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• W2004462514 abstract "Sir: Autologous fat grafting is a widely used technique in plastic and reconstructive surgery. Despite decades of clinical practice, a standardized procedure has yet to be adopted by all practitioners. One of the most critical disadvantages of this technique is the unpredictable postsurgical volume loss over time.1 Among the variables that remain to be standardized, harvesting technique, processing method, and injection technique are considered the most critical. The loss of grafted tissue could be explained by the lack of adequate vascularization, the lack of regenerative cells within the fat graft, the traumatic handling of the fat during preparation and implantation, immune system–mediated cellular phagocytosis in the proinflammatory environment after grafting, or likely a combination of all of these effects.2 Various methods for harvesting and processing of autologous fat grafts have been described and analyzed in the literature. One of the standard procedures, the Coleman technique,3,4 uses aspiration at reduced vacuum levels and centrifugation to concentrate adipose tissue. Other techniques use straining through a mesh to obtain the adipose tissue. However, none of these methods uses an efficient washing system to remove red blood cells, free oils, cellular breakdown products such as lactate dehydrogenase, or anesthetic substances. The rationale for performing this study is to obtain data that address questions regarding the adipose tissue physiologic conditions as harvested (raw lipoaspirate) and after washing using isotonic saline solution. Adipose samples were collected with standard liposuction technique from five healthy female donors after signed informed consent was obtained. One half of the samples were decanted without washing, whereas the other half were washed using a European Community–marked device that had been developed to process large volumes of human lipoaspirates (The GID Group, Inc., Louisville, Colo.). The aqueous phase of the tissues was quantitatively analyzed for triglyceride content, lactate dehydrogenase, hematocrit, and osmolarity using an automated analyzer (Dimension RxL Max Analyzer; Siemens, Munich, Germany). All results are expressed as means ± SEM (n = 5). The unpaired t test was used to compare the different values analyzed between the decanted and washed adipose tissue. Compared with decanted adipose tissue, washed adipose tissue demonstrated marked and significant reductions in triglycerides (6.4-fold increase of triglyceride content in the unwashed lipoaspirate sample), lactate dehydrogenase (unwashed lipoaspirate produced 3- to 4-fold more lactate dehydrogenase than that washed by means of the GID device), and hematocrit (unwashed lipoaspirate produced almost 8-fold more hematocrit than washed lipoaspirate). The levels of triglyceride content and free hemoglobin have been previously described to promote inflammation and mediate different pathways that lead to nitric oxide depletion and reactive oxidative species generation.5 Importantly, washing the adipose resulted in restoration of adipose graft osmolarity to within a normal physiologic range (Figs. 1 and 2).Fig. 1: Representative images of unwashed lipoaspirate (left) and washed lipoaspirate (right) after decantation (above). Note the raw lipoaspirate on the GID700 device before and after washing (below).Fig. 2: Comparison of triglyceride content (above, left), lactate dehydrogenase release (above, right), hematocrit (below, left), and osmolarity (below, right) in decanted adipose compared with adipose washed by means of the GID device. p < 0.001; p < 0.05; p < 0.01 (t test; n = 5). As indicated by the vertical bracket below, right, normal plasma osmolarity values are in the range of 275 to 295 mOsm/liter. TGC, triglyceride content; LDH, lactate dehydrogenase; Hct, hematocrit.The raw lipoaspirate is subjected to hyperosmolar conditions (>300 mOsm/liter) and is contaminated with red blood cells, free hemoglobin, and free oils. In this study, we demonstrate that the use of a fast and efficient washing system allows the fat graft to be returned to optimal physiologic conditions for reimplantation. DISCLOSURE Dr. Dos Anjos Vilaboa is an employee at the Stem Center and holds no financial interests or stock in The GID Group. Mr. Mendel’s internship at Stem Center Mallorca was funded by a University of Virginia Biotechnology Training Grant (National Institutes of Health T32 GM08715). He holds no financial interests or stock in The GID Group or Stem Center. Dr. Cerdá is a director at the Stem Center and maintains a consulting relationship and stock interest in The GID Group, Inc." @default.
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• W2004462514 date "2013-08-01" @default.
• W2004462514 modified "2023-10-18" @default.
• W2004462514 title "Returning Fat Grafts to Physiologic Conditions Using Washing" @default.
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• W2004462514 doi "https://doi.org/10.1097/prs.0b013e3182958be1" @default.
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