Subcutaneous reconstruction of hand dorsum and fingers for late sequelae of burn scars using adipose-derived stromal vascular fraction (SVF)

Background: Burn scar-derived skin fibrosis has functional and aesthetic sequelae for patients, still pose therapeutic challenges. This is specially pronounced in the hands where contractures limit function. Despite the fact that fat grafts have shown good results in partially restoring function and appearance, limitations still persist. Objectives: The aim of this case report is to show the functional and aesthetic effects of the application of adipose-derived stromal vascular fraction in the treatment of burn-related late sequelae affecting skin of the hand dorsum and the fingers’ function. Patients and Methods: The patient received intraarticular and subcutaneous injections of adiposederived autologous stromal vascular fraction. Muscle strength, range of motion, functional, dexterity and occupational statuses were assessed continuously before and after surgery (6 week and 6, 12 and 24 months follow-ups). Color power Doppler ultrasound imaging was performed at 4 months after SVF application to visualize small vessel presence and their associated density at the infiltrated locations. Results: No local/systemic complications were evidenced with the procedure. As early as 6 weeks (and extended throughout the follow-up period), all joints regained full and painless range of motion, handwriting was restored, as well as daily activities. Elasticity and color of the skin were improved. Ultrasound examination evidenced the presence of an intricate network of vessels surrounding each injected MCP joint and throughout the dermis of the dorsal surface of the treated hand. Conclusion: Having observed physical changes in scarred skin and functional improvement in hand/fingers after the application of SVF, we propose that this technique can constitute a novel and minimally invasive means to alleviate the effects of scarring in these patients.