on the fat graft. J Craniofac Surg 31(3):618–621
Funding
No funding was received for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics approval and consent to participate
The study was approved by the Institutional Scientific and Animal Research Ethics Committee of Adıyaman University. This study was performed in strict accordance with the recommendations in the Guide for the Care and Use of Laboratory Animals.
Informed consent
Informed consent was not applicable to this study because the sample did not include human subjects.
Consent for publication
Not applicable.
Conflict of interest
Fatma Nilay Tutak and Elfide Gizem Bakirhan declare no conflict of interest.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tutak, F.N., Bakirhan, E.G. The effects of the recipient site on fat graft survival in a murine model. Eur J Plast Surg 45, 733–740 (2022). https://doi.org/10.1007/s00238-022-01979-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-022-01979-6