Reconstructing Craniofacial Trauma with Fat Grafting: Predictors of Successful Outcomes
Debra Bourne, MD1, Jacqueline Bliley, MS1,8, Isaac James, MD1, Gretchen Haas, PhD2, Albert D. Donnenberg, PhD7, Vera Donnenberg, PhD7, Barton Branstetter, MD3, Ryan TM Mitchell, MD4, Spencer Brown, PhD5, Kacey Marra, PhD1,7,8, Sydney Coleman, MD1,6, J Peter Rubin, MD1,7,8.
11University of Pittsburgh Medical Center, Department of Plastic Surgery, Pittsburgh, PA, 2University of Pittsburgh Medical Center, Department of Psychiatry, and the VA Pittsburgh Healthcare System, Pittsburgh, PA, 3University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, 4The Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, MI, 5Cooper Medical School of Rowan University, Camden, NJ, 6New York Langone Medical Center, New York, NY, 7University of Pittsburgh McGowan Institute of Regenerative Medicine, Pittsburgh, PA, 8University of Pittsburgh Department of Bioengineering, Pittsburgh, PA.
PURPOSE - Craniofacial disfigurement creates psychological distress and functional impairment. Fat grafting improves contour, however, unpredictability of volume retention is a significant limitation.
METHODS - This IRB approved prospective cohort study was funded by the US Department of Defense. Twenty patients with craniofacial deformities underwent fat grafting. Volume retention was evaluated using CT scans (Figure 1). A portion of fat was evaluated for stromal vascular fraction (SVF) cell type populations by flow cytometry. Quality of life (QOL) measures were recorded. Five patients underwent a second fat grafting procedure after completing the 9 month follow-up period.
RESULTS - Volume retention stabilized at 3 months, and averaged 63% ±16 at 9 months. The retention at 3 months was significantly predictive of 9 month volume (p=0.006). Higher SVF cell viability was correlated with improved volume retention (p=0.008). Volume retention in the first procedure was predictive of the second operation (p=0.05). Satisfaction with physical appearance (p=.001) and social functioning quality of life (p<.04) improved from baseline to 9 months. There were no serious adverse events.
CONCLUSIONS - Fat grafting craniofacial defects is effective in improving volume deficits, with 40% volume loss anticipated. Viability of fat harvested impacts overall retention. The volume retention in subsequent procedures in the same patient had similar volume retention, suggesting a role for innate biologic characteristics of fat tissue in fat graft healing.
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