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      Transferencia de grasa autóloga en esclerodermia localizada y multicéntrica Translated title: Autologous fat transfer in localized and multicentric scleroderma

      case-report

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          Abstract

          La esclerodermia es una enfermedad autoinmune multisistémica caracterizada por una inflamación crónica del tejido conectivo. Intentando encontrar la técnica ideal para obtener el mejor resultado quirúrgico posible con un abordaje menos invasivo, proponemos la utilización de injertos autólogos de grasa para tratar las deformidades producidas por esta patología. Presentamos el caso de una paciente con diagnóstico de esclerodermia, difusa, multicéntrica, con compromiso extenso y severo de la cara y de varios segmentos corporales, con lesiones múltiples en placa (morfea) y lineales (golpe de sable) en cara, mamas y abdomen. Formulamos un plan de tratamiento quirúrgico basado en las posibilidades de remodelación y reestructuración facial y corporal con transferencia de tejido graso en 4 tiempos quirúrgicos consecutivos realizados en un período de 8 años. Consideramos que la transferencia de grasa es útil para la reversión de las alteraciones anatómicas y clínicas de la esclerodermia.

          Translated abstract

          Scleroderma is a multisystem autoimmune disease characterized by chronic inflammation of connective tissue. Trying to find the ideal solution for best results with less invasive surgical technique approache, we propose the use of autologous fat grafting. A patient with scleroderma, type diffuse, multicentric, committing extensive and severe face and several body segments, with multiple plate (morphea) and (coup sable) injuries, specifically on the face, breasts and abdomen, is presented. We formulate their surgical treatment plan based on the possibilities of remodeling and facial and body restructuring with the transfer of fatty tissue in 4 surgical times, performed along 8 years. Fat transfer is presented as a fundamental therapeutic in reversing the anatomical and clinical alterations of scleroderma.

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          Most cited references23

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          Fat grafting to the breast revisited: safety and efficacy.

          A 1987 American Society of Plastic and Reconstructive Surgeons position paper predicted that fat grafting would compromise breast cancer detection and should therefore be prohibited. However, there is no evidence that fat grafting to breasts is less safe than any other form of breast surgery. As discussions of fat grafting to the breast are surfacing all over the world, it is time to reexamine the opinions of the 1987 American Society of Plastic and Reconstructive Surgeons position paper. This is a retrospective examination of 17 breast procedures performed using fat grafting from 1995 to 2000. Indications included micromastia, postaugmentation deformity, tuberous breast deformity, Poland's syndrome, and postmastectomy reconstruction deformities. The technique used was the Coleman method of fat grafting, which attempts to minimize trauma and place grafted fat in small aliquots at many levels. All women had a significant improvement in their breast size and/or shape postoperatively and all had breasts that were soft and natural in appearance and feel. Postoperative mammograms identified changes one would expect after any breast procedure. Given these results and reports of other plastic surgeons, free fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures. It is time to end the discrimination created by the 1987 position paper and judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure.
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            Degeneration, regeneration, and cicatrization after fat grafting: dynamic total tissue remodeling during the first 3 months.

            Fat grafting is promising, but clinical outcomes are not always predictable. The mechanisms of tissue revascularization/regeneration, and tissue necrosis and subsequent absorption/fibrosis of the graft, are poorly understood.
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              Megavolume autologous fat transfer: part I. Theory and principles.

              This article describes the theory and principles behind the authors' success in megavolume (250-ml range) autologous fat transfer to the breasts. When large volumes are grafted into a tight space, the interstitial fluid pressure increases to impair capillary blood flow and the crowded graft droplets coalesce into lakes, with poor graft-to-recipient interface. These factors have historically restricted the volume of fat that can be grafted into small recipient breasts. The decreased interface increases the distance oxygen must diffuse to reach the grafted adipocytes, causing central necrosis to occur before neovascularization. The increased interstitial fluid pressure reduces capillary radius, reducing oxygen delivery to grafted adipose tissue. The Brava external expansion device harnesses the regenerative capabilities of mechanical forces to preoperatively increase the volume and vascularity of the recipient site, allowing megavolumes of fat to be grafted diffusely without significantly decreasing graft-to-recipient interface or increasing interstitial fluid pressure. The application of these principles has allowed the authors to successfully graft megavolumes of fat into the breasts of over 1000 patients with substantial long-term retention.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                September 2016
                : 42
                : 3
                : 285-292
                Affiliations
                [03] Rio de Janeiro orgnameInstituto Ivo Pitanguy Brasil
                [01] Rio de Janeiro orgnameInstituto Caldeira-Roth orgdiv1Departamento de Cirugía Plástica y Reconstructiva Brasil
                [02] Santo Domingo orgnamePlastimedic orgdiv1Departamento de Cirugía Plástica y Reconstructiva República Dominicana
                Article
                S0376-78922016000300011
                634c6740-95dd-48b1-af08-8c59af69d32b

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 06 July 2016
                : 01 August 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 8
                Product

                SciELO Spain


                Esclerodermia,Tejido graso,Tranferencia grasa,Lipoinfiltración,Scleroderma,Fat tissue,Fat transfer,Lipofilling

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