Lipomodeling - autologous fat transfer in aesthetic surgery.

Over 15 years of fat tissue research on cellular level established the technique of autologous fat grafting. Lipomodeling allows to change the shape and volume of the recipient tissue with the aim to reconstruct, rejuvenate and regenerate body features. The stem cells derived from fat tissue are responsible for the regenerating effect. The success of the procedure is based on proper technique of fat harvesting, fat processing and fat reinjection. In the field of the aesthetic surgery lipomodeling represents a gold tool particularly for face rejuvenation and breast enlargement. The rate of complications is very low and fat resorption varies between 10 to 40% according to the recipient site. Very rare complication is intraarterial application of the fatgraft, which can lead to fatal results. A surgeon performing lipomodeling should be very experienced and trained in this technique. Keywords: lipomodeling, autologous fat transfer, aesthetic surgery, stem cell.

Further developments in the twisted-toe technique for isolated thumb reconstruction: our method of choice.

BACKGROUND: Posttraumatic loss of the thumb is devastating. Toe-to-hand transfer is considered the criterion standard of reconstruction but is associated with donor-site issues. The twisted-toe technique uses parts from the great toe and the second toe, which allows for almost anatomical restoration of the donor foot. The authors present their experience and technical modifications of this method. METHODS: Between January of 2003 and November of 2011, 18 patients suffering from loss of thumb because of a variety of indications were treated with the authors' modification of the twisted-toe technique. The neothumb was constructed with a partial onychocutaneous flap from the great toe and an osseotendinous flap from the second toe. RESULTS: Of 18 transplanted twisted-toe flaps, 17 survived completely (5.6 percent flap loss rate). Similarity of the reconstructed thumb compared with the healthy side was very acceptable in all cases. All patients in whom the procedure was successful were able to use the neothumb in daily life without constraints. Reconstruction of the donor site yielded very acceptable outcomes with a distinct reduction in morbidity and disfigurement compared with conventional toe harvest. CONCLUSIONS: The modified twisted-toe technique is the authors' preferred choice of thumb reconstruction. It allows the reconstructive surgeon to construct a very natural-appearing neothumb with good stability and grip force. In addition, it eliminates many of the donor-site problems associated with pure great toe harvest, by recreating a "neo-great toe" at the donor foot. Although the procedure is more complicated and time-consuming compared with single toe harvest, the authors firmly believe that this extra effort takes thumb reconstruction to a next level. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.