title: Early experience with fat grafting as an adjunct for secondary burn reconstruction in the hand: Technique, hand function assessment and aesthetic outcomes.
abstract: BACKGROUND
  Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in secondary burn reconstruction. The aim of this study was to review our experience with autologous fat transfer in relation to hand function, scarring and cosmesis, in patients undergoing secondary reconstruction after burns.
  
  
  METHODS
  Retrospective analysis of burn patients (2010-2013) who underwent autologous fat transfer to improve scarring, contour deformity and/or scar contracture was performed. Hand function was assessed using grip strength measurement, Total Active Movement (TAM), the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Patients' satisfaction was assessed using the Patient Observer Scar Assessment Scale (POSAS).
  
  
  RESULTS
  Thirteen patients were included in this analysis. The average time from burns and from fat transfer were 2.3 years (10 months-3.9 years) and 9.1 months (3 months-1.3 years), respectively. There was a statistically significant improvement in TAM measurement. The total score, activity of daily living score and satisfaction score of the MHQ also statistically increased following fat transfer. The changes in function score, work score and pain score of the MHQ were not significant. Grip strength measurement and DASH score did not show improvement. For scar assessment, total score and overall score of POSAS improved significantly. Similarly, scores for scar colour, scar thickness, scar stiffness and scar regularity increased significantly.
  
  
  CONCLUSIONS
  Autologous fat transfer directly replaces volume loss in the subcutaneous layer, physically releases tethered skin from underlying tissues and exerts downstream regenerative effects. Skin quality improvements combined with replacement of the subcutaneous adipose volume in the hand reduces overall scar tightness and tissue tethering and has the potential to enhance hand therapy. In our series, modest improvement in range of movement, scar quality and hand outcome scores were demonstrated following a single session of fat transfer.
authors.affiliation: National Burns Centre & Department of Plastic, Reconstructive and Hand Surgery, Ireland. Electronic address: drmiriambyrne@yahoo.com.
authors.forename: Miriam
authors.initials: M
authors.lastname: Byrne
authors.affiliation: Department of Occupational Therapy, St. James's Hospital, Dublin 8, Ireland.
authors.forename: Michelle
authors.initials: M
authors.lastname: O'Donnell
authors.affiliation: Department of Occupational Therapy, St. James's Hospital, Dublin 8, Ireland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Fitzgerald
authors.affiliation: Senior Clinical Lecturer, School of Medicine, Trinity College Dublin, College Green, Dublin 2, Ireland; St. Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, United Kingdom.
authors.forename: Odhran P
authors.initials: OP
authors.lastname: Shelley
mesh_terms: D050153:Abdominal Fat / Q000637:transplantation*; D000328:Adult; D002056:Burns / Q000150:complications / Q000601:surgery*; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006230:Hand Injuries / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Aesthetic; Burn; Fat grafting; Function; Hand; Lipofilling