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Optimizing Fat Grafting Technique: An Anatomic Study of the Impact of Cannula Diameter and Injected Volume per Pass on the Internal Architecture of Grafted Fat within the Recipient Bed.
Isaac James, MD; Debra Bourne, MD; Gabriella DiBernardo, BS; Sheri Wang, BS; Jeffrey Gusenoff, MD; Kacey Marra, PhD, J. Peter Rubin, MD
University of Pittsburgh Dept. of Plastic Surgery
2016-02-01
Presenter: Isaac James
Affidavit:
The proposed material has not been previously published or presented at a major meeting. The work below represents the original work of the individual submitting to the degree described.
Director Name: Not a resident
Author Category: Medical Student
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
BACKGROUND: The placement of injected fat during grafting determines the internal architecture of the grafted tissue within the recipient bed. Fat placed >2mm from the nearest blood vessel is at risk for ischemic necrosis. In our previous work, we assessed the relationship between graft volume and recipient volume, showing that significant pooling of injected fat occurs when graft:recipient volume ratios exceed 1:4. In this study, we sought to specifically determine the impact of cannula diameter and volume injected per pass on the internal architecture of grafted fat within the recipient bed.
METHODS: Methylene blue-stained fresh lipoaspirate was injected into excised human pannus tissue after standard Coleman processing. Single-pass injections were grafted into 4x1x2cm sections of pannus using 11, 14, 16, or 19 gauge Coleman cannulas with volumes of 0.1, 0.5, or 1.0 cc/pass. Specimens were frozen and sectioned macroscopically (2mm thick). Tunnel diameter and percentage of sections at risk for central necrosis (radius >2mm) was recorded.
RESULTS: Cannula diameter significantly correlated to tunnel diameter within each volume group (p<0.01). Greater volumes injected per pass significantly increased tunnel size and resulted in more deposits with radius >2mm (p<0.001). When larger volumes were injected, smaller cannulas successfully maintained smaller tunnel sizes.
CONCLUSIONS: Smaller cannula diameters yield a narrower column of grafted fat for a given injection volume. However, increasing the volume injected per pass substantially alters the dimensions of grafted tunnels regardless of cannula diameter. Based on these findings, injection cannulas with gauges >14 and injection volumes <0.5cc/pass create favorable deposition patterns.
