A Comparative study between fat cell grafting alone and fat graft augmented with stromal vascular fraction (cell assisted lipotransfer) in the management of postburn hypertrophic scarring

Abstract

Post burn hypertrophic scarring is a major problem that face plastic surgeons on their daily practice as it is a serious problem which affect the patient physically, psychologically and socially. Post burn scar management include non surgical options e.g: pressure garment, silicone sheets or laser therapy and surgical options are scar revision, excision and coverage, release by z-plasty, application of tissue expander and recently fat grafting introduced as a good therapeutic option in the management of post burn scarring. Fat grafting was introduced to the field of plastic surgery as a filler to correct any soft tissue loss as it is cheap and readily available in a large amount and can be easily harvrsted as well. In mid 1990s Coleman et al., observed improvement in the skin overlying the grafted fat, it was observed that fat has other properties rather than volume restoration. In recent years there is increased interest in the regenerative properties of fat, many studies were done to evaluate those regenerative properties and their application where fat was injected in wound, ulcers and scars and its efficacy was proved. The regenerative properties of fat is attributed to the presence of A.D.S.Cs, other stromal cells and other growth factors present within it. A.D.S.Cs were first identified in 2001 by Zuk et al. as a group of cells capable of differentiation into various cell lines, one of the advantages of isolation of stem cells from adipose tissue that adipose tissue is easily harvested and available in large amount. Supplementing fat with A.D.S.Cs is termed cell assisted lipotransfer it was introduced by Yoshimura et al. 2008 as new technique of fat grafting where stromal vascular fraction obtained from fat after its digestion by collagenase. Stromal vascular fraction can be defined as heteregenous population of freshly isolated cells from adipose tissue after enzymatic dissociation, it is composed of A.D.S.Cs, endothelial cells, fibroblast, pericyte and mesenchymal stromal cells. In THIS study we compared between fat grafting alone (processed according Coleman’s technique) and fat enhanced with stromal vascular fraction (cell assisted lipotransfer) regarding their efficacy in improving post burn hypertrophic scars. This study included twenty patient suffering from post