• Kwan Lok Benjamin Ng, Meng-Chien Willie Hsieh, Yun-Nan Lin, Rong-Fu Chen, Tsai-Ming Lin, Sin-Daw Lin, and Yur-Ren Kuo.
• Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
• Medicine (Baltimore). 2021 Oct 22; 100 (42): e27577.

RationaleCurrently, there is no consensus regarding the best treatment for patients with thromboangiitis obliterans (TAO). Regenerative medicine, such as bone marrow stem cells or adipose-derived stem cell (ASC) transplantation, have proven efficacy in improving tissue perfusion and wound healing in clinical trials. In this case, we used nanofat grafting to treat severe conditions in a patient with TAO, with promising outcomes.Patient ConcernsThis is a case of a 48-year-old smoker who presented with cyanosis in both hands and the right foot, with gangrenous changes. Investigative angiography showed severe vasospasm in the radial and ulnar arteries of the patient's left hand. Progressive cyanosis of the patient's left hand was noted which may eventually require amputation if left untreated.DiagnosesHe was diagnosed with TAO under the Shionoya diagnostic criteria.InterventionsFasciotomy and necrotic tissue debridement were performed, followed by centrifuged nanofat grafting. The nanofat graft was prepared using Pallua method and deployed with a MAFT-GUN (Dermato Plastica Beauty Co., Ltd., Kaohsiung, Taiwan).OutcomesThree months later, computed tomography angiography revealed a radial artery patency. The patient's wrist function was preserved with uneventful wound healing.LessonsThe regenerative ability of centrifuged nanofat grafts not only helps wound healing but also helps reverse vasospasm and preserve remnant tissue perfusion.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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