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Henry Ford Hospital
BACKGROUND: Stomas are common surgical procedures with predictable outcome. When the operation is done properly there can still be a spectrum of morbidities from poor appliance fitting to chronic skin breakdown. Irregularities in parastomal skin contour secondary to scarring, wound contraction, and change in weight and body habitus are major culprits. In cases where revising the stoma of relocating it are not options, other solutions are necessary. We report our experience with six patients who underwent recontouring of the parastomal soft tissue with fat grafting for improved skin contour and ostomy care.intervention:Patients were evaluated for contour deformities that were the primary cause for stoma/appliance disfunction. Deformities including skin folds, contracted scars, fat necrosis, tissue atrophy were identified for fat grafting. Areas of soft tissue prominence and fullness were highlighted for lipectomy via liposuction. In the operating room the appliances removed, topography and deformities marked in sitting and supine positions. Subcision, fat grafting and liposuction performed as necessary to the different areas of the abdomen. The goal of the surgery was a 3 cm wide uniform ring around the stoma in the superficial subcutaneous plane. Volumes for the fat grafting and lipectomy varied by patient. Photographs and interviewing performed before and after surgery. We frequently over-corrected the parastomal depressions to account for the 30% anticipated loss of the fat grafted over time. Medical records were reviewed to assess the improvement of postoperative stoma care. Outcome: Six patients underwent parastomal fat grafting from February 2017 to June 2018. Three patients had an end-ileostomy, one had a loop ileostomy, one with a chronic enterocutaneous fistula with ostomy appliance, and one patient had a urostomy. An average of 192.5 mL lipoaspirate was harvested (range: 120 - 350 mL), and 108 mL of filtrated and washed fat was grafted (range: 58-230 mL). Lipectomy via liposuction to the target area was performed in 2 patients. Average fat aspiration was 85 mL (75 ml and 110 ml). One patient had near complete resolution of leaks after the surgery and no major issues were reported after one year from the procedure. Two patients had major improvement of appliance seal with short-term follow up. Three patients had partial improvement in seal when compared to continuous leakage preoperatively. No complications were related to the procedure. CONCLUSIONS: Fat grafting is a novel and safe technique that could provide a solution for difficult stoma. partial improvements can have a significant positive impact on lifestyle. The procedure can be repeated if necessary. This is especially useful when patients have prohibitive risks to have further transabdominal procedures. Larger sample size and long-term follow up will be needed for further assessment of the outcomes.
Saab, Ihab; Ahmad, Hassan; Ivanics, Tommy; Worten, Andrew; Yoho, Daniel; Assai, Megumi; Zimnicki, Katherine; and Siddiqui, Aamir, "Peri-stomal Fat Grafting to Enhance Parastomal Contour and Improve Ostomy Care" (2019). Case Reports. 42.