Fat grafting for scar revision and soft tissue defect correction

Plastic and Reconstructive Surgery · Dermatology

Scars resulting from trauma or surgery can cause significant aesthetic and functional impairment, affecting patients’ quality of life. As injured skin and its appendages have limited regenerative capacity, scar tissue lacks the structural and functional properties of normal skin. Associated loss of subcutaneous adipose tissue (hypodermis) may further contribute to volume deficits, contour irregularities, and scar adherence. Autologous fat grafting is an established reconstructive technique for restoring soft tissue volume, correcting contour deformities, and improving scar quality. The procedure involves harvesting, processing, and transferring adipose tissue to the affected area. Beyond volume restoration, it may improve tissue pliability, vascularity, and scar adherence, making it useful for managing post-traumatic and postsurgical scars and soft tissue defects. Successful outcomes depend on appropriate patient selection, careful graft handling, and precise placement to maximise graft retention.[1]Clinical applications of fat graftingFat grafting is used to correct soft tissue volume deficiencies following trauma, surgery, infection, or tissue lossIt can improve depressed, adherent, and irregular scars by restoring underlying tissue volume and facilitating tissue mobilizationIn patients with postsurgical scarring, fat grafting may improve contour deformities and reduce the appearance of localized tissue depressionIt is also used in reconstructive procedures following burns, where scar pliability and soft tissue quality may be impairedFat grafting can complement surgical scar revision when volume deficiency and tissue tethering contribute to the deformityPrinciples and procedural techniqueFat harvesting is generally performed through low-pressure liposuction from suitable donor sites, such as the abdomen, flanks, or thighsHarvested adipose tissue undergoes processing to separate viable adipose tissue from blood, free oil, and other unwanted componentsProcessing techniques may include centrifugation, filtration, or washing, depending on the surgeon's preferred protocolThe processed fat is transferred using small cannulas and deposited in multiple small aliquots across different tissue planesSmall-volume, evenly distributed graft placement helps maximize contact with recipient tissues and supports graft revascularizationOvercorrection may be considered selectively because some transplanted fat undergoes resorption; however, the degree of resorption is variable and cannot be predicted preciselyMechanisms of tissue improvementTransplanted adipose tissue provides volume replacement and improves contour irregularitiesAdipose-derived stromal cells and associated regenerative components may contribute to tissue remodeling and vascular changesFat grafting may improve scar pliability, reduce tissue adherence, and enhance local tissue qualityThese regenerative effects are clinically relevant in fibrotic scars and irradiated tissues, although the magnitude and durability of improvement vary among patientsPatient selection and postoperative considerationsPatient selection should consider scar maturity, tissue vascularity, defect dimensions, donor-site availability, and overall reconstructive goalsActive infection and poorly controlled local tissue conditions should be addressed before graftingPatients should be counseled regarding variable fat retention, possible contour irregularities, and the potential need for repeat graftingPostoperative assessment should evaluate graft retention, symmetry, scar mobility, and donor-site healingPotential complicationsComplicationClinical relevancePartial fat resorptionMay reduce the achieved volume and require repeat grafting.Fat necrosisCan produce palpable nodules, inflammation, or oil cysts.Contour irregularitiesMay result from uneven graft distribution or variable fat survival.InfectionCan affect graft survival and recipient-site healing.Hematoma and seromaMay occur at the donor or recipient site.Donor-site deformityMay result from uneven fat harvesting.ConclusionAutologous fat grafting has evolved from a technique primarily used for aesthetic volume restoration and contour correction to a promising regenerative approach in scar management and soft tissue reconstruction. Its potential benefits extend beyond volume restoration, with adipose-derived stem cells contributing to tissue remodelling and cutaneous wound healing through their differentiation and paracrine activities. Autologous fat grafting may improve scar pliability, tissue mobility, and local tissue quality, making it a valuable option for scar revision and soft tissue defect correction. However, variable graft retention, postoperative fat resorption, and the potential need for repeat procedures remain important considerations. Meticulous harvesting, processing, and controlled graft placement are essential to optimise graft survival and achieve satisfactory, durable reconstructive outcomes.[2]Reference(s):1. Brown JC, Shang H, Yang N, et al. Autologous Fat Transfer for Scar Prevention and Remodeling: A Randomized, Blinded, Placebo-controlled Trial. Plast Reconstr Surg Glob Open. 2020;8(5):e2830. Published 2020 May 27. doi:10.1097/GOX.0000000000002830. https://pmc.ncbi.nlm.nih.gov/articles/PMC7605847/2. Malik D, Luck J, Smith OJ, Mosahebi A. A Systematic Review of Autologous Fat Grafting in the Treatment of Acute and Chronic Cutaneous Wounds. Plast Reconstr Surg Glob Open. 2020;8(5):e2835. Published 2020 May 18. doi:10.1097/GOX.0000000000002835. https://pmc.ncbi.nlm.nih.gov/articles/PMC7605858/