A Comparative Study between Autologous Nanofat Graft and Fractional CO2 Laser in the Management of Post Burn Scars

Document Type : Research article

Authors

The Department of Plastic Reconstructive and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University

Abstract

Background: Post burn scarring is a common complication
that can lead to functional disability and cosmetic disfigurement.
Superficial burn wounds usually heal without complications,
unlike deep ones that have an increased risk for
abnormal scar formation.
Aim of Study: Is to compare between autologous nanofat
grafting and fractional CO2 laser in the management of post
burn scars regarding aesthetic improvement.
Patients and Methods: This is a prospective study carried
out at Plastic Surgery Department, Ain Shams University
Hospital from February 2020 to February 2022. The study
included 20 cases of post burn scars, they were divided
randomly into two equal groups; the first group was managed
by 2 sessions of autologous nanofat grafting while the other
group was managed by 6 sessions of fractional CO2 laser.
Results: There was statistically significant improvement
after nanofat grafting and fractional CO2 laser. According to
VSS; more statistically significant improvement of pliability
was found among nanofat grafting group than fractional CO2
laser. While POSAS observer scale showed more improvement
for pigmentation and pliability scores. Moreover, POSAS
patient scale found more improvement among nanofat grafting
group regarding itching, color, stiffness and total scores.
Conclusion: Autologous nanofat injection and fractional
CO2 laser use resulted in a significant aesthetic improvement
of post burn scars. However, autologous nanofat injection
had more significant improvement than laser regarding pliability,
pigmentation, itching, color and stiffness.

Keywords

Main Subjects

References

1- McKee D.M.: Acute management of burn injuries to the
hand and upper extremity. J. Hand Surg. Am., Sep. 35
(9): 1542-4, 2010.
2- Pfenninger J.L. and Fowler G.C.: Pfenninger and Fowler's
procedures for primary care. Mosby Elsevier, 1733 p,
2011.
3- Liotta D.R., Costantino P.D. and Hiltzik D.H.: Revising
large scars. Facial Plast Surg [Internet]. Oct [cited 2019
Nov 7], 28 (5): 492-6, 2012. Available from: http://www.
ncbi.nlm.nih.gov/pubmed/23027215.
4- Loder S., Peterson J.R., Agarwal S., Eboda O., Brownley
C., DeLaRosa S., et al.: Wound healing after thermal
injury is improved by fat and adipose-derived stem cell
isografts. J. Burn Care Res. [Internet]. [cited 2019 Nov
7]; 36 (1): 70-6. Available from: http://www.ncbi.
nlm.nih.gov/pubmed/25185931.
5- El-Hoshy K., Abdel-Halim M.R.E., Dorgham D., El-Din
Sayed S.S. and El-Kalioby M.: Efficacy of fractional
carbon dioxide laser in the treatment of mature burn scars:
A clinical, histopathological, and histochemical study. J.
Clin. Aesthet. Dermatol., Dec. 1; 10 (12): 36-43, 2017.
6- Bruno A., Delli Santi G., Fasciani L., Cempanari M.,
Palombo M. and Palombo P.: Burn scar lipofilling: Immunohistochemical
and clinical outcomes. J Craniofac
Surg [Internet]. [cited 2019 Nov 7], 24 (5): 1806-14,
2013. Available from: http://www.ncbi.nlm.nih.gov/
pubmed/24036785.
7- Klinger M., Caviggioli F., Klinger F.M., Giannasi S.,
Bandi V., Banzatti B., et al.: Autologous fat graft in scar
treatment. J Craniofac Surg [Internet]. Sep [cited 2019
Nov 7], 24 (5): 1610-5, 2013. Available from: http://
www.ncbi.nlm.nih.gov/pubmed/24036737.
8- Sullivan T., Smith J., Kermode J., McIver E. and Courtemanche
D.J.: Rating the Burn Scar. J. Burn Care Rehabil
[Internet]. May 1 [cited 2022 Mar 7], 11 (3): 256-60,
1990. Available from: https://academic.oup. com/jbcr/
article/11/3/256/4786520
9- Fearmonti R., Bond J., Erdmann D. and Levinson H.: A
review of scar scales and scar measuring devices. Eplasty
[Internet]. Jun 21 [cited 2021 May 6], 10: e43, 2010.
Available from: http://www.ncbi.nlm.nih.gov/
pubmed/20596233.
10- Draaijers L.J., Tempelman F.R.H., Botman Y.A.M., Tuinebreijer
W.E., Middelkoop E., Kreis R.W., et al.: The
Patient and Observer Scar Assessment Scale: A reliable
and feasible tool for scar evaluation. Plast. Reconstr.
Surg., Jun. 113 (7): 1960-5, 2004.
11- Azzam O.A., Bassiouny D.A., El-Hawary M.S., El Maadawi
Z.M., Sobhi R.M. and El-Mesidy M.S.: Treatment of
hypertrophic scars and keloids by fractional carbon dioxide
laser: A clinical, histological, and immunohistochemical
study. Lasers Med Sci [Internet]. Jan. 1 [cited 2021 Apr.
19], 31 (1): 9-18, 2016. Available from: https://link.
springer.com/article/10.1007/s10103-015-1824-4.
12- Lee S. jun, Suh D.H., Lee J.M., Song K.Y. and Ryu H.J.:
Dermal Remodeling of Burn Scar by Fractional CO2
Laser. Aesthetic Plast. Surg. [Internet]. Oct 1 [cited 2022
Jan 29], 40 (5): 761-8, 2016. Available from: https://
pubmed.ncbi.nlm.nih.gov/27519176/.
13- Tredget E.E., Levi B. and Donelan M.B.: Biology and
principles of scar management and burn reconstruction.
Surg. Clin. North Am. [Internet]. [cited 2022 Jan 29], 94
(4): 793-815, 2014. Available from: https://pubmed.ncbi.
nlm.nih.gov/25085089/.
14- Rinker B.D. and Vyas K.S.: Do Stem Cells Have an Effect
When We Fat Graft? Ann Plast Surg [Internet]. [cited
2022 Jan. 29], 76 (Suppl 4): S359-63, 2016. Available
from: https://pubmed.ncbi.nlm.nih.gov/26545225/
15- Tonnard P., Verpaele A., Peeters G., Hamdi M., Cornelissen
M. and Declercq H.: Nanofat grafting: Basic research and
clinical applications. Plast. Reconstr. Surg., 132 (4): 1017-
26, 2013.
16- Bollero D., Pozza S., Gangemi E.N., De Marchi A., Ganem
J., El Khatib A.M., et al.: Contrast-enhanced ultrasonography
evaluation after autologous fat grafting in scar
revision. G Chir [Internet]. [cited 2022 Jan 29], 35 (11-
12): 266, 2014. Available from: /pmc/articles/
PMC4321504/
17- Gu Z., Li Y. and Li H.: Use of Condensed Nanofat Combined
With Fat Grafts to Treat Atrophic Scars. JAMA
Facial Plast Surg [Internet]. Mar. 1 [cited 2022 Jan. 29],
20 (2): 128-35, 2018. Available from: https://pubmed.ncbi.
nlm.nih.gov/28975248/.
18- Lee J.W., Park S.H., Lee S.J., Kim S.H., Suh I.S. and
Jeong H.S.: Clinical Impact of Highly Condensed Stromal
Egypt, J. Plast. Reconstr. Surg., July 2022 221
Vascular Fraction Injection in Surgical Management of
Depressed and Contracted Scars. Aesthetic Plast. Surg.
[Internet]. Dec. 1 [cited 2022 Jan. 30], 42 (6): 1689-98,
2018. Available from: https://pubmed.ncbi.nlm.nih.
gov/30191279/.
19- Jan S.N., Bashir M.M., Khan F.A., Hidayat Z., Ansari
H.H., Sohail M., et al.: Unfiltered Nanofat Injections
Rejuvenate Postburn Scars of Face. Ann. Plast. Surg.
[Internet]. Jan. 1 [cited 2022 Jan. 29], 82 (1): 28-33, 2019.
Available from: https://pubmed.ncbi.nlm.nih.gov/
30285990/.
20- Ishaque M.A., Ali M., Mirza R., Sharif M. and Arshad
A.W.: Facial and Hand Scars Appearance after Autologous
Nanofat Grafting in Patients with Post Burn Scars. Proceedings
[Internet]. Dec. 3 [cited 2022 Jan. 29], 34 (1):
25-9, 2020. Available from: https://proceedings-szmc.
org.pk/index.php/szmc/article/view/45.
21- Gal S., Ramirez J.I. and Maguina P.: Autologous fat
grafting does not improve burn scar appearance: A prospective,
randomized, double-blinded, placebo-controlled,
pilot study. Burns [Internet]. May 1 [cited 2022 Jan. 29],
43 (3): 486-9, 2017. Available from: https://pubmed.
ncbi.nlm.nih.gov/28041747/.
22- Brown J.C., Shang H., Shang H., Yang N., Pierson J.,
Ratliff C.R., et al.: Autologous Fat Transfer for Scar
Prevention and Remodeling: A Randomized, Blinded,
Placebo-controlled Trial. Plast Reconstr surgery Glob
open [Internet]. [cited 2022 Jan. 30], 8 (5), 2020. Available
from: https://pubmed.ncbi.nlm.nih.gov/33154872/.
23- Ozog D.M., Liu A., Chaffins M.L., Ormsby A.H., Fincher
E.F., Chipps L.K., et al.: Evaluation of Clinical Results,
Histological Architecture, and Collagen Expression Following
Treatment of Mature Burn Scars With a Fractional
Carbon Dioxide Laser. JAMA Dermatology, Jan. 149 (1):
50, 2013.
24- Lee S.H., Zheng Z. and Roh M.R.: Early postoperative
treatment of surgical scars using a fractional carbon
dioxide laser: A split-scar, evaluator-blinded study. Dermatologic
Surg [Internet]. Aug. [cited 2022 Jan. 30], 39
(8): 1190-6, 2013. Available from: https://journals.
lww.com/dermatologicsurgery/Fulltext/2013/08000/Ear
ly_Postoperative_Treatment_of_Surgical_Scars.8.aspx.
25- Majid I. and Imran S.: Efficacy and Safety of Fractional
CO2 Laser Resurfacing in Non-hypertrophic Traumatic
and Burn Scars. J. Cutan Aesthet Surg. [Internet]. [cited
2022 Jan. 30], 8 (3): 159, 2015. Available from: https://
pubmed.ncbi.nlm.nih.gov/26644740/.
26- Caruana G., Bertozzi N., Boschi E., Grieco M.P., Grignaffini
E. and Raposio E.: Role of adipose-derived stem
cells in chronic cutaneous wound healing. Ann. Ital Chir
[Internet]. Jan. 1 [cited 2020 Dec. 16], 86 (1): 1-4, 2015.
Available from: https://europepmc.org/article/
med/25818696.
27- Mailey B., Saba S., Baker J., Tokin C., Hickey S., Wong
R., et al.: A comparison of cell-enriched fat transfer to
conventional fat grafting after aesthetic procedures using
a patient satisfaction survey. Ann. Plast. Surg. [Internet].
Apr [cited 2022 Jan. 31], 70 (4): 410-5, 2013. Available
from: https://pubmed.ncbi.nlm.nih.gov/23486128

Files

Share

How to cite

Statistics