BackgroundAutologous fat grafting (AFG) has been used in the treatment of cutaneous and subcutaneous graft neoplastic demolitions, in limited cutaneous sclerotic conditions and in localized scleroderma. Several reports showed the possible therapeutic effects in the management of cutaneous perioral thickness and digital ulcers (DU) in patients affected by systemic sclerosis (SScl). Patients suffering from SScl in the course of the pathology, undergo progressive thickening of the skin, especially in perioral area, with functional limitation in the opening of the mouth, chewing, swallowing and phonation. On the other hand is well known that digitals ulcers (DU) localized on the hands developed in more than 50% of SScl patients. Usually DU are very painful, debilitating and difficult healing despite various therapies adopted, and often are complicated by infections that lead to gangrene and amputation.ObjectivesWe evaluated the response to AFG in treatment of DU and perioral thickness in Sclerodermic pts.MethodsWe treated 9 SScl pts (median age 47±14 years, affected by diffuse SScl, mean age of onset of disease 11±9) with perioral thickening ad DU. All patient were in treatment with iv iloprost and 7 also with bosentan to prevent new DU onset. All the 9 pts were subjected to perioral region treatment and 6 also to DU treatment; altogether there were 10 DU active. Under local anesthesia and mild sedation three cc of subcutaneous autologous fat were taken from the periumbilical or trochanteric area (only in two patients), and after centrifugation and purification, injected into the perioral region in 6 standardized points, or in presence of DU at the finger base in two contiguous sites. Before and after the graft and during the follow up, all pts were monitored by measuring of mouth opening, SHAQ and pts self reports based on visual scale regarding phonation, chewing and swallowing. Monitoring of digital ulcers involved the counting of those number, size, activity and/or superinfection, improving the bending of the fingers and hand grip strength, need of advanced medications and analgesic.ResultsAFG was well tolerated and no adverse events were reported, there were no infections; only 3 pts showed a small hematoma in the areas of periumbilical graft. In all the pts three and six months after treatment, mouth opening were conserved, and it was not necessary to repeat the treatment. In 6 pts treated for DU a healing of ulcers occurs in 6/10 DU after a month, a significant reduction of size in 4/10 DU, but at 3th month of follow up 1 small DU appears, and 2 DU at 6th month (already present, increased their size). All the patients were very satisfied of the perioral AFG (also for a good aesthetic result agreement 95%), instead of DU treatment the agreement decreased at 60%.ConclusionsAFG treatment can be an another therapeutic opportunity in treatment of perioral thickness and DU in SScl pts non responsive to conventional treatments.ReferencesDel Bene M et al. Handchir Mikrochir Plast Chir 2014; 46: 242-247.Del Papa N et al...
Background:Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by progressive cutaneous and internal organ fibrosis. Orofacial manifestations are disabling and treatment options are limited. Fat Tissue Grafting (FTG) can be used for treating facial manifestations of the fibrosis.Objectives:In this study, we aimed to assess the safety and efficacy of FGT of our cohort of patients with SSc.Methods:We enrolled 20 SSc (18 W, 2 M) patients, from 2016 to 2019, suffering from facial sclerosis and restricted mouth opening capacity. FTG was carried out in accord with modified Colemans’ procedure (1): fat tissue was taken from periumbilical or trochanteric areas and was injected in 8 different points around the mouth. No side effects or adverse reactions have been documented. Evaluations included mouth opening capacity by measuring interincisal distance, oral functionality (MHISS scale) and patient global satisfaction (by Global Health scale).Results:A 11 mm (8 - 18mm range) median increase of interincisal distance was reported at month 6 and in 80% of patients at month 12, too (p<0.03). A significant improvement in MHISS scale was also observed (p<003). The patient satisfaction questionnaire showed 95% positive results and 80% of the patient replied affirmatively to the question about the repetition of FTG but only 2 patients required new FTG after 12 months.Conclusion:Our results showed that FTG improved mouth opening capacity and that aesthetic and functional results were satisfying to about 90% of the patients; long-term effects of this type of treatment are currently unknown. However, our and litterature data at 12 months follow-up seems to confirm the benefits in long term, despite the filling effect is over.This study – that’s one of the largest case series described right now (2) - supports the possible therapeutic role of autologous FTG in improving facial scleroderma both in aesthetic and in functional aspects.References:[1]Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg. 2006; 118: 108S-20S[2]Fat Grafting for the Treatment of Scleroderma.Strong AL, Rubin JP, Kozlow JH, Cederna PS. Plast Reconstr Surg. 2019 Dec;144(6):1498-1507. doi: 10.1097/PRS.0000000000006291.Disclosure of Interests:None declared
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