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Fat Grafting to the Abdominal Wall to Improve Ostomy Appliance Fit: An Unusual and Beneficial Application
Sharona Czerniak, Zoe MacIsaac, Dalit Amar, J. Peter Rubin
UPMC
2017-02-14
Presenter: Sharona Czerniak,
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: J. P. Rubin
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
For patients with an ostomy, a poor fitting appliance causes leakage, peri-stomal dermatitis, and frequent appliance changes. When secondary to contour abnormalities, local tissue rearrangement or ostomy site change are often used. Herein we report fat grafting to augment soft tissue deficiency and improve appliance fit.
Case description:
A 57-year-old female with Crohn's disease presented with soft-tissue deficiency and uneven contour around her ileostomy site. She was unable to properly fit an appliance, with leakage, chronic skin irritation, and need for almost daily appliance changes.
The patient underwent two sessions of fat grafting. Using syringe harvest, fat was aspirated from the medial thighs, centrifuged, and injected using blunt cannulas around the ostomy site. During the first operation 34cc of processed fat was injected, with immediate improvement, reducing daily appliance changes to every 3-4 days. At the second operation, 32cc of fat was injected to further improve appliance fit, reducing appliance changes to every 5 days and obviating the need to use adjustment rings.
The patient tolerated both procedures well, and no complications were associated with the procedure apart from mild donor site bruising.
Outcomes were additionally measured with pre- and post-operative computed tomography.
Conclusion:
In patients with a deficiency of abdominal wall adipose tissue, fat grafting around an ostomy site presents a safe and effective tool in improving contour and subsequent appliance fit. Patients may benefit from improved quality of life, including optimized appliance changing schedules and reduced skin irritation and leakage.
