Fat Grafting for Burn, Traumatic, and Surgical Scars

Fat grafting provides a reliable modality with expanding usefulness in reconstructive plastic surgery. Owing to its mechanical and theorized regenerative properties, adipose tissue can improve scar qualities and scar related symptoms when grafted adjacent to or within a scar. In this article, the literature describing the effect of fat grafting on various types of scars, current scientific understanding of fat grafting for scars, and our current approach to the management of problematic burn scars are reviewed.

Key points

  • An increasing volume of literature supports fat grafting for the treatment of problematic scars.

  • Transferred adipose tissue provides a mechanical effect and a putative regenerative environment that improves scar qualities and scar related symptoms.

  • Fat grafting may improve symptoms in patients with refractory neuropathic pain in burn scars.

  • With the expanding role of autologous fat grafts, regulatory issues surrounding its use must be considered continuously.

Introduction

Free autologous fat transfer was first described in 1893 when Franz Neuber reported the harvest of fat from a patient’s arm to fill a defect in the cheek cause by tuberculosis of the maxilla. Eugene Hollander was the first to report the use a needle and syringe to transfer fat into the face of a patient with lipoatrophy in 1912. Over the remainder of the 20th century, multiple reports emerged on the use of fat grafting as a soft tissue filler; however, these uses were associated with substantial variability in results. It was not until Sydney Coleman described a strict protocol for harvesting and injecting fat that results became more reliable. As a result, the popularity of fat grafting surged and its clinical applications diversified.

In 2007, Rigotti and colleagues described the use of autologous fat grafts to treat radiation-induced skin lesions, and showed that autologous fat grafts have the ability to improve local tissue environment in humans. They proposed that regeneration occurred owing to adipose-derived stem cells within the lipoaspirate. The usefulness of fat grafting continued to expand, and lipotransfer became recognized as a versatile medium possessing valuable mechanical and regenerative properties.

Reports began to emerge investigating the role of fat grafting for treating various types of scars, with promising results. In 2008, Klinger and colleagues published a case series of 3 patients with burns to the face who underwent fat grafting and had improvement in scar quality. Additional reports described fat grafting to various traumatic, surgical, and burn scars with improvement in scar qualities.

Many investigators noted that scar-related pain improved after fat grafting, which has led to recent interest in the use of fat grafting to treat painful scars. Fat grafting has been shown to improve symptoms in patients with painful surgical scars, traumatic scars, and postmastectomy pain syndrome. In 2016, we investigated the possible role of lipotransfer in treating neuropathic pain in burn scars and showed that adipose tissue can be safely grafted into burn scars and may improve symptoms in patients with refractory neuropathic pain after burn injury. A prospective study is currently underway to quantify the improvement in pain and quality of life that is observed after fat grafting in patients with chronic neuropathic burn scar pain.

In this article, we review the current literature on fat grafting for scars, discuss the physiology of fat grafting as it relates to management of problematic scars, present our approach for the use of fat grafting to manage painful burn scars, and elaborate on current regulatory issues surrounding autologous fat grafting.

Introduction

Free autologous fat transfer was first described in 1893 when Franz Neuber reported the harvest of fat from a patient’s arm to fill a defect in the cheek cause by tuberculosis of the maxilla. Eugene Hollander was the first to report the use a needle and syringe to transfer fat into the face of a patient with lipoatrophy in 1912. Over the remainder of the 20th century, multiple reports emerged on the use of fat grafting as a soft tissue filler; however, these uses were associated with substantial variability in results. It was not until Sydney Coleman described a strict protocol for harvesting and injecting fat that results became more reliable. As a result, the popularity of fat grafting surged and its clinical applications diversified.

In 2007, Rigotti and colleagues described the use of autologous fat grafts to treat radiation-induced skin lesions, and showed that autologous fat grafts have the ability to improve local tissue environment in humans. They proposed that regeneration occurred owing to adipose-derived stem cells within the lipoaspirate. The usefulness of fat grafting continued to expand, and lipotransfer became recognized as a versatile medium possessing valuable mechanical and regenerative properties.

Reports began to emerge investigating the role of fat grafting for treating various types of scars, with promising results. In 2008, Klinger and colleagues published a case series of 3 patients with burns to the face who underwent fat grafting and had improvement in scar quality. Additional reports described fat grafting to various traumatic, surgical, and burn scars with improvement in scar qualities.

Many investigators noted that scar-related pain improved after fat grafting, which has led to recent interest in the use of fat grafting to treat painful scars. Fat grafting has been shown to improve symptoms in patients with painful surgical scars, traumatic scars, and postmastectomy pain syndrome. In 2016, we investigated the possible role of lipotransfer in treating neuropathic pain in burn scars and showed that adipose tissue can be safely grafted into burn scars and may improve symptoms in patients with refractory neuropathic pain after burn injury. A prospective study is currently underway to quantify the improvement in pain and quality of life that is observed after fat grafting in patients with chronic neuropathic burn scar pain.

In this article, we review the current literature on fat grafting for scars, discuss the physiology of fat grafting as it relates to management of problematic scars, present our approach for the use of fat grafting to manage painful burn scars, and elaborate on current regulatory issues surrounding autologous fat grafting.

Literature review

Over the past decade, there has been an abundance of literature published about fat grafting ( Fig. 1 ). Recognition of the beneficial effects of transferred fat on local tissue has generated interest in fat grafting for problematic scars. Recent systematic literature reviews by Negenborn and colleagues and Condé-Green and colleagues provide a detailed analysis of studies reporting the use of fat grafting for scars, including burn scars, and scar-related conditions. Table 1 provides an updated summary of the literature on fat grafting for scars and scar-related conditions. Case reports, as well as studies that use autologous fat mixed with platelet-rich plasma, enhanced with stromal vascular fraction or similarly manipulated are not included in this review.

Fig. 1
Published articles on “Fat Grafting” over time (Based on Pubmed search for “Fat Grafting”).

Table 1
Studies on autologous fat grafting for scars
Author Wound Type Design n Therapy Processing Methods Results OCEBM
Sardesai and Moore, 2007 Scars, not specified PCS 14 AFG Centrifuge Cutometer, dermaspectrometer POSAS, VSS Significant improvement in stiffness, thickness, relief, and pliability. No significant improvement in height, vascularity, pigmentation, pain, pruritis, or irregularity. III
Klinger et al, 2008 Burn scars Case series 3 AFG Not specified Clinical assessment Improvement in mimic features, skin texture, and thickness. IV
Caviggioli et al, 2010 Traumatic scars and burns PCS 24 AFG Centrifuge Clinical assessment Improved nipple projection, skin texture, softness, color, and elasticity. Improved patient satisfaction. IV
Caviggioli et al, 2011 Postmastectomy pain syndrome RCT 113 AFG (72) vs no treatment (41) Centrifuge Pain (VAS) Significant decrease in pain II
Brongo et al, 2012 Burn scars Case series 18 AFG Centrifuge Patient satisfaction questionnaire, digital photographs assessed by surgeons and independent medical observer Improved satisfaction; better texture, softness, thickness, color, and elasticity. IV
Guisantes et al, 2012 Traumatic/surgical scars Case series 8 AFG Centrifuge Clinical assessment Improvement in scars in all patient IV
Ulrich et al, 2012 Painful episiotomy scars Case series 20 AFG Centrifuge Pain (VAS, Present Pain Intensity index), sexual function (Sabbatsberg Sexual Self-Rating Scale) Significant decrease in pain and improvement in sexual function. IV
Bruno et al, 2013 Burn scars Case control 93 AFG (split scar study) Centrifuge VSS, patient questionnaires, double-blind clinical assessment Improved scar qualities. III
Khouri et al, 2013 Burn scars Case series 5 AFG Centrifuge Clinical assessment Softened scar, improved mobility, and texture. IV
Klinger et al, 2013 Burn, traumatic, surgical scars PCS/case control 694 AFG (split scar study in 20 patients) Centrifuge Clinical assessment, POSAS and durometer in 20 patients Functional and aesthetic improvement in all scars, decreased scar hardness. III
Mazzola et al, 2013 Tracheostomy scar Case series 10 AFG Centrifuge Clinical assessment Aesthetic and functional improvement in all patients. IV
Gentile et al, 2014 Burn scars PCS 30 SVF-enhanced AFG (10) vs AFG plus PRP (10) vs AFG (10) Centrifuge Preoperative and postoperative photos, clinical evaluation, MRI, US, patient self-evaluation Improved texture and softness. III
Maione et al, 2014 Postmastectomy pain syndrome PCS 88 AFG (57) vs control (35) Centrifuge Pain (VAS) Decrease in pain. III
Maione et al, 2014 Surgical scars PCS 36 AFG Centrifuge Durometer, POSAS Improvement in scar quality, pain, POSAS scores (except itching). Decreased hardness. III
Pallua et al, 2014 Traumatic/surgical scars PCS 26 AFG Centrifuge Preoperative and postoperative photographs, POSAS Improved scar quality and POSAS. III
Huang et al, 2015 Painful traumatic scars RCS 13 AFG Centrifuge Pain (VAS, NPSI) Significant decrease in VAS and NPSI score. III
Piccolo et al, 2015 Traumatic scars and burns RCS 87 AFG Centrifuge Clinical assessment Improvement in all scars IV
Byrne et al, 2016 Burn scars—Hand RCS 13 AFG Centrifuge Grip strength measurement, TAM, the DASH Questionnaire, and MHQ, POSAS Improvement in TAM measurement. The total score, activity of daily living score and satisfaction score of the MHQ also statistically increased. The changes in function score, work score, and pain score of the MHQ were not significant. Grip strength measurement and DASH score did not show improvement. Improved POSAS. IV
Fredman et al, 2016 Painful burn scars RCS 7 AFG Read Head, Puregraft Patient-Reported Outcomes Measurement Information System Improvement in scar quality. Six of 7 patients had improvement in neuropathic pain. IV
Jaspers et al, 2017 Burn, traumatic, surgical scars PCS 40 AFG Centrifuge POSAS, Cutometer, Colometer Improved elasticity, POSAS. No improvement in color. III
Juhl et al, 2016 Postmastectomy pain syndrome RCT 15 AFG (8 fat grafted, .7 controls) Centrifuge Pain (Dolotest, VAS, NPSI), POSAS Improved pain, health related QOL, scar qualities II
Mende et al, 2016 Painful finger scars RCS 16 AFG Centrifuge Pain (VAS) Improved pain. IV
Piper et al, 2016 Axillary web syndrome Case series 18 AFG Not listed Clinical assessment 30° to 40° improvement in range of motion. Decreased or eliminated pain, improved scar qualities. IV
Only gold members can continue reading. Log In or Register to continue

Nov 21, 2017 | Posted by in Dental Materials | Comments Off on Fat Grafting for Burn, Traumatic, and Surgical Scars
Premium Wordpress Themes by UFO Themes