Use of Lipofilling for the Treatment of Severe Burn Outcomes

Abstract

Sir:FigureBurn outcomes still represent a problem because of aesthetic and functional concerns and also because of concern regarding the patient's social and psychological life. Lipofilling can be used in the treatment of the resulting scars, providing a sensitive improvement in the quality of the skin.1,2 Adipose tissue is a reserve of mesenchymal stem cells that can divide indefinitely, producing various cellular lines. It could be the physiologic means of replacing cells lost in atrophied scar tissues and ameliorating the mechanical and biological properties of the skin.3,4 From November of 2009 to December of 2010, 18 patients with postburn hypertrophic scars and keloids underwent surgery in the Plastic and Reconstructive Surgery Clinic at the Second University of Naples. They had previously undergone a mean of 5.5 (range, three to eight) restorative operations before fat grafting. The follow-up period was 15 months. Results were evaluated at the end of the follow-up period by the operating surgeons, by the patients themselves, and by an independent medical observer. The evaluations were obtained by means of a questionnaire (Table 1). Postoperative satisfaction was rated on a scale of 0 to 10. Clinical results were documented by preoperative and postoperative digital photographs.Table 1: Questionnaire Used to Determine the General Satisfaction of the PatientsGeneral anesthesia was used to avoid patient discomfort and the potential influence of local anesthetic on tissues. By means of 3-mm incisions, the abdominal or the trochanteric area was infiltrated with 0.9% sodium chloride cooled to 4°C, and fat was removed through a 20-ml syringe connected by a Luer-Lok attached to a cannula with a 3-ml exit hole, creating a small negative pressure inside the syringe. An adipose tissue sample (average, 40 cc per session) was obtained and then centrifuged once at 1300 rpm for 5 minutes.5 After centrifugation, the adipocyte cell fraction was isolated and transferred into syringes equipped with attached Luer-Lok of 2 ml with 17- to 18-gauge cannulas. The injection of the purified fat was achieved in multiple directions at the dermal-hypodermal junction of the scar areas. This procedure was performed three times for each patient, with a 3-month interval between sessions. A punch biopsy from the scar tissues was performed in each patient before and 9 months after the first surgical intervention, before the last operation. At 1-year follow-up, all of the patients noted an improvement of their clinical condition. The general satisfaction score of the patients, surgeons, and external observer was 7.5. Histologic findings showed new collagen deposition, neoangiogenesis, and dermal hyperplasia in the context of new tissue, demonstrating tissue regeneration. Clinically, a better texture, softness, thickness, color, and elasticity of the treated skin were observed, as was a reduction of the scar retraction (Figs. 1 and 2). The reported cases provide preliminary evidence that autologous fat grafting can greatly improve the aesthetic and functional outcomes in burned patients.Fig. 1: Patient with severe facial burn outcomes derived from the explosion of a hydrochloric acid tank.Fig. 2: Same patient as shown in Figure 1, 15 months after the first operation. Note the improvement in the skin softness and elasticity.The procedure can be adopted for most patients because fat is always available. Autologous fat grafting can complete and improve the results of the standard surgical approach used in burned patients. The procedure is safe and easy, with minimal morbidity, if performed by expert surgeons. Sergio Brongo, M.D., Ph.D. Giovanni Francesco Nicoletti, M.D., Ph.D. Simone La Padula, M.D. Carmine Michele Mele, M.D. Francesco D'Andrea, M.D., Ph.D. A.O.U. Second University of Naples, Naples, Italy DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. No outside funding was received.