Advertisement

Aesthetic Plastic Surgery

, Volume 42, Issue 6, pp 1689–1698 | Cite as

Clinical Impact of Highly Condensed Stromal Vascular Fraction Injection in Surgical Management of Depressed and Contracted Scars

  • Jun Won Lee
  • Seong Hoon Park
  • Seong Joo Lee
  • Seong Hwan Kim
  • In Suck Suh
  • Hii Sun Jeong
Original Article Special Topics
  • 132 Downloads

Abstract

Background

Recent research on stromal vascular fraction (SVF) has demonstrated the presence of numerous growth factors that aid in tissue regeneration and suggest the potential for scar treatment. This study was conducted to clinically show that adding stem cells can improve the surgical outcomes of scar formation.

Methods

Between March 2014 and February 2016, 17 patients underwent injections of fat and highly condensed SVF simultaneously with scar reduction surgeries and 15 patients received scar revision with or without simultaneous application of highly condensed SVF (4.90 × 107 stem cells/ml) at our institution. Clinical photographs were taken before and after surgery, and the scars were graded using the following standard scales: the Observer Scar Assessment Scale (OSAS), Stony Brook Scar Evaluation Scale (SBSES), Vancouver Scar Scale (VSS), and Visual Analog Scale (VAS).

Results

All patients showed improvement, registering significant increases in scar tissue scores (P < 0.05 in all four scoring systems). Patients in the SVF group showed more improved outcomes than patients in the non-SVF group for all scar tissue scores except the SBSES (OSAS, P = 0.029; SBSES, P = 0.281; VSS, P = 0.001; VAS, P = 0.021). Subcategories of these scales reflected more favorable outcomes in terms of height and pliability; however, there was no significant change in vascularity.

Conclusions

SVF injections enhance tissue regeneration by contributing stem cells and growth factors to improve outcomes in scar revisions or tissue grafts. Harvesting the SVF through liposuction also provides a cosmetic benefit. Significant SVF-related gains in the scoring of scars indicate the merit of SVF as an aspect of conventional scar management.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Cicatrix Stem cells Mesenchymal stem cell transplantation Treatment outcome Adipose tissue 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

References

  1. 1.
    Coleman SR (2006) Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 118:108S–120S.  https://doi.org/10.1097/01.prs.0000234610.81672.e7 CrossRefGoogle Scholar
  2. 2.
    Coleman SR, Katzel EB (2015) Fat grafting for facial filling and regeneration. Clin Plast Surg 42:289–300.  https://doi.org/10.1016/j.cps.2015.04.001 CrossRefGoogle Scholar
  3. 3.
    Zuk PA, Zhu M, Mizuno H et al (2001) Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng 7:211–228.  https://doi.org/10.1089/107632701300062859 CrossRefGoogle Scholar
  4. 4.
    Kim JH, Park SH, Lee BH et al (2016) Early intervention with highly condensed adipose-derived stem cells for complicated wounds following filler injections. Aesthet Plast Surg 40:428–434.  https://doi.org/10.1007/s00266-016-0636-7 CrossRefGoogle Scholar
  5. 5.
    Chae D-S, Han S, Son M, Kim S-W (2017) Stromal vascular fraction shows robust wound healing through high chemotactic and epithelialization property. Cytotherapy 19:543–554.  https://doi.org/10.1016/j.jcyt.2017.01.006 CrossRefGoogle Scholar
  6. 6.
    Draaijers LJ, Tempelman FRH, Botman YAM et al (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113:1960–1967CrossRefGoogle Scholar
  7. 7.
    Singer AJ, Arora B, Dagum A et al (2007) Development and validation of a novel scar evaluation scale. Plast Reconstr Surg 120:1892–1897.  https://doi.org/10.1097/01.prs.0000287275.15511.10 CrossRefGoogle Scholar
  8. 8.
    Sullivan T, Smith J, Kermode J et al (1990) Rating the burn scar. J Burn Care Rehabil 11:256–260CrossRefGoogle Scholar
  9. 9.
    Duncan JAL, Bond JS, Mason T et al (2006) Visual analogue scale scoring and ranking: a suitable and sensitive method for assessing scar quality? Plast Reconstr Surg 118:909–918.  https://doi.org/10.1097/01.prs.0000232378.88776.b0 CrossRefGoogle Scholar
  10. 10.
    Premaratne GU, Ma L-P, Fujita M et al (2011) Stromal vascular fraction transplantation as an alternative therapy for ischemic heart failure: anti-inflammatory role. J Cardiothorac Surg 6:43.  https://doi.org/10.1186/1749-8090-6-43 CrossRefGoogle Scholar
  11. 11.
    Sliwa A, Balwierz A, Kiec-Wilk B et al (2009) Differentiation of human adipose tissue SVF cells into cardiomyocytes. Genes Nutr 4:195–198.  https://doi.org/10.1007/s12263-009-0127-4 CrossRefGoogle Scholar
  12. 12.
    Robert S, Gicquel T, Victoni T et al (2016) Involvement of matrix metalloproteinases (MMPs) and inflammasome pathway in molecular mechanisms of fibrosis. Biosci Rep.  https://doi.org/10.1042/BSR20160107 CrossRefGoogle Scholar
  13. 13.
    He Y, Li Z, Chen Z et al (2018) Effects of VEGF-ANG-1-PLA nano-sustained release microspheres on proliferation and differentiation of ADSCs. Cell Biol Int.  https://doi.org/10.1002/cbin.10986 CrossRefGoogle Scholar
  14. 14.
    Tan SS, Yeo XY, Liang ZC et al (2018) Stromal vascular fraction promotes fibroblast migration and cellular viability in a hyperglycemic microenvironment through up-regulation of wound healing cytokines. Exp Mol Pathol 104:250–255.  https://doi.org/10.1016/j.yexmp.2018.03.007 CrossRefGoogle Scholar
  15. 15.
    Kim W-S, Park B-S, Sung J-H (2009) Protective role of adipose-derived stem cells and their soluble factors in photoaging. Arch Dermatol Res 301:329–336.  https://doi.org/10.1007/s00403-009-0951-9 CrossRefGoogle Scholar
  16. 16.
    Atalay S, Coruh A, Deniz K (2014) Stromal vascular fraction improves deep partial thickness burn wound healing. Burns 40:1375–1383.  https://doi.org/10.1016/j.burns.2014.01.023 CrossRefGoogle Scholar
  17. 17.
    Kim W-S, Park B-S, Sung J-H et al (2007) Wound healing effect of adipose-derived stem cells: a critical role of secretory factors on human dermal fibroblasts. J Dermatol Sci 48:15–24.  https://doi.org/10.1016/j.jdermsci.2007.05.018 CrossRefGoogle Scholar
  18. 18.
    Koh YJ, Koh BI, Kim H et al (2011) Stromal vascular fraction from adipose tissue forms profound vascular network through the dynamic reassembly of blood endothelial cells. Arterioscler Thromb Vasc Biol 31:1141–1150.  https://doi.org/10.1161/ATVBAHA.110.218206 CrossRefGoogle Scholar
  19. 19.
    Strong AL, Cederna PS, Rubin JP et al (2015) The current state of fat grafting: a review of harvesting, processing, and injection techniques. Plast Reconstr Surg 136:897–912.  https://doi.org/10.1097/PRS.0000000000001590 CrossRefGoogle Scholar
  20. 20.
    van Dongen JA, Tuin AJ, Spiekman M et al (2017) Comparison of intraoperative procedures for isolation of clinical grade stromal vascular fraction for regenerative purposes: a systematic review. J Tissue Eng Regen Med.  https://doi.org/10.1002/term.2407 CrossRefGoogle Scholar
  21. 21.
    Yoshimura K, Shigeura T, Matsumoto D et al (2006) Characterization of freshly isolated and cultured cells derived from the fatty and fluid portions of liposuction aspirates. J Cell Physiol 208:64–76.  https://doi.org/10.1002/jcp.20636 CrossRefGoogle Scholar
  22. 22.
    Aronowitz Ja, Ellenhorn JDI (2013) Adipose stromal vascular fraction isolation: a head-to-head comparison of four commercial cell separation systems. Plast Reconstr Surg 132:932e–939e.  https://doi.org/10.1097/PRS.0b013e3182a80652 CrossRefGoogle Scholar
  23. 23.
    Gentile P, De Angelis B, Pasin M et al (2014) Adipose-derived stromal vascular fraction cells and platelet-rich plasma. J Craniofac Surg 25:267–272.  https://doi.org/10.1097/01.scs.0000436746.21031.ba CrossRefGoogle Scholar
  24. 24.
    von Heimburg D, Hemmrich K, Haydarlioglu S et al (2004) Comparison of viable cell yield from excised versus aspirated adipose tissue. Cells Tissues Organs 178:87–92.  https://doi.org/10.1159/000081719 CrossRefGoogle Scholar
  25. 25.
    Yoshimura K, Sato K, Aoi N et al (2008) Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthet Plast Surg 32:48–55.  https://doi.org/10.1007/s00266-007-9019-4 CrossRefGoogle Scholar
  26. 26.
    Kuno S, Yoshimura K (2015) Condensation of tissue and stem cells for fat grafting. Clin Plast Surg 42:191–197.  https://doi.org/10.1016/j.cps.2014.12.006 CrossRefGoogle Scholar
  27. 27.
    Lin JY, Wang C, Pu LLQ (2015) Can we standardize the techniques for fat grafting? Clin Plast Surg 42:199–208.  https://doi.org/10.1016/j.cps.2014.12.005 CrossRefGoogle Scholar
  28. 28.
    Cheng C, Sheng L, Li H et al (2016) Cell-assisted skin grafting: improving texture and elasticity of skin grafts through autologous cell transplantation. Plast Reconstr Surg 137:58e–66e.  https://doi.org/10.1097/PRS.0000000000001949 CrossRefGoogle Scholar
  29. 29.
    Haas AF, Glogau RG (1994) A variation of composite grafting for reconstruction of full-thickness nasal alar defects. Arch Dermatol 130:978–980CrossRefGoogle Scholar
  30. 30.
    Yun IS, Jeon YR, Lee WJ et al (2012) Effect of human adipose derived stem cells on scar formation and remodeling in a pig model: a pilot study. Dermatol Surg 38:1678–1688.  https://doi.org/10.1111/j.1524-4725.2012.02495.x CrossRefGoogle Scholar
  31. 31.
    Wilson AM (2006) Use of botulinum toxin type A to prevent widening of facial scars. Plast Reconstr Surg 117:1758.  https://doi.org/10.1097/01.prs.0000209944.45949.d1 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  • Jun Won Lee
    • 1
  • Seong Hoon Park
    • 1
  • Seong Joo Lee
    • 1
  • Seong Hwan Kim
    • 1
  • In Suck Suh
    • 1
  • Hii Sun Jeong
    • 1
  1. 1.Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, College of MedicineHallym UniversitySeoulKorea

Personalised recommendations