A Low-cost, Sterile System for Fat Collection Using a Syringe Tube as a Reservoir.

Fat grafting is a widely performed procedure in the field of plastic surgery. It involves fat extraction, processing, and injection into a recipient site. It is imperative that the fat is collected and processed in a sterile system. A wide variety of equipment is required to perform the procedure (eg, a liposuction device, a vacuum pump, and syringes). Limitations often arise in the operating room, especially in low-resource areas, where task-specific equipment might be unavailable. This can present an opportunity for the surgeon to improvise and create a temporary solution. In this report, we describe our solution in dealing with the unavailability of a sterile vacuum pump canister during a large volume fat grafting procedure. We constructed a sterile reservoir using two syringes, through which negative pressure was delivered without breaking sterility. The items used were a 60-cm3 syringe barrel, a 10-cm3 syringe barrel, a 60-cm3 syringe plunger seal, a tube connected to the nonsterile vacuum pump, and the liposuction cannula. This technique allowed us to extract the fat in a sterile environment under the assistance of a suction device. Our novel technique was used for harvesting fat in a sterile reservoir, while still utilizing the assisted suction from the nonsterile vacuum pump, without breaking sterility.

Takeaways

Question: How to overcome the limitations of low resource areas regarding expensive machinery required in fat harvesting procedures?

Findings: A new method for fat collection using widely available tools in the operating room that can be constructed using syringes, a tubing suction catheter, a vacuum suction pump, and a liposuction device.

Meaning: Innovation is required in the operating room for overcoming limitations; in our study, we constructed a new, quick, and easy technique for harvesting large amounts of fat by using widely available tools in the operating room.

INTRODUCTION

In the operating room, the surgeon is occasionally faced with unanticipated limitations that require ingenuity to perform the task at hand. Despite the advent of modern technology and task-specific machinery, often times the surgeon stumbles upon a situation requiring a quick fix. This especially rings true in low-resource areas in which sophisticated machinery tailored to performing a specific task is scarce. Nevertheless, surgeons are presented with a wide array of tools in the operating room—creativity, improvisation, and a basic understanding of such tools can serve them well in overcoming certain obstacles.

One of the most commonly performed procedures in plastic surgery is liposuction, whereby fat is extracted and can be used for various aesthetic or reconstructive purposes. During the process of fat grafting, the initial step of liposuction utilizes negative pressure to aid in extraction. Following extraction, the fat is processed, purified, and reinjected into the recipient area. In the intermediary step between extraction and injection, it is imperative that fat is collected in a sterile reservoir.

Nevertheless, there are two basic methods for harvesting fat: either using a syringe or a vacuum pump. In 1988, Toledo[1] experimented with disposable syringes of different sizes to aspirate fat, and this allowed for a precise measurement of the harvested fat which was then used for grafting. On the other hand, the vacuum pump was introduced, being more convenient for extracting large quantities of fat.[2] In the absence of a sterile vacuum pump, a sterile syringe can be used as a reservoir for the harvested fat. Unfortunately, this technique is inefficient and laborious when large quantities of fat are required.

In the field of plastic surgery, innovations in the operating room are constantly being developed, with the aim of improving surgical outcomes and reducing operating time. An innovative example in fat grafting is the “fat trap” device, in which an 800-ml bottle was connected to a liposuction cannula allowing large amounts of fat to be harvested in a sterile container.[3] Although the Coleman technique is suitable when small volumes of fat tissue are needed, the fat trap technique allows for the harvesting of large amounts of fat, as it is simple to construct and reduces the duration of surgery.

In this article, we describe our experience in dealing with a dilemma faced during a procedure necessitating large volume fat grafting. There was a deficiency in a sterile vacuum pump canister. We describe a novel technique used for harvesting fat in a sterile reservoir, while still utilizing the assisted suction from the nonsterile vacuum pump, without breaking sterility.

METHODS

A 60-cm3 syringe was disassembled into its various components: the plunger, the plunger seal, and the barrel (Fig. 1). A hole was made in the plunger seal of the 60-cm3 syringe and then used to introduce the tip of the catheter (Fig. 2A), connected to the nonsterile vacuum pump. A 10-cm3 syringe was also disassembled, and the tip of the barrel was cut diagonally (Fig. 2B). The 10-cm3 syringe barrel was placed inside the 60-cm3 barrel, with the tips pointing in one direction forming a double barrel. Afterward, the newly modified plunger seal was used to seal off the 60- and 10-cm3 syringes simultaneously (Fig. 3). The liposuction cannula was then connected to the tip of the 60-cm3 syringe. The hole made in the 10-cm3 syringe helped contain the fat within the larger 60-cm3 syringe, as the liposuction device extracted the fat cells with the assistance of the suction from the vacuum pump (see figure, Supplemental Digital Content 1, which shows an illustration of the assembled equipment ready for use, http://links.lww.com/PRSGO/C51; see Video 1 [online], which displays the process of harvesting fat using the method specified, showing the syringe with its components connected to the liposuction cannula and vacuum suction pump).

Fig. 1.

A 60-cm3 syringe disassembled into its various components: the plunger, the plunger seal, and the barrel. A 10-cm3 syringe was also isolated, and a catheter was taken from the suction tubing system.

Fig. 2.

Assembly of the syringe tube. A, A hole was made in the plunger seal of the 60-cm3 syringe and then used to introduce the tip of the catheter to create a modified plunger seal. B, The 10-cm3 syringe was disassembled, and the tip of the barrel was cut diagonally.

Fig. 3.

The 10-cm3 syringe barrel was placed inside the 60-cm3 barrel forming a double barrel, and the newly modified plunger seal was used to seal off the 60- and 10-cm3 syringes simultaneously.

Video 1

See Video 1, which displays the process of harvesting fat using the method specified, showing the syringe with its components connected to the liposuction cannula and vacuum suction pump.

This created a closed suction within the larger syringe tube provided the syringe was kept horizontal with the rectangular hole facing downward. After the required amount of fat was extracted, a Kocher clamp was used to seal off the tail end of the tube connected to the vacuum suction, and the syringe was emptied into a sterile bowl. (See Video 2 [online], which displays the process of disassembly of the syringe and emptying of the fat into a sterile bowl followed by reassembly of the syringe.)

Video 2

See Video 2, which displays the process of disassembly of the syringe and emptying of the fat into a sterile bowl followed by reassembly of the syringe.

DISCUSSION

In this article, we describe a novel technique used to harvest fat in a sterile reservoir. At our hospital, a sterile vacuum pump canister was unavailable, and our alternative option was to harvest the fat in a sterile syringe. However, to facilitate the harvest, negative pressure was still required to achieve the harvest in a timely fashion, and this could only be achieved through a suction-assisted technique using a vacuum pump. To overcome the challenge, we used a novel technique by constructing a sterile reservoir using two syringes, through which negative pressure was also delivered without breaking sterility. These items were a 60-cm3 syringe barrel, a 10-cm3 syringe barrel, a 60-cm3 syringe plunger seal, a catheter tube connected to the nonsterile vacuum pump, and the liposuction cannula (see figure, Supplemental Digital Content 1, http://links.lww.com/PRSGO/C51). This technique allowed us to extract the fat in a sterile environment under the assistance of a suction device (see Video 1, [online]).

CONCLUSIONS

The wide availability, relatively cheaper cost of the selected tools, and their simplicity allow this type of device to be constructed in lesser-equipped, low-resource areas. The short time required to assemble the tools and ease of use also provide a temporary, quick solution that could be simulated in situations of anticipated or unanticipated lack of the required machinery. Our solution achieved the main goal of harvesting fat in a sterile container under suction assistance. This workaround solution was limited by the escape of some fat into the vacuum tank. One important aspect to consider is the effect of the fat extraction method on the viability of the graft, which may not be ideal. Considering the advanced techniques currently used to limit fat cell destruction during extraction, such as laser and ultrasonic-assisted liposuction, this technique may be further be expanded upon in the future to account for these limitations. We believe that our technique could be a potential solution for areas where more costly machinery to harvest fat is unavailable.