A retrospective study was performed of 694 patients with contracted and painful scars over a six year period. A total of 376 patients had burn scars, 54 patients had scars due to road trauma, 92 patients had scars from domestic accidents and 172 patients had scars after surgical reconstructions. All patients recruited had retractile and painful scars compromising the normal daily activity / mobility of the joint involved, patients were over age 15 years and the scar had been present for more than two years. Patients with keloid scars, pathological conditions affecting wound healing (diabetes, connective tissue disease) and therapies affecting wound healing (steroids, chemotherapy) were excluded. The Coleman fat grafting technique was performed to try to improve scar quality, with fat harvested from the abdomen or upper thigh. In all 694 patients, the presence of scar retraction and pain was evaluated preoperatively and postoperatively at day five, 14 and at month one, three, six and 12. In 20 randomised patients, clinical assessments using Patient and Observer Scar Assessment Scale (POSAS) and Durometer (scar hardness) measurements were also performed preoperatively and at three months postoperatively. In all treated scars, a qualitative improvement was shown both from an aesthetic and functional point of view. There was a reduction or complete resolution of pain and an increase in scar elasticity in all cases. In patients studied using the Durometer and POSAS score, areas treated with autologous fat graft showed statistically significant reduction in hardness measurements (P<0.05) between preoperative and postoperative values. POSAS scores showed a statistically significant reduction between preoperative and postoperative values of all of POSAS parameters apart from scar itching. This paper supports increasing evidence for the grafting of autologous fat as a promising and effective therapeutic approach for scars of different origins.  

Autologous fat graft in scar treatment.
Klinger M, Caviggioli F, Klinger FM, et al.
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Aina Greig

St Thomas' Hospital, London, UK

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