AUTOLOGOUS – SAFE – STERILE – ENZYME-FREE – SUSTANIBLE – SHARI’AH COMPLIANCE – CLINICALLY TESTED
ENGINEERING
CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
Lipocast Biotech UK Ltd
Standard Operating Procedure for
Lipogems Equine

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
Part 1 – Set up
Part 2 – Restraint and sedation of the horse
Part 3 – Select site for adipose extraction
Part 4 – Preparing the Lipogems kit
Part 5 – Prepare the saline
Part 6 – Making the incision
Part 7 – Infiltration of the subcutaneous tissue
Part 8 – Attaching the 13G cannula
Part 9 – Pulling the plunger fully out
Part 10 – Harvesting 15-30ml
Part 11 – Leave the harvested material to stand
vertically
This set of instructions covers the clinical use of the Lipogems adipose processing system for use in
therapy of equines. A power point presentation of this SOP with additional demonstration videos is also
available.
The instructions are divided into the following steps:
Part 12 – Surgical skin preparation for treatment
site
Part 13 – Connect saline to Lipogems and remove
air bubbles
Part 14 – Attach 50ml syringe to connector
Part 15 – Cleaning the lipoaspirate
Part 16 – Concentrate the Lipogems
Part 17 - Making the final surgical preparation
Part 18 – Bandage using sterile dressing
Do’s & Don’ts

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• Drugs for sedation, e.g. detomidine and butorphanol
• 100 ml lignocaine/adrenaline solution (2% lidocaine and
0.002% adrenaline/epinephrine)
• 1 x 500 ml bag of normal saline (0.9%) and 1 x 3 L bag of
the same (or 2 x 2 L)
• Local anaesthetic (mepivicaine 2%, 10-50 ml) for regional
analgesia of limb prior to injection of tendon/ligament
• Assorted syringes and needles (minimum 1 x 50 ml, 2 x 2
ml, 5 x10 ml, 18, 20, 21, 22 G needles),
• Scalpel blade (#11 or 15)
• Surgical scrub (povidone iodine) and spirit
• Surgical (sterile) gloves
• Sterile drape
Part I Setup - You will need in addition to the Lipogems kit

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
• Restrain the horse – preferably hand
held by a competent groom or
assistant
• Sedate the horse - drugs for
sedation; e.g. detomidine and
butorphanol
While it is not essential to have the
horse in stocks, as the lipoaspiration
procedure is well tolerated by the
majority of patients, it may help in
fractious horses or where the site to be
infiltrated with Lipogems necessitates
good restraint
Part 2 – Restraint and sedation of the horse

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• Select site for adipose extraction using
transcutaneous ultrasonography
• The recommended site is around the tail
head
• Clip a square (approximately 5 x 5 cm) of
hair 21 cm distant to this (we recommend
dorsolaterally to the deepest fat tissue),
approximately 13 cm from the midline on
both sides of the tail head
• Place a 2 ml bleb of local anaesthetic under
the skin in the centre of this square and
prepare the skin aseptically
Part 3 - Select site for adipose extraction

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
Part 4 – Preparing the Lipogems kit
Open the Lipogems kit and lay out the cannulae and syringes and
transfer the devices onto a sterile drape

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
• Add 50 ml of local anaesthetic (2%
lidocaine and 0.002%
adrenaline/epinephrine) to a 500
ml bag of sterile normal saline
• Fill the 50 ml syringes with the
resulting solution
Part 5 - Prepare the saline

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• Clip the area for the incision
• Prepare the incision area with
surgical scrub (povidone iodine)
and spirit
• Make a stab incision in centre of
one patch of clipped and
scrubbed skin with a No.15
scalpel blade
Part 6 – Making the incision

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• Using the 20G cannula
infiltrate the
subcutaneous tissue in the
region of deepest adipose
tissue with 150 ml local
anaesthetic/saline
solution. This should fan
out from the tail head
towards the ischial
tuberosity
• Repeat on the other side
of the tail head
Part 7 - Infiltration of the subcutaneous tissue

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
Part 8 - Attach 13G cannula and
move whilst under vacuum
• Attach the 13G cannula to the Vaclock syringe
and insert subcutaneously towards the area
infiltrated with saline/local anaesthetic
• Pull the plunger half way and lock
• Move the cannula backwards and forwards (as if
you were playing a violin)
• Taking care not let the cannula exit and lose
vacuum

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
•As the Vaclock syringe fills, pull the
plunger fully out and lock
•Once full, transfer the contents to
a 50ml syringe, which should be
held vertically with the nozzle
pointing downwards
•The lipoaspirate will then float
upwards
•The underlying aqueous solution
should be discarded
•It is not necessary to staple the
stab incisions at harvest sites
Part 9 - Pulling the plunger fully out

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
•Repeat until it is no longer
possible to aspirate solution
from the site
•Repeat at the second site on
the other side of the tail head
•You should aim to harvest 15-30
ml of lipoaspirate from each
site
Part 10 - Harvesting 15-30ml

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
Once the aspiration
procedure has been
completed leave the
harvested material
to stand in one or
more vertically held
50 ml syringes.
Part 11 - Leave the harvested material to stand vertically

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
•Ready the site for infiltration by clipping hair
•Place nerve blocks or other regional
anaesthesia
•Initial surgical skin preparation
Part 12 - Surgical skin preparation
for treatment site

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
•Tie a 3ltr bag of normal saline at head height
and connect the Lipogems device.
•With the grey end upper most allow saline to fill
the chamber and display air.
• If an air bubble remains, close the inlet clips
and attach a 10 ml luer lock syringe to both the
grey and blue ends of the canister
•Draw 10 ml saline into the syringe on the blue
end and close the inlet clip. With the air bubble
in the centre of the uppermost grey filter
rapidly inject the 10ml of saline to recover air in
the upper syringe
•Repeat until all air bubbles have been extracted
and remove the 10 ml syringe
•NB. THERE MUST BE NO AIR BUBBLES
Part 13 - Connect saline to Lipogems
and remove air bubbles

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•Turn the device through 180
degrees so that the blue end
is now uppermost
•Take the 50 ml syringe
containing lipoaspirate,
eject any aqueous tissue,
and attach to the connector
blue end
•Open the outlet clip and
inject slowly taking care
that fatty tissue does not
extend beyond the ‘S’ in
‘LIPOGEMS’ on the side of
the canister
Part 14 - Attach 50ml syringe to connector

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
•Remove the 50 ml syringe and
open the inlet clip and wash the
lipoaspirate for around 45
seconds
•Close the outlet then inlet clip
and shake in a vertical motion
for 15 seconds
•Open inlet and then outlet clips
and wash again for 45 seconds
•Repeat cycles of shaking and
washing until there are no traces
of blood or aqueous material and
only a clean lipoaspirate remains
Part 15 – Cleaning the lipoaspirate

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
•With the grey end upper most, attach 10 ml luer lock
syringes at both ends of the canister and open the inlet
clip
•Fill the syringe on the blue end with 10 ml saline and
close the inlet clip. This should then be rapidly injected
into the canister so that the Lipogems is ejected into
the upper syringe
•Repeat until all of the Lipogems have been extracted.
By holding the harvest syringes vertically aqueous
solution can be ejected and the Lipogems concentrated
Part 16 - Concentrate the Lipogems

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
Transfer Lipogems to 1 ml
syringes for infiltration
Make the final surgical
preparation of the site for
infiltration and inject
Lipogems observing aspetic
precausions
Part 17 - Making the final surgical preparation

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When structures of the lower limb have
been infiltrated bandage the limb using a
sterile dressing over the site
Following up:
The horse or pony should be on box rest
for 5 weeks or in a small coral if a stable is
not an option. Ideally a pressure bandage
should be applied during this time where
possible.
Scans should follow at 5 weeks before walk
work and fitness plans are implemented.
Part 18 - Bandage using sterile dressing

CONFIDENTIAL: FOR INTERNAL USE ONLY. DO NOT DISTRIBUTE.
•Don’t make the stab incision for harvesting too large as this will allow air to enter and ruin vacuum
pressure
•Do try to avoid contaminating the lipoaspirate with muscle
•Do allow harvested lipoaspirate to stand so that aqueous infranatant can be discarded prior to
microfracturing
•Do ensure effective analgesia of any tendon/ligament to be injected – do this immediately after
collection so that the ‘block can take’ while the lipoaspirate is being processed
•Do eliminate all air from the Lipogems device, including the bubble in the giving set
•Remember to harvest Lipogems with the grey end of the device uppermost
•Do allow Lipogems to stand so that remaining aqueous infranatant can be discarded prior to injection
•Inject Lipogems using a 1 ml luer lock syringe with a 20/21/22 G needle. Using a larger syringe and
needle actually makes it more difficult to inject due to greater hydraulic pressures within the syringe
•Administer NSAIDs for 5-7 days after the procedure
Lipogems – Do’s & Don'ts