Introduction:
Current guidelines suggest a multimodal approach to treating scars but there
is no gold standard for treatment; however, there is exciting therapeutic
potential for the use of autologous fat grafting (AFG). Functional and
aesthetic improvements have been reported, including pain relief and scar
quality improvement.Aims:To explore the current evidence regarding the use of AFG in hypertrophic and
painful scars.Methods:A systematic review of the literature was conducted using 11 MeSH terms in
PubMed, Medline and EMBASE. English studies that used AFG to treat scars in
human participants were included.Results:
A total of 746 studies were found and 23 studies (from 2008 to 2016) were
included: five studies were evidence level V; nine studies were evidence
level IV; eight were evidence level III; and one study was evidence level
II. A total of 1158 patients were assessed for improvement in scar
characteristics including colour, thickness, volume, pain and restoration of
function at affected sites, following treatment. Positive outcomes were
noted for all parameters and a significant improvement in AFG’s analgesic
effect was recorded in 567 out of 966 patients, P <
0.05.Discussion:
AFG is a minimally invasive and safe approach to treating scars, a promising
alternative to surgical excision. The technique of blunt cannula insertion
optimises the release of scar retraction, which contributes to the analgesic
effect of this treatment method. The evidence supports current theories of
mesenchymal stem cell’s regenerative and anti-inflammatory properties
responsible for scar healing. There are limited high quality studies to
support its use and future randomised controlled trials should be
conducted.
Moebius syndrome (MBS) is a congenital, non-progressive facial and abducens nerve palsy in the presence of full vertical gaze and may be associated with limb abnormalities and craniofacial dysmorphisms. MBS is now defined as a disorder of rhombencephalic maldevelopment and recent gene discoveries have shown this to be a dominant disorder in a subset of patients. Accurate diagnosis and management by a multidisciplinary team with expertise in congenital facial palsy is paramount.
We hope that, in encouraging a higher index of suspicion, prompt diagnosis, and accurate treatment, a better outcome for both patient and surgeon can be achieved in future cases.
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