Background Autologous fat tissue grafting (AFTG) has been successfully used in the treatment of different sclerotic conditions, including scleroderma.

Objectives We evaluated in patients with SSc who complained of a reduced mouth opening, the long-term efficacy of AFTG of the lips in improving mouth opening in comparison with hyaluronic acid (HA) filler. We also investigated whether these procedures may induce some changes in the microvascular architecture and dermal structure of the treated skin area.

Methods We studied 30 patients with dcSSc, (median age 37±12 yrs, disease duration 11±8yrs): 15 were treated by topical perioral AFTG according to Coleman technique and 15 by HA filler. The filler was repeated after 3 months. Baseline and after treatment (at months 3, 6, and 12) mouth opening changes were assessed by measuring inter-incisal distance and oral perimeter. Pre- and post-treatment modifications of microvascular architecture were assessed by counting capillaries in the inferior lip videocapillaroscopy (VC) images. Similarly, histological sections of perioral skin biopsy were examined at baseline and 3 months to evaluate dermo-epidermic junction (DEJ), the collagen content (by Masson's Trichrome staining) and microvessel density (MVD) (by anti-CD34/CD31staining).

Results 3 months after treatment both the inter-incisal distance and oral perimeter significantly increased (p<0.001). At the same time, a significant skin neovascularization became evident, both considering the VC images (p<0.001) and MVD scores in IH sections (p<0.0001). Finally, some skin histological aspects also improved, as shown by the significant changes in DEJ flattening scores (p<0.0001) and collagen content with less abnormal and denser collagen bundles. At 6 and 12 months, despite the disappearance of filling effect, both the functional improvement in mouth opening and the increased number of capillaries were maintained. No effect either on the mouth opening, VC images and skin histological aspects was observed in SSc patients treated by HA filler.

Conclusions The present study shows that, in patients with SSc, AFTG can improve mouth opening, induce a neovascularization, and partially restore the skin structure. All these effects were confirmed in the long-term observation. The lack of functional and biological effects in the control group treated by HA filler, suggests that the observed therapeutic effect of lipostructure may be specifically ascribed to the on site transplantation of fat tissue. Our study may open new perspectives for the local and general therapeutic approach to SSc.

Disclosure of Interest None declared