Reply: The Use of Autologous Fat Grafting for Treatment of Scar Tissue and Scar-Related Conditions: A Systematic Review.

Abstract

Sir: We have carefully read the comments of Oranges and Schaefer and we want to thank the authors for their letter. The authors state that there is a lack of consideration regarding the preparation of the recipient site in our review on the use of autologous fat grafting for the treatment of scar tissue and scar-related conditions.1 We have focused on clinically relevant outcomes as described by the authors of the studies included. Indeed, many elements of the fat grafting procedure remain open for discussion, concerning not only the preparation of the recipient site but also the method of harvesting and preparation of the fat graft, and the quality of the donor site. They are only partially discussed in our review. Oranges and Schaefer refer to the article by Khouri et al.,2 which is based on years of experience of grafting megavolumes of fat into the breasts of over 1000 patients. Khouri et al. report on their method for successful grafting and they state that “in this era of surgical evolution, we expect that many changes in our operative approach may occur.”2 With this statement, they perfectly address the shortcomings of current evidence regarding autologous fat grafting. The procedure is rapidly evolving and, although their method is based on extensive experience, it is not supported by scientific proof and was therefore not included in the review. We believe that current literature lacks randomized controlled trials with a methodologically strong design regarding the effects of autologous fat grafting on the treatment of scar tissue. In our review, we pointed out the limitations of the current evidence and therefore of our review. We encourage the authors and other researchers to conduct prospective controlled clinical trials to confirm the beneficial effects of autologous fat grafting on scar tissue and scar-related conditions, and extensively report the methods of fat harvesting and preparation of both the fat graft and the recipient and donor sites. Future reviews concerning the effects of autologous fat grafting could also focus on these subjects. The authors pointed out that the study by Mojallal et al.3 should have been included in the review as well. Mojallal et al. conducted a retrospective case series regarding 100 patients that were treated with autologous fat grafting according to the Coleman technique for facial volumetric restoration with a mean follow-up period of 23 months (range, 6 to 60 months). The preoperative and postoperative photographs of several patients are shown in the article. However, the majority of these patients were treated with autologous fat grafting combined with other reconstructive techniques, including rhinoplasties, full-thickness grafts, and preexpanded advancement flaps at the same time. We feel that it is difficult to assess the effects of the fat graft procedure alone on the scar if other reconstructive techniques are applied simultaneously. Because the article provides insufficient data regarding the reconstructive methods used combined with the autologous fat grafting treatment, it does not fit the inclusion criteria of our review. However, we want to thank the authors for bringing the article to our attention, because it is relevant for the discussion about the effectiveness of autologous fat grafting in scar treatment. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Vera L. Negenborn, M.D.Jan-Willem Groen, M.D.Department of Plastic, Reconstructive, andHand Surgery Jan Maerten Smit, M.D., B.Sc.Frank B. Niessen, M.D., Ph.D.Margriet G. Mullender, M.Sc., Ph.D.Department of Plastic, Reconstructive, andHand Surgery, andEMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdam, The Netherlands