Fat Grafting for Thermal Injury

Ranganathan, Kavitha; Wong, Vernon G.; Krebsbach, Paul H.; Wang, Stewart C.; Cederna, Paul S.; Lévi, Benjamin

doi:10.1097/bcr.0b013e318280e2dd

Cited by 30 publications

(9 citation statements)

References 42 publications

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“…One proposed mechanism for skin salvage is based on the fact that fat grafts are known to harbor adipose-derived stromal cells which may contribute to new vessel formation or elaborate a number of additional growth factors such as fibroblast growth factor, insulin-like growth factor, VEGF, and platelet-derived growth factor. (7, 33–36) Therefore, delivery of these cells may interrupt the cellular cascades that remain chronically activated in irradiated tissue.…”

Section: Discussionmentioning

confidence: 99%

Studies in Fat Grafting

Garza

Paik

Chung

et al. 2014

Plastic and Reconstructive Surgery

125

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Background Following radiation therapy, skin becomes fibrotic and can present a difficult problem for reconstructive surgeons. There is an increasing belief that fat grafting under radiated skin can reverse the damage caused by radiation. The present study evaluated the effect of fat grafting on irradiated skin, along with fat graft quality and retention rates in irradiated tissue. Methods Nine adult Crl:NU-Foxn1nu CD-1 mice received 30 Gy external beam radiation of the scalp. Four weeks following radiation, scalp skin from irradiated and non-irradiated mice was harvested and compared histologically for dermal thickness, collagen content, and vascular density. Human fat grafts were then injected in the subcutaneous plane of the scalp. Skin assessment was performed in the irradiated group at 2 and 8 weeks post-grafting, and fat graft retention was measured at baseline and every 2 weeks up to 8 weeks post-grafting using micro-CT. Finally, fat graft samples were explanted at 8 weeks, and quality scoring was performed. Results Fat grafting resulted in decreased dermal thickness, decreased collagen content, and increased vascular density in irradiated skin. CT analysis revealed significantly decreased fat graft survival in the irradiated group when compared to the non-irradiated group. Histological scoring of explanted fat grafts demonstrated no difference in quality between the irradiated and non-irradiated groups. Conclusions Fat grafting attenuates dermal collagen deposition and vessel depletion characteristic of radiation fibrosis. Although fat graft retention rates are significantly lower in irradiated than non-irradiated tissue, the quality of retained fat between the groups is similar.

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Section: Discussionmentioning

confidence: 99%

Studies in Fat Grafting

Garza

Paik

Chung

et al. 2014

Plastic and Reconstructive Surgery

125

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“…Patients with severe burns or underlying structural deficits may also require serial transplantation to overcome the scarred, fibrotic, and compromised recipient site. 65,70,71 Severe structural defects caused by progressive hemifacial atrophy have also been shown to improve with autologous fat grafting. However, poorer engraftment was noted in progressive hemifacial atrophy patients, suggesting that these more difficult cases may require the use of serial injections to achieve the desired volume.…”

Section: Recipient-site Variablesmentioning

confidence: 99%

The Current State of Fat Grafting

Strong

Cederna

Rubin

et al. 2015

Plastic and Reconstructive Surgery

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356

129

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Background Interest in and acceptance of autologous fat grafting for use in contour abnormalities, breast reconstruction, and cosmetic procedures have increased. However, there are many procedural variations that alter the effectiveness of the procedure and may account for the unpredictable resorption rates observed. Methods The authors highlighted studies investigating the effects of harvesting procedures, processing techniques, and reinjection methods on the survival of fat grafts. This review focused on the impact different techniques have on outcomes observed in the following: in vitro analyses, in vivo animal experiments, and human studies. Results This systemic review revealed the current state of the literature. There was no significant difference in the outcomes of grafted fat obtained from different donor sites, different donor-site preparations, harvest technique, fat harvesting cannula size, or centrifugation speed, when tumescent solution was used. Gauze rolling was found to enhance the volume of grafted fat, and no significant difference in retention was observed following centrifugation, filtration, or sedimentation in animal experiments. In contrast, clinical studies in patients found more favorable outcomes with fat processed by centrifugation compared with sedimentation. In addition, higher retention was observed with slower reinjection speed and when introduced into less mobile areas. Conclusions There has been a substantial increase in research interest to identify methodologies for optimizing fat graft survival. Despite some differences in harvest and implantation technique in the laboratory, these findings have not translated into a universal protocol for fat grafting. Therefore, additional human studies are necessary to aid in the development of a universal protocol for clinical practice.

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“…13 Adipose tissue is available in large quantities, is easy to manipulate, and is able to fill soft tissue deficits. Autologous fat transfer is already in use by surgeons for patients with lipoatrophy of the face associated with HIV or facial paralysis, radiation injury, chest wall defects, breast capsular contracture, chronic ulceration, and any other contour irregularities on the body.…”

Section: Introductionmentioning

confidence: 99%

“…Autologous fat transfer is already in use by surgeons for patients with lipoatrophy of the face associated with HIV or facial paralysis, radiation injury, chest wall defects, breast capsular contracture, chronic ulceration, and any other contour irregularities on the body. 13–4 While most fat grafting techniques rely on the homologous function of the graft as a space filler, there is a growing body of evidence that the paracrine effects of the graft alter the biochemical milieu of the wound leading to improvement in healing as well as in the functional and aesthetic resolution of the injury. 14–6 Recent evidence indicates that syngeneic fat has the capacity to both accelerate revascularization and reduce fibrosis in thermal injuries.…”

Section: Introductionmentioning

confidence: 99%

Wound Healing After Thermal Injury Is Improved by Fat and Adipose-Derived Stem Cell Isografts

Loder

Peterson

Agarwal

et al. 2015

Journal of Burn Care & Research

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Objectives Patients with severe burns suffer functional, structural, and aesthetic complications. It is important to explore reconstructive options given that no ideal treatment exists. Transfer of adipose and adipose-derived stem cells (ASCs) has been shown to improve healing in various models. We hypothesize that use of fat isografts and/or ASCs will improve healing in a mouse model of burn injury. Methods Twenty 6–8 week old C57BL/6 male mice received a 30% surface area partial-thickness scald burn. Adipose tissue and ASCs from inguinal fat pads were harvested from a second group of C57BL/6 mice. Burned mice received 500μl subcutaneous injection at burn site of 1) processed adipose, 2) ASCs, 3) mixed adipose (adipose and ASCs), or 4) sham (saline) injection (n=5/group) on the first day post-injury. Mice were followed by serial photography until sacrifice at days 5 and 14. Wounds were assessed for burn depth and healing by Hematoxylin and Eosin (H&E) and immunohistochemistry. Results All treated groups showed improved healing over controls defined by decreased wound depth, area, and apoptotic activity. After 5 days, mice receiving ASCs or mixed adipose displayed a non-significant improvement in vascularization. No significant changes in proliferation were noted at 5 days. Conclusions Adipose isografts improve some early markers of healing post-burn injury. We demonstrate that addition of these grafts improve specific structural markers of healing. This improvement may be due to an increase in early wound vascularity post-graft. Further studies are needed to optimize use of fat or ASC grafts in acute and reconstructive surgery.

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Fat Grafting for Thermal Injury

Cited by 30 publications

References 42 publications

Studies in Fat Grafting

Studies in Fat Grafting

The Current State of Fat Grafting

Wound Healing After Thermal Injury Is Improved by Fat and Adipose-Derived Stem Cell Isografts

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