Fat Harvesting (2012)

Sir:FigureWith recent advances in assisted forms of liposuction, the role for simple manual liposuction has diminished somewhat. However, many surgeons still prefer to use a simple manual harvesting technique, especially for the process of lipofilling and remodeling, where relatively small volumes of fat are harvested as atraumatically as possible, leading to better quality fat for transfer.1 This is often performed with a small-volume syringe, most commonly 10 ml, as the use of low negative pressure is recommended2 before the harvested fat is centrifuged and reinjected into the required area. Pulling the plunger of a 10-ml syringe to its maximum can provide between 40 and 100 percent of the pressure generated by liposuction.3 One of the main drawbacks to a totally manual approach to fat harvest is that the pressure subjected to the thumb, while maintaining the necessary vacuum in the syringe, can be tiring intraoperatively, with the quality of the fat harvested diminishing following the onset of fatigue. In this communication, the authors report a very simple, cheap, and effective way of maintaining the vacuum pressure in the syringe while sparing any undue stresses on that most valuable of commodities, the surgeon's digit. The senior author favors manual liposuction using 10-ml syringes and a blunt cannula for harvest. This is performed following infiltration of a mixture of saline, Marcaine, adrenaline, and hyaluronidase, to prepare the fat for harvest. The suggestion has been proposed that hyaluronidase aids in the process by “softening” the fat for harvest.4 Once the harvesting cannula is attached to a 10-ml Luer-lock syringe, the cannula is inserted into the stab incision made in the skin. The plunger is then retracted and usually prevented from slipping back to its “resting position” by using the pad of the thumb as a buttress against the flange of the syringe (Fig. 1). The syringe can then be advanced and retracted systematically and sequentially to ensure an even harvest of fat.Fig. 1: The standard practice of using the pad of the thumb as a buttress against the flange of the 10-ml syringe to maintain vacuum pressure is shown.The modification suggested here is to replace the use of the thumb as the buttress, with the plunger of a 2-ml syringe. This can be wedged into the harvesting syringe by placement between the flange of the plunger and the flange of the body of the syringe itself (Fig. 2). Removing the rubber seal portion of the 2-ml syringe plunger ensures a perfect fit and provides good stability. The 2-ml syringe plunger should clearly only be introduced into its position once the harvesting cannula has been inserted into the donor-site cavity, to maintain the vacuum.Fig. 2: Plunger of a 2-ml syringe, with the rubber seal removed, interposed between the plunger and flange of a 10-ml syringe.We feel that this modification to the traditional Luer-lock and cannula system has two distinct advantages. As previously mentioned, it provides welcome relief to the physical pressure placed on the interphalangeal joint of the operator's thumb. In addition, it also improves the standardization of the vacuum pressure produced in the system. We would suggest that this in turn should lead to a more standardized quality of fat harvest. In the experience of the authors, this system works very well and makes the lipofilling and remodeling procedure much more enjoyable to perform. Foiz Ahmed, M.R.C.S. Jean Nehme, M.R.C.S. Mountbatten Department of Plastic Surgery Matthew Turner, F.R.C.A. Department of Anesthesia Nicholas Bennett, F.R.C.S.(Plast.) Mountbatten Department of Plastic Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No outside funding was received.