Dermis Fat Graft Harvest
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This is Richard Allen at the University of Iowa. This video demonstrates harvesting of a dermis fat graft. A circle approximately 20 mm in diameter is placed in the area of the buttocks usually in the area of the bikini line. A 15 blade is then used to make an incision along the marking though the epidermis. An ellipse is also made around the area so that subsequent closure can be performed. The 15 blade is then used to excise the epidermis from the dermis. This will usually dull your blade, so you will need more than one blade. The epidermis is excised so that keratin is not produced in the socket. The 15 blade is then used to incise along the edges of the incision through the dermis to the underlying fat. Steven scissors or Metzembaum scissors are then used to bevel out to excise as much fat as possible. It is important to harvest more fat that what you think you will need since you will lose approximately 50% of your fat volume as things heal. The graft can then be placed in moist saline gauze. The ellipse is then completed with the 15 blade. The incision is then closed with deep interrupted 4-0 monocryl sutures. Vicryl sutures could also be used. These are placed in a deep, interrupted buried fashion in order to oppose the skin edges without tension. The skin can then be closed with a 5-0 prolene suture. The edges of the skin should be everted. In this case a running horizontal mattress suture is placed. At the conclusion of the case, the area is cleaned. Antibiotic ointment is placed over the incision followed by a dressing of telfa and tegaderm. The dressing can be removed in 3 days. The patient returns in approximately one week for suture removal.
