Clinical Implications of Gluteal Fat Graft Migration: A Dynamic Anatomical Study

Daniel A. Del Vecchio, Nathaniel L. Villanueva, Raja Mohan, Bret Johnson, Dinah Wan, Aniketh Venkataram, Rodney J Rohrich

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: The intraoperative mortality and overall complication rate for gluteal augmentation with fat transplantation is unacceptably high. The current controversy among experts regarding safety is whether fat should be placed within the gluteus muscle or limited to only the subcutaneous space. The purpose of the present study was to test the hypothesis that under certain pressures, fat injected within the gluteal muscle can actually migrate out of the muscle and into a deeper plane containing critical neurovascular structures, by means of the process of deep intramuscular migration. METHODS: A total of eight human cadaver dissections were performed. Four hemibuttocks were selected for intramuscular fat injection. The patterns of subfascial fat migration were evaluated in three of these hemibuttocks by direct visual inspection and in one hemibuttock by endoscopic evaluation. Four other hemibuttocks were selected for subcutaneous or suprafascial fat injection. RESULTS: Proxy fat was found to migrate through the muscle and into the deep submuscular space with each intramuscular injection. With subcutaneous injection, no proxy fat was found during dissection in the intramuscular septae or submuscular space. CONCLUSIONS: The intramuscular insertion of fat, which up to this point has been considered reasonable to perform in the superficial muscle and even recommended in the literature, is now deemed to be an inexact and risky surgical technique. This technique, because of the migratory nature of injected fat, should be avoided from further use in fat transplantation to the gluteal region.

Original languageEnglish (US)
Pages (from-to)1180-1192
Number of pages13
JournalPlastic and reconstructive surgery
Volume142
Issue number5
DOIs
StatePublished - Nov 1 2018

Fingerprint

Fats
Transplants
Muscles
Intramuscular Injections
Proxy
Dissection
Transplantation
Buttocks
Subcutaneous Injections
Cadaver
Safety
Pressure
Injections
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Del Vecchio, D. A., Villanueva, N. L., Mohan, R., Johnson, B., Wan, D., Venkataram, A., & Rohrich, R. J. (2018). Clinical Implications of Gluteal Fat Graft Migration: A Dynamic Anatomical Study. Plastic and reconstructive surgery, 142(5), 1180-1192. https://doi.org/10.1097/PRS.0000000000005020

Clinical Implications of Gluteal Fat Graft Migration : A Dynamic Anatomical Study. / Del Vecchio, Daniel A.; Villanueva, Nathaniel L.; Mohan, Raja; Johnson, Bret; Wan, Dinah; Venkataram, Aniketh; Rohrich, Rodney J.

In: Plastic and reconstructive surgery, Vol. 142, No. 5, 01.11.2018, p. 1180-1192.

Research output: Contribution to journalArticle

Del Vecchio, DA, Villanueva, NL, Mohan, R, Johnson, B, Wan, D, Venkataram, A & Rohrich, RJ 2018, 'Clinical Implications of Gluteal Fat Graft Migration: A Dynamic Anatomical Study', Plastic and reconstructive surgery, vol. 142, no. 5, pp. 1180-1192. https://doi.org/10.1097/PRS.0000000000005020
Del Vecchio DA, Villanueva NL, Mohan R, Johnson B, Wan D, Venkataram A et al. Clinical Implications of Gluteal Fat Graft Migration: A Dynamic Anatomical Study. Plastic and reconstructive surgery. 2018 Nov 1;142(5):1180-1192. https://doi.org/10.1097/PRS.0000000000005020
Del Vecchio, Daniel A. ; Villanueva, Nathaniel L. ; Mohan, Raja ; Johnson, Bret ; Wan, Dinah ; Venkataram, Aniketh ; Rohrich, Rodney J. / Clinical Implications of Gluteal Fat Graft Migration : A Dynamic Anatomical Study. In: Plastic and reconstructive surgery. 2018 ; Vol. 142, No. 5. pp. 1180-1192.
@article{43b9a012e105459685c14fc789c8361d,
title = "Clinical Implications of Gluteal Fat Graft Migration: A Dynamic Anatomical Study",
abstract = "BACKGROUND: The intraoperative mortality and overall complication rate for gluteal augmentation with fat transplantation is unacceptably high. The current controversy among experts regarding safety is whether fat should be placed within the gluteus muscle or limited to only the subcutaneous space. The purpose of the present study was to test the hypothesis that under certain pressures, fat injected within the gluteal muscle can actually migrate out of the muscle and into a deeper plane containing critical neurovascular structures, by means of the process of deep intramuscular migration. METHODS: A total of eight human cadaver dissections were performed. Four hemibuttocks were selected for intramuscular fat injection. The patterns of subfascial fat migration were evaluated in three of these hemibuttocks by direct visual inspection and in one hemibuttock by endoscopic evaluation. Four other hemibuttocks were selected for subcutaneous or suprafascial fat injection. RESULTS: Proxy fat was found to migrate through the muscle and into the deep submuscular space with each intramuscular injection. With subcutaneous injection, no proxy fat was found during dissection in the intramuscular septae or submuscular space. CONCLUSIONS: The intramuscular insertion of fat, which up to this point has been considered reasonable to perform in the superficial muscle and even recommended in the literature, is now deemed to be an inexact and risky surgical technique. This technique, because of the migratory nature of injected fat, should be avoided from further use in fat transplantation to the gluteal region.",
author = "{Del Vecchio}, {Daniel A.} and Villanueva, {Nathaniel L.} and Raja Mohan and Bret Johnson and Dinah Wan and Aniketh Venkataram and Rohrich, {Rodney J}",
year = "2018",
month = "11",
day = "1",
doi = "10.1097/PRS.0000000000005020",
language = "English (US)",
volume = "142",
pages = "1180--1192",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Clinical Implications of Gluteal Fat Graft Migration

T2 - A Dynamic Anatomical Study

AU - Del Vecchio, Daniel A.

AU - Villanueva, Nathaniel L.

AU - Mohan, Raja

AU - Johnson, Bret

AU - Wan, Dinah

AU - Venkataram, Aniketh

AU - Rohrich, Rodney J

PY - 2018/11/1

Y1 - 2018/11/1

N2 - BACKGROUND: The intraoperative mortality and overall complication rate for gluteal augmentation with fat transplantation is unacceptably high. The current controversy among experts regarding safety is whether fat should be placed within the gluteus muscle or limited to only the subcutaneous space. The purpose of the present study was to test the hypothesis that under certain pressures, fat injected within the gluteal muscle can actually migrate out of the muscle and into a deeper plane containing critical neurovascular structures, by means of the process of deep intramuscular migration. METHODS: A total of eight human cadaver dissections were performed. Four hemibuttocks were selected for intramuscular fat injection. The patterns of subfascial fat migration were evaluated in three of these hemibuttocks by direct visual inspection and in one hemibuttock by endoscopic evaluation. Four other hemibuttocks were selected for subcutaneous or suprafascial fat injection. RESULTS: Proxy fat was found to migrate through the muscle and into the deep submuscular space with each intramuscular injection. With subcutaneous injection, no proxy fat was found during dissection in the intramuscular septae or submuscular space. CONCLUSIONS: The intramuscular insertion of fat, which up to this point has been considered reasonable to perform in the superficial muscle and even recommended in the literature, is now deemed to be an inexact and risky surgical technique. This technique, because of the migratory nature of injected fat, should be avoided from further use in fat transplantation to the gluteal region.

AB - BACKGROUND: The intraoperative mortality and overall complication rate for gluteal augmentation with fat transplantation is unacceptably high. The current controversy among experts regarding safety is whether fat should be placed within the gluteus muscle or limited to only the subcutaneous space. The purpose of the present study was to test the hypothesis that under certain pressures, fat injected within the gluteal muscle can actually migrate out of the muscle and into a deeper plane containing critical neurovascular structures, by means of the process of deep intramuscular migration. METHODS: A total of eight human cadaver dissections were performed. Four hemibuttocks were selected for intramuscular fat injection. The patterns of subfascial fat migration were evaluated in three of these hemibuttocks by direct visual inspection and in one hemibuttock by endoscopic evaluation. Four other hemibuttocks were selected for subcutaneous or suprafascial fat injection. RESULTS: Proxy fat was found to migrate through the muscle and into the deep submuscular space with each intramuscular injection. With subcutaneous injection, no proxy fat was found during dissection in the intramuscular septae or submuscular space. CONCLUSIONS: The intramuscular insertion of fat, which up to this point has been considered reasonable to perform in the superficial muscle and even recommended in the literature, is now deemed to be an inexact and risky surgical technique. This technique, because of the migratory nature of injected fat, should be avoided from further use in fat transplantation to the gluteal region.

UR - http://www.scopus.com/inward/record.url?scp=85062094980&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062094980&partnerID=8YFLogxK

U2 - 10.1097/PRS.0000000000005020

DO - 10.1097/PRS.0000000000005020

M3 - Article

C2 - 30102666

AN - SCOPUS:85062094980

VL - 142

SP - 1180

EP - 1192

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 5

ER -