Letter to the Editor
Fat Grafting for Thermal Injury: Current State and Future Directions To the Editor: We read with interest the article entitled “Fat Grafting for Thermal Injury: Current State and Future Directions”1 We would like to congratulate Dr. Ranganathan and colleagues for their publication, reviewing current body of literature in fat grafting related to thermal injury. In their work, authors consider that all studies analyzed, however, are limited in size and scope and fail to report a significant amount of objective data. We would like to add our experience after 7 years of autologous fat grafting2,3 described in our recently published article.4 We enrolled 694 consecutive patients with retractile and painful scars, 376 of those were burn scar. We evaluated scar improvement after autologous fat graft procedure and we adopted a combined study protocol based on patient and observer scar assessment scale (POSAS) questionnaire5 and Durometer analysis.6 POSAS parameters were studied using the Wilcoxon rank sum test and a P value of less than .005, considered as statistically significant, was found for all POSAS parameters between preoperative and postoperative values. Itching was the only parameter showing any statistical reduction. Thinking that it was necessary to use an objective analysis as Ranganathan and colleagues suggest, in 20 patients we virtually divided each scar into two parts, one was treated using autologous fat graft (study group) and the second one was infiltrated with saline solution (control group). To analyze clinical outcomes we used the Durometer (REXGAUGE type 00; RexGauge Durometer, BuffaloGrove, IL), an instrument able to measure tissue hardness. This instrument has already been used in some clinical trial as a scar objective evaluation tool.6 At 3 months postoperative follow-up, skin hardness measured showed a statistically significant reduction (P
Fat Grafting for Thermal Injury: Current State and Future Directions To the Editor: We read with interest the article entitled “Fat Grafting for Thermal Injury: Current State and Future Directions”1 We would like to congratulate Dr. Ranganathan and colleagues for their publication, reviewing current body of literature in fat grafting related to thermal injury. In their work, authors consider that all studies analyzed, however, are limited in size and scope and fail to report a significant amount of objective data. We would like to add our experience after 7 years of autologous fat grafting2,3 described in our recently published article.4 We enrolled 694 consecutive patients with retractile and painful scars, 376 of those were burn scar. We evaluated scar improvement after autologous fat graft procedure and we adopted a combined study protocol based on patient and observer scar assessment scale (POSAS) questionnaire5 and Durometer analysis.6 POSAS parameters were studied using the Wilcoxon rank sum test and a P value of less than .005, considered as statistically significant, was found for all POSAS parameters between preoperative and postoperative values. Itching was the only parameter showing any statistical reduction. Thinking that it was necessary to use an objective analysis as Ranganathan and colleagues suggest, in 20 patients we virtually divided each scar into two parts, one was treated using autologous fat graft (study group) and the second one was infiltrated with saline solution (control group). To analyze clinical outcomes we used the Durometer (REXGAUGE type 00; RexGauge Durometer, BuffaloGrove, IL), an instrument able to measure tissue hardness. This instrument has already been used in some clinical trial as a scar objective evaluation tool.6 At 3 months postoperative follow-up, skin hardness measured showed a statistically significant reduction (P
