We performed cadaveric dissections of the lower limb in an attempt to support the safe and reliable approach of IM fat grafting of the muscles from the thigh and the leg. The vastus medialis, the vastus lateralis, the rectus femoris, the gastrocnemius, and the soleus muscles were all dissected following the anatomic models to locate the main pedicles and their distribution within the muscle. A scalpel with 15/20 blades, tissue scissors, and tissue forceps were used to separate the anatomic layers, vascular retractors, and markers that were used to denote the main pedicles and vessels. First, we located the pedicle, and then did a lipoinjection test on the contralateral virgin muscle with methylene blue to identify its proper placement at the IM layer for the thigh muscles and the gastrocnemius muscle. (See Video 1 [online], which displays cadaveric dissection of the thigh. Beware of the “danger triangle” where most vital structures of the thigh are located. Fat grafting of the vastus medialis and vastus lateralis muscles shows the superficial location of the graft, which is an actual premise for a safe approach.) (See Video 2 [online], which displays cadaveric dissection and fat grafting of the gastrocnemius muscle. The lateral head and the medial head have different access points to avoid the popliteal fossa, where critical neurovascular structures are present. The distal access [Achilles region] may be too close to neurovascular structures; hence, it should be avoided.)
This video displays cadaveric dissection of the thigh. Beware of the “danger triangle” where most vital structures of the thigh are located. Fat Grafting of the Vastus medialis and Vastus lateralis muscles shows the superficial location of the graft, which is an actual premise for a safe approach.1_jqhiyd6tKalturaThis video displays cadaveric dissection and fat grafting of the gastrocnemius muscle. The lateral head and the medial head have different access points to avoid the popliteal fossa where critical neurovascular structures are present. The distal access (Achilles region) may be too close to neurovascular structures, hence should be avoided.1_aclzx1xeKalturaThe senior author has incorporated the fat grafting technique for the rectus femoris, vastus medialis, vastus lateralis, and gastrocnemius muscles into dynamic definition liposculpture (HD2) since mid 2015; hence, we conducted a retrospective review of the medical records from January 2016 to May 2022 at a single center (Dhara Clinic) in Bogotá, Colombia. Inclusion criteria were any patient who underwent high definition liposculpture (HDL) or HD2 in addition to fat grafting of any muscle of the lower limb. Exclusion criteria included active smokers, patients with body mass index above 30 kg/m2, patients with PMH with blood clotting disorders or any thrombotic event (ie, DVT and PE), and patients with American Society of Anesthesiologists (ASA) risk classification of III or higher. Cardiology assessment, including EKG and chest X-ray, was required for patients older than 40 years old. All patients were subject to protocols for safe large-volume liposuction including those for thromboembolic event prevention, blood conservation, and hypothermia prevention.18 IV medications used were antibiotic prophylaxis with cefazolin (2 gr IV, 60 minutes before incision); dexamethasone, 8 mg; metoclopramide, 10 mg; diclofenac, 50 mg; and ranitidine, 50 mg. Photographic records were taken before and during follow-up at 2 days and 1, 3, 6, and 12 months after surgery.