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Fat Grafting for Neuropathic Pain After Severe Burns

Fredman, Rafi MD; Edkins, Renee E. DNP, ANP-C; Hultman, Charles Scott MD, MBA, FACS

doi: 10.1097/SAP.0000000000000674
Clinical Papers

Background Chronic neuropathic pain after burn injury is a significant problem that affects up to 29% of burn patients. Neuropathic burn scar pain is a challenge for plastic and burn surgeons, who have limited solutions. Fat grafting, with its mechanical and regenerative qualities, can improve neuropathic pain from various traumatic and postsurgical etiologies, but its effectiveness in neuropathic burn scar pain has yet to be demonstrated. In this study, the possible role of lipotransfer in treating neuropathic burn scar pain is explored, focusing on safety, graft take, and short-term efficacy.

Methods We performed an institutional review board–approved, retrospective case review of 7 patients with chronic, refractory neuropathic pain, who underwent fat grafting to burn scars. These patients had failed conventional therapy, which included pharmacologic, medical, and laser treatment of the burn scars. Each patient had 2 sessions of fat grafting, spaced 2 months apart. The Patient-Reported Outcomes Measurement Information System (PROMIS) was used to assess pain perception, with patients answering the questionnaire before and after fat grafting, to assess subjective outcomes.

Results Six of 7 patients had improvement in neuropathic pain after fat grafting, permitting reduction in their neuropharmacologic regimen. Tinel sign, present in all patients preoperatively, was absent on examination in all patients at follow-up. Three of the 5 patients who completed PROMIS questionnaires had PROMIS scores indicating improvement in pain by 1-year follow-up. One patient had similar preoperative and postoperative PROMIS scores, and 1 patient had an increase in pain at follow-up; however, he had suffered an additional burn to the same extremity. Analysis of pooled mean PROMIS scores reflects a statistically significant improvement in subjective outcomes by 1-year follow-up. Donor-site seroma in 1 patient was the only complication, with no cases of infection, wound breakdown, or graft loss.

Conclusions Adipose tissue can be safely grafted into burn scars and may improve symptoms in patients with refractory neuropathic pain after burn injury. Further translational and clinical research is necessary to elucidate mechanisms of action, indications, optimal type of transfer, and long-term effectiveness.

From the Division of Plastic Surgery, University of North Carolina Health Care System, Chapel Hill, NC.

Received October 12, 2015, and accepted for publication, after revision October 18, 2015.

Presented at the Hot Topics Paper Session, 58th Annual Scientific Meeting, Southeastern Society of Plastic and Reconstructive Surgeons; Amelia Island, FL; June 6–10, 2015.

Conflicts of interest and sources of funding: Funding was received from Ethel and JamesValone Plastic Surgery Research Endowment.

Reprints: Charles Scott Hultman, MD, MBA, FACS, Division of Plastic Surgery, University of North Carolina, Suite 7038, Burnett-Womack, CB#7195, Chapel Hill, NC 27599. E-mail: cshult@med.unc.edu.

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