LETTER TO THE EDITOR
Fat and Adipose-Derived Stem Cell Grafts in Acute Burns To the Editor: With great interest, we have read the paper of Loder et al,1 who demonstrated that fat and adipose-derived stem cell (ADC) isografts have an effect on acute burn wounds in a mouse model. Within their study, they prepared 20 mice with 30% surface area partial thickness burns. Immediately after thermal injury, they injected adipose-derived stem cells or adipose tissue, as well as both in combination. They assessed the wounds with serial photography and immunohistochemistry. After 5 days no significant improvement in vascularization was visible. Nevertheless, the mice who underwent transplantation of fat demonstrated improved specific structural markers of healing. Loder et al1 postulated that autologous fat may have an effect on both, the poor wound profile of thermal injuries and the tissue defect as a cosmetic aspect. We absolutely agree that ADCs improve neovascularization at wound site and may have a strong impact on the wound healing process especially in acute thermal wounds. A recent review by Ranganathan et al2 described quite well the pros and cons of fat grafting in thermally injured patients. We use fat grafting techniques as one of a variety of sources to provide stem cells to acute or chronic wounds. In our review from 2009, we could conclude that stem cells are a promising approach in wound healing.3 At the moment, we are establishing an animal model for the observation of the wound healing process in acute thermal wounds to validate stem cell therapy. Thereby, our focus is on the treatment of the acute phase in full-thickness burn wounds, whereas Loder et al1 focused on partial thickness burns. Over and above, we are using pigs for our wound models because of their structural resemblance to human skin.4 Up to now, we know that fat grafting is well known for reconstructive procedures. It is apparent that fat is used as permanent filler,5 for reconstruction of radiotherapy tissue damage6 or ulcers.7 Address correspondence to Paul Wurzer, MD, Shriners Hospital for Children, University of Texas Medical Branch, 815 Market Street, Galveston, Texas 77550. E-mail: [email protected]. Copyright © 2015 by the American Burn Association 1559-047X/2015 DOI: 10.1097/BCR.0000000000000234
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Our future investigations and studies should focus on the combination of stem cells and standard procedures as skin autografting, allografting, and xenografting. Especially in light of the fact that fat accelerates neovascularization and reduces fibrosis in burn wounds.8 These improvements are necessary to provide better functional and visually outcomes for burned patients. REFERENCES 1. Loder S, Peterson JR, Agarwal S, et al. Wound healing after thermal injury is improved by fat and adipose-derived stem cell isografts. J Burn Care Res 2015;36:70–6. 2. Ranganathan K, Wong VC, Krebsbach PH, Wang SC, Cederna PS, Levi B. Fat grafting for thermal injury: current state and future directions. J Burn Care Res 2013;34:219–26. 3. Branski LK, Gauglitz GG, Herndon DN, Jeschke MG. A review of gene and stem cell therapy in cutaneous wound healing. Burns 2009;35:171–80. 4. Meyer W, Schwarz R, Neurand K. The skin of domestic mammals as a model for the human skin, with special reference to the domestic pig. Curr Probl Dermatol 1978;7:39–52. 5. Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 2006;118(3 Suppl):108S–20S. 6. Rigotti G, Marchi A, Galiè M, et al. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg 2007;119:1409–22; discussion 1423–4. 7. Cervelli V, Gentile P, Grimaldi M. Regenerative surgery: use of fat grafting combined with platelet-rich plasma for chronic lower-extremity ulcers. Aesthetic Plast Surg 2009;33:340–5. 8. Sultan SM, Barr JS, Butala P, et al. Fat grafting accelerates revascularisation and decreases fibrosis following thermal injury. J Plast Reconstr Aesthet Surg 2012;65:219–27. Paul Wurzer, MD Ludwik K. Branski, MD, MMS Shriners Hospitals for Children University of Texas Medical Branch Galveston, Texas Division of Plastic, Aesthetic and Reconstructive Surgery Department of Surgery, Medical University Graz Graz, Austria Lars P. Kamolz, MD, PhD Division of Plastic, Aesthetic and Reconstructive Surgery Department of Surgery, Medical University Graz Graz, Austria David N. Herndon, MD, FACS Celeste C. Finnerty, PhD Shriners Hospitals for Children University of Texas Medical Branch Galveston, Texas
Fat and Adipose-Derived Stem Cell Grafts in Acute Burns To the Editor: With great interest, we have read the paper of Loder et al,1 who demonstrated that fat and adipose-derived stem cell (ADC) isografts have an effect on acute burn wounds in a mouse model. Within their study, they prepared 20 mice with 30% surface area partial thickness burns. Immediately after thermal injury, they injected adipose-derived stem cells or adipose tissue, as well as both in combination. They assessed the wounds with serial photography and immunohistochemistry. After 5 days no significant improvement in vascularization was visible. Nevertheless, the mice who underwent transplantation of fat demonstrated improved specific structural markers of healing. Loder et al1 postulated that autologous fat may have an effect on both, the poor wound profile of thermal injuries and the tissue defect as a cosmetic aspect. We absolutely agree that ADCs improve neovascularization at wound site and may have a strong impact on the wound healing process especially in acute thermal wounds. A recent review by Ranganathan et al2 described quite well the pros and cons of fat grafting in thermally injured patients. We use fat grafting techniques as one of a variety of sources to provide stem cells to acute or chronic wounds. In our review from 2009, we could conclude that stem cells are a promising approach in wound healing.3 At the moment, we are establishing an animal model for the observation of the wound healing process in acute thermal wounds to validate stem cell therapy. Thereby, our focus is on the treatment of the acute phase in full-thickness burn wounds, whereas Loder et al1 focused on partial thickness burns. Over and above, we are using pigs for our wound models because of their structural resemblance to human skin.4 Up to now, we know that fat grafting is well known for reconstructive procedures. It is apparent that fat is used as permanent filler,5 for reconstruction of radiotherapy tissue damage6 or ulcers.7 Address correspondence to Paul Wurzer, MD, Shriners Hospital for Children, University of Texas Medical Branch, 815 Market Street, Galveston, Texas 77550. E-mail: [email protected]. Copyright © 2015 by the American Burn Association 1559-047X/2015 DOI: 10.1097/BCR.0000000000000234
e302
Our future investigations and studies should focus on the combination of stem cells and standard procedures as skin autografting, allografting, and xenografting. Especially in light of the fact that fat accelerates neovascularization and reduces fibrosis in burn wounds.8 These improvements are necessary to provide better functional and visually outcomes for burned patients. REFERENCES 1. Loder S, Peterson JR, Agarwal S, et al. Wound healing after thermal injury is improved by fat and adipose-derived stem cell isografts. J Burn Care Res 2015;36:70–6. 2. Ranganathan K, Wong VC, Krebsbach PH, Wang SC, Cederna PS, Levi B. Fat grafting for thermal injury: current state and future directions. J Burn Care Res 2013;34:219–26. 3. Branski LK, Gauglitz GG, Herndon DN, Jeschke MG. A review of gene and stem cell therapy in cutaneous wound healing. Burns 2009;35:171–80. 4. Meyer W, Schwarz R, Neurand K. The skin of domestic mammals as a model for the human skin, with special reference to the domestic pig. Curr Probl Dermatol 1978;7:39–52. 5. Coleman SR. Structural fat grafting: more than a permanent filler. Plast Reconstr Surg 2006;118(3 Suppl):108S–20S. 6. Rigotti G, Marchi A, Galiè M, et al. Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg 2007;119:1409–22; discussion 1423–4. 7. Cervelli V, Gentile P, Grimaldi M. Regenerative surgery: use of fat grafting combined with platelet-rich plasma for chronic lower-extremity ulcers. Aesthetic Plast Surg 2009;33:340–5. 8. Sultan SM, Barr JS, Butala P, et al. Fat grafting accelerates revascularisation and decreases fibrosis following thermal injury. J Plast Reconstr Aesthet Surg 2012;65:219–27. Paul Wurzer, MD Ludwik K. Branski, MD, MMS Shriners Hospitals for Children University of Texas Medical Branch Galveston, Texas Division of Plastic, Aesthetic and Reconstructive Surgery Department of Surgery, Medical University Graz Graz, Austria Lars P. Kamolz, MD, PhD Division of Plastic, Aesthetic and Reconstructive Surgery Department of Surgery, Medical University Graz Graz, Austria David N. Herndon, MD, FACS Celeste C. Finnerty, PhD Shriners Hospitals for Children University of Texas Medical Branch Galveston, Texas
