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From Trauma to Congenital: Unveiling the Versatility of Fat Grafting in Pediatric Upper Extremity
Alejandra Aristizábal, MD
1; Luis Antezana, MD
1; Cole Holan, MD, MBA
1; Steve L. Moran, M.D.
21Mayo Clinic, Rochester, MN; 2Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN
Background: Fat grafting has emerged as a versatile technique in reconstructive surgery, offering potential benefits for upper extremity conditions in pediatric patients. This study aims to evaluate the indications, techniques, and long-term results of fat grafting procedures in pediatric upper extremity surgery. Methods: An Institutional Review Board approved retrospective chart review was conducted for pediatric patients (< 18 years old) undergoing upper extremity fat grafting procedures between 1989-2021. Data on demographics, indications, procedure details, complications (e.g. infection, seroma, hematoma, delayed wound healing), and long-term outcomes were collected. Results 40 patients, 20 females and 20 males were identified. The average age at fat grafting was 7.8 years (range 0-17). Indications were trauma-related (n=7, 17.5%) and non-trauma-related (n=33, 82.5%). Fat grafting donor sites were mostly from the ipsilateral upper extremity, no donor site complications were reported. Trauma-related procedures included excision of physeal bars secondary to previous fractures and fat interposition in the bony defects at the wrist (57.1%), forearm (28.6%), and arm (14.3%). Median follow up was 15.11 months. One complication was reported (e.g. delayed wound healing). Long-term outcomes were as follows: one patient had a recurrent physeal bar, two had arrested growth in the affected bone, two underwent ulnar shortening due to deformity afterwards and two did not require more interventions. Among non-traumatic indications, congenital hand differences were the most common (n=24, 72.7%), other indications (n=9, 27.2%) including soft tissue and bone defect correction secondary to a variety of conditions (Table 1). Median follow-up was 14.42 months. No complications were reported. The most common hand difference was clinodactyly with delta phalanx (n=9). 24 fingers with this condition were treated using a physiolisis technique with an interpositional fat graft. The mean angle correction was 16.5 degrees. One finger (4.2%) recurred. For Madelung's deformity, 7 limbs across 4 patients received an excision of Vickers ligament with osteotomy of the distal radius and fat graft interposition. One patient's deformity recurred, necessitating a radial osteotomy with bone graft. This patient was confirmed to have Leri-Weill dyschondrosteosis. Conclusion: Fat grafting procedures for the upper extremity in pediatric patients are safe in treating a wide range of conditions – demonstrated by a low complication rate, especially non-trauma related ones. 
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