RESUMO
BACKGROUND: Pedal fat grafting is a safe, minimally invasive approach to treat pedal fat pad atrophy. Prior randomized controlled trials demonstrate that the fat as measured directly under the metatarsal heads disappears between 2 and 6 months after fat grafting, despite patients having relief for 2 years. The authors aim to use magnetic resonance imaging to further assess three-dimensional volume of fat in the foot after autologous fat grafting to help explain the mechanism for improved pain. METHODS: A prospective study was performed using magnetic resonance imaging before and at 6 months after pedal fat grafting to assess changes in the three-dimensional morphology of the fat. RESULTS: Seventeen patients (six men and 11 women) underwent injections with a mean volume of 5.8 cc per foot. At 6 months, patients demonstrated increased tissue thickness (p = 0.008) and volume (p = 0.04). Improvements were seen in pain (p < 0.05) and activity (p < 0.05). Foot pressures and forces were significantly decreased and positively correlated with increased fat pad volume (p < 0.05). CONCLUSIONS: Pedal fat grafting significantly increases metatarsal fat pad volume. The distribution of the fat may contribute to lasting clinical relief in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Assuntos
Tecido Adiposo/transplante , Autoenxertos/diagnóstico por imagem , Dor Musculoesquelética/cirurgia , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/patologia , Atrofia/complicações , Atrofia/diagnóstico por imagem , Atrofia/cirurgia , Avaliação da Deficiência , Feminino , Pé , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Medição da Dor , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Transplante Autólogo/métodos , Resultado do TratamentoRESUMO
Decellularized scaffold materials are capable of regenerating missing tissues when utilized under appropriate conditions. Fat grafting also has reported advantages in revitalizing damaged tissue beds. This report details a case of traumatic fingertip amputation treated with a combination of decellularized materials in conjunction with fat grafting, resulting in a supple and functional reconstruction of the affected digit. After traumatic fingertip amputation, a patient was initially treated with decellularized porcine urinary bladder matrix powder. As a second stage, the healed tip scar tissue was reexcised, and a second application of powder was applied. As a third stage, the tip scar tissue was reexcised and a decellularized bilayer was sewn into the soft tissues of the debrided tip, resulting in an improved soft tissue envelope. As a final stage, the restored fingertip soft tissue envelope was fat grafted for additional bulk. Patient underwent treatment every other day with decellularized porcine urinary bladder matrix (powder and bilayer) and was able to reasonably regenerate the traumatic fingertip soft tissue envelope. This resulted in an envelope that was further enhanced with fat grafting. The resulting digit was sensate with maintained length, and possessed a more normal appearance than would be achieved by healing by secondary intention, or local flap or graft coverage. Decellularized materials can be utilized in conjunction with fat grafting to treat traumatic fingertip amputations in select patients. This combination approach is able to achieve a sensate fingertip and regain length lost in the affected digit. Additionally, we describe a novel technique that can be employed to maximize the amount of soft tissue regenerated by the decellularized products.