Despite that fact that fat necrosis is an increasingly common complication of free tissue transfer and fat grafting, there has been no clear consensus on how to define and classify it in the plastic surgery literature.
In an effort to correct this, a research team led by New York plastic surgeon Pierre B. Saadeh, M.D., undertook a systematic review of the literature. Using keywords such as “fat necrosis” and “plastic surgery,” the team searched the PubMed database of the National Library of Medicine and National Institutes of Health and Google Scholar for the period covering Jan. 1, 2003, to Nov. 1, 2013.
The researchers chose 69 articles that met their criteria for analysis. They found there was a wide variety of size requirements and postoperative timing among the definitions of fat necrosis. Moreover, they found that work-ups sought after clinical examination to confirm a diagnosis of fat necrosis varied widely, ranging from radiographic studies to histopathologic examination or a series of studies.
Based on their analysis, the authors suggest defining fat necrosis as “a palpable, discrete and persistent subcutaneous firmness found postoperatively that measures at least 1 cm during physical examination.” They write that necrosis can be identified and confirmed by imaging and histopathology or through intraoperative findings.
The authors provide a classification system for fat necrosis that can be used by clinicians to describe fat necrosis in varying grades of severity that ultimately could help guide clinical decision-making.