Fat grafting: an adjunct in management of chronic leg ulcers

Abstract

Chronic leg ulcers (CLU’s) are one of the most challenging medical conditions, mostly resistant to conventional therapy. Several treatment modalities are present but none have become standard of care. Autologous fat contains adipose derived stem cells (ADSC’s) which is believed to have abundant growth factors (GF’s) required for its regenerative and reparative properties. Our observational study was conducted to see the feasibility and efficacy of fat grafting in management of CLUs with complete wound healing as final outcome. 14 patients with CLUs (any etiology, >3 months and multiple ulcers were counted as individual cases if >3 cm apart) were included with coagulopathies, uncontrolled diabetes mellitus (Hba1c>9 mmol/mol) being the exclusions. Fat was harvested using standard Coleman’s technique. Study was conducted from December 2015 to December 2017 in tertiary care hospital and patients were followed up for next 24 months. All cases were evaluated clinically. Average age of wounds before intervention was 33.34 months, average wound size 16.46 cm2 and 4.9 cc of average fat was transferred underneath the ulcer. 11 out of 14 wounds healed completely within average 27.4 days and final outcome was not achieved in 3. Pain assessed using visual analogue scale (VAS) in immediate post operative period till 48 hours (telephonically). Patients were evaluated at 1 week, 1 month, 3 months and 6 months after procedure for pattern of wound healing and related complications. Fat grafting is easy, safe, effective and a minimally invasive OPD procedure with short recovery time for managing CLUs.