Results
In our survey, there were 24 German and 21 English speaking respondents.
Most of our responses came from Plastic and reconstructive surgeons [43/45; 95.5%] (see Figure 1), two Otorhinolaryngologists participated in and completed our questionnaire.
Nearly all of the participants declared experience with autologous fat grafting [42/45; 93.6%] whereas only three colleagues [3/45; 6.6%] had no experience with fat grafting. As shown in Figure 2, 38 percent [17/45; 37.7%] of the responders stated an AFG-use under ten times a year, nearly half [21/45; 46.6%] stated the usage of ten to fifty times per year and 14 percent [6/45; 13.3%] were frequent users of fat grafting (>50/year).
We observed common usage for aesthetic in 84% of respondents [38/45; 84.4%]. Further, a representative part of the participating colleagues [28/36; 62.2%] uses AFG for benign acquired pathologies such as HIV lipodystrophy, craniofacial anomalies, facial asymmetries, or scar treatment. Of particular interest, nearly two-thirds of our sample [28/36; 62.2%] do use AFG for post-cancer facial contouring or radiation-induced fibrosis treatment for facial/neck function.
As presented in Figure 3, we asked how the participating surgeons rank the indications for AFG in their practice. Based on 37 valid answers in the survey, 60% deemed “aesthetic facial contouring” as the most important AFG application [22/37; 59.6%], a further 25 percent [9/37; 24.3%] ranked “post-cancer facial contouring, post-cancer radiation treatment for facial/neck function” their most common indication.
Concerning harvest technique (see Figure 4), the majority use Syringe aspiration with a fine needle/cannula 1mm or greater [24/45; 53%], by the use of Vacuum aspiration with low pressure [17/45; 34%]. A few surgeons favour syringe aspiration with fine needle with a lower diameter than 0,7mm [4/45; 9%]. Interestingly, nobody of our survey cohort works with surgical excision in
AFG applications [0/45; 0%].
Nearly half of our colleagues process their harvested tissue by centrifugation [20/43; 46.5%], and the remainder (54%) had variable practices (see Table 2.)
Free Answers of processing technique | n | %-absolute |
Sedimentation and passive separation by gravity | 6 | 16.2% |
PureGraft | 3 | 8.1% |
decant liquid parts-no centrifuge | 2 | 5.4% |
Separation of fat and liquid parts in the syringe | 2 | 5.4% |
mesh washing | 2 | 8.1% |
Drainage of sediment and nanofat preparation | 1 | 2.7% |
Strain and irrigate | 1 | 2.7% |
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Table 2 AFG processing techniques [free text]
As demonstrated in Figure 4, nearly half of our survey participants [20/42; 47.6%] do not discuss the scientific conjecture around possible oncological stimulation and neoplastic potentiation by ASCs, in the fat graft matrix. This correlates with the fact that most respondents do not believe there is an elevated cancer risk with fat grafting in anatomical locations where cancer has been resected, but seemingly a proportion of these clinicians do not even consider it significant enough to discuss the controversies with patients.
Similarly, almost all respondents reported they had not observed new tumour recurrence in the fat grafted bed.