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Plast Reconstr Surg. 2013 Nov;132(5):1280-90. doi: 10.1097/PRS.0b013e3182a4c3a9.

Percutaneous aponeurotomy and lipofilling: a regenerative alternative to flap reconstruction?

Author information

1
Boston, Mass. From Brigham and Women's Hospital.

Abstract

BACKGROUND:

The application of a new approach is presented, percutaneous aponeurotomy and lipofilling, which is a minimally invasive, incisionless alternative to traditional flap reconstructions.

METHODS:

The restrictive subdermal cicatrix and/or endogenous aponeurosis is punctured, producing staggered nicks. Expansion of the restriction reconstructs the defect and creates a vascularized scaffold with micro-openings that are seeded with lipografts. Wide subcutaneous cuts that lead to macrocavities and subsequent graft failure are avoided. Postoperatively, a splint to hold open the neomatrix/graft construct in its expansive state is applied until the grafts mature. Thirty-one patients underwent one to three operations (average, two) for defects that normally require flap tissue transfer: wounds where primary closure was not possible (n=9), contour defects of the trunk and breast requiring large-volume fat grafts (n=8), burn contractures (n=5), radiation scars (n=6), and congenital constriction bands (n=3).

RESULTS:

The regenerated tissue was similar in texture and consistency to the surrounding tissues. Wider meshed areas had greater tissue gain (range, 20 to 30 percent). There were no significant wound-healing issues, scars, or donor-site morbidities. Advancement tension was relieved without flap undermining or decreased perfusion.

CONCLUSIONS:

Realizing that, whether scar or endogenous fascia, the subdermal aponeurosis limits tissue stretch and/or its three-dimensional expansion, a minimally invasive procedure that expands this cicatrix into a matrix ideally suited for fat micrografts was developed. Grafting this scaffold applies tissue-engineering principles to generate the needed tissue and represents a regenerative alternative to reconstructive flap surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.

PMID:
23924652
DOI:
10.1097/PRS.0b013e3182a4c3a9
[Indexed for MEDLINE]

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