Work

Cryopreserved Allogeneic Adipose Improves Neo-dermal and Epidermal Thickness after Burns

Year: 2021

Type: article

Abstract: INTRODUCTION: Hypodermal restoration via fat grafting after burn trauma to the face provides padding for the overlying skin, helps restore native features, and enhance contour and texture. While powerful, this technique is limited by graft retention often requires multiple rounds of grafting. Here we utilize a cryopreserved allogeneic fat transfer model to demonstrate the efficacy of cryopreserved fat in bolstering skin thickness and dermal-epidermal architecture after burn debridement and skin graft reconstruction. METHODS: Female Yorkshire swine received 16 4 × 4 cm full-thickness burns. After 48 hours escharectomy was performed to fascia. Wounds were allocated to the following treatment groups: (a) No Treatment; (b) Fat Grafting Only; (c): Skin Grafting Only; (d) Skin then Fat Grafting. Split-thickness skin autografts (0.012 in.) were collected from the lateral thighs, pie crusted at back table, and grafted directly to the wound base. After 10 days, cryopreserved allogeneic adipose from female Yorkshire swine were grafted immediately deep to the graft or eschar depending on group allocation. Subjects were maintained for 8 weeks with interval ultrasound and biopsy for histologic analysis. RESULTS: On ultrasonic evaluation total skin thickness was noted to be significantly greater in Skin + Fat group when compared with Skin Only (P < 0.05). On histologic assessment, dermal thickness was increased in both Fat Only versus Untreated (P = 0.0395) and Skin + Fat versus Skin Only groups samples (P = 0.0016). When compared with Skin Only samples, Skin + Fat groups demonstrated significantly increased epidermal depth (P = 0.0011). Both groups receiving skin grafts demonstrated significantly greater presence and depth of dermal papillae verus groups without skin graft (P < 0.052). CONCLUSIONS: Facial burns are highly morbid injuries affecting quality of life and psychosocial well-being. Debridement and reconstruction can require extensive and repeat surgical interventions often with significant soft tissue deficit and obliteration of native facial architecture with long-lasting disfigurement. Fat grafting may address this; however, uncertain retention and need for multiple surgeries provides a barrier to some patients. Cryopreservation of adipose at initial liposuction addresses that limitation and here we demonstrate the efficacy of this technique in enhancing the thickness and structure of reconstructed skin.

Source: Plastic & Reconstructive Surgery Global Open

DOI: 10.1097/01.gox.0000799532.02649.9f