Azzam, E., Elmidany, W., Zidan, A. (2020). Micro-Autologous Fat Transplantation (MAFT) for Dorsal Hand Rejuvenation. The Egyptian Journal of Plastic and Reconstructive Surgery, 43(3), 517-525. doi: 10.21608/ejprs.2020.68212
Ehab Z Azzam; Walid M Elmidany; Ahmed A Zidan. "Micro-Autologous Fat Transplantation (MAFT) for Dorsal Hand Rejuvenation". The Egyptian Journal of Plastic and Reconstructive Surgery, 43, 3, 2020, 517-525. doi: 10.21608/ejprs.2020.68212
Azzam, E., Elmidany, W., Zidan, A. (2020). 'Micro-Autologous Fat Transplantation (MAFT) for Dorsal Hand Rejuvenation', The Egyptian Journal of Plastic and Reconstructive Surgery, 43(3), pp. 517-525. doi: 10.21608/ejprs.2020.68212
Azzam, E., Elmidany, W., Zidan, A. Micro-Autologous Fat Transplantation (MAFT) for Dorsal Hand Rejuvenation. The Egyptian Journal of Plastic and Reconstructive Surgery, 2020; 43(3): 517-525. doi: 10.21608/ejprs.2020.68212
Micro-Autologous Fat Transplantation (MAFT) for Dorsal Hand Rejuvenation
1The Department of Plastic and Reconstructive Surgery, Main University Hospital, Alexandria University
2The Department of Plastic and Reconstructive Surgery, School Children Hospital, Health Insurance Authority, Alexandria
Abstract
Introduction: The dorsal surfaces of our hands are highly visible parts of the body. However with ageing, the aesthetic aspects of the hand deteriorate both in skin quality and contour with obvious appearance of dorsal blue veins and extensor tendons and loss or absence of subcutaneous fat tissue. The literature reports multiple options for addressing this problem, yet, all of these choices come with their own complications. Micro-autologous fat transplantation (MAFT) can be used in hand rejuvenation by a combined effect. First, it is possible to augment the dorsum of the hand and enabling visible blue and tortious veins as well as extensor tendons to be covered, resulting in a hand with uniform contour. Second, the fat cells have a beneficial effect on deep and superficial skin tissue via adipocytes derived stem cells (ASCs), thereby rejuvenating the hand. In this study, we performed (MAFT) technique to the three dorsal subcutaneous laminae for the rejuvenation of dorsal hand surfaces and determined its clinical results. Patients and Methods: MAFT was performed in 10 female patients. Fat was harvested by performing liposuction from different body sites, then processed, and refined by decantation. Purified fat was micro-transplanted to the dorsal surface of the hand in parcels of small volume. Post treatment checkups were performed at 24h, 7 days, 1 month, 3 months, and 6 months after treatment to evaluate the healing cascade of the hand. Patient-rated satisfaction was reported during the patient's final visit (at least 6 months after MAFT) using a 5- point scale. The Merz Hand Grading Scale (MHGS) was used to grade the appearance of the dorsal hand preoperatively and 6 months after MAFT. Results: The mean age was 46 years (range, 36-60 years). The time taken for MAFT injection of both hands was in an average of 30min. On average, the fat volume delivered was 20 and 18.5mL for the right and left hands, respectively. No major complications were reported, only mild to moderate swelling was noted, which subsided after 7 to 10 days postoperatively. Favorable outcomes were noted in patients which was reflected on the patient satisfaction rate (very satisfied, 60% and satisfied, 30%) and the remarkable up grading in the Merz Hand Grading Scale. Conclusion: In conclusion, the clinical results obtained using MAFT have demonstrated the feasibility and effectiveness of this approach in creating a younger and more beautiful dorsal hand appearance. However, longer studies in a larger patient population are required to assess long-term outcomes.
1- Bains R.D., Thorpe H. and Southern S.: Hand aging: Patients' opinions. Plast. Reconstr. Surg. 117 (7): 2212- 18, 2005. 2- Butterwick K.J.: Rejuvenation of the aging hand. Dermatol. Clin., 23: 515-27, 2005. 3- Teimourian B. and Adham M.: Rejuvenation of the hand: Fat injection combined with TCA peel. Aesthet. Surg. J., 20 (1): 70-71, 2000. 4- Kuhne U. and Imhof M.: Treatment of the ageing hand with dermal fillers. J. Cutan Aesthet. Surg., 5: 163-9, 2012. 5- Park T.H., Yeo K.K., Seo S.W., et al.: Clinical experience with complications of hand rejuvenation. J. Plast. Reconstr. Aesthet. Surg., 65: 1627-31, 2012. 6- Lee S.K., Kim S.M., Cho S.H., Lee J.D. and Kim H.S.: Adverse reactions to injectable soft tissue fillers: Memorable cases and their clinicopathological overview. J. Cosmet Laser Ther., 17: 102-8, 2015. 7- Wendt J.R.: Distal, dorsal superior extremity plasty. Plast. Reconstr. Surg., 106 (1): 210-13, 2000. 8- Handle M., Bonfatti-Ribeiro L.M., Barcaro-Machado B.H. and Pitanguy I.: Minimal-scar handlift: A new surgical approach. Aesthet. Surg. J., 31 (8): 953-62, 2011. 9- Fabi S.G. and Goldman M.P.: Hand rejuvenation: Our experience. Dermatol. Surg., 38 (7): 1112-27, 2012. 10- Alster T.S. and Konda S.: Plasma skin resurfacing for regeneration of neck, chest, and hands: Investigation of a novel device. Dermatol. Surg., 33 (11): 1315-21, 2007. 11- Fournier P.F.: Who should do syringe liposculpturing? J. Dermatol. Surg. Oncol., 14: 1055-56, 1988. 12- Coleman S.R.: Hand rejuvenation with structural fat grafting. Plast. Reconstr. Surg., 110 (7): 1731-44, 2001. 13- Villanueva N.L., Hill S.M., Small K.H. and Rohich R.J.: Technical refinements in autologous hand rejuvenation. Plast Reconstr. Surg., 136: 1175-79, 2015. 14- Bidic S.M., Hatef D.A. and Rohrich R.J.: Dorsal hand anatomy relevant to volumetric rejuvenation. Plast. Reconstr. Surg., 126: 163-168, 2010. 15- Justin B.: Outcome Analysis of Combined Lipoabdominoplasty versus Conventional Abdominoplasty. Plast. Reconstr. Surg., 121: 1821, 2008. 16- Bank J., Fuller S.M., Henry G.I. and Zachary L.S.: Fat grafting to the hand in patients with Raynaud phenomenon. Plast. Reconstr. Surg., 133 (5): 1109-18, 2014. 17- Fabio Fantozzi1 Hand Rejuvenation with Fat Grafting: A 12-year single-surgeon experience. Eur. J. Plast. Surg., 40: 457-464, 2017. 18- Cohen J.L., Carruthers A., Jones D.H., et al.: A randomized, blinded study to validate the merz hand grading scale for use in live assessments. Dermatol. Surg., 41 (1): 384-8, 2015. 19- Chung K.C., Kotsis S.V., Kim H.M., Burke F. and Wilgis E.F.: Reasons why rheumatoid arthritis patients seek surgical treatment for hand deformities. J. Hand Surg. Am., 31 (2): 289-94, 2006. 20- Jakubietz R.G., Jakubietz M.G., Kloss D. and Gruenert J.G.: Defining the basic aesthetics of the hand. Aesthetic Plast. Surg., 29: 546-51, 2005. 21- DeLorenzi C.: Complications of injectable fillers. Aesthet. Surg. J., 33 (4): 561-75, 2013. 22- Coleman S.R.: Structural fat grafting: More than a permanent filler. Plast. Reconstr. Surg., 118 (3): 108-20, 2006. Egypt, J. Plast. Reconstr. Surg., October 2019 525 23- Sommer B. and Sattler G.: Current concepts of fat graft survival: Histology of aspirated adipose tissue and review of the literature. Dermatol. Surg., 26 (12): 1159-66, 2000. 24- Carpaneda C.A. and Ribeiro M.T.: Percentage of graft viability versus injected volume in adipose autotransplants. Aesthetic Plast. Surg. 18 (1): 17-19 1994. 25- Chou C.K., Lin T.M. and Chou C.: Influential factors in autologous fat transplantation-focusing on the lumen size of injection needle and the injecting volume. J. IPRAS, 9: 25-7, 2003. 26- Kiray A., Ergur I., Tayefi H., Bag˘riyanik H.A. and Bacakog ˘lu A.K.: Anatomical evaluation of the superficial veins of the upper extremity as graft donor source in microvascular reconstructions: A cadaveric study. Acta. Orthop. Traumatol. Turc., 47: 405-10, 2013. 27- Khater R., Atanassova P., Anastassov Y., Pellerin P. and Martinot-Duquennoy V.: Clinical and experimental study of autologous fat grafting after processing by centrifugation and serum lavage. Aesthetic Plast. Surg., 33: 37-43, 2009. 28- Ali Asilian, Amir Hossein Siadat and Razieh Iraji: Comparison of fat maintenance in the face with centrifuge versus filtered and washed fat. J. Res. Med. Sci., 19 (6): 556-61, 2014. 29- Mizuno H., Tobita M. and Uysal A.C.: Concise review: Adipose-derived stem cells as a novel tool for future regenerative medicine. Stem Cells, 30 (5): 804-10, 2012. 30- Nakagami H., Maeda K., Morishita R., et al.: Novel autologous cell therapy in ischemic limb disease through growth factor secretion by cultured adipose tissue-derived stromal cells. Arterioscler. Thromb. Vasc. Biol., 25: 25- 42, 2005. 31- Cousin B., Munoz O., Andre M., et al.: A role for preadipocytes as macrophage-like cells. F.A.S.E.B. J., 13: 305, 1999. 32- Vara A.D., Miki R.A., Alfonso D.T. and Cardoso R.: Hand fat grafting complicated by abscess. Hand, 8 (3): 348-51, 2013
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