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Published in: European Journal of Plastic Surgery 2/2016

01-04-2016 | Original Paper

Fat grafting for the prevention of pressure ulcers: a case series

Authors: Giovanni Di Caprio, Fabio Larocca, Michelina Scioli, Pasquale Ziccardi, Gianfranco Nicoletti, Salvatore Iervolino, José Maria Serra Mestre, Francesco D’Andrea

Published in: European Journal of Plastic Surgery | Issue 2/2016

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Abstract

Background

Pressure sores tend to recur and become chronic, especially in high-risk groups such as paraplegics, who may present multiple wounds and have long life expectancies. Here, we assess the outcomes achieved with fat grafting as a new preventive strategy for pressure sores.

Methods

From 2010 to 2013, seven paraplegic patients presenting stage I or stage II pressure ulcers were treated with the injection of 115 to 620 cm3 of fat that was previously filtered and washed with saline solution. Patients were followed up at 2 and 4 weeks and at 3, 6, and 12 months after surgery.

Results

Our experience was encouraging. There was an increase in the thickness of the subcutaneous fat layer and in the degree of padding of the underlying bony protrusions, as a type of natural cushion, which restored the physiological sliding on the underlying fascial planes. A general improvement in the skin characteristics was noted, which reduced the risk of new recurrences. In addition, the fat allowed for satisfactory restoration of the anatomical profile. There were no major complications. Only two cases required new lipofilling due to partial resorption of the graft.

Conclusions

Fat grafting may prevent the evolution of lesions and reduce the risk of recurrence. This strategy may avoid the necessity of using assisted scarring devices or more aggressive surgical approaches.
Level of Evidence: Level IV, therapeutic study
Literature
2.
go back to reference Lyder C, Ayello E (2008) Patient safety and quality: an evidence-based handbook for nurses. AHRQ publication no. 08-0043. Agency for Healthcare Research and Quality, Rockville, pp 1–33 Lyder C, Ayello E (2008) Patient safety and quality: an evidence-based handbook for nurses. AHRQ publication no. 08-0043. Agency for Healthcare Research and Quality, Rockville, pp 1–33
3.
go back to reference Cushing CA, Phillips LG (2013) Evidence-based medicine: pressure sores. Plast Reconstr Surg 132(6):1720–32CrossRefPubMed Cushing CA, Phillips LG (2013) Evidence-based medicine: pressure sores. Plast Reconstr Surg 132(6):1720–32CrossRefPubMed
4.
go back to reference Chou R, Dana T, Bougatsos C et al (2013) Pressure ulcer risk assessment and prevention: a systematic comparative effectiveness review. Ann Intern Med 159(1):28–38CrossRefPubMed Chou R, Dana T, Bougatsos C et al (2013) Pressure ulcer risk assessment and prevention: a systematic comparative effectiveness review. Ann Intern Med 159(1):28–38CrossRefPubMed
5.
go back to reference Lin H, Hou C, Chen A et al (2010) Treatment of ischial pressure sores using a modified gracilis myofasciocutaneous flap. J Reconstr Microsurg 26:153–157CrossRefPubMed Lin H, Hou C, Chen A et al (2010) Treatment of ischial pressure sores using a modified gracilis myofasciocutaneous flap. J Reconstr Microsurg 26:153–157CrossRefPubMed
6.
go back to reference Pena MM, Drew GS, Smith SJ et al (1992) The inferiorly based rectus abdominis myocutaneous flap for reconstruction of recurrent pressure sores. Plast Reconstr Surg 89:90–95CrossRefPubMed Pena MM, Drew GS, Smith SJ et al (1992) The inferiorly based rectus abdominis myocutaneous flap for reconstruction of recurrent pressure sores. Plast Reconstr Surg 89:90–95CrossRefPubMed
7.
go back to reference Wong TC, Ip FK (2006) Comparison of gluteal fasciocutaneous rotational flaps and myocutaneous flaps for the treatment of sacral sores. Int Orthop 30:64–67CrossRefPubMedPubMedCentral Wong TC, Ip FK (2006) Comparison of gluteal fasciocutaneous rotational flaps and myocutaneous flaps for the treatment of sacral sores. Int Orthop 30:64–67CrossRefPubMedPubMedCentral
8.
go back to reference Ohjimi H, Ogata K, Setsu Y et al (1996) Modification of the gluteus maximus V-Y advancement flap for sacral ulcers: the gluteal fasciocutaneous flap method. Plast Reconstr Surg 100:1247–1252CrossRef Ohjimi H, Ogata K, Setsu Y et al (1996) Modification of the gluteus maximus V-Y advancement flap for sacral ulcers: the gluteal fasciocutaneous flap method. Plast Reconstr Surg 100:1247–1252CrossRef
9.
go back to reference Homma K, Murakami G, Fujioka H et al (2001) Treatment of ischial pressure ulcers with a posteromedial thigh fasciocutaneous flap. Plast Reconstr Surg 108:1990–1996CrossRefPubMed Homma K, Murakami G, Fujioka H et al (2001) Treatment of ischial pressure ulcers with a posteromedial thigh fasciocutaneous flap. Plast Reconstr Surg 108:1990–1996CrossRefPubMed
10.
go back to reference Higgins JP, Orlando GS, Blondeel PN (2002) Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap. Br J Plast Surg 55(1):83–5CrossRefPubMed Higgins JP, Orlando GS, Blondeel PN (2002) Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap. Br J Plast Surg 55(1):83–5CrossRefPubMed
11.
go back to reference Esposito G, Di Caprio G, Ziccardi P et al (1991) Tissue expansion in the treatment of pressure ulcers. Plast Reconstr Surg 87:501–508CrossRefPubMed Esposito G, Di Caprio G, Ziccardi P et al (1991) Tissue expansion in the treatment of pressure ulcers. Plast Reconstr Surg 87:501–508CrossRefPubMed
12.
go back to reference Esposito G, Ziccardi P, Di Caprio G et al (1993) Reconstruction of ischial pressure ulcers by skin expansion. Scand J Plast Hand Surg 27:133–136CrossRef Esposito G, Ziccardi P, Di Caprio G et al (1993) Reconstruction of ischial pressure ulcers by skin expansion. Scand J Plast Hand Surg 27:133–136CrossRef
13.
go back to reference Coleman SR (2011) Structural fat grafts: the ideal filler? Clin Plast Surg 28:111 Coleman SR (2011) Structural fat grafts: the ideal filler? Clin Plast Surg 28:111
14.
15.
go back to reference Hsu VM, Stransky CA, Bucky LP et al (2012) Fat grafting’s past, present, and future: why adipose tissue is emerging as a critical link to the advancement of regenerative medicine. Aesthet Surg J 32(7):892–9CrossRefPubMed Hsu VM, Stransky CA, Bucky LP et al (2012) Fat grafting’s past, present, and future: why adipose tissue is emerging as a critical link to the advancement of regenerative medicine. Aesthet Surg J 32(7):892–9CrossRefPubMed
16.
go back to reference Ranganathan K, Wong VC, Krebsbach PH et al (2013) Fat grafting for thermal injury: current state and future directions. J Burn Care Res 34(2):219–26CrossRefPubMed Ranganathan K, Wong VC, Krebsbach PH et al (2013) Fat grafting for thermal injury: current state and future directions. J Burn Care Res 34(2):219–26CrossRefPubMed
17.
go back to reference Brongo S, Nicoletti GF, La Padula S et al (2012) Use of lipofilling for the treatment of severe burn outcomes. Plast Reconstr Surg 130(2):374e–376eCrossRefPubMed Brongo S, Nicoletti GF, La Padula S et al (2012) Use of lipofilling for the treatment of severe burn outcomes. Plast Reconstr Surg 130(2):374e–376eCrossRefPubMed
18.
go back to reference Rigotti G, Marchi A, Galie M et al (2007) Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg 119:1409–1422CrossRefPubMed Rigotti G, Marchi A, Galie M et al (2007) Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg 119:1409–1422CrossRefPubMed
19.
go back to reference Serra-Renom JM, Muñoz-Olmo JL, Serra-Mestre JM (2010) Fat grafting in postmastectomy breast reconstruction with expanders and prostheses in patients who have received radiotherapy: formation of new subcutaneous tissue. Plast Reconstr Surg 125(1):12CrossRefPubMed Serra-Renom JM, Muñoz-Olmo JL, Serra-Mestre JM (2010) Fat grafting in postmastectomy breast reconstruction with expanders and prostheses in patients who have received radiotherapy: formation of new subcutaneous tissue. Plast Reconstr Surg 125(1):12CrossRefPubMed
20.
go back to reference Ribuffo D, Atzeni M, Guerra M et al (2013) Treatment of irradiated expanders: protective lipofilling allows immediate prosthetic breast reconstruction in the setting of postoperative radiotherapy. Aesthetic Plast Surg 37(6):1146–52 Ribuffo D, Atzeni M, Guerra M et al (2013) Treatment of irradiated expanders: protective lipofilling allows immediate prosthetic breast reconstruction in the setting of postoperative radiotherapy. Aesthetic Plast Surg 37(6):1146–52
21.
go back to reference Phulpin B, Gangloff P, Tran N et al (2009) Rehabilitation of irradiated head and neck tissues by autologous fat transplantation. Plast Reconstr Surg 123(4):1187–97CrossRefPubMed Phulpin B, Gangloff P, Tran N et al (2009) Rehabilitation of irradiated head and neck tissues by autologous fat transplantation. Plast Reconstr Surg 123(4):1187–97CrossRefPubMed
22.
go back to reference Klinger M, Caviggioli F, Vinci V et al (2010) Treatment of chronic posttraumatic ulcers using autologous fat graft. Plast Reconstr Surg 126(3):154e-5eCrossRefPubMed Klinger M, Caviggioli F, Vinci V et al (2010) Treatment of chronic posttraumatic ulcers using autologous fat graft. Plast Reconstr Surg 126(3):154e-5eCrossRefPubMed
23.
go back to reference Han SK, Kim HR, Kim WK (2010) The treatment of diabetic foot ulcers with uncultured, processed lipoaspirate cells: a pilot study. Wound Repair Regen 18(4):342–8CrossRefPubMed Han SK, Kim HR, Kim WK (2010) The treatment of diabetic foot ulcers with uncultured, processed lipoaspirate cells: a pilot study. Wound Repair Regen 18(4):342–8CrossRefPubMed
24.
go back to reference Cervelli V, Bocchini I, Di Pasquali C et al (2013) P.R.L. platelet rich lipotransfert: our experience and current state of art in the combined use of fat and PRP. Biomed Res Int 2013, 434191CrossRefPubMedPubMedCentral Cervelli V, Bocchini I, Di Pasquali C et al (2013) P.R.L. platelet rich lipotransfert: our experience and current state of art in the combined use of fat and PRP. Biomed Res Int 2013, 434191CrossRefPubMedPubMedCentral
26.
go back to reference Marangi GF, Pallara T, Cagli B, Schena E, Giurazza F, Faiella E et al (2014) Treatment of early-stage pressure ulcers by using autologous adipose tissue grafts. Plast Surg Int 2014:817283 Marangi GF, Pallara T, Cagli B, Schena E, Giurazza F, Faiella E et al (2014) Treatment of early-stage pressure ulcers by using autologous adipose tissue grafts. Plast Surg Int 2014:817283
27.
go back to reference Kachgal S, Putnam AJ (2011) Mesenchymal stem cells from adipose and bone marrow promote angiogenesis via distinct cytokine and protease expression mechanisms. Angiogenesis 14(1):47–59CrossRefPubMedPubMedCentral Kachgal S, Putnam AJ (2011) Mesenchymal stem cells from adipose and bone marrow promote angiogenesis via distinct cytokine and protease expression mechanisms. Angiogenesis 14(1):47–59CrossRefPubMedPubMedCentral
28.
go back to reference Puissant B, Barreau C, Bourin P et al (2005) Immunomodulatory effect of human adipose tissue-derived adult stem cells: comparison with bone marrow mesenchymal stem cells. Br J Haematol 129(1):118–29CrossRefPubMed Puissant B, Barreau C, Bourin P et al (2005) Immunomodulatory effect of human adipose tissue-derived adult stem cells: comparison with bone marrow mesenchymal stem cells. Br J Haematol 129(1):118–29CrossRefPubMed
29.
go back to reference Gonzalez-Rey E, Anderson P, González MA et al (2009) Human adult stem cells derived from adipose tissue protect against experimental colitis and sepsis. Gut 58(7):929–39CrossRefPubMed Gonzalez-Rey E, Anderson P, González MA et al (2009) Human adult stem cells derived from adipose tissue protect against experimental colitis and sepsis. Gut 58(7):929–39CrossRefPubMed
30.
go back to reference Salgado AJ, Reis RL, Sousa NJ (2010) Adipose tissue derived stem cells secretome: soluble factors and their roles in regenerative medicine. Curr Stem Cell Res Ther 5(2):103–10CrossRefPubMed Salgado AJ, Reis RL, Sousa NJ (2010) Adipose tissue derived stem cells secretome: soluble factors and their roles in regenerative medicine. Curr Stem Cell Res Ther 5(2):103–10CrossRefPubMed
31.
go back to reference D’Andrea F, Wirz FS, Serra-Mestre JM et al (2013) Noninvasive three-dimensional quantitative analysis of volume and contour modifications after fat grafting procedures. Plast Reconstr Surg 132(2):312e–314eCrossRefPubMed D’Andrea F, Wirz FS, Serra-Mestre JM et al (2013) Noninvasive three-dimensional quantitative analysis of volume and contour modifications after fat grafting procedures. Plast Reconstr Surg 132(2):312e–314eCrossRefPubMed
Metadata
Title
Fat grafting for the prevention of pressure ulcers: a case series
Authors
Giovanni Di Caprio
Fabio Larocca
Michelina Scioli
Pasquale Ziccardi
Gianfranco Nicoletti
Salvatore Iervolino
José Maria Serra Mestre
Francesco D’Andrea
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 2/2016
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-015-1172-4

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