Autologous fat grafting: use of closed syringe microcannula system for enhanced autologous structural grafting

Robert W Alexander, David B Harrell, Robert W Alexander, David B Harrell

Abstract

Objectives: Provide background for use of acquiring autologous adipose tissue as a tissue graft and source of adult progenitor cells for use in cosmetic plastic surgery. Discuss the background and mechanisms of action of closed syringe vacuum lipoaspiration, with emphasis on accessing adipose-derived mesenchymal/stromal cells and the stromal vascular fraction (SVF) for use in aesthetic, structural reconstruction and regenerative applications. Explain a proven protocol for acquiring high-quality autologous fat grafts (AFG) with use of disposable, microcannula systems.

Design: Explain the components and advantage of use of the patented super luer-lock and microcannulas system for use with the closed-syringe system. A sequential explanation of equipment selection for minimally traumatic lipoaspiration in small volumes is presented, including use of blunt injection cannulas to reduce risk of embolism.

Results: Thousands of AFG have proven safe and efficacious for lipoaspiration techniques for large and small structural fat grafting procedures. The importance and advantages of gentle harvesting of the adipose tissue complex has become very clear in the past 5 years. The closed-syringe system offers a minimally invasive, gentle system with which to mobilize subdermal fat tissues in a suspension form. Resulting total nuclear counting of undifferentiated cells of the adipose-derived -SVF suggests that the yield achieved is better than use of always-on, constant mechanical pump applied vacuum systems.

Conclusion: Use of a closed-syringe lipoaspiration system featuring disposable microcannulas offers a safe and effective means of harvesting small volumes of nonmanipulated adipose tissues and its accompanying progenitor cells within the SVF. Closed syringes and microcannulas are available as safe, sterile, disposable, compact systems for acquiring high-quality AFG. Presented is a detailed, step-by-step, proven protocol for performing quality autologous structural adipose transplantation.

Keywords: adipose-derived adult stem-stromal cell; autologous fat grafting; bioscaffolds; closed syringe lipoaspiration; lipoaspiration/liposuction; stromal vascular fraction (SVF).

Figures

Figure 1
Figure 1
Comparison of syringe-harvested isolated adipose-derived mesenchymal stromal cell (AD-MSC) counts (open circles) versus use of low-pressure machine harvest (wall suction or detuned lipoaspiration machine [dark circles]). Notes: Vertical axis shows AD-MSCs per cc. Microcannula lipoaspirants were harvested by offset 2.1 mm OD cannulas and processed by collagenase digestion to isolate cellular subsets; counts were based on MSC-specific cell-marker characterization. Abbreviation: OD, outside diameter.
Figure 2
Figure 2
Complete closed-syringe microcannula system (Tulip® GEMS™, Tulip Medical Systems, San Diego, CA, USA).
Figure 3
Figure 3
Tulip® super luer-lock connection (Tulip Medical Systems, San Diego, CA, USA). Note: Seal on threaded standard luer connection (internal) plus seal on outside of standard luer external hub.
Figure 4
Figure 4
Tulip® (Tulip Medical Systems, San Diego, CA, USA) cell-friendly (autoclavable) microcannulas.
Figure 5
Figure 5
Disposable microcannula cannulas for closed-syringe lipoaspiration of small-volume autologous adipose grafting (Tulip® GEMS™, Tulip Medical Systems, San Diego, CA, USA). Notes: Top: snap-lock option for syringes; middle: coated multiport infiltrator, offset harvester, single-port injector; bottom: clear luer–luer anaerobic transfer.
Figure 6
Figure 6
Close-up of microcannula openings. Notes: Top: multiport infiltrator cannula; middle: offset harvester cannula; bottom: single-port injector cannula.
Figure 7
Figure 7
Closed-syringe lock options. Notes: Left: internal snap lock (disposable); right: external Johnnie Lok™ (reusable) Tulip® (Tulip Medical Systems, San Diego, CA, USA).
Figure 8
Figure 8
Anaerobic luer-to-luer transfer shown loading adipose graft to 1 cc treatment syringe.
Figure 9
Figure 9
Mechanical injector gun (Tulip®, Tulip Medical Systems, San Diego, CA, USA).
Figure 10
Figure 10
Example marking of lower abdomen site for harvesting of subdermal adipose tissue. Note: Arrows show wheel-spoke pattern of tumescent infiltration and harvesting of abdominal donor site.
Figure 11
Figure 11
Placement of microcannula below Scarpa’s fascia in the adipose tissue plane.
Figure 12
Figure 12
(A) Gravity decant base (luer); (B) gravity decant in test tube rack.
Figure 13
Figure 13
The SmartPRep®2 APC+™centrifuge, which forms part of the AdiPRep™ Adipose Transfer System (Harvest-Terumo, Plymouth, MA, USA). Note: The left syringe is the counterbalance (containing saline) and the right contains the harvested adipose graft in a disposable processing syringe (with disk) prior to centrifugation (1000 g for 4 minutes).
Figure 14
Figure 14
Close-up of a disposable processing syringe containing extracted tissue that has separated. Notes: The top layer is free lipid in and above the white separator disk, the middle layer is compressed adipose tissue graft, and the bottom layer is infranatant fluid and debris.
Figure 15
Figure 15
Anaerobic transfer from disposable processing syringe (above) to adipose fat graft syringe (below).
Figure 16
Figure 16
Tulip® GEMS™ (Tulip Medical Systems, San Diego, CA, USA) single-port injection cannulas (top) and close-up of the tip of one of these (bottom).
Figure 17
Figure 17
(A) Close-up of closed-cell compression foam (TenderFoam™; T&N Industries, San Diego, CA, USA). (B) Foam in place prior to firm compression.
Figure 18
Figure 18
Clinical examples. Lips (A) pre- and (B) 1-year post-augmentation (autologous fat grafting [AFG] plus high-density platelet-rich plasma [HD PRP] [upper lip 3 cc; lower lip 2 cc]). (C) Pre- and (D) postoperative (20 months) AFG plus HD PRP grafting to lips, cheeks and nasolabial folds (lips: upper 2.5 cc; lower 2 cc; cheeks: 5 cc bilateral, malar and sub-malar placement; nasolabial folds: 3 cc bilateral). Cheeks (E and F) pre- and (G and H) 2 years post-AFG plus HD PRP (bilateral cheeks; total volume grafted, 5 cc bilateral malar and sub-malar) (Photos with permission). (I) Pre- and (J) postoperative (4 years) large-volume augmentation of both breasts (closed-syringe technique, cell-friendly cannulas) using AFG plus HD PRP concentrate; right, 300 cc; left, 325 cc).

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Source: PubMed

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