Autologous fat grafting (AFG), mostly in combination with adhesiolysis, has become the workhorse for reconstructing a dysfunctional or absent subcutaneous layer. In a previous study we showed that fat grafts isolated by centrifuging led to more than 20 % improvement in scar pliability. Nevertheless, there is still debate on which technique should be used to process and purify fat grafts. Therefore, a cohort with matured scars was obtained using the same study protocol but with filtration as processing technique. Scar quality was evaluated by the Patient and Observer Scar Assessment Scale (POSAS version 2.0), the Cutometer (pliability) and the DSM II ColorMeter (erythema and melanin). Scar evaluation was performed pre-operatively (baseline) and at 3 and 12 months after AFG. Between 2014 and 2018, 46 patients were included. Mean scar age was 20 ± 17 years and the majority of scars was caused by burns. Compared with baseline, patients showed improvement in scar quality measured by POSAS items at 12 months follow-up. The item score of 'pliability' improved the most from 7.4 to 5.8 (p = 0.001). Item scores of 'pain', 'itch' and 'color' also improved significantly. Clinicians also scored 'pliability' as most improved, but this was not statistically significant (p = 0.111). Objectively measured pliability and erythema and melanin showed no statistically significant differences at 12 months follow-up. Patient-reported outcomes revealed a significant improvement in scar quality, especially scar pliability, after AFG processed by filtration in patients with adherent scars. However, no scar quality improvement was found when assessed with objective tools.
Keywords: Autologous fat grafting; Filtration; PROM; Scar assessment; Scars; Subcutis.
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