Week 6: The Salad Spinner

This week's surgery was fat transfer from the abdomen to the breast to correct an anatomical asymmetry. To prep for the liposuction, the patient's abdomen was injected with a mixture of epinephrine and Lydocaine. This approach is either a wet or super wet liposuction procedure classified by the amount of fluid that is added. The epinephrine induces vasoconstriction to reduce blood flow and minimize bleeding while the Lydocaine is a local anesthetic to numb the tissue. In a fat transfer all the tissue that is removed from the donor site needs to be saved to be implanted. Adipocytes must be kept alive and there are special procedural considerations such as reducing sheer stresses and  reducing exposure to the air that need to be taken. These differ from a standard liposuction because for example, in liposuction you can use laser or ultrasound assisted liposuction which help to remove the fat from the body but these techniques cause cell death in the extracted adipose tissue. During this fat grafting procedure, the fat collected for the transfer was sucked into a "salad spinner" device called the REVOLVER system. With a hand crank motion just like a salad spinner this device was used to rinse the tissue in lactated ringers solution, filter out components, and then to drain and dry the tissue. This process concentrates the fat by removing the injected solution, blood, and water. To further dry the fat after it is rinsed it's rolled out on fluid absorbing telfa pads until it is a thicker consistency. Next the fat is loaded into syringes for transfer to the breast. A special tip is used on the syringe for the injection where the opening for the injection tip is on the side so a vessel can't be punctured which could lead to an embolism. I learned it is  important to distribute the fat in small amounts to increase the surface area to volume ratio. If the injected tissue is not near a blood supply and not re-vascualrized then fat necrosis can occur and lead to calcifications and cysts.

Resident conference

In the OR  Dr. Spector teaches me about what is happening during surgeries which allows me to be able to  follow along during the plastic surgery resident conferences and have a  grasp of the topics at hand. This week the session was on grafts and flaps. Flaps are vascularized while grafts are not. Last week I had seen a flap implantation but at the meeting I learned how they monitor the flap and determine a prognosis after surgery. Things to look for are the color, blanching, thermal output, oxygen saturation, pH, the appearance at the edges, and the doppler signal from the flap. It was interesting to watch the residents do flap design and to see how they would complete a wound closure.

Research

I am happy to report that my cells are alive and well. The first round of Lean (low BMI) cells grew to the appropriate confluence and I was able to freeze them for storage and future use. Learning to do ASC isolations in my short time here has been an great opportunity to optimize the procedure close to the tissue source and this will be a great skill set to have in the future. My decell project is ongoing and awaiting analysis. The preliminary results show evidence of my ability to decell at the tissue level. As part of this project I've learned new lab skills and carried out my first tissue processing, paraffin embedding, sectioning, and H&E stains here. The LBMS has been a such a supportive and fun working environment and it's been a great place to spend my summer. 

Figure 1: Isolated Lean ASCs in culture