title: Effectiveness of Autologous Fat Grafting in Adherent Scars: Results Obtained by a Comprehensive Scar Evaluation Protocol.
abstract: BACKGROUND
  Nowadays, patients normally survive severe traumas such as burn injuries and necrotizing fasciitis. Large skin defects can be closed but the scars remain. Scars may become adherent to underlying structures when the subcutical fat layer is damaged. Autologous fat grafting provides the possibility of reconstructing a functional sliding layer underneath the scar. Autologous fat grafting is becoming increasingly popular for scar treatment, although large studies using validated evaluation tools are lacking. The authors therefore objectified the effectiveness of single-treatment autologous fat grafting on scar pliability using validated scar measurement tools.
  
  
  METHODS
  Forty patients with adherent scars receiving single-treatment autologous fat grafting were measured preoperatively and at 3-month follow-up. The primary outcome parameter was scar pliability, measured using the Cutometer. Scar quality was also evaluated by the Patient and Observer Scar Assessment Scale and the DSM II ColorMeter. To prevent selection bias, measurements were performed following a standardized algorithm.
  
  
  RESULTS
  The Cutometer parameters elasticity and maximal extension improved 22.5 percent (p < 0.001) and 15.6 percent (p = 0.001), respectively. Total Patient and Observer Scar Assessment Scale scores improved from 3.6 to 2.9 on the observer scale, and from 5.1 to 3.8 on the patient scale (both p < 0.001). Color differences between the scar and normal skin remained unaltered.
  
  
  CONCLUSIONS
  For the first time, the effect of autologous fat grafting on functional scar parameters was ascertained using a comprehensive scar evaluation protocol. The improved scar pliability supports the authors' hypothesis that the function of the subcutis can be restored to a certain extent by single-treatment autologous fat grafting.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Beverwijk and Amsterdam, The Netherlands.|From the Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital; the Association of Dutch Burn Centers; the Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute; and the LaserLab Amsterdam, Department of Sciences, Faculty of Physics, VU University Medical Center.
authors.forename: Mariëlle E H
authors.initials: MEH
authors.lastname: Jaspers
authors.affiliation: Beverwijk and Amsterdam, The Netherlands.|From the Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital; the Association of Dutch Burn Centers; the Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute; and the LaserLab Amsterdam, Department of Sciences, Faculty of Physics, VU University Medical Center.
authors.forename: Katrien M
authors.initials: KM
authors.lastname: Brouwer
authors.affiliation: Beverwijk and Amsterdam, The Netherlands.|From the Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital; the Association of Dutch Burn Centers; the Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute; and the LaserLab Amsterdam, Department of Sciences, Faculty of Physics, VU University Medical Center.
authors.forename: Antoine J M
authors.initials: AJM
authors.lastname: van Trier
authors.affiliation: Beverwijk and Amsterdam, The Netherlands.|From the Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital; the Association of Dutch Burn Centers; the Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute; and the LaserLab Amsterdam, Department of Sciences, Faculty of Physics, VU University Medical Center.
authors.forename: Marloes L
authors.initials: ML
authors.lastname: Groot
authors.affiliation: Beverwijk and Amsterdam, The Netherlands.|From the Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital; the Association of Dutch Burn Centers; the Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute; and the LaserLab Amsterdam, Department of Sciences, Faculty of Physics, VU University Medical Center.
authors.forename: Esther
authors.initials: E
authors.lastname: Middelkoop
authors.affiliation: Beverwijk and Amsterdam, The Netherlands.|From the Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital; the Association of Dutch Burn Centers; the Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute; and the LaserLab Amsterdam, Department of Sciences, Faculty of Physics, VU University Medical Center.
authors.forename: Paul P M
authors.initials: PPM
authors.lastname: van Zuijlen
mesh_terms: D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002985:Clinical Protocols; D004548:Elasticity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D050151:Subcutaneous Fat / Q000637:transplantation*; D000267:Tissue Adhesions / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome