Applications and Indications of autologous fat grafting
Fat grafting has a number of monikers and this paper will use the term AFG. Applications of AFG are broad and treatable regions are various. A variety of clinical problems have been treated using fat, including post oncological contour defects, scar therapy, connective tissue disease, post-radiation skin injury, chronic lymphoedema, facial and body asymmetries of the soft tissues and in complex/simple burns (12, 18). Ultrastructural analysis of radio-damaged tissue showed a significant reduction of the capillary bed, where AFG has shown to enhance tissue hydration, the induction of blood vessel formation and increased local regeneration of damaged tissue (19). Furthermore, AFG can be of use in the treatment of the microangiopathic patient (19, 20). Autologous fat grafting, therefore, is beneficial for patients with volume loss due to the natural process of ageing, disease, trauma, congenital defects and it improves skin quality, tissue quality and scars and further gives enlarged volume in the treated region (21).
In head and neck cancer HNC, squamous cell carcinoma HNSCC is the most common and frequently requires surgical ablation plus radiotherapy. This oncologic treatment can often lead to major functional impairment, lymphoedema and radiation-induced soft tissue changes inducing neck lymphedema and radiation injury and a restriction of function, and in facial cancer ablation, contour defects (22, 23).
Fat grafting first gathered prominence in the aesthetic area(24), and subsequent study showed it had a favourable complication profile compared to synthetic filler materials (25, 26).
However, there remains a weak consensus on the optimal conditions of fat aspiration, processing, and injection that confers a greater ‘take’ in aesthetic applications (25, 27-29). Further, the amount of infiltrated fat in the face is not yet standardized. (24) Moreover, due to the chronicity of radiation injury in HNC treatment, the optimal time of treatment is not clear, and what is the exact change in the irradiated skin micro-environment (2, 30).