Dr. TAUSEEF UL HASSAN

TMO PLASTIC SURGERY

FASCIA GRAFT

Tensor Fascia Lata Temporoparietal Fascia Radial Forearm Posterior Calf Anterior Thigh Lateral Forearm.

HISTORY

McArthur in early 1900s reported first free fascial graft transfer. These were non-vascular grafts consisting of strips of external oblique apeneurosis used as biological sutures to repair inguinal hernias.

Blair in 1920s popularized a technique to correct facial nerve palsy using fascial strips of autogenous fascia lata as slings

INDICATIONS Free TFL graft used if there is a defect of

fascia only with well vascularized adequate local soft tissue coverage. Wounds should additionally be clean or only lightly contaminated.

Free fascial grafts are also used ONLAY grafts when the primary fascia repair may be difficult.

Facial palsy has been traditionally treated with fascial strips used either as static slings to represent facial components or as connectors between the active and the paralyzed facial components.

Indications (Cont.)

Free TFL grafts may be used in epigastrium or in place of two pedicled flaps.

Fascial grafts have also been used for augmentation of nasal or facial defects and typically harvested from temporalis muscle fascia.

Closure of Nasal septal defects. Repair of Urethral fistulas

HARVESTING:

TFL grafts from illiotibial tract from later aspect of thigh.

Open Approach; For larger grafts

Close Approach; For long thin grafts.

OUTCOME:

Facial grafts can achieve vascularization in good conditions. However, even when conditions are poor, significant structural integrity remains for a relatively longer time

FAT GRAFT

Also known as fat transfer, fat autographs, autologous fat transplantation, fat injecting or microlipoinjections.

HISTORY: Fat injections reportedly started in 1893 when

German physician Franz Neuber used a small piece of upper arm fat to build up the face of a patient whose cheek had a large pit caused by a tubercular inflammation of the bone.

In 1895, another German Karl Czerny documented the first breast augmentation when he transplanted a fatty tumor from patient’s lumbar region or lower buttock to a breast defect.

Throughout early part of 20th century, attempts were made to correct other conditions including hemi facial atrophy and breast defects, but modern fat grafting did not develop until the early 1980s with the popularity of

Liposuction. Illouz reported the transfer of liposuction aspirate fat in 1984.

Procedure for Grafting__

Harvesting; Prepare site for removal by injecting local

anesthesia.

Insert cannula (Mercedes e.g.;) connected to a syringe through small incision and carefully suck out fat.

Common donor sites include periumblical, lumbar and trochanteric areas, the thigh and medial sides of knee and arm.

Purification and Transfer;

Fat is purified either by hand or mechanically to get fat cells for grafting.

Prepare fat cells for transfer.

Placement; Area for graft is prepared. Regional

nerve blocks are most useful to avoid obscuring defect to be treated.

Needle or cannula is inserted into incision point of site being augmented and fat cells carefully injected into area.

Fat is grafted from deep layers to the superficial layer.

o Slight over-correction is important because some absorption of the liquid carrier occurs. 30% over-correction is normally recommended.

o If it’s facial graft transfer, avoid massage and excessive facial movements as this will stop migration of fat away from the desired areas of treatment.

o Ice compressions can be used for first 24-48 hours after the procedure.

The key points of the theory of fat survival are;

(1) fat is a dynamic tissue

(2) cells that suffer trauma lose more volume.

Therefore, careful handling of the graft is critical. Scarring and the added bulk of reactive tissue may contribute to the anticipated result.

INDICATIONS; Correction of atrophy due to aging or

scarring and enhancement of facial elements (e.g; to provide fuller, more voluptuous lips, to correct glabellar frown lines).

Smooth and repair aged hands.

Fill wrinkled creased faces.

Create more sharply, curvaceous buttocks.

Indications (Cont.) Breast augmentation.

Cheek and chin implants.

Repair of inverted nipples.

Filling in sunken areas beneath eyes.

Filling in forehead creases.

DURABILITY is somewhat between half a year to 08 years.

CONTRAINDICATIONS; Presence of any disease process that adversely

affects wound healing and poor overall health status of individual.

The use of free fat grafting for the treatment of contour abnormalities resulting from breast biopsy or for breast augmentation is generally contraindicated. The grafted fat can cause both palpable nodules and calcifications, situations that may hinder a diagnosis of breast cancer or cause unnecessary intervention.

SIDE EFFECTS;

A moderate amount of swelling is expected after fat graft. This is usually evident for 02 weeks after the procedure.

Some bruising may also be apparent.

COMPLICATIONS; UNDERCORRECTION;

Desired amount not achieved thus requiring a furthur graft to achieve correction.

OVERCORRECTION;

Too much fat is injected. This prevents new blood vessels growing to supply the graft, leading to cell death and a lump consistency.

Complications (Cont.)

Accidental Damage to Underlying Structures;

e.g. vessels and nerves particularly around eye.

BLEEDING;Usually associated with the use of sharp needles for fat

injection.

Clumping of Graft.

Scarring of Donor Site.

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