Fat Grafting Technique Helps Patients With Raynaud's Phenomenon
Injecting Fat into Hands Reduces Symptoms in Patients With Painful Blood Flow Disorder, Reports PRS
PHILADELPHIA — For patients with Raynaud's phenomenon—episodes of abnormal blood flow in the hands triggered by cold—injections of the patient's own fat into the hands can reduce pain and other symptoms, according to a report in the May issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
"Fat grafting in patients with Raynaud's phenomenon of varying degrees provides a durable clinical improvement in the majority of treated patients," write ASPS Member Surgeon Dr. Lawrence S. Zachary and colleagues of University of Chicago Medical Center. But they emphasize that more research is needed to confirm the benefits of the procedure and clarify how it works.
Fat Grafting Reduces Symptoms of Raynaud's Phenomenon
The authors describe their experience with autologous (patient's own) fat injection of the hands to treat Raynaud's phenomenon in 13 patients.
Patients with Raynaud's phenomenon have painful attacks of decreased blood flow to the hands and feet, most often triggered by exposure to cold. Over time, progressive declines in blood flow can lead to severe complications.
A wide range of medical and surgical treatments have been used for Raynaud's phenomenon, with mixed results. Dr. Zachary and colleagues were prompted to try fat grafting, based on improvements in patients undergoing fat injection of the hands for other reasons—such as burn reconstruction, radiation-induced dermatitis, and hand rejuvenation procedures.
The procedure was relatively simple, with the surgeon obtaining a small amount of fat—about one fluidounce—from the abdomen. The fat was then injected into various locations around the hand and fingers. Most patients underwent injection of both hands, for a total of 21 treated hands.
In three out of the 13 patients, fat grafting led to significant improvement in hand symptoms. Average pain score decreased from 6.86 to 2.38 on a ten-point scale. Patients also reported fewer cold attacks, decreased skin ulcers, and improved hand function up to 18 months after fat injection
Mixed Findings on Blood Flow Measurement
Using a relatively new technique called "laser speckle imaging," the researchers measured blood flow before and after fat injection in 11 hands. Surprisingly, the clinical benefits of fat grafting were unrelated to improvements in blood flow. In six patients, blood flow actually appeared to be reduced after the fat grafting procedure.
Raynaud's phenomenon is a relatively common condition that may progress despite treatment. The patients in the study had undergone many previous treatments, including botulinum toxin (Botox) injection and surgery on the nerves of the hand (sympathectomy).
In 11 patients, Raynaud's phenomenon was associated with the autoimmune disease systemic sclerosis (scleroderma) or other connective tissue disorder. The other two patients had primary Raynaud's phenomenon, with no underlying disease.
While the initial results are encouraging, future studies will need to confirm the benefits of hand fat grafting for Raynaud's phenomenon. Especially with the conflicting results on blood flow, more research is needed to understand how the treatment works; one possibility is new blood cell formation and decreased scarring promoted by stem cells contained in the transferred fat cells.
"We believe that there is a continued role for fat grafting in advanced, refractory Raynaud's phenomenon," Dr. Zachary and colleagues conclude, "and are working towards further characterizing and assessing this treatment option."
Plastic and Reconstructive Surgery is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.
About Plastic and Reconstructive Surgery
For over 75 years, Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.
The American Society of Plastic Surgeons (ASPS) is the largest organization of board-certified plastic surgeons in the world. Representing more than 11,000 physician members worldwide, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 92 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
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