Background Autologous 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.
Objectives We evaluated the response to AFG in treatment of DU and perioral thickness in Sclerodermic pts.
Methods We 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.
Results AFG 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%.
Conclusions AFG treatment can be an another therapeutic opportunity in treatment of perioral thickness and DU in SScl pts non responsive to conventional treatments.
Del Bene M et al. Handchir Mikrochir Plast Chir 2014; 46: 242-247.
Del Papa N et al. Cell Transplantation 2015; 24:63–72, 2015.
Disclosure of Interest None declared