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To introduce the diagnosis and treatment, as well as the result of a patient with fat embolism at cerebral and ophthalmic artery, following fronto-temporal autologous fat transplantation. The patient, a 39-year-old woman, who received fronto-temporal autologous fat transplantation in other hospital in May 2018. Hemiplegia and right eye blindness happened right after autologous fat transplantation. The patient was transferred to the 940th Hospital of PLA Joint Service Support Force 5 hours after operation, but the function of the limbs and the right eye were not well restored after intensive treatment. Fat embolism is the most serious complication in fat transplantation. Once it occurs, the prognosis is poor. Therefore, the process of autologous fat transplantation should be standard to prevent related complications.
ABSTRACT
Objective@#Report the experience of autologous fat grafting forfacial contouring and rejuvenation patients.@*Methods@#Retrospective analysis the treatment of 450 facial contouring and rejuvenation patients with global optimization autologous fat grafting in Plastic Surgery Hospital of Chinese Academy of Medical Sciences from January 2011 to December 2017. Using low negative pressure liposuction technical and blunt cannula (diameter 2.5 mm and 2.0 mm), different fat particle was harvested and concentrated by a cotton pad. The one-hole blunt cannula was used for fat grafting with multi tunnel and multi-point and two layer(deep and superficial)injection ways, regularly following up and taking picture for imaging evaluation.@*Results@#All patients were successfully performed with fat grafting. Grafted fat volume was 15-65 ml. There were 132 cases of local skin bruising after operation, which gradually subsided about 2 weeks, no severe complications occurred. 450 patients were followed up for 6-12 months. Facial contour and skin texture were improved without subcutaneous nodules and irregularity. The outcome of all patients were satisfactory. Of a total of 450 patients, 319 (70.89%) were evaluated as very good result, 94 (20.89%) as good result, and 37(8.22%) asregular result.@*Conclusions@#Optimization autologous fat grafting can improve the facial contouring and rejuvenation with little complications and satisfactory results.
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Objective@#To study the morphological characteristics and important anatomical structures of each soft tissue layer of gluteal region, and discuss the recommended levels and safe areas for liposculpture in this region.@*Methods@#Twenty-eight specimens of unilateral buttocks from 14 adult cadavers, including 16 specimens of unilateral buttocks from 8 fresh cadavers and 12 specimens from 6 formaldehyde fixed cadavers were dissected. Among the cadavers, there were 2 males with an average age of 49 years, and 12 females from 23 to 72 years old, median age 46 years. Through anatomy study of soft tissue layers of gluteal region, the morphological features of each layer were observed and documented, and the characteristics of fascia system and adipose tissue, as well as the relationship between the blood vessels and nerves with corresponding layers.@*Results@#The layers of the gluteal region that range from superficial to deep are skin, subcutaneous fat, superficial fascia system, deep fascia system, muscle and fascia compartments. Subcutaneous fat is distributed in superficial and deep layers; the superficial fascia system is well developed and dense with a layered structure; the deep fascia is thin with the characteristic of epimysium. There is a danger zone for deep fat graft in the gluteal region, with its apex at the first sacral vertebra, and its base goes along the gluteal fold, compromising the thighs′ medial two-thirds. Nearly all important blood vessels and nerves of gluteal region are located in deep layer of this danger zone.@*Conclusions@#Based on the characteristics of buttocks of Chinese people, liposuction is mainly performed in the iliolumbar region and posterolateral thigh, which can significantly increase the relative height and fullness of buttocks. For full buttocks, deep fat can be sucked appropriately, which should be longitudinal and gentle to reduce the damage to the superficial fascial system. There is a high risk for fat graft in the buttock. It is recommended to use a blunt needle with an inner diameter of more than 3 mm parallel to the fiber orientation of gluteus maximus for uniform fan-shaped injection with needle withdrawal. Satisfactory result can be obtained by injecting most fat into the subcutaneous adipose layer. Deep injection of grafts into dangerzoneis forbidden.
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Objective@#To summarize the clinical effects of meticulous fat transplantation with fat grafts in the treatment of sunken upper eyelid.@*Methods@#From September 2016 to January 2019, 58 patients with sunken upper eyelid were treated in the 940th Hospital of the Joint Logistic Support Force of PLA. There were 2 males and 56 females, aged from 20 to 63 years. Among them, 14 cases were congenital, 30 cases were senile, 8 cases were postoperative, and 6 cases were traumatic. The prepared autologous granule fat was extracted with a 1 ml syringe, which matched with a 1.0 mm diameter needle. The 1 ml syringe was packed into the card slot of a fat graft booster, and the needle was inserted into the orbital fat zone of a depressed upper eyelid to homogenously inject the granule fat. For patients with iatrogenic and traumatic upper eyelid depression, the adhesion was released by small needle knife before injection. For those with aging skin, subcutaneous injection of nano-fat was applied.@*Results@#The amount of granule fat transplantation was 0.5 ml to 3.6 ml, with an average of 1.5 ml. The amount of nano-fat injection was 0.5 ml to 1.0 ml, with an average of 0.7 ml. All patients were followed up for 1 month to 2 years. Except 2 patients with severe traumatic upper eyelid depression, the other patients were satisfied with their full and natural upper eyelids after treatments.@*Conclusions@#When the upper eyelid depression was treated with granule fat transplantation by the booster, the small needle knife peeling technique and nano fat transplantation can be combined to correct different types of congenital, aging and surgical derived sunken upper eyelid and traumatic sunken upper eyelid from mild to severe cases. At the same time, the skin of the upper eyelid can be rejuvenated as well.
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Objective@#To treat the depressed scars by injecting nanofat and investigate its therapeutic effect.@*Methods@#Autologous fat was harvested from abdomen or thigh using low-pressure suction. The lipoaspirate was mechanically emulsified after rinsing. Emulsification of the fat was achieved by shifting the fat between two 5 ml syringes connected to each other by a three direct connector. After this emulsification process, the fatty liquid was again filtered over the sterile nylon cloth. Nanofat was injected into the dermis of depressed scars using a 26-gauge needle and the injection volume was 1-2 ml/cm2. After three months, another injection would be performed if the depressed scar remained obvious.@*Results@#From January 2016 to October 2017, eighteen patients and thirty-three depressed scars were treated. There was a temporary erythema of the injected area that lasted two to three weeks. The clinical result gradually improved over time and were maximal from three months postoperatively for most cases. Three months after nanofat injecting, the cavity of scars was significantly decreased; The color of scars were significantly improved and more close to the adjacent skin; The stiffness of scars was also obvious decreased. The follow-up ranged 4 months to 18 months and the average was 11.0±4.6 months. Seventeen patients were satisfied with the result, one patients was not satisfied and the satisfaction rate was 94%. No infections, fat cysts, granulomas, or other unwanted side effects were observed.@*Conclusions@#Nanofat injecting is a definite and effective treatment for depressed scars with fewer complications.