Treating fat pad atrophy with the implantation of a celular human dermal allograft

anDRe · Mar 4, 2010

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Hello all

Lately much has been discussed about treatment options for fat pad atrophy, such as the use of silicone injections or dermal fillers.
But recently I learned about a technique which applies a human cellular dermal allograft called GRAFTJACKET ® Regenerative Tissue Matrix from the Wright Medical Technology company.

http://www.wmt.com/woundcare//physic...ation_phys.asp

I found this technique very interesting because although I use in my practice silicone injections for the treatment of various diseases from calluses to fat pad atrophy I am aware that these injections have a degree of risk especially migration of the product, this procedure with human dermal allograft appears to be safer, although it requires a surgical intervention to apply it, as the injections can be performed in the office.

Hope this will start an interesting debate!

Cheers

G Flanagan · Mar 4, 2010

a few words about the allograft have been mentioned here

http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=725

Jose Antonio Teatino · Mar 15, 2010

anDRe said: ↑

http://www.wmt.com/woundcare//physic...ation_phys.asp
Click to expand...

Estimado André: no funciona el acceso...

anDRe · Mar 15, 2010

Hola Teatino

Perdona pruebe este enlace:

http://www.wmt.com/woundcare/physicians/default.asp

Corn Cutter · Mar 15, 2010

Hello Andre/Jose

Try this link...

http://www.wmt.com/woundcare/physicians/plantar_augmentation_phys.asp

Cheers,

NewsBot · Jun 6, 2015

This clinical trial was just registered:

Fat Grafting and Retention for Heel Fat Pad Atrophy

Plantar heel pain is the most common problem of the foot. Plantar fasciitis is the leading cause of this pain, accounting for 11-15% of all foot symptoms seeking professional care, and occurs in 10% of the US population. The cause of heel pain can be from bone, soft tissue, nerve, or systemic disease. The second most common cause of heel pain is fat pad atrophy, followed by a combination of both fat pad atrophy and plantar fasciitis. [1-4] Fat pad displacement may be seen in the heel as well.

Current treatments for plantar fasciitis include stretching and external support with orthotics with the goal of reducing local pressure as well as tissue breakdown.[5] However, patient compliance with extrinsic devices is challenging, and they may experience increased friction, irritation and breakdown at a different location on the foot due to thickness of the device in the shoe. Also, the patient must replace the device as soon as it breaks down but the breakdown often goes unnoticed. Failure of conservative management may lead to treatment with steroids or surgical intervention by endoscopic plantar fasciotomy, open fasciotomy or excision of bone spurs. Injection of steroids can instigate or exacerbate pre-existing heel fat pad atrophy. Autologous fat grafting to the heel may reduce plantar pressures, and thus serve as a treatment for heel pain. Autologous fat grafting is currently under investigation for a myriad of clinical scenarios.[6-19] Even though autologous fat grafting is not yet an established therapeutic approach for the cited indications, some of the reported results have been intriguing.[19] The variable resorption of fat, however, is an important confounding factor in all these studies. Currently the literature reports fat retention rates ranging from 25% to 80%.[20]

The specific aim of this study is to assess the adipose stem cell characteristics in patients undergoing autologous fat grafting for heel fat pad atrophy and correlate these characteristics with fat retention. Data from this study will help determine the characteristics of the adipose stem cells in this population and open the door to additional studies. This pilot study will also help build new collaborative efforts between Foot and Ankle Specialists, Plastic Surgery, and Adipose Stem Cell Biologists, combining biomechanical expertise with fat grafting and basic science expertise.
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NewsBot · Sep 12, 2018

"Fat Grafting for Pedal Fat Pad Atrophy in a 2-Year, Prospective, Randomized Cross-over, Single-Center Clinical Trial".
Minteer DM, Gusenoff BR, Gusenoff JA
Plast Reconstr Surg. 2018 Aug 31]

BACKGROUND:
By age 60, 30% of Americans suffer from fat pad atrophy of the foot. Forefoot fat pad atrophy results from long-term aggressive activity, genetics dictating foot type, multiple forefoot steroid injections, surgery and foot trauma.

METHODS:
We present data from a two-year, prospective, randomized cross-over study performed to assess pain and disability indexes, fat pad thickness, forces and pressures of stance and gait. Group 1 underwent fat grafting with two years of follow-up, while Group 2 underwent conservative management for 1 year, then received fat grafting with 1 year of follow-up.

RESULTS:
18 subjects (14 female, 4 male) comprised Group 1. 13 subjects (9 female, 4 male) comprised Group 2. Group 1 reported the worst pain at baseline, Group 2 experienced the worst pain at 6, 12-month Standard of Care (SOC) visits; pain for both groups immediately improved following fat grafting and lasted through study follow up (p<0.05). Group 1 demonstrated functional improvements at 12, 18, 24 months post-operatively (p<0.05); while Group 2 demonstrated highest function at 12-months post-op (p<0.05). Pedal fat pad thickness of subjects in Group 1 increased following post-op and returned to baseline thickness at 2 months post-op; subjects in Group 2, experienced return to baseline thickness at 6 months post-op (p<0.01). Forces and pressures of stance and gait increased over the 2 years of follow-up for Group 1 (p<0.05).

CONCLUSIONS:
Pedal fat grafting provides long-lasting improvements in pain, function, and prevents against worsening from conservative management.
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NewsBot · Mar 23, 2020

Differences in the Sub-Metatarsal Fat Pad Atrophy Symptoms between Patients with Metatarsal Head Resection and Those without Metatarsal Head Resection: A Cross-Sectional Study.
Molines-Barroso RJ et al
J Clin Med. 2020 Mar 14;9(3)

We aimed to evaluate the differences in the sub-metatarsal skin and fat pad atrophy between patients at a high risk of ulceration with and without previous metatarsal head resection. A cross-sectional study was performed in a diabetic foot unit involving 19 participants with a history of metatarsal head resection (experimental group) and 19 (control group) without a history of metatarsal head resection but with an ulcer in other locations in the metatarsal head. No participants had active ulcerations at study inclusion. Sub-metatarsal skin thickness and fat pad thickness in the first and second metatarsals were evaluated by an ultrasound transducer. The experimental group showed sub-metatarsal fat pad atrophy (3.74 ± 1.18 mm and 2.52 ± 1.04 mm for first and second metatarsal, respectively) compared with the control group (5.44 ± 1.12 mm and 4.73 ± 1.59 mm) (p < 0.001, confidence interval: (CI): 0.943-2.457 and p < 0.001, CI: 1.143-3.270 for first and second metatarsal, respectively); however, sub-metatarsal skin thickness was not different between groups (experimental 2.47 ± 0.47 mm vs. control 2.80 ± 0.58 mm (p = 0.063, CI: -0.019-0.672) and 2.24 ± 0.60 mm vs. 2.62 ± 0.50 mm (p = 0.066, CI: -0.027-0.786) for first and second metatarsal, respectively). Patients with previous metatarsal head resection showed sub-metatarsal fat pad atrophy, which could be associated with the risk of reulceration in the metatarsal head.
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