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ABSTRACT: Aim. Fat transfer is commonly used to fill loss of volume in depressed scars caused by trauma, deep burns or surgery. The aim of the study is to investigate the degree of fat graft take through evaluation of the microcirculation of grafted autologous adipose tissue using contrast-enhanced ultrasonography. Patients and method. From 2010 to 2012 at the Department of Plastic and Reconstructive Surgery of the Traumatological Center in Turin, a study population was selected from patients with surgical indications for autologous fat transfer for scar correction. For each surgical procedure patients underwent a clinical and sonographic evaluation before and after intervention (at 1 month and 3 months). Results. Out of a total of 28 interventions, 24 showed a good result; defined as improvement of the scar, and confirmed by the presence of vascularization in the transplanted tissue. In 4 cases, there was a lack of blood supply at the first evaluation but an initial good clinical scar correction. The absence of blood vessels was confirmed at 3 months accompanied by complete resorption of the transferred fat with a failure of good clinical outcome. Conclusion. Contrast-enhanced ultrasonography was able to evaluate the microvasculature of adipose tissue after fat transfer. Due to this characteristic, it allows to monitor and predict the take of adipose tissue and provide realistic and early information on the clinical outcome of fat transfer.
Il Giornale di chirurgia 11/2014; 35(11-12):266-73.
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ABSTRACT: To describe the clinical characteristics of postburn scars and determine the independent risk factors specific to these patients. While burns may generate widespread and disfiguring scars and have a dramatic influence on patient quality of life, the prevalence of postburn pathologic scarring is not well documented, and the impact of certain risk factors is poorly understood.
A retrospective analysis was conducted of the clinical records of 703 patients (2440 anatomic burn sites) treated at the Turin Burn Outpatient Clinic between January 1994 and May 15, 2006. Prevalence and evolution time of postburn pathologic scarring were analyzed with univariate and multivariate risk factor analysis by sex, age, burn surface and full-thickness area, cause of the burn, wound healing time, type of burn treatment, number of surgical procedures, type of surgery, type of skin graft, and excision and graft timing.
Pathologic scarring was diagnosed in 540 patients (77%): 310 had hypertrophic scars (44%); 34, contractures (5%); and 196, hypertrophic-contracted scars (28%). The hypertrophic induction was assessed at a median of 23 days after reepithelialization and lasted 15 months (median). A nomogram, based on the multivariate regression model, showed that female sex, young age, burn sites on the neck and/or upper limbs, multiple surgical procedures, and meshed skin grafts were independent risk factors for postburn pathologic scarring (Dxy 0.30).
The identification of the principal risk factors for postburn pathologic scarring not only would be a valuable aid in early risk stratification but also might help in assessing outcomes adjusted for patient risk.
Archives of Facial Plastic Surgery 03/2008; 10(2):93-102. DOI:10.1001/archfaci.10.2.93 · 1.71 Impact Factor
Burns 02/2007; 33(1). DOI:10.1016/j.burns.2006.10.151 · 1.88 Impact Factor