Elsevier

Burns

Volume 43, Issue 3, May 2017, Pages 486-489
Burns

Autologous fat grafting does not improve burn scar appearance: A prospective, randomized, double-blinded, placebo-controlled, pilot study

https://doi.org/10.1016/j.burns.2016.09.019Get rights and content

Highlights

  • Fat grafting is used to “treat” scars in hopes of improving scar appearance.

  • We tested the effects of fat grafts compared to control areas injected with saline.

  • Blinded observers did not see improvement comparing fat grafted and control sides.

  • The blinded patients did not see improvement when comparing fat grafted and control sides.

Abstract

Objective

It has been proposed that fat grafts can improve the appearance of mature burn scars. The pluripotent progenitor cells contained within autologous adipose tissue grafts are believed to induce skin repair and improve scar appearance. We conducted a prospective, randomized, double-blinded, placebo-controlled study to evaluate the effects of fat grafts on the appearance of mature burn scars.

Methods

Pediatric burn survivors with mature scars were recruited for this study. A homogeneous scar measuring 10 × 5 cm was randomized into two halves: one was injected with autologous fat graft and the other with normal saline. Scar injection was performed using standard Coleman technique. Appearance of the two scar halves was assessed, six to twelve months later by the operating surgeon, by blinded observers and by the blinded patients.

Results

Eight patients completed the study pilot with 6–12 month follow-up. Assessment by the patients did not clearly favor fat grafts or saline injections; the operating surgeon did not identify any differences on any of the patients; the blinded observers measured all scars using Vancouver Scar Scale and noticed no differences in pigmentation, vascularity and height; differences in pliability showed similar changes in both the fat grafted and control arms. After the pilot was completed, decision was made to stop enrolling patients for this study since no benefit to fat grafting was observed.

Conclusions

Single treatment with autologous fat grafts did not improve mature pediatric burn scars when compared to normal saline injections.

Introduction

Fat grafting has been utilized for over 100 years. It was first introduced by Neuber and Czerny in the 1890s. It was also used by Gillies, who noted that the quality of scars was improved after the subcutaneous application of fat grafts. It then soared into mainstream in the 1990s when Coleman popularized the technique of structured fat grafting [1].

Since then, autologous fat grafting has become a commonly used technique in the reconstructive as well as the esthetic arena, due to its wide availability and biocompatibility [1], [2]. More recently, the discovery of adipose-derived stem cells in fat grafts has prompted the study of their role in tissue healing, regeneration and repair. It has been postulated that fat grafting can improve the qualitative and quantitative appearance of scars, including complicated scars such those caused by radiation and thermal injury [1], [3], [4], [5]. To date, no prospective randomized blinded studies have been published to support the effectiveness of this technique for burn patients. In this study, we set out to elucidate whether autologous fat grafting actually does induce scar repair and improve the appearance of mature burn scars.

Section snippets

Materials and methods

Patients with mature burn scars who were scheduled to undergo unrelated surgical reconstruction at a pediatric burn unit were recruited to participate in this study. The Institutional Review Board approved the study with an enrollment goal of fifty patients and a provision to perform an initial evaluation of safety and efficacy after the first 10 patients were enrolled. Inclusion criteria included pediatric patients with late effects of burns requiring surgical reconstruction procedures who

Results

Ten patients, with age ranging between 5 to 20 years (mean 13 years), were enrolled into the first phase of the study. One patient opted out of the study on the day of the scheduled surgery. Complete data for analysis was available on eight of the nine remaining patients: one patient was lost to follow up. Postoperative follow-up ranged between 156–359 days (mean 240 days). The Scar injection sites were the forearm in 7 cases, the lower leg in one case and the chest in one case (see Table 1).

Discussion

Traditional methods of managing secondary burn scarring include commonly used approaches such as steroid injections, compression garments, silicone sheets and laser phototherapy. More recently, fat grafts have been used to induce improvements in mature burn scars.

Fat grafts include not only adipocytes, but all cells found in the adipose tissue. Vyas and Valeriano reported that fat grafts contain adipose derived stem cells that can improve wound healing and improve scar quality in patients with

Conclusions

Autologous fat grafting has become a popular tool to the reconstructive and esthetic surgeon for treating volume defects, contour abnormalities, and scars. However, no prospective randomized double blinded studies support this practice for pediatric burn survivors. Our study failed to observe any benefits for fat grafts of mature burn scars. While many experts have reported successful use of fat grafts to improve scars, further studies will be needed to obtain level I evidence to support this

Conflicts of interest

None.

Funding disclosure

None.

Acknowledgments

None.

References (8)

There are more references available in the full text version of this article.

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