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Quantitative Analysis of Pedal Fat Compartments for Pedal Fat Grafting: An Anatomical Study
Ki-Hyun Cho, MD, MSc; Christopher C. Surek, DO; James E. Zins, MD
Cleveland Clinic Foundation, Department of Plastic Surgery
2018-02-15
Presenter: Ki-Hyun Cho
Affidavit:
This project is the original work of the research fellow. Dr. Cho has assembled the design, execution, and write-up of this study under my mentorship. Data collection and interpretation was assisted by the other authors on this paper.
Director Name: James E. Zins, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Background: Fat grafting to the regions of plantar fat pad atrophy may reduce plantar pressures, and thus serve as an effective treatment for metatarsalgia. Quantitative analysis of pedal fat compartments can offer valuable information for pedal fat grafting.
Objective: To quantify the fat compartments in the metatarsal area and describe fat grafting technique for metatarsalgia.
Methods: Nine paired fresh cadaveric feet (mean age 69.7 years; range 59–80 years) were investigated. The studied fat compartments were injected with methylene blue for identification and volume was calculated by water displacement method. An operative technique video was created.
Result: Five submetatarsal cushions below each of the metatarsal bones were identifiable in all dissections. Four fat compartments which were located between the cushions could be defined in each subject by methylene blue staining. The fat compartments covered and protected the digital nerves and vessels in their passage. The volume of the fat compartments under the metatarsal heads was progressively lower from medial to lateral. Mean volume of the 1st to 4th fat compartments was, 4.2 cc (SD, 0.5; range 3.3-5.1 cc), 3.0 cc (SD, 0.4; range 2.5-3.3 cc), 2.4 cc (SD, 0.3; range 1.7-2.9), 1.7 cc (SD, 0.1; range 1.4-1.9 cc) respectively.
Conclusion: This study clarifies pedal fat pad anatomy and can equip clinicians with a roadmap during pedal fat grafting for metatarsalgia, particularly in estimating the volume to be replaced. When performing pedal fat grafting, the surgeon must be cognizant of the digital nerves and vessels in the fat compartments.
