Long Term Outcomes of Autologous Fat Grafting to Hands and Feet for Patients with Raynaud’s

Abstract

PURPOSE: Autologous fat grafting (AFG) has emerged as a promising treatment option for primary and secondary Raynaud’s, both with and without digital ulcers. However, prospective and retrospective studies of the procedure are limited by short follow-up, and there is scant data regarding factors that can impact the likelihood of successful long-term outcomes. The aims of this study were to (1) characterize the long-term outcomes and patient satisfaction for AFG used to treat Raynaud’s and digital ulcers, and (2) identify factors that affected the longevity and magnitude of symptom relief. METHOD: A retrospective chart review was performed of all patients (n=17) treated with AFG to the hands or feet at our institution for primary or secondary Raynaud’s over an 11-year period between 2010 and 2021. Standardized phone interview follow ups were conducted with all patients, with a 65% response rate (n=11 patients). AFG to each extremity was defined as a separate surgery, and results were measured per surgery (n=23). Demographics, medical information, operative notes, and post-operative clinic notes were collected from chart review. A phone survey was used to assess pre- and post-operative symptoms based on the validated Raynaud Condition Score (RCS), initial response to AFG, long-term symptom relief, and satisfaction. RESULTS: Digital ulcers were present prior to AFG in 65% of surgeries, the average RCS was 5.8 (scored 0-10), and patients experienced an average of 3.5 cold attacks per day that lasted for 19.2 mins with an intensity of 2.0 (scored 0-3). At peak response level 83% of surgeries improved Raynaud’s symptoms and 87% of those with ulcers reported healing. Diminished symptom relief following peak response was reported in 70% of surgeries, but in 81% of those cases symptoms at follow-up were still better than before AFG. At follow-up (defined as time of survey or time of presentation for subsequent AFG), the average RCS was 3.5 (delta -2.3, p<0.01), frequency of cold attacks was 2.4 per day (delta -1.1, p<0.01), duration was 13.7 mins (delta -5.4, p<0.01), and intensity was 1.1 (delta of -0.9, p<0.01). Younger age and primary Raynaud’s correlated with larger improvements in RCS (p<0.05). Average follow-up was 2.9 years from AFG; 2.5 for surgeries with eventually diminishing symptom relief and 3.9 for those without. Diminishing symptom relief with symptom recurrence at 0.5, 1, and 2 years was observed in 30%, 52%, and 64% of surgeries. Median duration of maximum symptom relief was 10.5 months post-operatively. Patients with no ulcers prior to AFG (OR 0.43), higher BMI (26.2 vs. 22.6), and non-White race (OR 0.40) were less likely to experience diminishing symptom relief (p<0.05). In addition, patients with primary Raynaud’s were less likely to experience diminishing symptom relief than those with CREST or systemic scleroderma (33% vs. 50% vs. 91%, p<0.10). Average patient satisfaction with AFG was 7.2/10, and 91% would recommend AFG to others. CONCLUSION: AFG is an effective, albeit sometimes temporary, treatment for Raynaud’s and digital ulcers. Certain subsets of patients may be more likely to experience lasting symptom relief beyond 1 year.