Use of membrane-stabilized lipotransfer in lower extremity wound closure

Autotransplantation of adipose tissue becomes a promising method in the treatment of deep wounds with muscle damage and exposure of neurovascular structures, especially against the background of chronic ischemia and venous insufficiency. The necessity of the regenerative approach was the reason for the present study. Aims. To investigate the effectiveness of primary closure of deep wounds of the lower limbs using the modified autograft of the own adipose tissue obtained from the distant donor zones in order to accelerate the reparative processes, to prevent the formation of pathological scars and to achieve the optimal aesthetic result. Materials and methods. We compared 2 adipose tissue samples placed in solutions with different chemical content for each group (0.9% NaCl solution, 15% dimethyloxobutylphosphonyl dimethylate solution), with exposure for 5 hours and evaluation of ionic composition by electron microscopy in low vacuum and energy dispersive X-ray spectral analysis (EDX) with evaluation of potential cell viability. A clinical case is described in which autotransplantation of adipose tissue was performed in a patient with a gaping wound of the lower limb after primary surgical treatment of the wound surface under intravenous sedation and local anesthesia on the 3rd day. Results. The viability of fat cells can be improved by modifying the microenvironment with artificial solutions. The effectiveness of the surgical method was confirmed in practice – on the 7th day there was a complete closure of the wound defect with the formation of a stable skin cover. The subsequent restoration of the skin cover was carried out by secondary tension on the base represented by the transplanted fat tissue (“subcutaneous base” – according to the modern anatomical terminology). Conclusion. Autotransplantation of adipose tissue is an effective technique for primary closure of deep soft tissue defects characterized by a high level of safety and a favorable potential for further recovery. Clinical observations confirm the prospectivity of this approach with the further possibility of improving the effectiveness of the method.