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Preliminary results of the new lipogluing technique plus full-thickness skin graft in post traumatic lower limb reconstructive surgery

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Abstract

Soft tissue reconstruction of a complex wound in the lower leg still presents a challenge to reconstructive surgeons, especially in the foot and ankle with exposed bones. We report the preliminary results of soft tissue complex defect treatment and coverage with our new lipogluing technique plus full-thickness skin graft. From September 2015, five patients with complex soft tissue defects on the lower leg underwent the coverage procedure with our new lipogluing technique plus full-thickness skin graft. At the first surgical step after standard debridement, we fix by fibrin glue the graft of fat cells withdrawn using the standard Coleman technique. Lipoglued fat cells enhance the soft tissue cover and better supplement the final skin thickness and pliability. This allows us to achieve the ultimate goal of reconstructive procedures: the recreation of all anatomical cutaneous and subcutaneous layers. Based on this preliminary personal experience, reliable information can be given about the safety, effectiveness, and usefulness of the lipogluing technique plus skin graft. All patients were able to wear normal footwear and to return to their usual activities thanks to the good results obtained and, when necessary, to thin coverage. To date, the coverage appears durable on all patients and they do not show any secondary problems of skin ulceration or breakdown. The lipogluing technique represents an evolution of the reconstructive process that aims to augment the autologous soft tissue under the skin graft avoiding more invasive procedure, in order to obtain a skin cover that feels natural.

Level of Evidence: Level V, therapeutic study.

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Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors and the authors have no financial interest to declare in relation to the content of this article.

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Authors and Affiliations

  1. Division of Plastic Surgery, “Papa Giovanni XXIII” Hospital, Bergamo, Italy

    Maurizio Verga, Marcello Carminati & Enrico Robotti

  2. Division of Plastic Surgery, “Ospedale Maggiore”, Lodi, Italy

    Omar Jaber

Authors
  1. Maurizio Verga
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  2. Marcello Carminati
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  3. Omar Jaber
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  4. Enrico Robotti
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Corresponding author

Correspondence to Maurizio Verga.

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Conflict of interest

The authors M. Verga, M. Carminati, O. Jaber, and E. Robotti declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration developed by the World Medical Association and subsequent amendments or comparable ethical standards and an informed consent for the surgical procedure and for the use of fibrin glue and lipofilling technique was obtained in writing form from each patient selected for the study.

Informed consent statement

The authors M. Verga, M. Carminati, O. Jaber, and E. Robotti declare that an informed consent for the surgical procedure and for the use of fibrin glue and lipofilling technique was obtained in writing form from each patient selected for the study.

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Fig.7

A 49-year-old male has had a total skin heel necrosis on his left foot when he was 19 years old, following a motorcycle accident and orthopedic treatment for femoral fracture, treated by local debridement and dressing determining a slow worsening chronic ulcer of Achilles tendon region for the last 30 years . First step of our procedure with radical debridement and placement of lipoglued fat grafting (Clinical Case 1) (PNG 1686 kb)

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Fig 8

Results of the vascularization process inside the lipoglued fat graft at 20 days (left) and at 35 days (right) after the first surgical procedure (PNG 1068 kb)

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Fig. 9

40 days after the first step, in order to re-establish all the layers of the soft-tissue defect, we placed a full thickness skin graft taken from the inside of the arm. Results at 20, 45 and 60 days after the skin graft (PNG 635 kb)

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Fig. 10

Results at 8 months after the procedure of lipogluing technique plus full-thickness skin graft in the treatment of a cutaneous and subcutaneous defect with exposed bone at the Achilles tendon region (PNG 955 kb)

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Fig 11-12

A 51-year-old female sustained a mechanical trauma and penetration injury during a Quad motorcycle accident, which resulted after primary treatment in an area of necrotic skin of her right thigh (Clinical Case 4). (PNG 567 kb)

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(PNG 730 kb)

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Fig. 13

At the first step, surgical debridement was performed to remove the devitalized tissue just to muscles underlying (size 18 × 10 cm); we then placed lipoglued fat grafting to fill up the deep loss of subcutaneous tissue about for 14 to 20 mm as described above (PNG 700 kb)

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Fig. 14

The results of the vascularization process inside the lipoglued fat graft at 15 days (left), 30 days (center) and at 60 days (right photo) post first surgical procedure (PNG 488 kb)

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Fig. 15

Results at 6 months (above) and at 12 months (bottom) after the procedure of lipogluing technique plus full-thickness skin graft taken from the abdominal region in the treatment of a cutaneous and subcutaneous tight defect (PNG 690 kb)

High resolution image (TIF 1450 kb)

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Verga, M., Carminati, M., Jaber, O. et al. Preliminary results of the new lipogluing technique plus full-thickness skin graft in post traumatic lower limb reconstructive surgery. Eur J Plast Surg 42, 615–622 (2019). https://doi.org/10.1007/s00238-019-01537-7

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  • DOI: https://doi.org/10.1007/s00238-019-01537-7

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