Contrast-enhanced ultrasonography evaluation after autologous fat grafting in scar revision

Abstract

Aim: Fat transfer is commonly used to fill loss of volume in depressed scars caused by trauma, deep burns or surgery. The aim of the study is to investigate the degree of fat graft take through evaluation of the microcirculation of grafted autologous adipose tissue using contrast-enhanced ultrasonography.

Patients and method: From 2010 to 2012 at the Department of Plastic and Reconstructive Surgery of the Traumatological Center in Turin, a study population was selected from patients with surgical indications for autologous fat transfer for scar correction. For each surgical procedure patients underwent a clinical and sonographic evaluation before and after intervention (at 1 month and 3 months).

Results: Out of a total of 28 interventions, 24 showed a good result; defined as improvement of the scar, and confirmed by the presence of vascularization in the transplanted tissue. In 4 cases, there was a lack of blood supply at the first evaluation but an initial good clinical scar correction. The absence of blood vessels was confirmed at 3 months accompanied by complete resorption of the transferred fat with a failure of good clinical outcome.

Conclusion: Contrast-enhanced ultrasonography was able to evaluate the microvasculature of adipose tissue after fat transfer. Due to this characteristic, it allows to monitor and predict the take of adipose tissue and provide realistic and early information on the clinical outcome of fat transfer.

Figures

Fig. 1

Large scar with important soft tissue gap; in order to have a reproducible measurement in subsequent examinations the operator looked for precise anatomical landmarks and signed the point with a dermographic pencil.

Fig. 2

Successful case of autologous fat transfer. A) Traumatic scar of the dorsum of the foot with strong adherence to the deep layers and loss of volume. B) Clinical improvement of scar quality, with release and volume restore.

Fig. 3

Successful case of autologous fat transfer documented by sonography and contrast-enhanced ultrasonography. A) Thickness of subcutaneous tissue pre-treatment. B–C) Increase of thickness (B) and homogenous vascularization (C) 1 month post autologous fat transfer. D–E) Fat graft stabilized 3 months post treatment.

Fig. 4

Unsuccessful case of autologous fat transfer documented by sonography and contrast-enhanced ultrasonography. A) Thickness of subcutaneous tissue pre-treatment. B–C) Increase of thickness (B) with absence of vascularization after contrast injection (C) 1 month post autologous fat transfer. DE) Fat graft resorption (D) with complete losing of vascularization (E) 3 months post treatment.