Correction of cicatricial ectropion by autologous fat graft

Investigating the Efficacy of Modified Lipoaspirate Grafting to Improve the Appearance of Atrophic Acne Scars: A Pilot Study

BACKGROUND

Processed lipoaspirate grafting describes several techniques theorized to leverage the inflammatory and regenerative capacities of mechanically processed adipocytes to rejuvenate and correct skin pathology. Although lipoaspirate grafting is typically leveraged to fill visible defects such as depressed scars and dermal lines, additional fat processing allows grafts to stimulate mechanisms of wound healing, including the promotion of fibroblast activation, neovascularization, and neocollagenesis.

OBJECTIVES

This study intends to assess the efficacy and tolerability of processed lipoaspirate grafting monotherapy to improve the clinical appearance of atrophic acne scars.

METHODS

Patients underwent a single autologous processed lipoaspirate grafting procedure at the site of atrophic acne scars. Objective and subjective scar analysis was performed at 3 and 6 months posttreatment. Scars were assessed with standard photography, topographic analysis, and noninvasive skin measurements. In addition, microbiopsies were obtained before and after treatment to assess histological or genetic changes. Clinical improvement was assessed with patient and clinician Global Aesthetic Improvement Scales (GAIS) and blinded photographic evaluation.

RESULTS

Ten patients between ages 18 and 60 completed the study. Clinical evaluation demonstrated that fat grafting improved the appearance of atrophic acne scars. Clinician GAIS and patient GAIS scores showed clinical improvement at both 3- and 6-month follow-up compared with baseline (P < .05). Blinded clinician GAIS scores also showed statistically significant improvement when clinicians compared clinical photographs taken at 6-month follow-up to baseline (P < .0001). The attenuation coefficient increased at 6-month follow-up, suggesting collagen remodeling and reorganization over the study period. Patients experienced anticipated posttreatment symptoms including transient erythema and edema; however, no unexpected adverse events were reported.

CONCLUSIONS

Micronized lipoaspirate injection is a viable and effective option to improve the appearance of facial acne scarring. Favorable improvements in atrophic acne scarring were captured by objective analysis of skin ultrastructure as well as improvement in subjective assessments of scarring.

LEVEL OF EVIDENCE: 4

Towards the Development of a Device for Assessing the Pliability of Burn Scars

Burn injuries requires post-accident medical treatment. However, the treatment of burns does not end with first aid because scarred skin must be managed for many years, and in some circumstances, for life. The methods used to evaluate the state of a burn scar based, for instance, on Patient and Observer Scar Assessment Scale or similar ones, often lacks in univocally assessing the scarred skin’s state of health. As a result, the primary aim of this research is to design and build a prototype that can support the doctor during scar assessment, and eventually therapy, by providing objective information on the state of the lesion, particularly the value of skin pliability. The developed tool is based on the depressomassage treatment probe named LPG, currently used to treat burn scars in a number of hospitals. It consists of a non-invasive massage technique using a mechanical device to suction and mobilize scar tissue and is used as a post-operative treatment to speed up the healing process to make the mark of the scar less visible. The prototype is specifically designed to be manufactured using Additive Manufacturing and was validated comparing its performances against the ones of a certified instrument (i.e., the Romer Absolute ARM with RS1 probe). Validation was carried out by designing and developing a tool to put the RS1 probe in the same measurement conditions of the new prototype probe. Tests performed to assess the performance of the devised prototype show that the probe developed in this work is able to provide measurements with a sufficient degree of accuracy (maximum error ±0.1 mm) to be adopted for a reliable estimation of the pliability value in a hospital environment.

Autologous Fat Grafting in Plastic and Reconstructive Surgery: An Historical Perspective

Autologous fat grafting (AFG or lipofilling) is a common technique used in plastic and reconstructive surgery that involves the transfer of autologous fat tissue from one region of the body to another. The indications and techniques of AFG have changed dramatically over the years. We recount the historic milestones to the current state.

Secondary Treatment of Cleft Lip Correction Sequelae With Percutaneous Needleotomy, Autologous Fat Grafting, and Local Flaps: An Integrated Approach

INTRODUCTION

Cleft lip and/or palate (CL/P) is the most common congenital craniofacial malformation. The severity of the anatomic deformity is highly variable and different techniques can be employed depending on whether the defect is unilateral or bilateral, complete or incomplete. Patients usually undergo multiple steps of reconstruction throughout childhood and adolescence and, for this reason, secondary deformities of the nasolabial region of the midface may ensue. Considering our experience in the treatment of scars, we opted to correct the cleft lip surgery sequelae not only with local flaps/scar revisions, but we decided to add the use of the autologous fat grafting (AFG) to induce a regenerative effect in these young patients.

MATERIALS AND METHODS

In this study we present the results obtained from a series of 12 consecutive Caucasian patients aged from 23 to 44 years with widened paramedian lip scars secondary to cleft lip reconstruction surgery, treated with a combination of needle-induced lysis of the scar tissue and AFG from January 2013 to December 2018.

RESULTS

After the procedure we observed an overall improvement in the quality of the scar tissue, in the function of mimic features, in the symmetry and cosmetics of the lower third of the nose. Patients' satisfaction was excellent. Results were long lasting and remained virtually unchanged after 1 year of follow-up.

CONCLUSIONS

Scar release by needle, AFG and local flaps are excellent tools for the treatment of cleft lip correction sequelae, but the combination of these surgical techniques can lead to even better results.Level of Evidence: Level V.

Hepatocyte Growth Factor Secreted from Human Adipose-Derived Stem Cells Inhibits Fibrosis in Hypertrophic Scar Fibroblasts

AIMS

To study the effect of Adipose-derived stem cells (ADSCs) on fibrosis of hypertrophic scar-derived fibroblasts (HSFs) and its concrete mechanism.

BACKGROUND

ADSCs have been reported to reduce collagen production and fibroblast proliferation in co-culture experiments. Conditioned medium from adipose-derived stem cells (ADSCs-CM) has successfully inhibited fibrosis by decreasing the expression of collagen type І (Col1) and α-smooth muscle actin (α-SMA) in rabbit ear scar models. Hepatocyte growth factor (HGF), the primary growth factor in ADSCs-CM, has been shown to reverse fibrosis in various fibrotic diseases.

OBJECTIVE

To test the hypothesis that ADSCs inhibit fibrosis of HSFs through the secretion of HGF.

METHODS

HSFs were treated with DMEM containing 0%, 10%, 50% and 100% concentration of ADSCs-CM. The effect of ADSCs-CM on the viability was determined by cell viability assay, and the collagen production in HSFs was examined by Sirius red staining. Expression and secretion of fibrosis and degradation proteins were detected separately. After measuring the concentration of HGF in ADSCs-CM, the same number of HSFs were treated with 50% ADSCs-CM or HGF. HGF activity in ADSCs-CM was neutralized with a goat anti-human HGF antibody.

RESULTS

The results demonstrated that ADSCs-CM dose-dependently decreased cell viability, expression of fibrosis molecules, and tissue inhibitor of metalloproteinases-1 (TIMP-1), and significantly increased matrix metalloproteinase-1 (MMP-1) expression in HSFs. Collagen production and the ratio of collagen type І and type III (Col1/Col3) were also suppressed by ADSCs-CM in a dose-dependent manner. When HSFs were cultured with either 50% ADSCs-CM or HGF (1 ng/ml), a similar trend was observed in gene expression and protein secretion. Adding an HGF antibody to both groups returned protein expression and secretion to basal levels but did not significantly affect the fibrosis factors in the control group.

CONCLUSION

Our findings revealed that adipose-derived stem cell-secreted HGF effectively inhibits fibrosis-related factors and regulates extracellular matrix (ECM) remodeling in hypertrophic scar fibroblasts.

The antifibrotic adipose-derived stromal cell: Grafted fat enriched with CD74+ adipose-derived stromal cells reduces chronic radiation-induced skin fibrosis

Fat grafting can reduce radiation‐induced fibrosis. Improved outcomes are found when fat grafts are enriched with adipose‐derived stromal cells (ASCs), implicating ASCs as key drivers of soft tissue regeneration. We have identified a subpopulation of ASCs positive for CD74 with enhanced antifibrotic effects. Compared to CD74− and unsorted (US) ASCs, CD74+ ASCs have increased expression of hepatocyte growth factor, fibroblast growth factor 2, and transforming growth factor β3 (TGF‐β3) and decreased levels of TGF‐β1. Dermal fibroblasts incubated with conditioned media from CD74+ ASCs produced less collagen upon stimulation, compared to fibroblasts incubated with media from CD74− or US ASCs. Upon transplantation, fat grafts enriched with CD74+ ASCs reduced the stiffness, dermal thickness, and collagen content of overlying skin, and decreased the relative proportions of more fibrotic dermal fibroblasts. Improvements in several extracellular matrix components were also appreciated on immunofluorescent staining. Together these findings indicate CD74+ ASCs have antifibrotic qualities and may play an important role in future strategies to address fibrotic remodeling following radiation‐induced fibrosis.

Histological Evaluation of the Skin After Fat Grafting: A Blinded, Randomized, Controlled Clinical Study

BACKGROUND

Autologous fat graft is often employed to treat body contour defects. There is currently increased interest in the regenerative properties of fat grafting.

OBJECTIVES

The authors evaluated the histological changes of fat grafting in a blinded randomized controlled trial of staged fat grafting-abdominoplasty.

METHODS

Ten women between 24 and 55 years of age with a body mass index <30 kg/m2 and previous cesarean scar were submitted to fat grafting followed by staged abdominoplasty. The C-section scar served as a landmark for standardization of fat grafting site and control. One side of the abdomen was fat grafted and the other was left intact (control). At the time of abdominoplasty, 4 months later, a full-thickness skin sample from each hemi abdomen (fat-grafted area and control) was collected and sent to histological analysis.

RESULTS

All of the fat-grafted samples showed extracellular lipids and signs of fat graft viability, whereas no such changes occurred in the control group. There were no statistically significant differences in fat-grafted vs control samples regarding skin inflammatory infiltrate (P = 0.582), dermis thickness (P = 0.973), vascular density (P = 0.326), and amount of elastic fibers (P = 1).

CONCLUSIONS

The histological evaluation of women's abdominoplasty surgical site skin after 4 months of fat grafting showed signs of fat graft in 100% of the grafted sides but no change in skin inflammatory infiltrate, dermis thickness, vascularity density, or elastic fiber quantity.

Approach to treatment of cicatricial ectropion: a systematic review and meta-analysis comparing surgical and minimally invasive options

Cicatricial ectropion can involve the skin, subcutaneous tissue, muscle, and septum to result in chronic tearing and keratopathy. Surgery involving the orbital rim or eyelid is a common cause. Minimally invasive techniques may provide alternative options for correction, but the comparative benefit to surgery is unknown. To compare the efficacy of surgical and minimally invasive minimally invasive treatment options for cicatricial ectropion. A comprehensive literature search of Medline, EMBASE, and the Cochrane Library published from 1960 to August 2019 was performed for studies that described any treatment of cicatricial ectropion. 1391 studies were found, of which 31 had extractable data for 299 patients. Pooling of outcome data occurred for the primary and secondary outcomes. The complete and partial response rates to treatment (primary outcomes) as well as the recurrence rate and physician global assessment of cosmesis (secondary outcomes) were analyzed. Surgical correction resulted in complete correction in 79% of patients compared to 63% of hyaluronic acid treated patients. Hyaluronic acid injection had a better aesthetic outcome, but a higher recurrence rate overall. Hyaluronic acid filler with a high G' along with delayed dissolution trended toward a lower recurrence rate. Other minimally invasive treatments had little data. The literature found was limited to mostly single-center, observational studies. Hyaluronic acid may be a viable alternative for cicatricial ectropion in those patients who cannot undergo surgery. Further prospective studies are required to routinely recommend minimally invasive techniques.

Adipose-Derived Tissue in the Treatment of Dermal Fibrosis: Antifibrotic Effects of Adipose-Derived Stem Cells

Treatment of hypertrophic scars and other fibrotic skin conditions with autologous fat injections shows promising clinical results; however, the underlying mechanisms of its antifibrotic action have not been comprehensively studied. Adipose-derived stem cells, or stromal cell-derived factors, inherent components of the transplanted fat tissue, seem to be responsible for its therapeutic effects on difficult scars. The mechanisms by which this therapeutic effect takes place are diverse and are mostly mediated by paracrine signaling, which switches on various antifibrotic molecular pathways, modulates the activity of the central profibrotic transforming growth factor β/Smad pathway, and normalizes functioning of fibroblasts and keratinocytes in the recipient site. Direct cell-to-cell communications and differentiation of cell types may also play a positive role in scar treatment, even though they have not been extensively studied in this context. A more thorough understanding of the fat tissue antifibrotic mechanisms of action will turn this treatment from an anecdotal remedy to a more controlled, timely administered technology.

Correction of cicatricial ectropion using non-ablative fractional laser resurfacing

Lower eyelid malposition is the most frequent and severe complication after blepharoplasty and ectropion is observed in 1% of patients after surgery. This article describes a non-surgical method to treat lower eyelid cicatricial ectropion using a non-ablative laser as an alternative to surgery. Twelve patients with unilateral or bilateral lower lid cicatricial ectropion, following surgery or trauma, underwent laser therapy from 2012 to 2016. Laser therapy was performed with a fractional non-ablative laser emitting at a wavelength of 1540 nm. Ten patients had a full correction of their ectropion and two patients had a partial recovery after laser therapy at 6-month follow-up visit. No serious adverse events were reported. Non-ablative fractional laser resurfacing can successfully treat cicatricial ectropion by remodeling the periocular scar tissue and improving the scar texture, and as such may be considered as a valuable alternative to surgery in selected patients.

Lagophthalmos caused by cicatricial adhesion of orbital adipose tissue to orbital roof: A case report

Purpose

To report a case of lagophthalmos caused by cicatricial adhesion of orbital adipose tissue to the orbital roof.

Observations

A 23-year-old female was presented with right lagophthalmos. Five months prior to consult at our clinic, she suffered from a penetrating trauma to the frontal lobe of the brain through the right orbital roof with cerebrospinal fluid leakage. Decompressive craniectomy was performed immediately after the injury using a coronal incision, which was followed by reconstruction with an artificial bone 1 month later. On examination at our clinic, she showed right exposure keratopathy with best corrected visual acuity of 20/100 due to corneal opacity. The palpebral contracted scar was first elongated using Z-plasty technique but excursion of the upper eyelid under a finger force assistance was insufficient to eliminate lagophthalmos. However, complete eyelid closure under a finger force assistance was achieved after sharp dissection of the cicatrized adipose tissue from the orbital roof. An autogenous dermis-fat was grafted on the orbital roof and superior orbital rim to avoid adhesion of orbital adipose tissue onto the bone again.

Conclusion and importance

Cicatricial adhesion of an orbital adipose tissue to the orbital roof is one of the possible causes of posttraumatic lagophthalmos in patients with an orbital roof fracture. Surgeons need to be aware of this condition in planning of surgical repair when such a fracture is encountered.

Comparison of Efficacy and Complications Among Various Spacer Grafts in the Treatment of Lower Eyelid Retraction: A Systematic Review

BACKGROUND

Lower eyelid retraction is a difficult problem to treat, but it is a prevalent condition and a common complication of blepharoplasty. The use of spacer grafts to increase eyelid height and improve symptoms has been described for a long time, but the optimal choice of spacer graft material is unknown.

OBJECTIVES

The authors reviewed the currently available evidence to determine the best available spacer graft material in terms of efficacy and complications.

METHODS

A systematic review of all available literature published between 1985 and the present was performed using the Pubmed, Ovid MEDLINE, and Cochrane library databases. Inclusion criteria were that the studies contain original content assessing the treatment of lower eyelid retraction in humans using a spacer graft and provide quantitative outcomes data.

RESULTS

One hundred and twelve articles were reviewed following an initial screen using titles, and 19 articles were chosen for inclusion in this systematic review. Analysis of these articles revealed no spacer graft material that is clearly superior to others.

CONCLUSIONS

Due to a lack of high quality evidence, this review did not reveal one spacer graft material that is clearly superior to others. However, a narrative summary of the available evidence reveals unique sets of advantages and disadvantages associated with the various materials currently available. Further research in the form of well-designed studies will be necessary to further clarify advantages of certain spacer graft materials over others.

LEVEL OF EVIDENCE

5.

Evidence-Based Scar Management: How to Improve Results with Technique and Technology

BACKGROUND

Scars represent the visible sequelae of trauma, injury, burn, or surgery. They may induce distress in the patient because of their aesthetically unpleasant appearance, especially if they are excessively raised, depressed, wide, or erythematous. They may also cause the patient symptoms of pain, tightness, and pruritus. Numerous products are marketed for scar prevention or improvement, but their efficacy is unclear.

METHODS

A literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae was performed. The evidence from these articles was analyzed to generate recommendations. Each intervention's effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention.

RESULTS

For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, CO2 laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy. No intervention seems to have significant efficacy in the prevention or treatment of striae distensae.

CONCLUSION

Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.

Autologous fat grafting for scars, healing and pain: a review

INTRODUCTION

Current guidelines suggest a multimodal approach to treating scars but there is no gold standard for treatment; however, there is exciting therapeutic potential for the use of autologous fat grafting (AFG). Functional and aesthetic improvements have been reported, including pain relief and scar quality improvement.

AIMS

To explore the current evidence regarding the use of AFG in hypertrophic and painful scars.

METHODS

A systematic review of the literature was conducted using 11 MeSH terms in PubMed, Medline and EMBASE. English studies that used AFG to treat scars in human participants were included.

RESULTS

A total of 746 studies were found and 23 studies (from 2008 to 2016) were included: five studies were evidence level V; nine studies were evidence level IV; eight were evidence level III; and one study was evidence level II. A total of 1158 patients were assessed for improvement in scar characteristics including colour, thickness, volume, pain and restoration of function at affected sites, following treatment. Positive outcomes were noted for all parameters and a significant improvement in AFG's analgesic effect was recorded in 567 out of 966 patients, P < 0.05.

DISCUSSION

AFG is a minimally invasive and safe approach to treating scars, a promising alternative to surgical excision. The technique of blunt cannula insertion optimises the release of scar retraction, which contributes to the analgesic effect of this treatment method. The evidence supports current theories of mesenchymal stem cell's regenerative and anti-inflammatory properties responsible for scar healing. There are limited high quality studies to support its use and future randomised controlled trials should be conducted.

Eyelid fat grafting: Indications, operative technique and complications; a systematic review

INTRODUCTION

Many recent studies concerning autologous fat grafting in the eyelids have been published, mostly consisting of case reports and retrospective case series. However, no study on the overall complication or satisfaction rate associated with the various grafting techniques exists. We performed a comprehensive literature review to determine the outcomes and complications of eyelid fat grafting, as well as patient satisfaction.

METHODS

A systematic review of the literature using the PRISMA criteria was conducted. This protocol was registered at the Prospective Register of Systematic Reviews at the National Institute for Health Research.

RESULTS

Sixteen studies, representing 1,159 patients and published between June 2004 and December 2014, were included. Satisfactory results, judged by clinical examination, were observed in all studies. Few postoperative complications were reported.

CONCLUSIONS

We demonstrated that the procedures were easy to perform, and achieved satisfactory and sustainable results with few complications in both reconstructive and cosmetic surgery. However, a wide disparity exists in the various fat harvesting, fat purification, and reinjection techniques. Further studies are required to assess the long-term outcomes. Our conclusions should be accepted cautiously due to the small number of articles and the lack of evidence in published studies.

Early experience with fat grafting as an adjunct for secondary burn reconstruction in the hand: Technique, hand function assessment and aesthetic outcomes

INTRODUCTION

Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in secondary burn reconstruction. The aim of this study was to review our experience with autologous fat transfer in relation to hand function, scarring and cosmesis, in patients undergoing secondary reconstruction after burns.

METHOD

Retrospective analysis of burn patients (2010-2013) who underwent autologous fat transfer to improve scarring, contour deformity and/or scar contracture was performed. Hand function was assessed using grip strength measurement, Total Active Movement (TAM), the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Patients' satisfaction was assessed using the Patient Observer Scar Assessment Scale (POSAS).

RESULTS

Thirteen patients were included in this analysis. The average time from burns and from fat transfer were 2.3 years (10 months-3.9 years) and 9.1 months (3 months-1.3 years), respectively. There was a statistically significant improvement in TAM measurement. The total score, activity of daily living score and satisfaction score of the MHQ also statistically increased following fat transfer. 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. For scar assessment, total score and overall score of POSAS improved significantly. Similarly, scores for scar colour, scar thickness, scar stiffness and scar regularity increased significantly.

DISCUSSION

Autologous fat transfer directly replaces volume loss in the subcutaneous layer, physically releases tethered skin from underlying tissues and exerts downstream regenerative effects. Skin quality improvements combined with replacement of the subcutaneous adipose volume in the hand reduces overall scar tightness and tissue tethering and has the potential to enhance hand therapy. In our series, modest improvement in range of movement, scar quality and hand outcome scores were demonstrated following a single session of fat transfer.

Autologous fat graft in scar treatment

INTRODUCTION

Regenerative medicine is an emerging and rapidly evolving field of research and therapy, thanks to new discoveries on stem cells. Adipose tissue is a connective tissue which contains a reserve of mesenchymal stem cells. Clinical improvements in trophic characteristics of teguments after autologous fat graft are well described in literature. In this paper, we present our observation after 6 years of autologous fat graft experience in scar remodeling.

MATERIALS AND METHODS

All patients recruited had retractile and painful scars compromising the normal daily activity/mobility of the joint involved. We performed surgical procedure with Coleman technique. In 20 patients, we performed a clinical assessment using Patient and Observer Scar Assessment Scale (POSAS) and Durometer measurements.

RESULTS

In all treated scars, a qualitative improvement was shown both from an aesthetic and functional point of view. Most importantly, reduction or complete resolution of pain and increases in scar elasticity were objectively assessable in all cases. In patients studied using Durometer and POSAS score, areas treated with autologous fat graft showed statistically significant reduction in hardness measurements in comparison with areas infiltrated with saline solution. POSAS scores showed a statistically significant reduction of a great deal of POSAS parameters as a result of an improvement of both clinical evaluation and patient perception.

CONCLUSIONS

Injection of processed autologous fat seems to be a promising and effective therapeutic approach for scars with different origin such as burns and other trauma scars, and post-surgery and radiotherapy outcomes. In general, we can affirm that treated areas regain characteristics similar to normal skin, which are clinically objectivable, leading not only to aesthetic but also functional results.

Autologous fat graft as treatment of post short stature surgical correction scars

INTRODUCTION

Surgical limb lengthening is undertaken to correct pathological short stature. Among the possible complications related to this procedure, painful and retractile scars are a cause for both functional and cosmetic concern. Our team has already shown the efficacy of autologous fat grafting in the treatment of scars with varying aetiology, so we decided to apply this technique to scars related to surgical correction of dwarfism. A prospective study was conducted to evaluate the efficacy of autologous fat grafting in the treatment of post-surgical scars in patients with short-limb dwarfism using durometer measurements and a modified patient and observer scar assessment scale (POSAS), to which was added a parameter to evaluate movement impairment.

PATIENTS AND METHODS

Between January 2009 and September 2012, 36 children (28 female and 8 male) who presented retractile and painful post-surgical scars came to our unit and were treated with autologous fat grafting. Preoperative and postoperative mean durometer measurements were analysed using the analysis of variance (ANOVA) test and POSAS parameters were studied using the Wilcoxon rank sum test.

RESULTS

There was a statistically significant reduction in all durometer measurements (p-value <0.05) and in all but one of the POSAS parameters (p-value <0.05) following treatment with autologous fat grafting.

DISCUSSION

Surgical procedures to camouflage scars on lower limbs are not often used as a first approach and non-surgical treatments often lead to unsatisfactory results. In contrast, our autologous fat grafting technique in the treatment of post-surgical scars has been shown to be a valuable option in patients with short-limb dwarfism.

CONCLUSION

There was a reduction of skin hardness and a clinical improvement of all POSAS parameters in all patients treated. Moreover, the newly introduced POSAS parameter appears to be reliable and we recommend that it is included to give a more complete evaluation of patient perception.

Comparison of cell number, viability, phenotypic profile, clonogenic, and proliferative potential of adipose-derived stem cell populations between centrifuged and noncentrifuged fat

BACKGROUND

Autologous fat grafting is a widely adopted surgical technique in both the reconstructive and aesthetic fields. This study aimed to compare centrifuged lipoaspirates harvested and refined by the Coleman technique with noncentrifuged lipoaspirates in terms of cell number and viability, phenotypic profile, and clonogenic and proliferative potential of adipose-derived stem cell (ADSC) populations.

METHODS

For each patient, both a centrifuged sample using the Coleman's technique and a noncentrifuged sample of adipose tissue were collected. Adipose-derived stem cells from both the centrifuged fraction (CF) and the noncentrifuged fraction (NCF) were isolated. The recovered ADSCs were used to set up flow cytometry analysis, colony-forming units-fibroblast (CFU-F) assays, and ADSC cultures.

RESULTS

The number of recovered cells was variable among the different donors but significantly higher in the CF donors. Cell viability, determined by the Trypan Blue dye assay, always exceeded 95 %, in both the CF and NCF fractions. Analysis of the putative ADSC subpopulations showed a significant enrichment of the mesenchymal and endothelial progenitors in CF compared with NCF. No differences in the clonogenic efficiency of the ADSC samples were observed when the same number of cells were plated from each fraction. On the contrary, when equal fat volumes were compared, the colony-forming ability of CF was always significantly higher than that of its NCF counterparts.

CONCLUSIONS

This is the first study to comprehensively characterize the impact of Coleman's technique on the quality of lipoaspirates, showing that centrifugation is safe and feasible and does not impair cell viability, can augment the content in ADSC and the frequency of CFU-F, and reduces the number of proinflammatory blood cells.

Comparing calvarial transport distraction with and without radiation and fat grafting

The purpose of this study is to: a) assess transport distraction to reconstruct cranial defects in radiated and non-radiated fields b) examine adipose grafting's effect on the bony regenerate and overlying wound, and c) elucidate sources of bone formation during transport distraction osteogenesis. Twenty-three male New Zealand white rabbits (3 months; 3.5 kg) were used, 10 non-irradiated and 13 irradiated (17 treatment, 6 control) with a one-time fraction of 35 Gy. A 16 × 16 mm defect was abutted by a 10 × 16 mm transport disc 5 weeks after irradiation, and 11 animals were fat grafted at the distraction site. Latency (1 day), distraction (1.5 mm/day), and consolidation (4 weeks) followed. Fluorochromes were injected subcutaneously and microCT, fluorescence, and histology assessed. In distracted animals without fat grafting, bone density measured 701.87 mgHA/ccm and 2271.95 mgHA/ccm in irradiated and non-irradiated animals. In distracted animals with fat grafting, bone density measured 703.23 mgHA/ccm and 2254.27 mgHA/ccm in irradiated and non-irradiated animals. Fluorescence revealed ossification emanating from the dura, periosteum, and transport segment with decreased formation in irradiated animals. Transport distraction is possible for cranial reconstruction in irradiated fields but short-term osseous fill is significantly diminished. Adipose grafting enhances wound healing in previously irradiated fields but does not enhance ossification.

Free transplantation of autogenous palmaris longus tendon in the repair of cicatricial ectropion of lower eyelid

Treatment of cicatricial lower eyelid ectropion is often difficult and requires surgical intervention. Numerous techniques have been developed over the years to treat the cicatricial lower eyelid ectropion. This article describes an effective surgical technique using the free transplantation of autogenous palmaris longus tendon in the repair of cicatricial lower eyelid ectropion. The operation was performed with the patient under local anaesthesia. After the contracture of the lower eyelid skin or conjunctiva had been thoroughly released, a palmaris longus tendon graft was obtained through small transverse incisions along the non-dominant forearm. The graft is suspended between the medial canthal ligament and lateral orbital rim with proper tension. Then a local skin flap was transferred to cover the wound at the lower eyelid. In this study, 15 patients were treated using autogenous palmaris longus tendon between December 2008 and October 2012. At the 9-18 months of follow-up assessment, there were no major complications reported with any of the cases, and all have achieved good function and satisfactory appearance of the lower eyelid. However, five patients (33%) still had lagophthalmos, but it was in remission. In conclusion, free transplantation of autogenous palmaris longus tendon in the repair of cicatricial ectropion of the lower eyelid is an effective procedure for cicatricial ectropion, the functional and cosmetic results were satisfactory, the recurrence rate is low. Especially for the moderate and severe ectropion this method is a good choice.

Three-dimensional volumetric restoration by structural fat grafting

The use of adipose tissue transfer for correction of maxillofacial defects was reported for the first time at the end of the 19th century. Structural fat grafting (SFG) was introduced as a way to improve facial esthetics and in recent years has evolved into applications in craniomaxillofacial reconstructive surgery. Several techniques have been proposed for harvesting and grafting the fat. However, owing to the damage of many adipocytes during these maneuvers, the results have not been satisfactory and have required several fat injection procedures for small corrections. The author's (L.C.) overview the application of SFG in the management of volumetric deficit in the craniomaxillofacial in patients treated with a long-term follow-up.

Treatment of chronic posttraumatic leg injury using autologous fat graft

We present the results obtained in a case of a 20-year-old Caucasian woman with a posttraumatic injury “hard-to-heal” of the left leg treated using autologous fat graft. Considering our experience in treatment of chronic posttraumatic ulcers by autologous fat graft, we decided to use this surgical technique to induce a regenerative effect in this young patient. We have had complete wound closure with only a single surgical procedure after 1 month; after the second intervention of autologous fat graft we observed an improvement in the quality of the scar tissue. The patient satisfaction was excellent. The results were long lasting and remained virtually unchanged after 1 year.

Fat grafting's past, present, and future: why adipose tissue is emerging as a critical link to the advancement of regenerative medicine

Fat grafting is a common reconstructive and aesthetic procedure with extensive clinical applications. Recently, significant strides have been made in investigating the biology behind the success of this procedure. Surgeons and scientists alike have advanced this field by innovating fat graft harvesting and injection techniques, expanding the use of adipose tissue and its stem cell components, and broadening our understanding of the viability of fat grafting at the molecular and cellular levels. The objectives of this review are to (1) discuss the clinical applications of fat grafting, (2) describe the cellular biology of fat and the optimization of fat graft preparation, (3) illustrate the significance of adipose-derived stem cells and the potentiality of fat cells, (4) highlight the clinical uses of adipose-derived stem cells, and (5) explore the current and future frontiers of the study of fat grafting. Although collaborative knowledge has increased exponentially, many of the biological mechanisms behind fat grafting are still unknown. Plastic surgeons are in a unique position to pioneer both the scientific and clinical frontiers of fat grafting and to ultimately further this technology for the benefit of our patients.

Staged reconstruction of the lower eyelid following tri-lamellar injury: a case series and anatomic study

PURPOSE

Lower eyelid scaring and malposition following violation of all three lamellae pose a significant ophthalmologic reconstructive challenge. The purpose of our study was to document a staged approach for this problem using: 1) transconjunctival scar release followed by palatal graft below the tarsal plate and subciliary scar release followed by full-thickness skin graft superficial to the tarsal plate and 2) subsequent autologous fat grafting to the lower eyelid.

METHODS

Cadaveric anatomic dissections were performed. Post-traumatic and post-surgical lower eyelid deformities requiring reconstruction were reviewed and outcome assessment was based on symptomatic improvement, perioperative complications, reoperations and long-term follow-up (> 1 year).

RESULTS

Cadaver dissections demonstrated consistent lower eyelid tarsal plate and lamellar anatomy for the use of palatal graft and skin grafting. Clinically, 75% cases resulted from full thickness traumatic laceration of the lower eyelid or malar region and 25% of cases occurred after transconjunctival incisions were made for zygomatic maxillary repositioning following partial lower eyelid laceration. Preoperative symptoms of: epiphora, tearing, redness, blurry vision and dryness improved in all patients and complete resolution was seen in 63% of patients. Thirty-seven percent of patients had complications: Redundancy of palatal graft, Partial FTSG loss, cellulitis after fat transfer.

CONCLUSIONS

We describe an approach for the scarred and displaced lower eyelid following injury to all three lamellae that provided symptomatic improvement after lower lid scar tissue release, lengthening of the contracted septum, support of the posterior lamellae with a palatal graft and a replacement of anterior lamella with full thickness skin graft.

Breast fistula repair after autologous fat graft: a case report

We report the case of a 55-year-old female patient who attended our clinic for the presence of a scar retraction in the upper pole of the left breast as a complication of breast augmentation. In the scar area, we observed an orifice that probing revealed to be a fistula. The patient was referred to surgical intervention under general anesthesia to obtain scar contracture release using autologous fat graft; one month after autologous fat injection, following healing of the fistula, the patient underwent a second surgical procedure to replace the left breast implant. Unexpectedly, two weeks after the surgical procedure, complete healing of the breast fistula within the scar area was observed; this observation was confirmed during the second surgical step for left breast implant repositioning, when we observed the absence of the fistula orifice in the breast implant cavity. Upon clinical examination at 1-year followup, tissue integrity was preserved. The patient's satisfaction was excellent. We have observed a possible additional effect of fat graft.

Effects of a new centrifugation method on adipose cell viability for autologous fat grafting

The use of adipose tissue transfer in plastic and reconstructive surgery is not new and has been studied extensively. Due to different results with regard to adipose cell damage and the level of survival of the transferred tissue in clinical practice, the authors aimed to investigate the effects of centrifugation on fat aspirates to optimize the centrifugal force for fat transplantation and to obtain an increased number of intact adipose progenitor cells. The following different centrifugation forces were evaluated in vitro in terms of fat decantation: 3,000 rpm (1,500×g), 1,300 rpm (250×g), and 500 rpm (50×g). Moreover, the density level, morphology of fat cells, cell viability, and progenitor cell number also were evaluated. Centrifugation leads to a good fat tissue density, with a significant number of progenitor cells, and efficiently removes the liquid portion. High centrifugal forces (at 3,000 rpm) caused significant damage to fat cells with low cell viability, whereas very low centrifugal forces (at 500 rpm) showed little effect on adipose tissue density, resembling fat decantation. Fat aspirates, withdrawn from 30 healthy donors in vivo, were centrifuged at different rotations per minute (rpm), as follows. For the 10 patients in group A, Coleman's technique was used with a centrifugation of the aspirated fat at 3,000 rpm (1,500×g) for 3 min. For the 10 patients in group B, the authors' technique was used, with centrifugation of the aspirated fat at 1,300 rpm (250×g) for 5 min. For the 10 patients in group C, simple decantation of fat was used. In conclusion, a centrifugal force of 1,300 rpm resulted in better density of adipose tissue, with good cell viability and increased ability to preserve a significant number of progenitor cells.