Treatment of Early-Stage Pressure Ulcers by Using Autologous Adipose Tissue Grafts

Abstract

Assessing pressure ulcers (PUs) in early stages allows patients to receive safer treatment. Up to now, in addition to clinical evaluation, ultrasonography seems to be the most suitable technique to achieve this goal. Several treatments are applied to prevent ulcer progression but none of them is totally effective. Furthermore, the in-depth knowledge of fat regenerative properties has led to a wide use of it. With this study the authors aim at introducing a new approach to cure and prevent the worsening of early-stage PUs by using fat grafts. The authors selected 42 patients who showed clinical and ultrasonographic evidence of early-stage PUs. Values of skin thickness, fascial integrity, and subcutaneous vascularity were recorded both on the PU area and the healthy trochanteric one, used as control region. Fat grafting was performed on all patients. At three months, abnormal ultrasonographic findings, such as reduction of cutaneous and subcutaneous thickness, discontinuous fascia, and decrease in subcutaneous vascularity, all were modified with respect to almost all the corresponding parameters of the control region. Results highlight that the use of fat grafts proved to be an effective treatment for early-stage PUs, especially in the care of neurological and chronic bedridden patients.

Lipofilling (fat grafting) in the secondary prevention of ischial tuberosity and pelvic pressure ulcers

“…11,18 The survival of grafted fat over time is a key issue. For ischial and sacral lipofilling, Marangi et al 13 showed significant improvement of subcutaneous thickness at 3 months follow-up in all but one of their 42 patients. For breast lipofilling, it seems that most of the volume loss occurs within the first 3 months after surgery, 11,12 and that the graft is steadily integrated at the 9th month so that further resorption thereafter is unexpected.…”

“…Our results confirm the good outcomes already described for ischial and sacral lipofilling in the treatment of earlystage pressure ulcer in chronic bedridden patients with neurologic conditions, including patients with SCI. 13 With the advent of liposuction technique in the 1980s, plastic surgeons obtained access to large volumes of adipose tissue. In the 1990s, Coleman described a three staged procedure for fat grafting consisting of: (1) manual lipoaspiration under low pressure; (2) 3 min of centrifugation at 3400 r.p.m.…”

“…13 There is evidence that adipose-derived stem cells may transdifferentiate into epithelial stem cells after fat grafting. 8 This may explain the improvement of skin quality reported by our patients.…”

“…[6][7][8][9][10][11][12] Recently, fat grafting has been described for the treatment of early stage ischial or sacral pressure ulcers in patients with SCI and other chronic bedridden patients, with good results at 3 months follow-up. 13 We present the preliminary results of lipofilling as a secondary prevention of recurrence of ischial tuberosity and pelvic PrUs in patients with unsatisfactory outcome of previous surgical flap procedures.…”

Does Freeze–Thawing Influence the Effects of Platelet Concentrates? An In Vitro Study on Human Adipose-Derived Stem Cells

“…6 Autologous lipofilling has become popular in aesthetic and plastic surgery for many indications, including scar remodeling (especially in acne and burn patients), lip augmentation and deformity treatment, mandibular and buccal deficiency of both bone and soft tissue after tumor resection management, skin rejuvenation, wrinkle filling, lipo-facelift, malar and mental regions augmentation, 7 and breast reconstruction after cancer or for deformities. 8 This technique has found application also in vocal cord tissue regeneration, 9 in the treatment of chronic ulceration, 10 end-stage radiation dermatitis, 11 alopecia, 12 and other medical applications. Stem cell therapy has shown to be promising in aesthetic and reconstructive surgery 13 and several recent studies have shown adipose tissue as a convenient source of multipotent adult stem cells, called adipose-derived stem cells (ASCs).…”