Autologous lipotransfer for bone defects secondary to osteomyelitis: A report of a novel method and systematic review of the literature

Int Wound J. 2019 Aug;16(4):916-924. doi: 10.1111/iwj.13119. Epub 2019 Mar 27.

Abstract

Autologous bone grafting is the gold standard in patients with bone defects but is associated with significant pain and donor site morbidity. Autologous lipotransfer (fat grafting or lipofilling) has become very popular in the therapy of chronic wounds. Mesenchymal stem cells from adipose tissue are known for their regenerative, reparative, and immunomodulatory effects. This case study and review evaluates the use of autologous lipotransfer for chronic osteomyelitis in a 26-year-old patient. A 26-year-old female suffering from chronic tibial osteomyelitis was initially treated with surgical debridement and antibiotics followed by lipoharvest and autologous lipofilling. MRI and computed tomography scans were performed at 2 and 6 weeks and 6 months postoperatively. A formal systematic review of clinical trials investigating autologous lipotransfer for osteomyelitis was conducted. The patient remained asymptomatic without recurrence, and the bone defect cavity showed vascularised adipose tissue after 6 weeks, with early signs of osteogenesis. The highest foot and ankle disability index was 100. The systematic review identified 266 studies after duplicates were removed. After screening for eligibility, seven manuscripts were further assessed, with none meeting the inclusion criteria. This is the first study to report the successful use of autologous lipotransfer with early signs of osteogenesis in a patient suffering from chronic osteomyelitis. Autologous lipotransfer is relatively simple, safe, and minimally invasive, making it a potential alternative to current treatments. Further research is required to assess the safety, feasibility, and efficacy of autologous fat grafting and the mechanism of osteogenesis.

Keywords: autologous fat grafting; bone defects; lipofilling; osteomyelitis.

Publication types

  • Systematic Review

MeSH terms

  • Adipose Tissue / transplantation*
  • Adult
  • Bone Diseases / etiology*
  • Bone Diseases / therapy*
  • Female
  • Humans
  • Osteomyelitis / complications*
  • Reconstructive Surgical Procedures / methods*
  • Transplantation, Autologous / methods*
  • Treatment Outcome