Fat Autograph Retention: Use of Albumin to Correct Physiologic Perturbation Caused by Klein Solution

Abstract

Introduction: Correction of the dilution effect of Kline Solution on colloid osmotic pressure in fat harvested for autografting may be an important factor in enhancing graft viability. The specific deficit is an acute decrease in interstitial soluble protein concentration as tumescent solution is infiltrated for local anesthesia. The most important protein component creating colloid osmotic pressure in interstitial fluid is albumin. Thus, the commercial availability of human serum albumin makes correction of this physiologic perturbation easily accomplished by the addition of 1 ml of albumin per 10-ml fat-harvesting syringe. Materials and Methods: Review of the literature and description of technique. Results: The steps to ensure fat autograph retention include: harvest using small cannulas (16- or 18-gauge), restore colloid pressure using albumin in the collection syringe, inject the graft with relatively atraumatic needles (modified 18- or 22-gauge needles), and inject the fat to produce a trail of small beads in multiple fine layers with each bead touching the nutrient bed. Discussion: The study of fat grafting continues to evolve. As it does, the science behind graft has led to better understanding of the adipocyte as a member of a dynamic organ with endocrine, apocrine, and paracrine functions. The fat mass is dynamic. Adipocyte number is not as stagnant as previously thought. They can differentiate and dedifferentiate and become stem cells with the potential to become bone, cartilage, fat and nerve cells. Stem cells from lipo-aspirate make more sense than bone marrow or embryonic sources. For one thing, fat is easy to obtain, and when used in the same patient its endogenous genetic code is identical, removing another obstacle to retention. Conclusion: These observations are reported here as they seem to result in a nearly 90% graft retention rate and reduce the need to overfill.