- 1.Fat Transfer to the Upper and Lower Extremities in Patients
With Raynauds Phenomenon A Novel Therapeutic Modality Jonathan
Bank, MD, Sam A. Fuller, MD Ginard I. Henry, MD, Lawrence S.
Zachary, MD Section of Plastic and Reconstructive Surgery
Department of SurgeryNo disclosures
2. Fat Transfer to the Upper and Lower Extremities in Patients
With Raynauds Phenomenon A Novel Therapeutic Modality Jonathan
Bank, MD, Sam A. Fuller, MD Ginard I. Henry, MD, Lawrence S.
Zachary, MD Section of Plastic and Reconstructive Surgery
Department of Surgery 3. 3 Raynauds Phenomenon Vasodilation
Vasoconstriction Fat Transfer in Raynauds 4. 4 Raynauds Phenomenon
PrimaryVasoconstriction Cold attacks Pain Secondary Fibrosis
Scarring Contracture Ulceration Autoamputation Fat Transfer in
Raynauds 5. 5Fat Transfer in Raynauds Treatment Ca Channel Blockers
ARB Protective Measures PDE-I Clopidogrel Endothelin Receptor
Blockers Alpha Blockers Topical Nitrates ACE-I ASA Prostanoids 6.
6Fat Transfer in Raynauds Treatment Ca Channel Blockers ARB
Protective Measures PDE-I Clopidogrel Endothelin Receptor Blockers
Alpha Blockers Topical Nitrates ACE-I ASA Prostanoids Invasive
Modalities Surgical Sympathectomy Neuro- modulators Fat Transfer 7.
Clinical improvement radiation dermatitis, burns Histological
evidence Sultan, PRS 2011 Radiation dermatitis murine model fat
injection Regression of hyperpigmentation, ulcers and fibrosis
Improvements in the inflammatory, microvascular, and fibrotic
characteristics Mechanism unclear Restoration of depleted
adipose-derived stem cells? 7Fat Transfer in Raynauds Fat Transfer
Rationale Raynauds - different pathogenesis similar end effect 8.
8Fat Transfer in Raynauds Goal as a means to delay progression of
Raynauds Phenomenon after failure of medical management Utilize fat
grafting 9. Adaptation of rejuvenation of the hand by fat grafting
Approximately 30 ml of decanted fat Abdominal depots Injected via
blunt cannulae into the affected extremity 9Fat Transfer in
Raynauds Technique 10. 10Fat Transfer in Raynauds Technique 10 ml -
dorsum of hand 3 ml - snuff-box 2-3 ml - each dorsal webspace 6 ml
- along palmar arch 1 ml - palmar webspaces 2-4 2 ml - first
webspace 2 ml - ulnar border of small finger 11. 11Fat Transfer in
Raynauds Technique 12. 12 Results Fat Transfer in Raynauds Total
patients 14 Total extremities 25 Hand 20 Feet 5 Mean follow up 12
months (4-17) Female: Male 13:1 Primary: Secondary 8:6 Average fat
injected 23.29 ml (10-30) Concomitant digital sympathectomy 4 13.
13 Results Overall improvement 92.5% of patients Pain reduction
85.7% (7 2.6) 1 patient no change 1 patient increased pain Cold
attacks 78.5% decreased frequency and severity Ulcerations 66%
improvement Major complications 0 Minor complications 2 Subsequent
neuromodulator 1 Subsequent sympathectomy 1 Fat Transfer in
Raynauds 14. 14Fat Transfer in Raynauds 15. 15Fat Transfer in
Raynauds 16. 16Fat Transfer in Raynauds 17. 17Fat Transfer in
Raynauds 18. 18Fat Transfer in Raynauds 19. 19Fat Transfer in
Raynauds Hand Vascular Perfusion by Laser Doppler Normal Moderate
Severe 20. 20Fat Transfer in Raynauds Hand Vascular Perfusion by
Laser Doppler 21. 21Fat Transfer in Raynauds Hand Vascular
Perfusion by Laser Doppler 22. 22Fat Transfer in Raynauds Preop
Postop 200 150 100 50 Perfusionunits Hand Vascular Perfusion by
Laser Doppler QMRADASH 23. Durable clinical improvement in the
majority of treated patients Safe, relatively straightforward
Mechanism to be elucidated (stem cell angiogenesis? padding?) Role
in treatment of advanced, refractory Raynauds Phenomenon 23
Conclusions Fat Transfer in Raynauds