We read with interest the article entitled “Rehabilitation of Irradiated Head and Neck Tissues by Autologous Fat Transplantation” (Plast Reconstr Surg. 2009;123:1187–1197). We would like to congratulate Dr. Phulpin and colleagues for their publication, reporting functional and aesthetic improvement in irradiated tissues, treated by a technique similar to Coleman's lipostructure. Their pathologic findings showed normalization of histologic architecture and high vascular network density. Functional results were satisfactory and a clear improvement of neck mobility was observed.
These clinical observations are similar to our reports regarding autologous fat transplantation in more than 250 patients1–4—including outcomes of burns, trauma, radiation damage, and chronic ulceration—and to other studies.5 We also reported encouraging histologic findings.1 In particular, from December of 2005 to November of 2008, we treated 35 patients with burn scars in the head and neck region. We performed Coleman's procedure: after tumescent infiltration, 10 to 50 ml of fat was harvested from the lower abdominal quadrants, centrifuged at 3000 rpm, purified, and injected at the dermal-subdermal junction in the scar area. Nineteen patients underwent one treatment, six patients underwent two treatments, six patients underwent three treatments, one patient underwent four treatments, and one patient underwent five treatments. At follow-up of at least 1 year, we observed in all patients a significant improvement in skin quality, pain, and functional mobility of mimic muscles and neck. No complications occurred. Patients were satisfied with their final outcome.
The role of lipostructure in these applications is discussed. Our research group1–3 and Rigotti et al.5 suggested an active role of adult mesenchymal stem cells from the stromal fraction of harvested fat, but it is uncertain whether the molecular components and the surrounding microenvironment are involved in modulating cicatricial remodeling. Indeed, in our opinion, autologous fat transplantation should be considered a standard option of treatment, not only for irradiated tissues but also for mature scars.
Federico Villani, M.D.
Fabio Caviggioli, M.D.
Francesco Klinger, M.D.
Marco Klinger, M.D.
Cattedra di Chirurgia Plastica
Università degli Studi di Milano
U.O. Chirurgia Plastica 2
IRCCS Istituto Clinico Humanitas
Rozzano, Milano, Italy
1. Klinger M, Marazzi M, Vigo D, Torre M. Fat injection for cases of severe burn outcomes: A new perspective of scar remodeling and reduction. Aesthetic Plast Surg
2. Caviggioli F, Klinger F, Villani F, Fossati C, Vinci V, Klinger M. Correction of cicatricial ectropion by autologous graft. Aesthetic Plast Surg
3. Klinger M, Caviggioli F, Klinger F, Pagliari AV, Villani F, Bandi V. Scar remodeling following burn injuries. In: Coleman SR, Mazzola RF, eds. Fat Injection: From Filling to Regeneration
. St. Louis: Quality Medical; 2009.
4. Klinger M, Caviggioli F, Forcellini D, Villani F. Scars: A review of emerging and currently available therapies. Plast Reconstr Surg
5. Rigotti G, Marchi A, Galiee M, et al. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: A healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg
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