Effectiveness of Autologous Fat Grafting in Adherent Scars: Results Obtained by a Comprehensive Scar Evaluation Protocol
We read with interest the article entitled “Effectiveness of Autologous Fat Grafting in Adherent Scars: Results Obtained by a Comprehensive Scar Evaluation Protocol,”1 where Jaspers et al. presented a prospective study on 40 patients with an adherent scar who underwent a single session of autologous fat transfer. Their results showed a significant improvement in the Cutometer (Courage + Khazaka electronic GmbH, Cologne, Germany) parameters “elasticity” and “maximal extension” and in all the single Patient and Observer Scar Assessment Scale items, except for the item “itch.” Conversely, erythema and melanin differences between the scar and healthy skin remained unaltered at 3-month follow-up. We would like to congratulate Jaspers et al. for their article and kindly thank them for citing our study. Considering the data listed in the article, we would like to contribute by adding our more recent experience in the treatment of retractile and painful scars derived from surgical correction of children of short stature with pathologic dwarfism.2 The use of autologous fat grafting on 36 patients resulted in an improvement in the scar quality from both functional and cosmetic points of view. In particular, relief from pain and increase in scar elasticity were clinically assessable in all cases. The clinical assessment of the study population was conducted using durometer measurements and a modified Patient and Observer Scar Assessment Scale, to which a new item was added in the patient section to investigate scar-related movement impairment. This new item has been shown to be reliable after test and retest, with an excellent intraclass correlation coefficient and has been shown to be the feature most closely related to overall patient satisfaction. Therefore, we suggest that the authors introduce the use of this new parameter in the Patient and Observer Scar Assessment Scale to provide a more complete evaluation of patient perception of their own scar.
The biological effect of autologous fat graft could be attributed in part to the presence of mesenchymal multipotent stem cells in the adipocyte cell fraction of the graft that are responsible for remodeling through engraftment and differentiation and could induce molecular changes in the microenvironment of the posttraumatic scars. Our study in the treatment of postmastectomy pain syndrome shows the positive effect of autologous fat graft in controlling pain following lumpectomy and radiotherapy.3,4 The low complication rate, the patients’ high tolerance of the procedure, and the rapid resumption of normal daily life after surgery are all elements that favor the use of this technique on an increasing number of patients, leading to a wider experience and broadening of the therapeutic applications of autologous fat grafting.5
In conclusion, our results are encouraging in terms of improvement of both clinical characteristics of the scar and the patient’s quality of life. In addition, we support the use of our modified Patient and Observer Scar Assessment Scale, which contains a specific item regarding impairment to movements, which is reliable and relevant in a more thorough evaluation of a patient’s perception of their own scar.