38 y/o, Caucasian Male, who developed a PECTORALIS TENDON RUPTURE while lifting weights. He developed acute pain on his left chest wall and a Hematoma. He was taken to the Operating Room immediately to drain the hematoma and to try to repair the tendon.
He came to Eterna MD for consultation stem cell treatment into the area that was injured. He had his tendon repair close to 4 months. He visited to several clinics in Europe, as well as California and Arizona, but he was told that he was not a candidate because they have never delivered stem cells into the Pectoralis tendon. He was told that it could be dangerous because the “heart and the lungs can be punctured.” He was told they didn’t have the technology to deliver the stem cells into precisely the correct area.
His orthopedic surgeon is contacted after his consultation at Eterna MD, and we discussed the case. He agreed to proceed with the stem cell procedure. His orthopedic surgeon states that this was a very severe injury and that he tried to repair as much as he could, but he felt the pectoralis muscles fibers were disrupted, and that the cell therapy might be beneficial for the healing process.
A review of the anatomy and simulation of the Pectorlais tendon repair is performed at our facility in order to understand exactly how his operation was performed using his original orthopedic report. This type of injury is extremely painful, and it relates to the use of brutal force, in this case bench pressing close to 300 pounds. The Pectoralis Tendon is attached to the Bone (Humerus Bone: arm). The main function of the Pectoralis is to push up. So, imagine how painful it would be to have the tendon pulling out from the bone!
Our patient had history of pectoralis tendon rupture on his right side close to 10 years ago.
In order to deliver the stem cells, we used Ultrasound Technology in order to deliver the cells precisely into the site of injury. However, it can be done clinically as well if the physician has knowledge of the anatomy and has the skills for injection technique.
Patient is schedule for his Pre-op evaluation and medical clearance, and then he is scheduled for the procedure. Our Team coordinated all the details in preparation for his procedure. Many hours are spent in planning the surgery, education, phone calls, traveling, scheduling, paper work, and trying to fit the patient into our busy procedure room ,which is very challenging. I am glad I just do the procedure!!
The day of the procedure, some premeds are given orally, in order to initiate the procedure. Patient is taken to our procedure room and prepared for fat harvesting trough a mini-liposuction. No general anhestesia is required. All done in a sterile ambient and using a close system to collect the fat.
The fat is numbed using what is called “TUMESCENT ANHESTESIA;” fat is infiltrated with a mixture of LIDOCAINE (the same as what dentist uses), Epinephrine and Bicarbonate. A very tiny incision is made. I usually hide my incisions as much as possible and try to use only one to lipo the abdomen.
Once the FAT is collected, then it is taken to our onsite laboratory. The cells are then separated from the fat. Then, the fat is placed in syringes for injection. Both the mini-liposuction and the fat processing are done in sterile conditions.
Usually, patients state between 2 to 4 hours in our facility. The procedure is basically painless. It uses the patient’s own fat so there is no risk of rejection. The risk of complications relates the same as injecting a joint with cortisone as an example. However, Cortisone (product per se) has risk of cartilage damage, skin atrophy, compared to cell therapy that has no risk of rejection. So, the possible complications are related to the procedure per se: injecting a joint as in the example with cortisone: meaning risk of infections, bleeding, nerve damage, blood vessel rupture, infections that can destroy the joint. That is the main reason we perform our cell therapy in a sterile environment and use a close sterile system for the fat collection.
It is well known that the fat contains more stem cells than the bone marrow. Traditionally, stem cells are taken from the bone marrow (usually several punches are taken from the bone marrow). The bone marrow procedure is very painful and is probably best to have it done with some type of IV sedation or General Anesthesia.
Going back to our patient.
Fat was difficult to obtain since his percentage of body fat was 8 percent, and he had liposuction procedure in the past. I removed some fat from his lower abdomen and other part from his Infragluteal area and inner leg. My incision was placed in the infragluteal area midline in order to be hidden. 200 ml of fat was collected. Our patient also was scheduled for a cosmetic procedure: he had bilateral defects on his preaxillary areas that he developed from his previous surgery on his right tendon and another indentation on the recent operated site. Also, his scar on his shoulder was scheduled for stem cell therapy to accelerate the healing process.
INJECTION OF STEM CELLS GUIDED BY ULTRASOUND
The stem cells are now ready for injection. Ultrasound is used to identify the PECTORALIS TENDON, and the anchors used for the attachment to the humerus are visualized. Once the area is identified, then the injection is performed delivering the cells to the tendon using the Ultrasound to guide the needle. View the videos of the procedure below.
The Ultrasound shows the Pectoralis Major Muscle, which in several areas appears disrupted, and cells are delivered guided by the Ultrasound.
Every sample of stem cells is counted using a machine called the Flowcytometer that measures the number of cells, as well as viability of cells. A patient receives a copy of his cell count.
The 2 indentations on his chest are injected with a mixture of his own fat and his own stem cells. The indentations are filled with the mixture of fat and stem cells. Also, his recent scar on his left shoulder (Big scar) is injected just with pure stem cells.
During his initial consultation, CALF AUGMENTATION with FAT was discussed, but this was postponed since he did not have enough much fat to do his calf augmentation at the same time.
Fat Banking was also postponed since the fat removed was just enough to do the procedures mentioned
Actually, I suggested that he gain weight prior to his procedure, but it was not enough fat to do his calf augmentation.
Our patient went home after being in our facility for 3 hours. His wife drove him home. Next day, he felt well, with no pain on the site of the injection. Some discomfort on the “banana rolls” where the fat was removed, and he returned to his normal activity. He did not experience pain on his PECTORALIS MUSCLE where several injections were performed. We used very small diameter needle for the injection, which makes the injection basically painless and minimal trauma. He is schedule to continue his weight lifting in 2 weeks.
FAT TRANSFERS: It is very common to do a cosmetic procedure at the same time the stem cells are injected into the joint. In our patient above, since he was so lean, we were not able to do his calf augmentation. However, he is intended to gain more weight (more fat deposits) which might be difficult since he already had liposuction. We filled the indentations with the mixture of fat and stem cells. The idea is that the stem cells might provide a vascular environment in order to increase survival.
FAT BANKING: I do really recommend any patient who has liposuction to have his fat banked. We used a “Fat Bank” that specializes just in fat banking. They only deal with FAT. This is so important since it is like “donate your own BLOOD” and put in a bank in case you might needed in the future let’s say in a car accident where you lose a lot of blood or any emergency that requires a blood transfusion. This fat once is stored then can be used later for many uses: example to use it instead of Synthetic Fillers for the Face. Also many protocols for stem cells are under way so you can retrieve that fat then extract the stem cells and being used for a medical condition: example: Protocols in progress outside the United States for patients with Congestive Heart Failure, Heart Attacks etc. Our patient wants to store his fat but he didn’t have enough!
ULTRASOUND GUIDED INJECTION STEM CELLS: Please see the VIDEOS ( you can see how the needle is trespassing the planes and once positioned in the area of injury then you will see a “flush” that is filling the gap: those are the cells being delivered)