Reply: Effectiveness of Autologous Fat Grafting in Adherent Scars

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We would like to thank the authors for their comments on our article: “Effectiveness of Autologous Fat Grafting in Adherent Scars: Results Obtained by a Comprehensive Scar Evaluation Protocol.”1 We would also like to thank the authors for pointing at their histologic results that were obtained after reconstruction with Integra (Integra LifeSciences, Plainsboro, N.J.), a split-thickness skin graft, and lipofilling at a later stage. The authors mention that they found improved vascularization, new collagen, and a decrease of fibrosis between 90 and 120 days after lipofilling. Although an exact description of how the histologic evaluations were performed is not provided, the results seem positive and support their “three-step protocol.” Clearly, our study was not focused on histology but on demonstrating the clinical effectiveness of autologous fat grafting by means of objective and subjective scar evaluation tools. Remarkably, such studies appeared to be rare. Besides that, we work on a project using multiphoton microscopy to increase our knowledge on the biological effects of autologous fat grafting and to evaluate the presence and/or viability of fat grafts over time.
Some remarks about the content of the authors’ letter could be made, as some references appear to be interesting choices. The cited study by Markman et al. is a decent study performed in 1987 that describes the anatomy of subcutaneous tissue located on the trunk and lower extremity. Interestingly, the authors state that this study highlights the regenerative qualities of fat. In addition, the authors positively mention that they performed lipofilling in numerous scar cases, although the corresponding reference by Portincasa et al. represents a study focusing on the adaptation of fasciocutaneous free flaps after being transferred to a recipient area. Finally, a previous letter of the research group—the article by Annacontini et al.—is cited, which commented on a prospective study that evaluated surgical excision and adjuvant irradiation for therapy-resistant keloids. It seems that keloidal treatment is not particularly related to the topic of lipofilling or fat grafting. Thus, after reading the current letter by the authors, it is considered that it is quite undesirable in scientific research to provide the reader with confusing references. Moreover, as letters are usually not peer reviewed, they should probably not contain original or primary data, as also supplied by the authors.
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