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Foot Rejuvenation with Pedal Fat Grafting: A Randomized Crossover Clinical Trial

Stephanie Dreifuss, Danielle Minteer, Jeffrey Gusenoff
University of Pittsburgh Medical Center Department of Plastic Surgery
2016-12-12

Presenter: Stephanie Dreifuss

Affidavit:
This abstract represents the original work of the resident Stephanie Dreifuss.

Director Name: Vu T. Nguyen

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction

INTRODUCTION:
Pedal fat pad atrophy is a devastating condition affecting 30% of patients over the age of 60 and impacting foot function, pain, and appearance. We hypothesize that pedal fat grafting may benefit dermal and soft tissue thickness, which may account for the prolonged symptomatic improvement despite loss of grafted fat.

METHODS:
Patients with pedal fat atrophy were enrolled in a randomized crossover clinical trial. Group 1 underwent fat grafting immediately with 2-year follow-up. Group 2 was managed conservatively for 1 year then crossed over into the fat grafting group with 1-year follow-up.
Patients underwent pedal ultrasounds postoperatively to determine thickness of the pedal fat pad and dermis. Additionally, the Manchester Foot Pain and Disability Index was administered to study participants.

RESULTS:
3 men and 20 women were included in the study with an average age of 63 (±6 years). 26 and 17 feet were injected in Groups 1 and 2 respectively.
In both groups, fat pad thickness was temporarily increased (p<0.05). Neither group had a significant increase in dermal thickness.
Group 1 had significant improvement in pain (p<0.001) and function (p<0.05) post-injection. Group 2 had significant improvement in pain and increased work and leisure activities (p< 0.05).

CONCLUSION:
Though fat grafting for pedal atrophy has minimal effect on the dermis, it does have a significant impact on pain and function. Future studies are planned to determine whether the grafted fat disperses over time, allowing for fat-mediated rejuvenation of the pedal tissue without a measurable impact on tissue thickness.

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