Skip to main content
Top
Published in: Aesthetic Plastic Surgery 3/2008

01-05-2008 | Original Article

Fat Injection for Cases of Severe Burn Outcomes: A New Perspective of Scar Remodeling and Reduction

Authors: M. Klinger, M. Marazzi, D. Vigo, M. Torre

Published in: Aesthetic Plastic Surgery | Issue 3/2008

Login to get access

Abstract

Background

Despite civilization and progress, burns occur frequently in the world. Remarkable discoveries of wound healing mechanisms have been reported. On the other hand, long-term outcomes from burn injuries represent a barrier to improvement of patients’ social, functional, and psychological condition. Lipofilling, described since the 1980s, currently is used for several clinical applications. This study aimed to verify whether lipofilling could ameliorate scar remodeling in three clinical cases.

Methods

Three adult patients with hemifacial hypertrophic scars and keloids resulting from severe burns 2 to 13 years previously were selected. The patients were treated by injection of adipose tissue harvested from abdominal subcutaneous fat and processed according to Coleman’s technique. Two injections (with a 13-month interval between) were administered at the dermohypodermal junction. Histologic examination of scar tissue punch biopsies (hematoxylin-eosin staining) before and after the treatment was performed as well as magnetic resonance scan with contrast.

Results

The clinical appearance and subjective patient feelings after a 6-month follow-up period suggest considerable improvement in the mimic features, skin texture, and thickness. Histologic examination shows patterns of new collagen deposition, local hypervascularity, and dermal hyperplasia in the context of new tissue, with high correspondence to the original.

Conclusions

The preliminary results show that lipofilling improves scar quality and suggest a tissue regeneration enhancing process.
Literature
1.
go back to reference Alster CS, Williams CM (1995) Treatment of keloid sternotomy scars by the 585-nm flashlamp-pumped pulsed-dye laser. Lancet 345:1198–1200PubMedCrossRef Alster CS, Williams CM (1995) Treatment of keloid sternotomy scars by the 585-nm flashlamp-pumped pulsed-dye laser. Lancet 345:1198–1200PubMedCrossRef
2.
go back to reference Billings E Jr, May JW Jr (1989) Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast Reconstr Surg 83:368–381PubMedCrossRef Billings E Jr, May JW Jr (1989) Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast Reconstr Surg 83:368–381PubMedCrossRef
3.
go back to reference Boyadjiev C, Popchristova E, Mazgalova J (1995) Histomorphologic changes in keloids treated with Kenacort. J Trauma 38:299–302PubMedCrossRef Boyadjiev C, Popchristova E, Mazgalova J (1995) Histomorphologic changes in keloids treated with Kenacort. J Trauma 38:299–302PubMedCrossRef
4.
go back to reference Carney SA, Cason CG, Gowar JP, Stevenson JH, McNee J, Groves AR, Thomas SS, Hart NB, Auclair P (1995) Cica-Care gel sheeting in the management of hypertrophic scarring. Burns 20:163–167CrossRef Carney SA, Cason CG, Gowar JP, Stevenson JH, McNee J, Groves AR, Thomas SS, Hart NB, Auclair P (1995) Cica-Care gel sheeting in the management of hypertrophic scarring. Burns 20:163–167CrossRef
5.
go back to reference Carr-Collins JA (1992) Pressure techniques for the prevention of hypertrophic scar. Clin Plast Surg 19:733–743PubMed Carr-Collins JA (1992) Pressure techniques for the prevention of hypertrophic scar. Clin Plast Surg 19:733–743PubMed
6.
go back to reference Coleman SR (1997) Facial recontouring with lipostructure. Clin Plast Surg 24:347–367PubMed Coleman SR (1997) Facial recontouring with lipostructure. Clin Plast Surg 24:347–367PubMed
7.
go back to reference Coleman SR (1995) Long-term survival of fat transplants: Controlled demonstrations. Aesth Plast Surg 19:421–425CrossRef Coleman SR (1995) Long-term survival of fat transplants: Controlled demonstrations. Aesth Plast Surg 19:421–425CrossRef
8.
go back to reference De Ugarte DA, Ashjian PH, Elbarbary A, Hedrick MH (2003) Future of fat as raw material for tissue regeneration. Ann Plast Surg 50:215–219PubMedCrossRef De Ugarte DA, Ashjian PH, Elbarbary A, Hedrick MH (2003) Future of fat as raw material for tissue regeneration. Ann Plast Surg 50:215–219PubMedCrossRef
9.
go back to reference Ellenbogen R (2000) Fat transfer: Current use in practice. Clin Plast Surg 27:545–556PubMed Ellenbogen R (2000) Fat transfer: Current use in practice. Clin Plast Surg 27:545–556PubMed
10.
go back to reference Ersek RA (1991) Tranplantation of purified autologous fat: A 3-year follow-up is disappointing. Plast Reconstr Surg 87:219–227PubMedCrossRef Ersek RA (1991) Tranplantation of purified autologous fat: A 3-year follow-up is disappointing. Plast Reconstr Surg 87:219–227PubMedCrossRef
11.
go back to reference Gibran NS, Heimbach DM (2000) Current status of burn wound pathophysiology. Clin Plast Surg 27:11–22PubMed Gibran NS, Heimbach DM (2000) Current status of burn wound pathophysiology. Clin Plast Surg 27:11–22PubMed
12.
go back to reference Harrop AR, Ghahary A, Scott PG, Forsyth N, Uji-Friedland A, Tredget EE (1995) Regulation of collagen synthesis and mRNA expression in normal and hypertrophic scar fibroblasts in vitro by interferon-gamma. J Surg Res 58:471–477PubMedCrossRef Harrop AR, Ghahary A, Scott PG, Forsyth N, Uji-Friedland A, Tredget EE (1995) Regulation of collagen synthesis and mRNA expression in normal and hypertrophic scar fibroblasts in vitro by interferon-gamma. J Surg Res 58:471–477PubMedCrossRef
13.
go back to reference Horl HW, Feller AM, Biemer E 1991 Technique for liposuction fat reimplantation and long-term volume evaluation by magnetic resonance imaging. Ann Plast Surg 26:248–258PubMed Horl HW, Feller AM, Biemer E 1991 Technique for liposuction fat reimplantation and long-term volume evaluation by magnetic resonance imaging. Ann Plast Surg 26:248–258PubMed
14.
15.
go back to reference Illouz YG (1983) Body contouring by lipolysis: A 5-year experience with over 3,000 cases. Plast Reconstr Surg 72:591–597PubMedCrossRef Illouz YG (1983) Body contouring by lipolysis: A 5-year experience with over 3,000 cases. Plast Reconstr Surg 72:591–597PubMedCrossRef
16.
go back to reference Illouz YG (1988) Present results of fat injection. Aesth Plast Surg 12:175–181CrossRef Illouz YG (1988) Present results of fat injection. Aesth Plast Surg 12:175–181CrossRef
17.
go back to reference Lawrence WT (1991) In search of the optimal treatment of keloids: Report of a series and review of the literature. Ann Plast Surg 27:164–178PubMedCrossRef Lawrence WT (1991) In search of the optimal treatment of keloids: Report of a series and review of the literature. Ann Plast Surg 27:164–178PubMedCrossRef
18.
go back to reference Mojallal A, Foyatier JL (2004) Historical review of the use of adipose tissue transfer in plastic and reconstructive surgery. Ann Chir Plast Esthét 49:419–425PubMedCrossRef Mojallal A, Foyatier JL (2004) Historical review of the use of adipose tissue transfer in plastic and reconstructive surgery. Ann Chir Plast Esthét 49:419–425PubMedCrossRef
19.
go back to reference Neuber GA (1893) Fettransplantation. Langenbecks Arch Klin Chir Ver Dtsch Z Chir 22:66 Neuber GA (1893) Fettransplantation. Langenbecks Arch Klin Chir Ver Dtsch Z Chir 22:66
20.
go back to reference Norris JE (1995) Superficial x-ray therapy in keloid management: A retrospective study of 24 cases and literature review. Plast Reconstr Surg 95:1051–1055PubMedCrossRef Norris JE (1995) Superficial x-ray therapy in keloid management: A retrospective study of 24 cases and literature review. Plast Reconstr Surg 95:1051–1055PubMedCrossRef
21.
go back to reference Rigotti G, Marchi A, Galie M, Baroni G, Benati D, Krampera M, Pasini A, Sbarbati A (2007) Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: A healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg 119:1409–1422PubMedCrossRef Rigotti G, Marchi A, Galie M, Baroni G, Benati D, Krampera M, Pasini A, Sbarbati A (2007) Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: A healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg 119:1409–1422PubMedCrossRef
22.
go back to reference Tholpady SS, Llull R, Ogle RC, Rubin JP, Futrell JW, Katz AJ (2006) Adipose tissue: Stem cells and beyond. Clin Plast Surg 33:55–62PubMedCrossRef Tholpady SS, Llull R, Ogle RC, Rubin JP, Futrell JW, Katz AJ (2006) Adipose tissue: Stem cells and beyond. Clin Plast Surg 33:55–62PubMedCrossRef
23.
go back to reference Von Heimburg D, Pallua N (2001) Two-year histological outcome of facial lipofilling. Ann Plast Surg 46:644–646CrossRef Von Heimburg D, Pallua N (2001) Two-year histological outcome of facial lipofilling. Ann Plast Surg 46:644–646CrossRef
24.
go back to reference Von Heimburg D, Hemmrich K, Haydarlioglu S, Staiger H, Pallua N (2004) Comparison of viable cell yield from excised versus aspirated adipose tissue. Cells Tissues Organs 178:87–92CrossRef Von Heimburg D, Hemmrich K, Haydarlioglu S, Staiger H, Pallua N (2004) Comparison of viable cell yield from excised versus aspirated adipose tissue. Cells Tissues Organs 178:87–92CrossRef
25.
go back to reference Yowler CJ, Fratianne RB (2000) Current status of burn resuscitation. Clin Plast Surg 27:1–10PubMed Yowler CJ, Fratianne RB (2000) Current status of burn resuscitation. Clin Plast Surg 27:1–10PubMed
26.
go back to reference Zuk PA, Zhu M, Mizuno H, Huang J, Futrell JW, Katz AJ, Benhaim P, Lorenz HP, Hedrick MH (2001) Multilineage cells from human adipose tissue: Implications for cell-based therapies. Tissue Eng 7:211–228PubMedCrossRef Zuk PA, Zhu M, Mizuno H, Huang J, Futrell JW, Katz AJ, Benhaim P, Lorenz HP, Hedrick MH (2001) Multilineage cells from human adipose tissue: Implications for cell-based therapies. Tissue Eng 7:211–228PubMedCrossRef
27.
go back to reference Zuk PA, Zhu M, Ashjian P, De Ugarte DA, Huang JI, Mizuno H, Alfonso ZC, Fraser JK, Benhaim P, Hedrick MH (2002) Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell 13:4279–4295PubMedCrossRef Zuk PA, Zhu M, Ashjian P, De Ugarte DA, Huang JI, Mizuno H, Alfonso ZC, Fraser JK, Benhaim P, Hedrick MH (2002) Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell 13:4279–4295PubMedCrossRef
28.
go back to reference Brzoska M, Geiger H, Gauer S, Baer P (2005) Epithelial differentiation of human adipose tissue-derived adult stem cells. Biochem Biophys Res Comm 330:142–150PubMedCrossRef Brzoska M, Geiger H, Gauer S, Baer P (2005) Epithelial differentiation of human adipose tissue-derived adult stem cells. Biochem Biophys Res Comm 330:142–150PubMedCrossRef
Metadata
Title
Fat Injection for Cases of Severe Burn Outcomes: A New Perspective of Scar Remodeling and Reduction
Authors
M. Klinger
M. Marazzi
D. Vigo
M. Torre
Publication date
01-05-2008
Publisher
Springer-Verlag
Published in
Aesthetic Plastic Surgery / Issue 3/2008
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-008-9122-1

Other articles of this Issue 3/2008

Aesthetic Plastic Surgery 3/2008 Go to the issue