Evaluation of the efficacy of lipotransfer to manage radiation‐induced fibrosis and volume defects in head and neck oncology

Abstract

Background Multimodality treatment for head and neck cancer leads to substantial functional and esthetic impairment mainly manifested as radiation‐induced skin fibrosis (RIF) in combination with volumetric defects and reduction in neck mobility. This study assessed the impact of lipotransfer as part of secondary surgical procedure(s) in patients treated for head and neck malignancies. Methods Retrospective analysis was performed between 2005 and 2016. All patients with a history of head and neck malignancy, multimodal treatment including at least surgery or radiotherapy, and at least 2‐year disease‐free survival were included. Thirty‐eight patients (22 men, 16 women) matched the inclusion criteria. Results Thirty seven (97%) reported esthetic and functional improvements in their RIF and volumetric defect at follow‐up of 32 months. Major improvement in esthetic and functional outcome was reported by 24 (63%) patients and surgeons and minor by 13 patients and surgeons (34%) without causing any complications. Lipotransfer was also found to significantly improve patient's psychological health postoperatively as showed by significant improvements in Derriford Appearance Scale (DAS24), Short Form Health Survey (SF‐36), and University of Washington Quality of Life Questionnaire (UW‐QOL V4) scores (P < .001). Conclusions Lipotransfer is effective for volume restoration and treating scar and RIF from head and neck defects.

Prophylactic treatment with transdermal deferoxamine mitigates radiation-induced skin fibrosis

“…Serial injections of DFO into irradiated tissue prior to fat grafting was observed to increase perfusion in the overlying skin and improve retention of fat graft volumes, thereby mitigating some of the detrimental fibrotic effects of radiation therapy. Lipotransfer has also been successfully used in patients with head and neck malignancies to improve functional and aesthetic outcomes of RIF 54,55 . Repeated injections as well as potential for donor site morbidity at fat graft harvest sites, however, can damage the soft tissue and raise concerns regarding patient comfort and compliance with each of these approaches.…”

Regenerative Strategy for Persistent Periprosthetic Leakage around Tracheoesophageal Puncture: Is It an Effective Long-Term Solution?

“…The tissue changes associated with irradiation may reduce the elasticity and integrity of TEP, and radiation-induced fibrosis (RIF) has been implicated as potential risk factors for enlarged puncture [ 19 ]. Evidence shows that fat grafting can minimize the side effects of radiation therapy by reducing RIF [ 32 , 33 , 34 , 35 ]. First proposed by Rigotti et al, the use of AFG has shifted the therapeutic approach of radio-damaged tissues [ 32 ].…”

Regenerative medicine approaches for the management of respiratory tract fistulas

“…Reproduced with permission from Díaz-Agero Álvarez et al [38] amount of tissue surrounding the tumor; moreover, adjuvant therapeutic irradiation may result in extensive tissue damage and induction of radiation-induced skin fibrosis. Administration of autologous fat has been evaluated as a suitable method to achieve both esthetic and functional reconstruction in head and neck oncologic patients, partially restoring volume loss, reducing excessive scar formation and radiation-induced skin fibrosis in the treated areas [63][64][65]79]. More than 60 patients have been treated using autologous fat administration in three different studies [63][64][65]79].…”

“…Administration of autologous fat has been evaluated as a suitable method to achieve both esthetic and functional reconstruction in head and neck oncologic patients, partially restoring volume loss, reducing excessive scar formation and radiation-induced skin fibrosis in the treated areas [63][64][65]79]. More than 60 patients have been treated using autologous fat administration in three different studies [63][64][65]79]. Some concerns have been raised about the possibility of administered fat to promote residual tumor cell invasion and metastasis [80].…”