Autologous Fat Grafting to Prevent Erosion and Pain Over Neuromodulation Hardware: Technical Case Series

Implanted neuromodulatory devices can be threatened by thin overlying tissue and refractory device-associated pain, both of which present significant clinical challenges with few reliable management strategies. We describe the technical workflow and preliminary clinical outcomes of autologous fat graft (AFG) for the management of neuromodulation device-related pain and dermal erosion.

This retrospective single-center technical case series details the indications, operative technique, and early postoperative results in 2 patients treated with a novel application of a standard plastic surgery technique in the context of functional neurosurgery. Autologous fat was harvested from patient donor sites and applied around a spinal cord stimulator to alleviate pain in one case and around a deep brain stimulation electrode to prevent dermal erosion in the other. Patients were followed for a minimum of 1 month of postoperative care.

In both cases, AFG successfully addressed the hardware-related complication without requiring complete device revision. The first patient experienced substantial and durable pain reduction for 2 years before requiring repeat grafting due to progressive graft resorption. In the second case, improved scalp thickness prevented progression of early erosion, although mild thinning was noted at 1 month. No perioperative complications occurred in either case.

This early technical experience demonstrates that AFG is feasible, well-tolerated, and may provide meaningful symptomatic and reconstructive benefit as a minimally invasive adjunct in neuromodulation surgery. Longer-term prospective evaluation is required before definitive conclusions regarding durability and clinical efficacy can be drawn.