Histological study of the role of fat injection in scar remodeling following burn injury

Abstract

BackgroundFat grafting had been shown clinically to improve the quality of burn scars. The mechanism of fat graft survival was not clear, and the role of adipose-derived stem cells and preadipocytes in fat survival remains to be determined. Aim of the work To clinically and histologically evaluate the role of fat grafting in postburn mature scars. Patients and methodsThis study was conducted on 20 postburn mature scars. Patients' ages ranged from 18 to 38 years. Patients were selected randomly to be treated with structural fat graft. It was performed twice for the same scar at a 3-month interval. The abdomen and buttocks were the most commonly chosen donor sites. Fat was processed according to Coleman's technique and injected at the dermohypodermal junction. ResultsFat grafting proved to have a significant role in scar remodeling. This was measured clinically by Vancouver Scar Scale and proved by histological examination of skin biopsy. The skin biopsies taken from scar sites preoperatively and 3 and 6 months after injection showed significant changes in epidermal thickness, appearance of newly formed vessels, healthy collagen deposition, and new hair follicles and sweat and sebaceous glands surrounded by fat cells. ConclusionThe autotransplanted harvested fat after centrifugation led to the formation of new healthy collagen bundles and new dermal and epidermal cells replacing the diseased ones. This could be attributed to the presence of adipose-derived stem cells, which are considered the key to the scar remodeling process.

Hypertrophic scarring: the greatest unmet challenge after burn injury

“…104 To reduce post-burn scar, fat can be injected into the scar every 8–12 weeks and repeated up to four times, significantly reducing skin hardness as measured with a Durometer and decreasing scarring assessed with the POSAS. 105 Adipose-derived stem cells are believed to underlie the positive effects on the grafted fat, 106 with preliminary work suggesting that fibroblast ECM production is altered by interactions with adipose-derived stem cells. 107 …”

The Use of Adipose-Derived Stem Cells (ADSCs) and Stromal Vascular Fraction (SVF) in Skin Scar Treatment—A Systematic Review of Clinical Studies

“…Eventually, full texts of 54 articles were assessed for eligibility. We excluded 36 studies due to: use of normal lipofilling [17][18][19][20][21][22][23][24] (nine), use in other medical conditions [25][26][27][28][29][30][31] (seven), insufficient outcome data [32,33] (three), use of an artificial material for SVF delivery [34,35] (two), inappropriate design [36][37][38] (three), non-English language [39][40][41] (three), ongoing clinical trial [42,43] (two), and use of predifferentiated cells [44] (one). In four cases [45][46][47][48] full texts were unavailable and in two [49,50] only conference abstracts were accessible.…”