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Handchir Mikrochir Plast Chir 2014; 46(04): 242-247
DOI: 10.1055/s-0034-1376970
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Autologous Fat Grafting for Scleroderma-Induced Digital Ulcers. An Effective Technique in Patients with Systemic Sclerosis

Autologe Fettransplantation für Skleroderma verursachte Finger Ulzera. Eine effektive Technik für Patienten mit Systemische Sklerodermie
M. Del Bene
1   S. Gerardo Hospital, Department of Plastic, Hand Surgery and Reconstructive Microsurgery, Monza, Italy
,
M. R. Pozzi
2   S. Gerardo Hospital, Clinica Medica – Università Milano Bicocca, Monza, Italy
,
L. Rovati
1   S. Gerardo Hospital, Department of Plastic, Hand Surgery and Reconstructive Microsurgery, Monza, Italy
,
I. Mazzola
1   S. Gerardo Hospital, Department of Plastic, Hand Surgery and Reconstructive Microsurgery, Monza, Italy
,
G. Erba
2   S. Gerardo Hospital, Clinica Medica – Università Milano Bicocca, Monza, Italy
,
S. Bonomi
3   Department of Plastic Reconstructive Surgery and Burn Unit, Niguarda Ca’ Granda Hospital, Milano, Italy
› Author Affiliations
Further Information

Publication History

received 20 October 2013

accepted 25 April 2014

Publication Date:
27 August 2014 (online)

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Abstract

Background: Digital ulcers (DUs) occur in up to 50% of patients with Systemic Sclerosis (SSc). DUs are painful, recurring and lead to functional disability. Management of DUs includes pharmacologic and local therapy, the healing process is slow and the ulcer can become infected or evolve to gangrene. Autologous fat grafting (AFG) is a technique used to promote tissues repair. We used AFG to treat DUs refractory to conventional treatment to enhance healing process.

Patients and Methods: We treated 9 SSc patients for a total of 15 ulcers. All 9 patients were treated with iv Iloprost. The purified fat tissue was injected at the border of larger ulcers or at the finger base of smaller DUs. The AFG was performed from 2 to 8 months since the ulcer onset.

Results: Complete healing occured in 10 DUs and size reduction ≥50% in 2, within 8–12 weeks. In all but 2 patients the pain improved allowing a reduction of analgesics. In the majority of the cases AFG was able to hasten ulcer healing and to reduce pain and the need of pharmacological therapy. The lack of efficacy on healing and pain reduction was observed when the ulcers were long-lasting, located on legs and with concurrent atherosclerotic macroangiopathy.

Conclusions: Surgical resective treatment for finger ulcers in patients affected by SSc is fraught with morbidity and long prolonged recovery. This study introduces a novel minimally invasive approach. The procedure is safe and effective, with short recovery time and local deficient vascularization improvement.

Zusammenfassung

Hintergrund: Digitale Ulzeras kommen in 50% der Patienten mit systemische Sklerose (SSc) vor. Fingerulzera sind schmerzhaft, wieder auftretend und führen zu funktionelle Körperunfähigkeit. Die Behandlung besteht sowohl aus einer pharmakologischen als auch von einer lokalen Wundtherapie. Aufgrund einer verlangsamten Wundheilung, können sich leicht Infektionen und Gangräne entwickeln. Autologe Fettransplantation wird zur Regeneration von Gewebe benutzt. Wir haben diese Technik bei schwer heilende digitale Ulzeras angewendet welche keine positive Antwort zur konventionelle Therapie ergeben haben.

Methoden: Wir haben 9 unter systemische Sklerodermie leidende Patienten behandelt, insgesamt 15 Ulzeras. Alle Patienten erhielten eine Therapie mit Iloprost. Das mittels der Coleman Technik purifizierte Fett wurde an der Basis der betroffenen Phalanx transplantiert. Die autologe Fettransplantation erfolgte zwischen 2 und 8 Monate nach Erscheinung der Ulzera.

Ergebnisse: In einen Zeitraum von 8 bis 12 Wochen erfolgte eine komplette Wundheilung in 10 Ulzeras und eine Reduktion ≥50% des Wunddurchmessers ergab sich in 2 Fällen. Alle Patienten außer 2 berichteten eine sofortige Schmerzenverminderung sodass eine Reduktion der Analgesie möglich war. Alle Ulzeras zeigten eine erschnellte Wundheilung und eine sofortige Verminderung der lokalen Schmerzen, welche eine Reduzierung der pharmakologischen Therapie ermöglichte. Ein Fehlen des Heilungsprozesses und der Schmerzreduktion zeigten sich nur in seit längerer Zeit bestehende Wunden welche sich an den unteren Extremitäten befanden.

Schlussfolgerung: Eine chirurgische Resektion der digitalen Ulzeras bei durch Systemische Sklerodermie erkrankte Patienten, bedingt eine erhöhte Morbidität und ein verlängertes Heilungs­prozess. Die Vorliegende Arbeit gibt eine Übersicht über ein neues Behandlungskonzept bei Patienten mit systemische Sklerodermie und zeigt die minimale Invasivität der chirurgischen Vorgangsweise. Das Verfahren ist sicher und effektiv. Eine Beschleunigung der Wundheilung und eine Verbesserung der mangelhaften lokalen Vaskularisation werden somit erreicht.

Key words

autologous fat grafting - digital ulcers - systemic sclerosis - chronic ischemia - adipose-derived stem cells

Schlüsselwörter

autologe Fettransplantation - digitale Ulzera - systemische Sklerodermie - chronische Ischämie - Adipose-derived stem cells
 

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