Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Autogenous fat grafting for mild-to-moderate postoperative temporal hollowing after decompressive craniectomy: One-year follow-up

  • Choi, Jaemin (Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center) ;
  • Choi, Hyungon (Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center) ;
  • Shin, Donghyeok (Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center) ;
  • Kim, Jeenam (Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center) ;
  • Lee, Myungchul (Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center) ;
  • Kim, Soonheum (Department of Plastic and Reconstructive Surgery, Konkuk University Choongju Hospital, Konkuk University School of Medicine) ;
  • Jo, Dongin (Department of Plastic and Reconstructive Surgery, Konkuk University Choongju Hospital, Konkuk University School of Medicine) ;
  • Kim, Cheolkeun (Department of Plastic and Reconstructive Surgery, Konkuk University Choongju Hospital, Konkuk University School of Medicine)
  • Received : 2017.06.26
  • Accepted : 2017.10.17
  • Published : 2018.01.20
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Abstract

Background Temporal hollowing is inevitable after decompressive craniectomy. This complication affects self-perception and quality of life, and various techniques and materials have therefore been used to restore patients' confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue. Methods Autologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman's strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit. Results The thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0-32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5-7.1 mL) and 4.6 mL on the left side (IQR, 3.7-5.9 mL). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year. Conclusions Despite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.

Keywords

References

  1. Albanese J, Leone M, Alliez JR, et al. Decompressive craniectomy for severe traumatic brain injury: evaluation of the effects at one year. Crit Care Med 2003;31:2535-8. https://doi.org/10.1097/01.CCM.0000089927.67396.F3
  2. Aarabi B, Hesdorffer DC, Simard JM, et al. Comparative study of decompressive craniectomy after mass lesion evacuation in severe head injury. Neurosurgery 2009;64:927-39. https://doi.org/10.1227/01.NEU.0000341907.30831.D2
  3. Lacey M, Antonyshyn O, MacGregor JH. Temporal contour deformity after coronal flap elevation: an anatomical study. J Craniofac Surg 1994;5:223-7. https://doi.org/10.1097/00001665-199409000-00005
  4. Antonyshyn OM. Soft tissue deformity after craniofacial fracture repair: analysis and treatment. J Craniomaxillofac Trauma 1999;5:19-29.
  5. Persing JA, Mayer PL, Spinelli HM, et al. Prevention of "temporal hollowing" after fronto-orbital advancement for craniosynostosis. J Craniofac Surg 1994;5:271-4. https://doi.org/10.1097/00001665-199409000-00018
  6. Kim S, Matic DB. The anatomy of temporal hollowing: the superficial temporal fat pad. J Craniofac Surg 2005;16:760-3. https://doi.org/10.1097/01.scs.0000180010.83480.10
  7. McNichols CH, Hatef DA, Cole P, et al. Contemporary techniques for the correction of temporal hollowing: augmentation temporoplasty with the classic dermal fat graft. J Craniofac Surg 2012;23:e234-8. https://doi.org/10.1097/SCS.0b013e31824de5b8
  8. Klinger M, Lisa A, Klinger F, et al. Regenerative approach to scars, ulcers and related problems with fat grafting. Clin Plast Surg 2015;42:345-52. https://doi.org/10.1016/j.cps.2015.03.008
  9. Klein JA. The tumescent technique: anesthesia and modified liposuction technique. Dermatol Clin 1990;8:425-37.
  10. Coleman SR. Facial recontouring with lipostructure. Clin Plast Surg 1997;24:347-67.
  11. Illouz YG. The fat cell "graft": a new technique to fill depressions. Plast Reconstr Surg 1986;78:122-3. https://doi.org/10.1097/00006534-198607000-00028
  12. Sommer B, Sattler G. Current concepts of fat graft survival: histology of aspirated adipose tissue and review of the literature. Dermatol Surg 2000;26:1159-66. https://doi.org/10.1046/j.1524-4725.2000.00278.x
  13. Smahel J. Biology of the stage of plasmatic imbibition. Br J Plast Surg 1971;24:140-3. https://doi.org/10.1016/S0007-1226(71)80033-4
  14. Rigotti G, Marchi A, Galie M, et al. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg 2007;119:1409-22. https://doi.org/10.1097/01.prs.0000256047.47909.71
  15. Klinger M, Marazzi M, Vigo D, et al. Fat injection for cases of severe burn outcomes: a new perspective of scar remodeling and reduction. Aesthetic Plast Surg 2008;32:465-9. https://doi.org/10.1007/s00266-008-9122-1

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