ADVANCED FOOT AND ANKLE SPECIALISTS, PA
Jay S. Weingarten, DPM, FACFAS, FACFAOM
Podiatric Physician and Surgeon
Board Certified Physician – Treating Pediatrics to Geriatrics
Fat pad replacement
The Graft Jacket, from Wright Medical, was developed for
ulcer repair and tendon repair and is used to treat fat pad
atrophy.
One common complaint that we get in our office is "I feel like I
am walking on my bones." During weight bearing the plantar
foot is cushioned and protected by the plantar fat pad. This
anatomic structure is organized as fat lobules held in place by
surrounding fiberous septa.
Five individual sub-metatarsal pads combine to form the
metatarsal plantar pad. The metatarsal fat pad is constrained
dorsally by attachments to the capsule of the metatarsal heads
and to the more plantar sub-dermal layer. These fat pads act as a
shock absorber to cushion, defuse force, and resist shear during
weight bearing. This fat pad also acts to protect and cushion the
underlying bone, tendons and neurovascular structures of the
foot. This plantar fat pad can become displaced or atrophied
from any number of traumatic events including multiple surgical
incisions, fractures, or chronic metatarsal plantar flexion. These
conditions often result in a painful plantar weight bearing surface
that can lead to callus, or worse, ulceration.
Several attempts at surgical correction over the years have been
attempted with little success. Most of these lacked long-term
correction and pain relief due to the migration, short resorption
profile, or inconsistent delivery characteristics of the material. A
couple of years ago, a novel surgical treatment was introduced
using Graft Jacket from Wright Medical which was developed for
ulcer repair and tendon repair. Graft Jacket is a human dermal
collagen template that is readily incorporated into the body. The
matrix undergoes a patented process that renders that material
essentially acellular and is freeze dried with a proprietary process
that prevents the formation of ice crystals to preserve the intact
matrix including vascular channels. Graft Jacket Matrix contains
collagen, elastin, hyualuronan, fibronectin, blood vessel channels,
and proteoglycans.
A key factor to Graft Jacket is an intact, three-dimensional matrix
to build on. The three-demensional structure provides a means
for the body to rebuild the area of missing tissue. Another
important aspect of Graft Jacket is that it is readily revascularized
by the body. This means that new blood vessels gain access
through preserved blood vessel channels and allows the
conversion of Graft Jacket into the host tissue.
The surgical procedure involves a minimal incision near the area
of interest to create a pocket for the graft in the deep
subcutaneous tissue layer. Next, with a suture technique the graft
is pulled into the pre-determined position. Then the
subcutaneous layer is closed, the skin is repaired, and the foot is
placed in a soft compressive dressing. The patient should remain
non weight-bearing for 2 weeks. Using diagnostic ultrasound
pre- and post-operatively, we can see the change in the
thickness of the fat pad.
This minimally invasive procedure provides a new technique to
treat fat pad atrophy when previous surgical attempts had been
unsuccessful.
1233 SE Indian St., Suite 102, Stuart, FL 34997
tel. 772-223-8313, fax 772-223-8675
1106 W Indiantown Rd, Suite 4, Jupiter, FL 33458 tel. 561-744-6683, fax 561-744-7033