CT Imaging for Large Scale Anatomic Study of the Gluteal Veins
David M. Turer, MD, MS, Erin Anstadt, MD, Alexander Skidmore, MD, April Lawrence, BS, April Krivoniak, BS, Darshit Thakrar, MD, Amir Borhani, MD, Jesse Goldstein, MD, J. Peter Rubin, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
PURPOSE - A significant safety issue in plastic surgery is the risk of morbidity and mortality associated with gluteal fat grafting. A recently published study in the Aesthetic Surgery Journal suggested that the mortality rate may be as high as 1:3,0001. The significance of this issue is highlighted by the formation of a multi-society task force to further elucidate the safety concerns and develop strategies for mitigating risk. The Gluteal Fat Grafting Task Force has identified injury to the gluteal veins with associated fat embolism as a cause of mortality. Importantly, the anatomic danger zone in which injury can occur appears to be deep to the gluteus maximus muscle in the medial portion of the buttocks2. The Gluteal Fat Grafting Task Force has issued a statement that all deaths associated with gluteal fat grafting have demonstrated intramuscular and submuscular injection of fat.3 Despite this position statement, some surgeons continue to advocate that intramuscular injection is safe as long as it occurs in the lateral portion of the buttock. To date, no study exists which clearly defines the gluteal venous anatomy as it relates to gluteal fat grafting, and the data that does exist was obtained in limited cadaver dissection studies.
METHODS - Here we present our experience using existing CT scans of the pelvis to assess the gluteal venous anatomy.
RESULTS - Our techniques are able to accurately map the venous anatomy including the location of vessels in relation to bony landmarks and vessel size. In addition, we have produced both virtual and physical 3D models of the gluteal venous anatomy to be used as an educational resource for surgeons (Figures 1 and 2).
CONCLUSIONS - This study provides a conceptual framework to use existing CT scans to perform large volume anatomic studies.
Mofid MM, Teitelbaum S, Suissa D, et al. Report on mortality from gluteal fat grafting: Recommendations from the ASERF task force. Aesthetic Surg J. 2017;37(7):796-806. doi:10.1093/asj/sjx004.
Villanueva NL, Del Vecchio DA, Afrooz PN, Carboy JA, Rohrich RJ. Staying Safe during Gluteal Fat Transplantation. Plast Reconstr Surg. 2018;141(1):79-86. doi:10.1097/PRS.0000000000003934.
Mills D, Rubin JP, Saltz R. Multi-Society Gluteal Fat Grafting Task Force issues safety advisory urging practitioners to reevaluate technique. images/gluteal-Fat-Grafting-02-06-18_0.pdf. Published 2018.
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