Autologous fat transfer is a time-tested, well-established technique in cosmetic and reconstructive surgery. Its versatility and relative simplicity secure it as a valuable part of the reconstructive surgeon’s armamentarium. The indications for fat transfer are broad and grow wider with each passing year. With a focus on scars and burns, this chapter will outline the history and basic technique of fat transfer and describe the feasibility of fat transfer in reconstruction and rehabilitation of traumatic and burn scars with an emphasis on the head and neck region.
HISTORY OF THE USE OF THE METHOD
The history of autologous fat transfer as a technique for reconstructing soft tissue defects is peopled with giants of surgical history. The first autologous fat transfers were documented by Gustav Neuber, a German surgeon from the late nineteenth century, who, in addition to pioneering fat transfer to reconstruct scars from tuberculous osteomyelitis,1 is credited with opening the world’s first aseptic hospital. A precursor to today’s fat injection technique was designed by Höllander in 1912, who injected a mixture of autologous fat and ram’s fat for the reconstruction of soft tissue defects2 (Fig. 13-1). Harold Gillies, the “Father of Plastic Surgery,” furthered fat grafting during and after World War I, when he employed the technique in the reconstruction of a wide variety of traumatic defects3 (Fig. 13-2).
The first fat injection. Berlin Höllander performed injections of mixed ram xenograft and human allograft fat for reconstruction of facial atrophy. According to the author, patients had a satisfactory outcome after 2 to 3 days of a painful rash.
Free fat autograft. Sir Harold Gillies pioneered fat grafting as a strategy for the reconstruction of war wounds after World War I. This patient with a comminuted mandible fracture and soft tissue defect was treated with scar excision and fat grafting after the initial defect (not pictured) was allowed to heal.
The technique and science behind autologous fat transfer underwent further development in the latter half of the twentieth century. Peer performed the early fundamental work regarding fat graft survival in 1950 and described an average of 45% graft survival after 1 year.4 In 1974 the technique of liposuction was developed, setting the stage for the popularization of autologous fat transfer.1,5
The next major step in the development of fat grafting must be credited to Sydney Coleman, who pioneered the concept of structural fat grafting and described a standardized method for harvesting, processing, and injecting fat.6–9 This technique and close variations are now widely employed in clinical and research settings in the quest for further refinement and increased survival of fat grafts.