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Original Article | ONLINE FIRST

Increasing the Viability of Fat Grafts by Vascular Endothelial Growth Factor

Alpaslan Topcu, MD; Osman E. Aydin, MD; Mehtat Ünlü, MD; Ali Barutcu, MD; Atay Atabey, MD
Arch Facial Plast Surg. 2012;14(4):270-276. doi:10.1001/archfacial.2011.1633.
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Objective  To increase the viability of fat grafts using vascular endothelial growth factor (VEGF) in a calcium alginate microsphere controlled release system.

Design  Twenty-four rats were divided into 4 groups of 6 rats each. Group 1 was the preconditioning group in which VEGF was applied prior to the fat grafting. In group 2, VEGF was given at the time of the grafting. In group 3, an empty microsphere was added to the grafting material. The fourth group, which received the fat graft only, was the control group. At the 90th day, samples of the fat grafts were weighed and compared with preimplantation weights.

Results  The graft viability ratios of the first 3 groups were significantly higher than those of the control group. The relative adipocyte index was significantly higher in the first and second groups compared with the control group and group 3. Consistent with the literature, VEGF used both in the preconditioning procedure and simultaneously with the grafting procedure increased the graft viability ratio and relative adipocyte index.

Conclusion  This study suggests that VEGF-induced preconditioning of the recipient bed improves fat graft viability via increased revascularization.

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Figures

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Figure 1. Schematic illustration of preparation of calcium alginate microspheres. VEGF indicates vascular endothelial growth factor.

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Figure 2. Photographs of the microspheres from different stages of the procedure. A, Scanning electron microscopic view of microspheres. B, Fat graft harvesting. C, Fat graft after harvest. D, Diced fat graft prior to plantation. E, Implanted graft in the pocket. F, Sample fat graft explanted 90 days after implantation.

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Figure 3. Summary of the groups and procedure in flowchart. VEGF indicates vascular endothelial growth factor.

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Figure 4. Percentages of weight changes of the grafts. Group 1, preconditioning, in which vascular endothelial growth factor (VEGF) was applied prior to the fat grafting; group 2, fat grafting and VEGF; group 3, grafting and empty microsphere; and control group. The weight difference was tested using the t test. The control group weight was lower than the weights of other groups (P < .05). There was no difference between group 2 and group 1 (P > .05).

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Figure 5. Photomicrographs of fat grafts from each group of rats (hematoxylin-eosin, original magnification ×20). Group 1, preconditioning, in which vascular endothelial growth factor (VEGF) was applied prior to the fat grafting; group 2, fat grafting and VEGF; group 3, grafting and empty microsphere; and control group. A and B, Group 1. Note increased adipocyte viability and vascular structures. C and D, Group 2. Note increased adipocyte viability. E, Group 3. Note dense fibrosis and mononuclear cell infiltration. F, Control group. Note less fibrosis than in group 3, increased fat necrosis, and mononuclear cell infiltration.

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Figure 6. Relative adipocyte index of the grafts. Group 1, preconditioning, in which vascular endothelial growth factor (VEGF) was applied prior to the fat grafting; group 2, fat grafting and VEGF; group 3, grafting and empty microsphere; and control group. There was a significant difference between group 2 and the control group using the t test (P < .05).

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Figure 7. Microvascular density of the grafts. Group 1, preconditioning, in which vascular endothelial growth factor (VEGF) was applied prior to the fat grafting; group 2, fat grafting and VEGF; group 3, grafting and empty microsphere; and control group. Statistical evaluations revealed that group 1 had significantly higher microvascular density than all other groups (P < .001). Group 2 had significantly higher microvascular density than group 3 and the control group (P < .001).

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