Autologous Fresh Fat Grafting Followed by Autologous Cryopreserved Fat Grafting
ConditionFacial Defect
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorUniversity of Pittsburgh
About this trial
The goal of this clinical trial is to validate the safety and effectiveness of a two-stage approach for minimally invasive craniofacial soft tissue reconstruction using autologous fat grafting in wounded service members and veterans. The main questions it aims to answer are:
1. Will treating subjects with post-traumatic craniofacial deformities using fresh fat grafts, followed by a second treatment 3 months later with cryopreserved fat stored at -80°C, improve facial tissue regeneration and appearance? 2. How do volume retention and tissue health change between fresh and cryopreserved grafts in humans? 3. How do factors such as cellular composition of the graft, patient demographics, and medical conditions (including diabetes, tobacco use, medications, age, and BMI) affect fat graft volume retention and overall outcomes?
Researchers will compare results from the second-stage cryopreserved fat grafting to fresh fat grafting to assess outcomes like volume retention, patient recovery, and cost reduction.
Participants will:
Undergo an initial fat grafting procedure. Have additional fat harvested and cryo-stored for use in a second-stage procedure.
Receive the cryopreserved fat in a later stage without the need for a second fat harvest.
Receive small test injections behind each ear for later analysis. Provide data on demographics and medical conditions for correlation with outcomes.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Aged 18 years or older and able to provide informed consent,
Have suffered injury resulting in craniofacial volume defects which could be treated with a graft volume of between 3 and 150 cc of lipoaspirate (the patient's own fat, collected through liposuction). This may include patients who have not had craniofacial surgical procedures, as well as those who have undergone surgical procedures and have remaining deformities (post-surgical deformities).
Be at least 3 months post-injury or most recent surgery, so that acute edema (swelling) is resolved.
Volume defects (facial injury) are covered by intact skin and do not communicate with oral cavity or sinuses.
Disqualifiers
Age less than 18 years.
Inability to provide informed consent.
Craniofacial defects intended for treatment have open wounds or communicate with oral cavity or sinus (note: A second facial injury, that will not be treated by the study, that includes this type of defect, will not necessarily exclude the patient from participating).
Active infection anywhere in the body.
Trial design
Design model
Single group
Treatments tested in this trial
Serial Fat Grafting Fresh followed by Cryopreserved Fat
Procedure/SurgeryThe therapeutic intervention is a two stage surgical procedure (with a third stage biopsy for research purposes in this trial) in which a primary traumatic or post-surgical craniofacial deformity is treated first with autologous fat grafting using freshly harvested adipose tissue. A second fat grafting procedure is performed at 3.0 months after the first procedure using autologous adipose tissue that had been cryopreserved during the first procedure.
Treatment groups
22 Participants
are divided into 1 treatment groupGroup A: Clinical InterventionExperimental treatment 1 intervention
Trial outcomes
Primary outcomes
1
Facial volume and appearance scale
This is a validated visual 3-point grading scale that will be scored by 4 blinded observers (2 physicians and 2 lay-observers) from standardized photographs The definitions for each of three points on the scale are listed here: a score of 1 means: for baseline grading of a given facial aesthetic region assessed there is an obvious contour defect that would benefit from volume fill. For post-treatment grading, no discernable improvement from baseline. A score of 2 means: for a given facial aesthetic region with a history of a traumatic deformity and treatment of the deformity according to the study protocol, there is a discernable improvement in the contour defect from baseline which does not yet approximate the contralateral side (if uninjured) or represent a normal appearance. A score of 3 means: for a given facial aesthetic region there is a normal appearance and/or close to matching contralateral structure (if uninjured).
Time frame
The key timepoint is 3 months post-graft. The difference between the Facial Volume and Appearance Scale scores from the Pre-treatment baseline to the 3-months post-1st treatment, for each subject, will be generated.Secondary outcomes
1
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]
Incidence of adverse events will be counted, as well as a subscore for those adverse events that are considered related to the study intervention.
Time frame
From intervention to the final study visit (3 months post 2nd treatment, or approximately 6 months after initial intervention)2
Change in facial injury volume from Pre to Post CT Scans- within each subject- High resolution Computed Tomography with 3D reconstruction (CT) will be performed.
Craniofacial fine cut CT with 3D reconstruction \& volume analysis. 5 CTs of the face will be done on each subject. The first scan will be pre-procedural and will serve as a baseline. All CT scans will be done on a 64-slice scanner (LightSpeed, GE Healthcare), using collimation of 0.625mm and slice interval of 0.3mm, resulting in approximately 50% overlap between adjacent slices. kVp, mA, and FOV will be optimized to the subject, but will approximately be kVp=120; mA=320, FOV=18cm. Soft tissue and bone kernels will be employed. These images will be volumetrically reformatted into coronal and sagittal planes for confirmation of findings. Additionally, surface-rendered volumetric reformats will be created emphasizing both bony structures and soft tissues. Images will be reviewed by a dedicated head and neck radiologist with 25 years of experience in CT of the face.
Time frame
Facial volume analysis of the injured area will be calculated from the individual CTs, comparing from each subject's pretreatment baseline to the final study visit (3 months post 2nd treatment, or approximately 6 months after initial intervention)Sponsors and contacts
Click on the lead sponsor to view all of their trials.
University of Pittsburgh
Lead sponsor
Armed Forces Institute of Regenerative Medicine
Collaborator
Source ClinicalTrials.gov