Dessy, Luca A.

Marcasciano, Marco

Mazzocchi, Marco

Pacitti, Federico

Rossi, Antonio

English

Archivio della ricerca- Università di Roma La Sapienza

A Simple Device for Syringe-to-SyringeTransfer During LipofillingLuca A. Dessy, MD; Marco Marcasciano, MD; Federico Pacitti, MD;Antonio Rossi, MD; and Marco Mazzocchi, MDBACKGROUNDSince the end of the 19th century, autologous fat grafting hasbeen performed often by plastic surgeons. The procedureevolved from work by Coleman, who developed the lipo-structure technique.1 With the “Coleman technique,” fattissue is extracted by nontraumatic liposuction, purified aftercentrifugation, and injected to fill tissues or to contributecells to damaged tissues. Autologous fat grafting has manyapplications, including breast reconstruction, breast aug-mentation, facial rejuvenation, primary and secondary faciallipoatrophy, liposuction sequelae, buttock augmentation,scar revision, and radiodermatitis.Grafted fat is an ideal filler because it is biocompatible,versatile, stable, long lasting, and provides a naturalappearance; however, the results are dependent on tech-nique.2 Many surgeons have refined their techniques toobtain long-term survival of adipocytes and to improve cos-metic results. When large amounts of adipose tissue areneeded, such as in breast reconstruction, performing syringeaspiration or connecting syringes of different volumes canbe tedious and time-consuming.The estimated mean volume of harvested fat in our pro-cedures is 400 cc (range, 200-1000 cc), and the mean vol-ume of injected fat is 150 cc (range, 40-470 cc). Due to thedetailed and delicate nature of fat grafting, some authorsrecommend multiple injections of small amounts of fat (insyringes of 3-10 cc), which may reduce trauma and permitbetter control of injection.3To maximize the likelihood of graft survival, adiposetissue must be as refined (“clean”) as possible and manipu-lated with the lowest exposure to air before injection.4Frequent stops are often required for emptying and charg-ing of syringes, which slows the passage of fat from thelarger syringes (usually 10-50 cc) to the smaller ones(usually 3-10 cc).In this article, we describe the utility of a plastic, medical-grade, single-use, 3-way stopcock5 to connect syringes,which we prefer to the traditional metal transfer system(Figure 1A-C).MY EXPERIENCEIf 2 small-volume plastic syringes are needed for injection,the 3-way stopcock allows us to fill both syringes simulta-neously, which has cut our fill time in half. (A brief videodemonstrating the transfer technique is available at www.aestheticsurgeryjournal.com). With the 3-way stopcock,we can also fill just one syringe at a time, similar to themetal transfer system.Advantages of this TechniqueSyringe-to-syringe transfer with the stopcock is equallysterile to the traditional technique but is more convenient.Equal amounts of fat can easily be obtained in multiplesyringes, with less exposure to air and thus greater assur-ance of fat viability.There are many advantages to this technique. It permitsfaster fat accommodation in a sterile deposit device, andallows continuous quantification of the fat, leading to bettercontrol during injection.With its fully transparent body and uniform smoothbore, the stopcock allows continuous and maximum infu-sion flow—without turbulence or air-bubble formation.This permits rapid flow of fat, and minimizes hand actionfor the surgeon.Drs Dessy, Marcasciano, Pacitti, and Rossi are plastic surgeons in theDepartment of Plastic and Reconstructive and Aesthetic Surgery,Sapienza University of Rome, Rome, Italy. Dr Mazzocchi is a plasticsurgeon in the Department of Plastic and Reconstructive Surgery,Ospedale Santa Maria della Misericordia, Perugia, Italy.Corresponding Author:Dr Antonio Rossi, Sapienza University of Rome, Viale Ippocrate, No.52, 00161, Roma, Italy.E-mail: antonio.rossicz@gmail.comMyWayAesthetic Surgery Journal2015, Vol 35(1) 91–93© 2015 The American Society forAesthetic Plastic Surgery, Inc.Reprints and permission:journals.permissions@oup.comDOI: 10.1093/asj/sju010www.aestheticsurgeryjournal.com3-Way Stopcock vs Metal Transfer SystemThe stopcock is more convenient than the metal transfersystem because it reduces fat exposure to air, and increasesthe likelihood of obtaining the same volume in each syringe(Fig 1D,E).In some situations, the metal transfer system may not beavailable, particularly in office-based settings. Moreover, itmay be broken, not sterile, or misplaced. In contrast, it iseasy and economical to keep a supply of plastic stopcockson hand.OUTCOMESWe have used this device for more than 60 patients. Resultshave been excellent with respect to efficiency and patientcomfort. The device has functioned reliably in all cases, andthere have been no instances of breakage.COSTAND CONVENIENCEThe plastic, medical-grade stopcock is convenient and cost-effective. It is particularly valuable for plastic surgery clinicsFigure 1. (A) The traditional metal transfer system, which connects 2 syringes. (B) The plastic 3-way stopcock. (C) The stopcockin relation to a partially filled 10-cc syringe (length 4 cm, height 1 cm, width 1.7 cm). (D) Transfer obtained via the classic metaldevice. (E) Transfer of adipose cells between syringes of different caliber with the stopcock.92 Aesthetic Surgery Journal 35(1)that have limited economic resources, and it is readily avail-able in medical institutions. The device is disposable, easilyreplaceable, and very inexpensive (0.35 €; .50 USD).Moreover, the device is ready for use as it is packed sterileduring manufacturing.CONCLUSIONSSyringe-to-syringe transfer of fat with the plastic 3-waystopcock has been effective, reliable, and efficient in ourhands. The device is especially useful when more than 1small-volume syringe is required for injection. Fat can bedistributed easily, evenly, and simultaneously. Fill time andexposure to air are minimized, and fat viability is maxi-mized. This inexpensive and readily available tool is assterile as the traditional metal system.DisclosuresThe authors declared no potential conflicts of interest withrespect to the research, authorship, and publication of this article.FundingThe authors received no financial support for the research, au-thorship, and publication of this article.REFERENCES1. Coleman WP. Autologous fat transplantation. PlastReconstr Surg. 1991;88:736.2. Coleman SR. Structural fat grafting: more than a perma-nent filler. Plast Reconstr Surg. 2006;118:108S-120S.3. Gonzalez AM, Lobocki C, Kelly CP, Jackson IT. An alterna-tive method for harvest and processing fat grafts: an invitro study of cell viability and survival. Plast ReconstrSurg. 2007;120:285-294.4. Coleman SR. Long-term survival of fat transplants: con-trolled demonstrations. Aesthetic Plast Surg. 1995;19:421-425.5. MacMillan K, Struthers C. The three-way stop-cock: howto master a crucial innovation. Can Crit Care Nurs J.1987;4:13-15.Dessy et al 93

A simple device for syringe-to-syringe transfer during lipofilling

Luca A. Dessy

Marco Marcasciano

Federico Pacitti

Antonio Rossi

Marco Mazzocchi

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Aesthetic Surgery Journal

A Simple Device for Syringe-to-Syringe Transfer During Lipofilling

https://iris.uniroma1.it/bitstream/11573/1101542/1/Dessy_syringe-to-syringe_2015.pdf

A simple device for syringe-to-syringe transfer during lipofilling

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