Background Autologous fat grafts (AFG) for restoring soft tissue defects have been used for many decades and has many clinical applications. Recent studies have shown the efficacy of the AFG in the treatment of localized scleroderma. Besides mechanical lipofilling, AFG seems to produce trophic effects on both vascular and stromal cells. However, the exact mechanisms underlying the clinical results are far to be completely understood.
Objectives A prospective pilot study has been carried out aimed at evaluating whether the perioral AFG in SSc patients may improve the mouth functional impairment related to the sclerotic changes. In addition, we tried to clarify whether the perioral fat filling might induce local trophic changes in the stromal and vascular structures.
Methods Twenty-five patients with diffuse SSc (dcSSc) (mean age + SD 36.5+16 yrs, disease duration of 12±9 yrs) and perioral skin fibrotic changes with limited mouth opening were treated by topical perioral administration of AFG. Lipofilling was performed according to the Coleman tecnique. Follow-up was performed at 1 and 3 months postoperatively by evaluating measure of inter-incisal distance and mouth perimeter; skin hardness was measured by a digital durometer. A baseline and 3 months post-treatment evaluation of microcirculatory abnormalities was made using labial video capillaroscopy and skin biopsy.
Results: Results. All patients made good postoperative recovery without complications showing an immediate subjective improvement of their skin stiffness. One and 3 months after lipofilling, the median measure of inter-incisal distance was significantly increased in comparison with the score before treatment (p=0.02); the same results, with overtime significant improvement from baseline to 1 and 3 months, were confirmed by measuring mouth perimeter (p=0.004 and 0.003). Durometer evaluations showed that skin hardness resulted significantly lower after treatment (p=0.014 and 0.019). Labial capillaroscopy of treated patients showed significant improvement in microvascular patterns after AFG in term of increase in capillary density (p=0.001) with more regular organization of microcirculation, increased length and reduced diameter shapes. Pathological studies confirmed the improvement in capillary density in the areas of treated skin with a significant upregulation of CD31 and CD34 expression (p<0.001); a significant increase in the number of dermal papillas was also observed after lipostructure.
Conclusions Our study suggest that AFG of SSc fibrotic perioral changes can provide immediate and long-lasting benefits in terms of both aesthetic and functional improvement. Itis a safe, relatively non-invasive, and rapid procedure. In addition we provide evidences that AFG has the potential to favour neovascularization in SSc and revert SSc fibrotic features. The overtime increase of treatment benefits suggests that other mechanisms different from the simple fat filling may be involved. The cellular and/or tissue mechanisms underlying these changes need further investigation.
Disclosure of Interest None Declared