SLR - August 2019 - Ricardo Navarrete Jr.

Autologous Lipotransfer For Bone Defects Secondary to Osteomyelitis: A Report of A Novel Method and Systematic Review of the Literature

Reference: Reinisch, K. B., Zuk, G., Raptis, D. A., Bueter, M., Guggenheim, M., Stasch, T., & Palma, A. Autologous Lipotransfer for Bone Defects Secondary to Osteomyelitis: A Report of a Novel Method and Systematic Review of the Literature. Int Wound J. 2019 Mar 12;1-9

Scientific Literature Review

Reviewed By: Ricardo Navarrete Jr., DPM
Residency Program: Maricopa Medical Center/Creighton University – Phoenix, AZ

Podiatric Relevance: Osteomyelitis is one of the most devastating conditions of the foot and ankle. Dead space secondary to osteomyelitis poses additional difficulty in management. Though autologous bone grafting is the gold standard for bone defects, it can be associated with complications such as pain and donor site morbidity. The use of synthetic beads or spacers and allografts create a nidus for re-infection and/or rejection. Autologous lipotransfer (fat grafting) has become popular in the therapy of chronic wounds. The authors present lipotransfer as an alternative, providing fat as a bone defect filler as well as a facilitator toward bone healing due to the effects of mesenchymal stem cells from adipose tissue. This paper presents a method of autologous fat grafting for bone defects secondary to osteomyelitis along with a systematic literature review.

Methods: This case report and systematic review was conducted from a board-approved, single-center. The case refers to a 26-year-old female suffering from acute on chronic osteomyelitis following trauma. After successful initial management, including debridement, local and systemic antibiotic therapy, dead space management was considered. Autologous bone grafting was excluded due to potential complications and patient need for immediate weight-bearing. Fat harvest and grafting were performed utilizing water jet-assisted abdominal liposuction; lipoaspirate was injected into a 7cm³ bone defect. MRI and CT scans were completed at 2 weeks, 6 weeks and 6 months postoperatively. A systematic review was performed according to PRI-SMA 2009 checklist. All levels of evidence studies that evaluated autologous lipotransfer for osteomyelitis were considered.

Results: Full weight-bearing was reached at 2 weeks, reduced pain and satisfaction was described from both ankle and abdomen. The patient remained asymptomatic without recurrence at 6 weeks. The bone defect showed a reduction of bone edema and increased vascularized adipose tissue after 6 weeks, with early signs of osteogenesis. The highest foot and ankle disability index scored 100. The systematic review identified a total of 343 articles and abstracts, with 266 duplicates removed. After screening for the eligibility criteria, seven were assessed further, with none meeting the inclusion criteria.

Conclusions: This study claims the first successful use of autologous fat transfer with early signs of osteogenesis in a patient suffering from chronic osteomyelitis. The authors relate autologous fat transfer is relatively safe, simple, cost-effective and minimally invasive, making it a potential alternative to current treatments in selective cases. Limited literature indicates further research and clinical studies are needed to assess the complete safety, viability, and efficacy of autologous fat grafting and the mechanism of osteogenesis. This study would also benefit from longer follow up to better understand long term outcomes of this procedure.

Educational Opportunities