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Fat grafting promotes dermal rejuvenation in patients with fat pad atrophy of the heel: Data from a randomized controlled clinical trial.
James IB, Gusenoff BR, Wang S, Dibernardo G, Gusenoff JA
University of Pittsburgh
2019-02-14
Presenter: Isaac James
Affidavit:
This is the original work of the resident
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
BACKGROUND: The shock absorbing soft tissues of the heel are composed of dermis and specialized fat pads. Atrophy of these soft tissues can be painful and debilitating. In our previous work, fat grafting improved patient-reported pain scores at 1-year, despite fat pad thickness returning to baseline. Prior work with fat grafting to the forefoot demonstrated long-term increases in dermal thickness. In this study, we investigate the impact of autologous fat grafting on the overlying dermis of the heel.
METHODS: Fat was harvested from the abdomen using manual liposuction then processed and injected by Coleman technique into the heel fat pad of 7 patients (12 feet) with an average volume of 7.7cc per heel. Patients were then offloaded for 4wks using a custom Darco shoe. Ultrasound-measured tissue thickness and Manchester Foot Pain and Disability Index (MFPDI) were followed for 1 year. Outcomes were compared against 7 patients (9 feet) that were randomized to the control group during enrollment. They received standard-of-care offloading only.
RESULTS: Average age was 55.1. Average BMI was 30.5. 50% of patients were female. No patients were active smokers or diabetic. Subjects receiving fat grafting had significantly increased dermal thickness at 6 months and 12 months compared to controls (p<0.05). Similarly, foot pain, function, and appearance as measured by the MFPDI was increased significantly at 6 and 12 months when compared to controls (p<0.05).
CONCLUSION: Our data suggest that fat grafting of the heel helps to rejuvenate the overlying dermis and improve patient-reported foot pain, function, and appearance.
