Plastic Surgery Research Council

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Autologous Fat Transfer for Scar Prevention and Remodeling (AFT-SPAR): Could Saline be as Efficacious as Fat?
James C. Brown, MD, Hulan Shang, MS, Ning Yang, PhD, Adam J, Katz, MD, FACS.
University of Florida, Gainesville, FL, USA.

PURPOSE: Despite a lack of high-level evidence to support improved skin and scar quality, interest in autologous fat grafting for such continues to grow. This multi-center, double-blinded, randomized, placebo-controlled trial aimed to evaluate the effect of autologous fat grafting in patients with cutaneous scars.
METHODS: 17 patients with cutaneous scars affecting quality of life underwent Coleman-type fat grafting, completed with autologous fat/saline at a density of 1mL/cm2. Outcomes were measured at baseline, and 6/12 months. Scars were subjectively and objectively evaluated using POSAS, durometer (hardness), cutometer (elasticity), colorimeter (wavelength absorbance), and single-observer histological analyses.
RESULTS: POSAS score totals, cutometer and durometer analyses were not significantly different between grafted (fat) and control (saline) scar appearance, elasticity or hardness at 0, 6, or 12 months, respectively. A single significant colorimetric difference in the a* color coordinate at 6 months (p = 0.037) was demonstrated, but was not durable at 12 months (p = 0.49). Single-observer histological 5-point scale ranking revealed no significant differences between AFT-treated and control scar vascularity or inflammation, nor epidermal thickness at baseline, six or twelve months. There was no statistically reliable difference of categorical evaluations, including vascular orientation, collagen organization and remodeling, and inflammation chronicity at the 0.05 level.
CONCLUSION: In conclusion, these results suggest that autologous fat transfer can improve the qualitative profile of scar from a patient and observer perspective, consistent with a large body of level-III and -IV scientific work. These qualitative improvements, however, are not corroborated by measurable differences in skin hardness, elasticity, color, or histology. Further rigorous, large volume, randomized-controlled trials are required to elucidate the quantitative effects of autologous fat transfer. Insight into these effects may yield the clinical treatment requisites, and subsequently, the realization autologous fat transfer's potential for scar prevention and remodeling.


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