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Klinger M, Giannasi S, Bandi V, Veronesi A, Maione L, Lisa A, Battistini A, Caviggioli F, Klinger F, Vinci V. Update on "Fat Injection for Cases of Severe Burn Outcomes: A New Perspective of Scar Remodeling and Reduction". Aesthetic Plast Surg 2020; 44:1283-1285. [PMID: 32766903 DOI: 10.1007/s00266-020-01775-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Marco Klinger
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy.
| | - Silvia Giannasi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Valeria Bandi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Alessandra Veronesi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Luca Maione
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Andrea Lisa
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Andrea Battistini
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, 20090, Rozzano, MI, Italy
| | - Fabio Caviggioli
- Plastic Surgery Unit, MultiMedica Holding S.p.A., Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Sesto San Giovanni, Milan, Italy
| | - Francesco Klinger
- Plastic Surgery Unit, MultiMedica Holding S.p.A., Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Sesto San Giovanni, Milan, Italy
| | - Valeriano Vinci
- Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
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Cuomo R, Giardino FR, Nisi G, Han J, Diluiso G, Tresoldi MM, Pieretti G, Brandi C, Grimaldi L. Fat graft for reducing pain in chronic wounds. Wound Repair Regen 2020; 28:780-788. [PMID: 32706138 DOI: 10.1111/wrr.12846] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Chronic wounds are one of the most important challenge for regenerative surgery. Plastic surgeon can use fat graft to increase wound healing because its growth factors can enhance tissue regeneration. In a recent study, the authors evaluated a reduction of pain in a cohort of patients submitted to breast reconstruction with breast implant and lipofilling, putting into evidence that growth factors in fat graft can reduce post-surgical pain. The aim of this work is to evaluate ultra-filtered fat graft potential in reducing pain in chronic wounds. PATIENTS AND METHODS Fifty new patients with chronic wounds of different etiology were recruited for this study and divided into two groups: A, treatment and B, control. Twenty-five patients per group. Negative pressure therapy dressing was applied after surgical debridement. Three days later patients in group A received ultrafiltered fat graft. Pain was evaluated with preoperative Visual Analogic Scale, repeated twice a day for 14 days and finally 21 days from procedures. RESULTS In group A (treated patients), pain was lower. These data were confirmed even after 7 days. The overall statistical analysis of the average of all values (SD 1.72) confirmed that the differences were significant at the 95% with the Chi-square test and analysis of variance (P value < .05). CONCLUSIONS The ultra-filtered fat graft placed on the wound bed and edges was effective in reducing pain in chronic wounds. The reduction of pain was statistically significant.
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Affiliation(s)
- Roberto Cuomo
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Francesco R Giardino
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Jingjian Han
- Jining First People's Hospital, Jining Medical University, Jining city, China
| | - Giuseppe Diluiso
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco M Tresoldi
- Plastic and Reconstructive Surgery Unit, Maugeri Clinic Scientific Institutes, Pavia, Italy.,Plastic and Reconstructive Surgery, Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Gorizio Pieretti
- Multidisciplinary Department of Medical and Dental Specialties, University "Luigi Vanvitelli"-Plastic Surgery Unit, Naples, Italy
| | - Cesare Brandi
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Grimaldi
- S. Maria Alle Scotte Hospital, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Reinisch KB, Zuk G, Raptis DA, Bueter M, Guggenheim M, Stasch T, Palma AF. Autologous lipotransfer for bone defects secondary to osteomyelitis: A report of a novel method and systematic review of the literature. Int Wound J 2019; 16:916-924. [PMID: 30916475 DOI: 10.1111/iwj.13119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022] Open
Abstract
Autologous bone grafting is the gold standard in patients with bone defects but is associated with significant pain and donor site morbidity. Autologous lipotransfer (fat grafting or lipofilling) has become very popular in the therapy of chronic wounds. Mesenchymal stem cells from adipose tissue are known for their regenerative, reparative, and immunomodulatory effects. This case study and review evaluates the use of autologous lipotransfer for chronic osteomyelitis in a 26-year-old patient. A 26-year-old female suffering from chronic tibial osteomyelitis was initially treated with surgical debridement and antibiotics followed by lipoharvest and autologous lipofilling. MRI and computed tomography scans were performed at 2 and 6 weeks and 6 months postoperatively. A formal systematic review of clinical trials investigating autologous lipotransfer for osteomyelitis was conducted. The patient remained asymptomatic without recurrence, and the bone defect cavity showed vascularised adipose tissue after 6 weeks, with early signs of osteogenesis. The highest foot and ankle disability index was 100. The systematic review identified 266 studies after duplicates were removed. After screening for eligibility, seven manuscripts were further assessed, with none meeting the inclusion criteria. This is the first study to report the successful use of autologous lipotransfer with early signs of osteogenesis in a patient suffering from chronic osteomyelitis. Autologous lipotransfer is relatively simple, safe, and minimally invasive, making it a potential alternative to current treatments. Further research is required to assess the safety, feasibility, and efficacy of autologous fat grafting and the mechanism of osteogenesis.
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Affiliation(s)
- Katharina B Reinisch
- Department of General Surgery and Traumatology, GZO Spital Wetzikon, Wetzikon, Switzerland
| | - Grzegorz Zuk
- Department of General Surgery and Traumatology, GZO Spital Wetzikon, Wetzikon, Switzerland
| | - Dimitri A Raptis
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Merlin Guggenheim
- Department of Hand Surgery and Plastic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Tilman Stasch
- Private Practice in Plastic und Hand Surgery, Valentis Clinic, Nairobi, Kenya
| | - Adrian F Palma
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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Smith OJ, Kanapathy M, Khajuria A, Prokopenko M, Hachach-Haram N, Mann H, Mosahebi A. Systematic review of the efficacy of fat grafting and platelet-rich plasma for wound healing. Int Wound J 2018; 15:519-526. [PMID: 29745047 DOI: 10.1111/iwj.12892] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/31/2017] [Indexed: 12/17/2022] Open
Abstract
Adipose-derived stem cells found in fat grafts may have significant healing properties. When fat is combined with autologous platelet-rich plasma (PRP), there may be enhanced healing effects due to the pro-angiogenic and anti-inflammatory effects of PRP. This study aimed to evaluate the current evidence on fat grafting in combination with PRP for wound healing to establish the efficacy of this technique. A comprehensive search in the MEDLINE, EMBASE, CENTRAL, Science Citation Index, and Google Scholar databases (to March 2017) was conducted to identify studies on fat grafting and PRP for wound healing. Case series of less than 3 cases and studies only describing harvest technique were excluded. The database identified 571 articles, of which 3 articles that used a combination of fat and PRP for wound healing (1 RCT and 2 case series) were included in this review. A total of 69 wounds in 64 patients were treated with an average wound size of 36.32cm2 . Of these, 67% of wounds achieved complete healing. When reported, the mean time to healing was 7.5 weeks for those who underwent a single treatment. There were no significant complications in any patients. The combination of fat grafting and PRP may achieve adequate wound healing with relatively quick wound healing time compared with standard wound management options. However, evidence is extremely limited, and further studies are required to evaluate its efficacy for wound healing.
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Affiliation(s)
- Oliver J Smith
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Muholan Kanapathy
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Ankur Khajuria
- Academic Surgery Foundation Programme, St Mary's Hospital, Imperial College London, London, UK
| | - Max Prokopenko
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Nadine Hachach-Haram
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Haroon Mann
- Department of Trauma and Orthopaedics, Royal Free Hospital, London, UK
| | - Ash Mosahebi
- London Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
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Smith OJ, Kanapathy M, Khajuria A, Prokopenko M, Hachach-Haram N, Mann H, Mosahebi A. Protocol for a systematic review of the efficacy of fat grafting and platelet-rich plasma for wound healing. Syst Rev 2017; 6:111. [PMID: 28587666 PMCID: PMC5461711 DOI: 10.1186/s13643-017-0505-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/24/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The use of fat grafting as a reconstructive surgical option is becoming much more common. Adipose-derived stem cells found in fat grafts are believed to facilitate wound healing via differentiation into fibroblasts and keratinocytes and the release of pro-healing growth factors. Several small studies have shown a positive effect of fat grafting in healing of wounds of a variety of aetiologies. When fat is combined with autologous platelet-rich plasma (PRP), there may be enhanced healing effects. This may be due to the pro-angiogenic and anti-inflammatory effects of PRP. We aim to synthesise the current evidence on combination fat grafting and PRP for wound healing to establish the efficacy of this technique. METHODS/DESIGN We will conduct a comprehensive literature search in the MEDLINE, EMBASE, CENTRAL, Science Citation Index, and Google Scholar databases (up to July 2017) to identify studies on fat grafting and PRP for wound healing. All primary studies and systematic reviews of these studies will be included, except case reports and case series with fewer than three patients, to evaluate the outcome of fat grafting and PRP on wound healing either on its own or when compared to other studies. Primary outcome measures are expected to be the proportion of total wounds healed at 12 weeks and the average wound healing time (time for 100% re-epithelialisation). Expected secondary outcome measures are the proportion of wounds achieving 50% wound healing, the type of wound benefitting most from fat grafting, economic evaluation, health-related quality of life, and adverse events. Subgroup analysis will be performed for the proportions of wounds healed based on wound aetiology. DISCUSSION This review will provide robust evidence of the efficacy of fat grafting and PRP for wound healing. This is an emerging technique, and this review is expected to guide clinical practice and ongoing research aimed at improving wound care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016049881.
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Affiliation(s)
- Oliver J Smith
- Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Muholan Kanapathy
- Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK. .,Division of Surgery and Interventional Science, University College London, London, UK.
| | - Ankur Khajuria
- Academic Surgery Foundation Programme, St Mary's Hospital, Imperial College London, London, UK
| | - Max Prokopenko
- Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Nadine Hachach-Haram
- Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Haroon Mann
- Department of Trauma and Orthopaedics, Royal Free Hospital, London, UK
| | - Ash Mosahebi
- Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
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Huang SH, Wu SH, Lee SS, Chang KP, Chai CY, Yeh JL, Lin SD, Kwan AL, David Wang HM, Lai CS. Fat Grafting in Burn Scar Alleviates Neuropathic Pain via Anti-Inflammation Effect in Scar and Spinal Cord. PLoS One 2015; 10:e0137563. [PMID: 26368011 PMCID: PMC4569053 DOI: 10.1371/journal.pone.0137563] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/17/2015] [Indexed: 12/22/2022] Open
Abstract
Burn-induced neuropathic pain is complex, and fat grafting has reportedly improved neuropathic pain. However, the mechanism of fat grafting in improving neuropathic pain is unclear. Previous investigations have found that neuroinflammation causes neuropathic pain, and anti-inflammatory targeting may provide potential therapeutic opportunities in neuropathic pain. We hypothesized that fat grafting in burn scars improves the neuropathic pain through anti-inflammation. Burn-induced scar pain was confirmed using a mechanical response test 4 weeks after burn injuries, and autologous fat grafting in the scar area was performed simultaneously. After 4 weeks, the animals were sacrificed, and specimens were collected for the inflammation test, including COX-2, iNOS, and nNOS in the injured skin and spinal cord dorsal horns through immunohistochemistry and Western assays. Furthermore, pro-inflammatory cytokines (IL-1 β and TNF-α) in the spinal cord were collected. Double immunofluorescent staining images for measuring p-IκB, p-NFκB, p-JNK, and TUNEL as well as Western blots of AKT, Bax/Bcl-2 for the inflammatory process, and apoptosis were analyzed. Fat grafting significantly reduced COX2, nNOS, and iNOS in the skin and spinal cord dorsal horns, as well as IL-1β and TNF-α, compared with the burn group. Moreover, regarding the anti-inflammatory effect, the apoptosis cells in the spinal cord significantly decreased after the fat grafting in the burn injury group. Fat grafting was effective in treating burn-induced neuropathic pain through the alleviation of neuroinflammation and ameliorated spinal neuronal apoptosis.
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Affiliation(s)
- Shu-Hung Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Sheng-Hua Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Anesthesia, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Su-Shin Lee
- Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Kao-Ping Chang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Chee-Yin Chai
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jwu-Lai Yeh
- Department and Graduate Institute of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Sin-Daw Lin
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Aij-Lie Kwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Hui-Min David Wang
- Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Fragrance and Cosmetic Science, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- * E-mail: (H-MDW); (C-SL)
| | - Chung-Sheng Lai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
- * E-mail: (H-MDW); (C-SL)
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Comparison of cell number, viability, phenotypic profile, clonogenic, and proliferative potential of adipose-derived stem cell populations between centrifuged and noncentrifuged fat. Aesthetic Plast Surg 2014; 38:985-93. [PMID: 25053112 DOI: 10.1007/s00266-014-0372-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 06/14/2014] [Indexed: 01/25/2023]
Abstract
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.
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Abstract
BACKGROUND The management of neuropathic pain after burn injury is a critical clinical issue. Autologous fat grafting has been shown to alleviate neuropathic pain in certain cases, but has not been shown to alleviate the pain associated with burn-induced scars. The authors assessed the effectiveness of autologous fat grafting for the management of pain in burn-induced scars. METHODS One paw of the experimental rats received a third-degree burn using a heated metal block. Neuropathic pain in the affected paw was assessed based on behavioral responses to thermal and mechanical stimuli. A graft (0.4 ml of autologous fat or a sham graft) was administered by injection to the burn scar and sham-burned paw. The animals were killed 4 weeks after the fat graft treatments; Masson trichrome stain of hind-paw skin and expression of phosphorylated p38 and OX42 in the dorsal horns of the spinal cords were examined. RESULT The third-degree burns were completely healed at 4 weeks. Burn-induced scarring caused mechanical allodynia and increased the expression of phosphorylated p38 and OX42 in spinal cord dorsal horn microglial cells. Autologous fat grafting significantly alleviated mechanical allodynia (p < 0.05), and immunohistochemistry showed that the expression of phosphorylated p38 and OX42 was significantly lower in spinal cord dorsal horn microglial cells 4 weeks after fat grafting (p < 0.05). CONCLUSIONS Autologous fat grafting is used daily in clinical practice. It is an effective treatment for the relief of burn-induced mechanical allodynia in rats. Further investigation of the clinical use of autologous fat grafting in burn patients is warranted.
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Autologous fat graft in postmastectomy pain syndrome following breast conservative surgery and radiotherapy. Aesthetic Plast Surg 2014; 38:528-32. [PMID: 24764106 DOI: 10.1007/s00266-014-0311-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women worldwide, affecting one in eight women. Breast-conserving surgery (BCS) has become a well-established alternative to mastectomy in the treatment of breast cancer, providing a less invasive treatment. Just as life expectancy after breast cancer has improved, so has morbidity increased. One of the most relevant and debilitating consequences of oncological breast surgery is postmastectomy pain syndrome (PMPS). Our results published in 2011 on the treatment of PMPS in patients who had undergone mastectomy and radiotherapy and our experience in scar treatment with fat grafts were the theoretical bases for this prospective study. METHODS From April 2011 to April 2012 a total of 96 patients, who had undergone lumpectomy and radiation therapy, with the diagnosis of PMPS were considered for fat grafts. We performed autologous fat grafting in 59 patients (study group), whereas 37 patients did not receive any further surgical procedure (control group). Pain assessment was performed using the visual analog scale (VAS) before and after treatment in the treated group and in the control group at the first visit and the control visit, with a mean follow-up of 10 months. Results were analyzed using the Wilcoxon rank sum test. RESULTS Four patients were lost to follow-up (two patients in the control group and two patients in the treated group). A significant VAS pain decrease was detected in patients treated with autologous fat grafting (3.1 point reduction, p ≤ 0.005). CONCLUSION Because of the safety, efficacy, and optimal tolerability of the procedure, we believe that fat grafting can be considered useful in treating PMPS in patients who have undergone BCS and radiotherapy. LEVEL OF EVIDENCE III For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Fat grafting versus adipose-derived stem cell therapy: distinguishing indications, techniques, and outcomes. Aesthetic Plast Surg 2013; 37:856-7. [PMID: 23661192 DOI: 10.1007/s00266-013-0127-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
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Vaienti L, Merle M, Battiston B, Villani F, Gazzola R. Perineural fat grafting in the treatment of painful end-neuromas of the upper limb: a pilot study. J Hand Surg Eur Vol 2013; 38:36-42. [PMID: 22415427 DOI: 10.1177/1753193412441122] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the effectiveness and middle-term durability of the results achieved with perineural fat grafting of painful neuromas of the upper limb. We retrospectively analysed eight patients, affected by eight neuromas, treated by neuroma excision and fat grafting around the proximal nerve stump. Clinical parameters, the disabilities of the arm shoulder and hand score, and the visual analogue scale were recorded at 2, 6 and 12 months after surgery. A reduction of 23.2% was observed in the mean disabilities of the arm shoulder and hand scores at 12 months. The spontaneous baseline visual analogue scale score showed a mean improvement of 22% at 12 months, although not this was not statistically significant. Perineural fat grafting is a quick and useful procedure and could represent a useful primary operation in the treatment of pain syndromes of neuropatic origin.
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Affiliation(s)
- L Vaienti
- Plastic Surgery Department Università degli Studi di Milano, IRCCS Policlinico San Donato, Milan, Italy.
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Abstract
BACKGROUND Mastectomy with axillary dissection is still one of the most common procedures in oncologic surgery. Unfortunately, a condition of neuropathic pain, termed postmastectomy pain syndrome, can appear after mastectomy. Although evidence regarding the epidemiology of postmastectomy pain syndrome is well researched, an effective therapy is still unknown. The aim of this study was to assess the clinical effectiveness of lipoaspirate graft in the treatment of postmastectomy pain syndrome. METHODS From February of 2006 to August of 2008, a total of 113 patients affected by postmastectomy pain syndrome and severe scar retractions were enrolled for this clinical study. Seventy-two patients were treated with autologous fat grafted in painful scars, and 41 patients did not undergo any further surgical procedure. Pain assessment was performed using a visual analogue scale before and after treatment, with a mean follow-up of 13 months. In addition, antalgic drug intake was recorded in the 34 patients who received a surgical treatment. Results were analyzed using the Wilcoxon rank sum test. RESULTS A significant decrease in pain according to the visual analogue scale was detected in patients treated with autologous fat graft (3.23-point reduction, p = 0.0005). Twenty-eight of 34 patients stopped their analgesic therapy with a significant follow-up (13 months). CONCLUSIONS Autologous fat grafting is a safe, relatively noninvasive, and rapid surgical procedure. The authors' results suggest its effectiveness for treatment of postmastectomy pain syndrome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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14
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Villani F, Caviggioli F, Giannasi S, Klinger M, Klinger F. Current applications and safety of autologous fat grafts: a report of the ASPS Fat Graft Task Force. Plast Reconstr Surg 2010; 125:758-759. [PMID: 20124871 DOI: 10.1097/prs.0b013e3181c722cf] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Federico Villani
- Cattedra di Chirurgia Plastica; Università degli Studi di Milano; U.O. Chirurgia Plastica 2; IRCCS Istituto Clinico Humanitas; Rozzano, Milan, Italy
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Rehabilitation of Irradiated Head and Neck Tissues by Autologous Fat Transplantation. Plast Reconstr Surg 2009; 124:2190-2191. [DOI: 10.1097/prs.0b013e3181bcf72a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Anatomical Variations of the Occipital Nerves: Implications for the Treatment of Chronic Headaches. Plast Reconstr Surg 2009; 124:1727-1728. [DOI: 10.1097/prs.0b013e3181b98d6f] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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