A 23-year-old woman with a history of scleroderma was referred to our hospital.
Relatives report that at the age of 5 years, there began to be hardening and stiffness of the skin in the right mental and subcutaneous tissue associated with progressive facial deformity, which was accentuated bimetrically accentuated.
To these alterations of the adipose tissue of the lower third to the bilateral temporofrontal region, there is a severe deterioration of the elevated unilateral right eyelid function, characterized by bleaching.
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Simultaneously, this condition manifested as extensive plaque lesions affecting the lateral quadrants of the right breast, extended in significant depth and ipsilateral depressed linear breast lesion in the axillary area, and associated with severe axial hypotrophy.
The multicentric character of this pathology was completed simultaneously with the lower right quadrant of the abdomen, associated with small plaques dermal location and subcutaneous cellular tissue.
We had previously received this patient when she was 15 years old, brought by her parents who sought correction of her facial deformities.
Due to the lack of development of the patient at that time, there is little fat reserve, and there is limited healing of the aforementioned sclerodermic alterations.
Three years later, after verifying its development with the presence of moderate adipose clusters in the dorso-lumbar and glútea zones, we propose to perform surgical correction with the prospect of regeneration of the main deforming tissues.
We propose a technique based on the performance of a localized liposuction, specific and specific for the removal of small fats in surgical sites, as well as extensive liposuction with liposuction gene and reuse.
Fat removal would be done with cannulas of 5 and 6 mm in diameter, which are progressively reduced along with the decrease in the thickness of the adipose panniculus to 4 and 3.5 mm. Any intermediate handling or withdrawal of adipose tissue occurs due to lack of medication.
This decanted fat in 60 ml syringes is transferred to syringes of different calibers according to the area to be injected: 20 ml for body areas and 10 ml for breasts.
When injecting, we preferred microcannulas of 0.7 to 1.2 mm in diameter for the face and 1.4 to 2 mm for the breast and abdomen, always using a tunnel technique.
With this technical approach, we started the surgical procedures when the patient was 18 years old, and after observing the stabilization of her clinical condition.
We begin with facial manifestation with autologous fat graft taken from the dorsolumbar area.
The procedure was performed under general anesthesia.
Lipoaspiration of the mentioned area was performed using 4 mm and 5 mm cannulas, after removing the donor site with standard sodium chloride solution at 1:10 000).
We removed a total volume of 600 ml; we settle this fat for 30 to 40 minutes, and finally placed it in the abdomen between 30 and 40 ml using microcannulas of 0.8 to 1.7 mm in diameter, in the areas of scleroderma
On the face, in the genian, paramentonian and frontotemporal regions, we did not observe a total of 150 ml of fat on the right side and 120 ml on the left side.
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Nine months after the first surgery, the patient underwent a second intervention to complement facial manifestation, achieve a more aesthetic symmetry, and stimulate the process of immunomodulation of mesenchymal cells.
On this occasion, we removed a total of 600 ml, obtaining a total of 540 ml of fat in the left, using the same scheme of anesthesia and removing a total of 95 ml menda.
In the same operative time, sclerodermic plaques of the right infraumbilical anterior abdominal region and of the right anterior axillary region were not surgically identified, using 40 ml of fat in each plane described and following the same pattern.
Finally, in order to correct hypotrophy and breast cancer resulting from the disease, we fixed 100 ml of pure decanted fat in each breast in subcutaneous, glandular and muscular planes.
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Two years after the second surgery, the patient underwent a third autologous fat transfer to the face.
On this occasion, we took as a donor area the dorsolumbar and sacral regions, and again under the same scheme of anesthetic and surgical technique, looking for a nasotrophic persisting process with a total volume of 60 ml in chin region.
In this third surgical time we associated a second breast lipoinjection for symmetrization and improvement of the quality of adjacent tissues, mainly in the scleroderma plaque of the right anterior axillary region.
We used 115 ml on the right side and 40 ml on the left breast, in different breast planes, specifically subcutaneous, grandular and muscular.
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Twelve months after the third surgery, the patient underwent a fourth and last surgical time.
In this intervention, we removed the excess fat previously placed in the right upper region by liposuction with 1.2 to 1.4 mm microcannulas in the left upper region of the left ventricle with the same pattern of left anesthesia and routine.
At this same time, we also performed a complementary right mammoplasty inject 140 ml pure decanted fat plus a 50 ml fat graft below the right anterior axillary scleroderma plaque.
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In all surgical procedures, we instructed the patient to follow the usual postoperative scheme of liposuction, and regarding the grafts we used elastic bandages in all first treated areas 48 hours without excessive compression during the procedures.
Then, we used a modeling bead for the liposuctioned body regions, postoperative support for the breasts, and we used the face of disqualification.
In all surgeries, antibiotics and analgesics were administered during the first 7 postoperative days.
The patient was followed up weekly in consultation during the first month after each surgery, and then monthly during the first year to monitor the behavior of the fat transferred in each area.
