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The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids

Caviggioli, Fabio M.D.; Maione, Luca M.D.; Vinci, Valeriano M.D.; Klinger, Marco M.D.

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Plastic and Reconstructive Surgery: September 2010 - Volume 126 - Issue 3 - p 1130-1131
doi: 10.1097/PRS.0b013e3181e3b804
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We read with interest the article entitled “The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids” (Plast Reconstr Surg. 2010;125:557–568) and would like to congratulate Dr. Ogawa. In his article, he stated that burn injuries are still a frequent cause of hypertrophic scars. We agree that burns are a common cause of keloids and hypertrophic scars. Surgical treatment includes traditional techniques for scar remodelling. The most common techniques include Z-plasty, W-plasty, and geometric broken line. Considering all strategies listed in the article, we would like to add our topics about scar remodeling by lipostructure. Lipostructure is a technique of autologous fat grafting, originally described by Coleman for filling and aesthetic purposes.1 Its clinical applications are now extending to unexpected fields, including regenerative surgery and related research. Many studies have demonstrated that this tissue contains adipose-derived stem cells and many types of growth factors.2

Our experience in the treatment of hypertrophic burns using fat injection,3 a procedure that we have been among the first to adopt, suggested to us the treatment with autologous fat graft hypertrophic scars caused by other injuries.

Following these considerations, we have started a case-control study in which we treated patients with keloids using autologous fat graft and, at the moment, the results obtained show a considerable improvement of skin texture, thickness, and clinical reduction of pain in treated areas (Fig. 1).

Fig. 1.
Fig. 1.:
(Left) Hypertrophic burn injury before autologous fat graft. (Right) Hypertrophic burn injury after autologous fat graft showing improvement of skin texture and thickness and clinical reduction of pain.

Fabio Caviggioli, M.D.

Luca Maione, M.D.

Valeriano Vinci, M.D.

Marco Klinger, M.D.

Cattedra di Chirurgia Plastica

Università degli Studi di Milano

U.O. Chirurgia Plastica 2

Istituto Di Ricovero e Cura a Carattere Scientifico

Istituto Clinico Humanitas

Rozzano, Milano, Italy


1.Coleman SR. Structural fat grafting: More than a permanent filler. Plast Reconstr Surg. 2006;118 (3 Suppl):108S–120S.
2.Zuk PA, Zhu M, Mizuno H, et al. Multilineage cells from human adipose tissue: Implications for cell-based therapies. Tissue Eng. 2001;7:211–228.
3.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. 2008;32:465–469.

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