Autologous fat injection improvements in hand surgery – Dupuytren and posttraumatic hand's scars treatment

Abstract

Introduction Hypertrophic scar, retraction and wound dehiscence can result from surgical treatment of Dupuytren disease, particularly in severe cases. These patients need to secondary open surgery usually performed after 6 months–1 year according to biological scar evolution. The aim of this preliminary study is to demonstrate the role of fat injections in the treatment of surgical scar complications after surgical aponeurectomy in Dupuytren's disease and in the treatment of posttraumatic scar complications of the hand. Materials and methods From January 2011 to June 2015 we have treated 21 selected cases of palmar-digital Dupuytren (2nd or 3rd degree) in male patients from 45 to 75-years-old (average 54). In these cases one month after surgical aponeurectomy we noted surgical scar complications as retractile scars or hypertrophic scars or wound dehiscence without infection signs. They presented 2nd degree scar contractures in nine cases and 3rd degree contractures in twelve cases. We performed fat injections after 6 weeks post-op. We repeated fat injections after 2 months. We injected autologous fat graft. In all cases periumbilical abdominal subcutaneous fat was the donor site after local anaesthesia (Klein solution: 500 mL saline, 12 mL lidocaine, 6 mL sodium bicarbonate, 0.5 mL adrenalin) by Coleman technique. We used a static decantation for a few minutes (average 10) to separate cell components from Klein solution. We injected each scar with 3–5 mL fat graft using a 1.5 mm diameter smooth or traumatic micro-cannula. Vascular and nervous structures have been preserved carefully after local anaesthesia. All patients mobilized the hand immediately after surgery. Eighteen patients with posttraumatic scar complications have been selected. Results Postoperative controls were at 2 weeks and 1 month. We clinically evaluated all patients after the second fat injections at 2 weeks, 1, 3 and 6 months. Patients with wound dehiscence obtained complete reepithelization after two weeks. In patients with scar retractions, improvement of the tropism of the skin was present since the second week after the second injections. Considerable improvement after 6 months. No sensory and motor defects have been added to the treated areas. Conclusions Lipofilling on the hand is a minimally invasive technique under local anaesthesia. Normal manual activities can be start after 1 week after lipofilling. Oedema is an early complication and disappears after 4 or 5 days. Injection sites and donor sites are usually painless.