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Interim Analysis of a Prospective Clinical Trial: Correlation of Biologic Parameters with Clinical Outcome in Craniofacial Fat Grafting
Tara Grahovac, MD; Brian Philips, PhD; Sydney Coleman, MD; David Kaplan, PhD; Gretchen Haas, MD; Albert Donnenberg, PhD; Vera Donnenberg, PhD; Barton Branstetter, MD; Robert Hale, MD; David Baer, PhD;
University of Pittsburgh
2012-02-16
Presenter: Tara Grahovac
Affidavit:
All basic science work and data analysis is original work of the resident. The resident was also active in gaining regulatory approval for this study and participated in the surgical cases.
Director Name: J. Peter Rubin
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
This presentation addresses new basic science and clinical research regarding techniques to improve outcomes of craniofacial fat grafting, specifically through the use of adipose stem cells.
How will your presentation be used by practicing physicians in the audience?
Many plastic surgeons utilize fat grafting in their practices and can apply knowledge gained from this presentation to help improve their clinical outcomes.
Background: Disfiguring craniofacial trauma is devastating and correction of the soft tissue form remains a challenge. Current treatments such as tissue flaps can cause tremendous morbidity. Fat grafting is a promising alternative, although graft survival is unpredictable and factors that affect outcome have not been well-defined. Adipose stem cells (ASCs) may play an important role. The objectives of this study were to characterize the therapeutic potential of craniofacial fat grafting and correlate outcomes with biologic parameters through a prospective clinical trial.
Methods: Subjects underwent fat grafting to craniofacial defects using standard Coleman techniques. Changes in soft tissue volume were followed with CT scanning. Lipoaspirate was analyzed for ASC yield, proliferation, differentiation, and growth factor secretion. Additionally, athymic mice were injected with processed fat. Grafts volumes were measured at 8 weeks.
Results: Thirteen subjects have undergone fat grafting. Average volume retention at both 3 and 9 months is 60%. FACS analysis revealed an average ASC yield of 21.7±15% and fat graft retention in mice averaged 54±10%, demonstrating a correlation coefficient of 0.72 between these two endpoints.
Conclusions: Fat graft reabsorption in the craniofacial region occurs within the first three months and approximates 40%. ASC content within fat tissue varies among patients and higher ASC yields correlates positively with increased fat retention in mice. Current results support future studies in which we will concentrate fat grafts with ASCs. We hypothesize that ASC-rich fat will better withstand the ischemic insult that results from fat harvesting, leading to improved graft retention and vascularization.
