Andrea Lisa

Autologous fat graft as treatment of post short stature surgical correction scars

INTRODUCTION Surgical limb lengthening is undertaken to correct pathological short stature. Among the possible complications related to this procedure, painful and retractile scars are a cause for both functional and cosmetic concern. Our team has already shown the efficacy of autologous fat grafting in the treatment of scars with varying aetiology, so we decided to apply this technique to scars related to surgical correction of dwarfism. A prospective study was conducted to evaluate the efficacy of autologous fat grafting in the treatment of post-surgical scars in patients with short-limb dwarfism using durometer measurements and a modified patient and observer scar assessment scale (POSAS), to which was added a parameter to evaluate movement impairment. PATIENTS AND METHODS Between January 2009 and September 2012, 36 children (28 female and 8 male) who presented retractile and painful post-surgical scars came to our unit and were treated with autologous fat grafting. Preoperative and postoperative mean durometer measurements were analysed using the analysis of variance (ANOVA) test and POSAS parameters were studied using the Wilcoxon rank sum test. RESULTS There was a statistically significant reduction in all durometer measurements (p-value <0.05) and in all but one of the POSAS parameters (p-value <0.05) following treatment with autologous fat grafting. DISCUSSION Surgical procedures to camouflage scars on lower limbs are not often used as a first approach and non-surgical treatments often lead to unsatisfactory results. In contrast, our autologous fat grafting technique in the treatment of post-surgical scars has been shown to be a valuable option in patients with short-limb dwarfism. CONCLUSION There was a reduction of skin hardness and a clinical improvement of all POSAS parameters in all patients treated. Moreover, the newly introduced POSAS parameter appears to be reliable and we recommend that it is included to give a more complete evaluation of patient perception.

Autologous Fat Grafting Reduces Pain in Irradiated Breast: A Review of Our Experience

Introduction. Pain syndromes affect women after conservative and radical breast oncological procedures. Radiation therapy influences their development. We report autologous fat grafting therapeutical role in treating chronic pain in irradiated patients. Materials and Methods. From February 2006 to November 2014, we collect a total of 209 patients who meet the definition of “Postmastectomy Pain Syndrome” (PMPS) and had undergone mastectomy with axillary dissection (113 patients) or quadrantectomy (96 patients). Both procedures were followed by radiotherapy. We performed fat grafting following Colemans procedure. Mean amount of adipose tissue injected was 52 cc (±8.9 cc) per breast. Seventy-eight in 209 patients were not treated surgically and were considered as control group. Data were gathered through preoperative and postoperative VAS questionnaires; analgesic drug intake was recorded. Results. The follow-up was at 12 months (range 11.7–13.5 months). In 120 treated patients we detected pain decrease (mean ± SD point reduction, 3.19 ± 2.86). Forty-eight in 59 patients stopped their analgesic drug therapy. Controls reported a mean ± SD decrease of pain of 1.14 ± 2.72. Results showed that pain decreased significantly in patients treated (p < 0.005, Wilcoxon rank-sum test). Conclusion. Our 8-year experience confirms fat grafting effectiveness in decreasing neuropathic pain.

Matching Biological Mesh and Negative Pressure Wound Therapy in Reconstructing an Open Abdomen Defect

Reconstruction of open abdominal defects is a clinical problem which general and plastic surgeons have to address in cooperation. We report the case of a 66-year-old man who presented an abdominal dehiscence after multiple laparotomies for a sigmoid-rectal adenocarcinoma that infiltrated into the abdominal wall, subsequently complicated by peritonitis and enteric fistula. A cutaneous dehiscence and an incontinent abdominal wall resulted after the last surgery. The abdominal wall was reconstructed using a biological porcine cross-linked mesh Permacol (Covidien Inc., Norwalk, CT). Negative Pressure Wound Therapy (NPWT), instead, was used on the mesh in order to reduce wound dimensions, promote granulation tissue formation, and obtain secondary closure of cutaneous dehiscence which was finally achieved with a split-thickness skin graft. Biological mesh behaved like a scaffold for the granulation tissue that was stimulated by the negative pressure. The biological mesh was rapidly integrated in the abdominal wall restoring abdominal wall continence, while the small dehiscence, still present in the central area, was subsequently covered with a split-thickness skin graft. The combination of these different procedures led us to solve this complicated case obtaining complete wound closure after less than 2 months.

Periareolar Approach in Oncoplastic Breast Conservative Surgery

Breast cancer represents the most frequent cancer in female population. Nowadays breast conservative surgery (BCS) is an accepted option for breast malignancies, and its indications has been extended thanks to the advent of oncoplastic surgery, reducing both mastectomy and re‐excision rate, avoiding at the same time breast deformities. From January 2008 to November 2011, 84 women underwent BCS with periareolar approach for oncoplastic volume replacement. We divided patients into four groups analyzing breast size and resection volume (Group 1: small‐moderate sized breast with resection <20%; Group 2: small‐moderate sized breast with resection >20%; Group 3: big sized breast with resection <20%; Group 4: big sized breast with resection >20%). We evaluated patients’ satisfaction regarding final esthetic outcome using the specific module “Satisfaction with outcome” of the Breast‐Q questionnaire 1 year after surgery. The mean age was 52.1 years, and the mean follow‐up was 11.2 months. During the follow‐up, 12 patients have been lost. We obtained high satisfaction mean value with Breast‐Q questionnaire in each group: 75.8 in group 1, 63.4 in group 2, 81.1 in group 3, 69.7 in group 4. Periareolar approach as oncoplastic volume replacement technique is useful in correction of breast deformity after BCS: it is a versatile technique that can be easily adapted for any breast tumor location and for wide glandular resection.

Autologous fat grafting in secondary breast reconstruction

To the Editor: We read with interest the article entitled ‘‘Autologous fat grafting in secondary breast reconstruction.’’ We would like to congratulate Dr. Carlson, Dr. Anderson and colleagues for their publication, reviewing their experience with fat grafting for the correction of acquired breast deformities in patients who had secondary breast reconstruction. We believe that a systematic elaboration about the use of autologous fat grafting in secondary breast reconstruction was useful to summarize the main available therapeutic strategies to improve aesthetic result after mastectomy and breast reconstruction and encouraging a scientific debate about therapeutic effects that could possibly emerge in the future. Considering all currently available applications listed in the article, we would like to add our personal experience in autologous fat graft as ancillary surgical procedure in secondary breast reconstruction. Our study, published in August 2011, gave evidence of a therapeutic action of autologous fat graft in patient affected by postmastectomy pain syndrome, a condition of neuropathic pain, which could appear after mastectomy or quadrantectomy. In our study, 71 patients were treated with autologous fat graft in painful scars, and we subsequently recorded a statistical significant decrease in pain according to visual analog scale with 13 months of follow-up. Moreover, we described that 28 of 34 patients stopped their pharmacological analgesic therapy, with a significant mean free time. We already published works about autologous fat graft’s analgesic effect in scar treatment and Arnold’s Neuralgia correction. We hypothesize that autologous fat graft yields not only scar tissue’s architectural remodeling, as we have already described for various type of tissue damage, but it probably also provides molecular changes in local microenvironment. Considering our clinical results, we support autologous fat graft use in the treatment of postmastectomy pain syndrome as a new field of application of this technique in secondary breast reconstruction. Fabio Caviggioli, MD

Autologous Fat Grafting in the Treatment of Painful Postsurgical Scar of the Oral Mucosa

Background. Persistent pain as a consequence of surgical treatment has been reported for several common surgical procedures and represents a clinical problem of great magnitude. Material and Methods. We describe the case of a 47-year-old female who presented a retractile scar that adhered to deep planes at the upper right of the vestibule due to surgical removal of maxillary exostosis, which determined important pain symptoms extending till the right shoulder during both chewing and rest. We subsequently treated her with autologous fat grafting according to Colemans technique. Results. Clinical assessments were performed at 5 and 14 days, 1, 3, and 6 months, and 1 year after surgical procedure. We observed a progressive release of scar retraction together with an important improvement of pain symptoms. Conclusion. The case described widens the possible application of autologous fat grafting on a new anatomical site as buccal vestibule and in one specific clinical setting confirming its promising biological effects.

A systematic review of peripheral nerve interventional treatments for chronic headaches.

To the Editor: Ducic and colleagues have recently published on the Annals of Plastic Surgery a very interesting systematic review based on the available published literature entitled ‘‘A systematic review of peripheral nerve interventional treatments for chronic headaches.’’ We would like to congratulate Ducic and coworkers for their paper which systematically compares the outcomes of different types of interventional procedures offered for the treatment of headaches and targeted toward peripheral nerves. Considering all the data listed in the article, we would like to add our experience in the treatment of chronic headaches of cervical origin (both chronic cervicogenic and occipital neuralgia) with autologous fat grafting described by our recent papers. We treated with lipostructure a total of 24 patients presenting headache of cervical origin, previously evaluated by a neurologist, refractory to conventional treatment for at least 3 months, and showing positivity to occipital nerve block test with local anesthetic agent. The visual analog scale of pain and the medication diary were adopted in the 3 months preceding the treatment; moreover, to verify quality of life, patients were required to fill in before surgery the Neck Pain Disability Index, the Headache Disability Index, migraine disability assessment scale questionnaire, and the short-form 12 standard v1 questionnaire. Follow-up control were fixed at 3 and 6 months. In our case series, we detected a significant reduction in disability and pain scores together with a significant reduction of need for pharmacologic treatment and a fast return to previous working activities. Headaches of cervical origin generally present myofascial spasm and local, scar-like, entrapment of the occipital nerve by local fibrosis and adherences, conditions which represent a continuous trigger for nerve excitatory pattern. The key point of our therapeutic strategy might be the regenerative role of the stromal fraction of adipose tissue grafted in the area of the occipital nerve entrapment. Autologous fat grafting could induce scar tissue release, as already observed in other clinical settings, promoting soft tissue reorganization and regeneration, reducing nerve excitatory pattern. Moreover, it is possible to hypothesize that fat grafting could induce analgesia by inhibition of inflammation, as described by our group in post mastectomy pain syndrome condition. The technique is minimally invasive and no complications were recorded. Because our results are encouraging both in terms of reduction of pain scores and in terms of quality of life improvement, we believe that our papers can be considered in a systematic review about the different types of peripheral nerve interventional procedures for the treatment of chronic headaches.

Outcomes of immediate tissue expander breast reconstruction followed by reconstruction of choice in the setting of postmastectomy radiation therapy.

A common sequence for performing staged tissue expander breast reconstruction is to immediately insert a tissue expander, complete expansion before radiotherapy, and then perform the definitive reconstruction after radiotherapy is complete. This study evaluates the outcomes of this treatment regimen in 237 patients over a 10-year period at Northwestern Memorial Hospital. Overall, 62% of the patients successfully completed tissue expander/ implant reconstruction, 22.3% experienced major complications leading to explantations or conversions to flap, and 13.5% completed tissue expander/ elective autologous reconstruction. Of the patientswho underwent second-stage tissue expander to implant exchange, 87.5% successfully completed reconstruction without experiencing complications leading to explantation or conversion to autologous reconstruction. Thus, this study indicates that immediate tissue expander followed by reconstruction of choice breast reconstruction in the setting of postmastectomy radiation therapy can be successfully performed in most of the patients.

Alleviation of Neuropathic Scar Pain Using Autologous Fat Grafting

Dear Editor: e read with interest the article entitled W “Alleviation of Neuropathic Scar Using Autologous Fat Grafting,” in which Huang et al. assess the effects of fat grafting on neuropathic scar pain. In this study, the authors show an important and significant decrease of neuropathic pain in 1 week after treatment, according to visual analogue scale and neuropathic pain symptom inventory scores. Authors also illustrate that the effects of autologous fat grafting persist for at least 6 months. We would like to thank the authors for having mentioned our researches and for sharing their experience in fat grafting that once again reinforces our evidences about its therapeutical role in the treatment of neuropathic pain. Considering the data listed in this article, we would like to present our recent updates about this topic. Recently, we started to widen our indication for autologous fat grafting to patients who developed chronic neuropathic pain after lumpectomy and radiation therapy. In our study, “Autologous Fat Graft in Postmastectomy Pain Syndrome Following Breast Conservative Surgery and Radiotherapy” (Aesthetic Plast Surg. 2014 Jun;38(3):528–32), we present our results in this study population with a statistical significant pain reduction evaluated with a visual analogue scale. We are persuaded that our results, which confirm previous reports, are obtained because of the capability of fat grafting to induce scar tissue architectural remodeling and regeneration, neovessel formation, and improved hydration, leading to scar entrapment release

Autologous fat graft in irradiated orbit postenucleation for retinoblastoma

ABSTRACT Autologous fat grafting has been extensively and successfully adopted in a number of pathologic conditions in regenerative surgery especially on irradiated fields in order to improve pain symptoms and tissue trophism promoting scar release. In the present study, we report our experience with autologous fat grafting for the treatment of postirradiation fibrosis and pain on three consecutive patients undergoing orbital enucleation for locally advanced retinoblastoma (RB) and subsequent radiotherapy. We selected three consecutive patients who underwent orbital enucleation for locally advanced RB and subsequent local radiotherapy showing severe reduction in orbital volume and eyelid length and retraction due to fibrosis, spontaneous local pain exacerbated after digital pressure with no possibility to place an ocular implant. They underwent autologous fat grafting in the orbital cavity and results were evaluated by clinical examination at 5 and 14 days, and 1, 3, 6 months, and 1 year after surgery. A significant release of scar retraction, reduction of fibrosis and orbital rim contraction together with an important improvement of pain symptoms was observed in all patients. The local changes observed enabled an ease placement of an ocular prosthetic implant (implant). No local or systemic complication occurred. Fat grafting is a promising treatment for patients showing radiotherapy related complication in the orbital area and it should be adopted by all oculoplastic surgeon in order to improve pain syndrome creating the ideal local conditions for the placement of an ocular prosthetic implant.