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      Uso de lipoinjertos para el manejo de cicatrices patológicas en una población pediátrica Translated title: Use of fat graft for treatment of pathological scars in a pediatric population

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          Abstract

          Resumen Background and objective. Due to the cosmetic and functional implications, scars in children represent a concern for patients and their parents. Currently, there are multiple lines of treatment with variable effectiveness. Adipose tissue transfer is a relatively new alternative in the treatment of different alterations including scars, because this tissue contains among other elements growth, angiogenic and antiapoptotic factors, in addition to a reserve of mesenchymal stem cells with the ability to replicate indefinitely and differentiate into several cell types that can promote the reorganization and regeneration of tissue. We show the results of the use of fat graft for treatment of pathological scars in a series of pediatric patients. We base its use on the satisfactory effects found on scars in adults to suggest this method as an alternative in the management in children, considering that this technique represents an emerging treatment for the management of this condition in this age group. Methods. Retrospective, observational, non-randomized study, carried out in pediatric patients underwent to autologous fat grafts for the management of pathological scars during the period from January 2016 to January 2018. The scars were treated with autologous fat grafts and evaluated before the procedure and 3 and 6 postoperative months, using the Vancouver scale. The data obtained were statistically analyzed using the Wilcoxon rank test. Results. Nine patients were included in the study (5 women and 4 men) with an age range of 2 to 17 years (average 8.8 years). A statistically significant reduction in the averages of the variables vascularization, elasticity and in total score of the Vancouver scale (p value <0.05) after treatment with fat graft was identified. All patients showed a decrease of at least 1 point in the total of the Vancouver scale at the end of the evaluated period. The variable with the greatest decrease in the score at 6 months was elasticity and the one with the least change was thickness/height. No patient presented complications early or late during the follow-up period. Conclusions. The data obtained suggest that also in pediatric patients, the scars show a clinical improvement after the application of fat grafts (especially in elasticity), based on the decrease in the score on the Vancouver scale.

          Translated abstract

          Abstract Introducción y objetivo. Debido a implicaciones cosméticas y funcionales, las cicatrices en los niños son una preocupación para pacientes y familiares. Existen múltiples líneas de tratamiento con efectividad variable. La transferencia de tejido adiposo es una alternativa relativamente nueva en el tratamiento de diferentes alteraciones, incluyendo las cicatrices, debido a que este tejido contiene entre otros elementos factores de crecimiento, angiogénicos y antiapoptóticos, además de una reserva de células madre mesenquimales con capacidad de replicarse indefinidamente y diferenciarse en varios tipos celulares que pueden favorecer la reorganización y regeneración de los tejidos. Mostramos los resultados del uso de lipoinjertos autólogos para el tratamiento de cicatrices patológicas en una serie de pacientes pediátricos. Basamos su empleo en los efectos satisfactorios encontrados sobre cicatrices en adultos, con la finalidad de exponer este método como alternativa en el tratamiento en niños, teniendo en cuenta que es una técnica emergente para esta condición en este grupo etario. Material y método. Estudio retrospectivo, observacional, no aleatorizado, en pacientes pediátricos sometidos a lipoinjertos autólogos para el manejo de cicatrices patológicas durante el periodo comprendido entre enero de 2016 y enero de 2018. Las cicatrices fueron evaluadas antes del procedimiento y en controles postoperatorios a 3 y 6 meses por medio de la escala de Vancouver. Los datos obtenidos fueron analizados estadísticamente mediante la prueba de rangos de Wilcoxon. Resultados. Incluimos en el estudio 9 pacientes, 5 mujeres y 4 varones, con edades entre 2 y 17 años (media de 8.8 años). Identificamos una reducción estadísticamente significativa en los promedios de las variables vascularización, elasticidad y en la puntuación total de la escala de Vancouver (valor p <0.05) después del tratamiento con lipoinjertos. Todos los pacientes presentaron disminución de por lo menos 1 punto en el total de la escala al final del periodo de evaluación. La variable con mayor disminución a los 6 meses fue la elasticidad, y la que tuvo menor cambio fue el grosor/altura. Ningún paciente presentó complicaciones tempranas o tardías durante el seguimiento. Conclusiones. Los datos obtenidos sugieren que también en pacientes pediátricos, las cicatrices presentan una mejoría clínica posterior a la aplicación de injertos grasos (especialmente en la elasticidad), basada en la disminución de puntuación en la escala de Vancouver.

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          Most cited references27

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          Multilineage cells from human adipose tissue: implications for cell-based therapies.

          Future cell-based therapies such as tissue engineering will benefit from a source of autologous pluripotent stem cells. For mesodermal tissue engineering, one such source of cells is the bone marrow stroma. The bone marrow compartment contains several cell populations, including mesenchymal stem cells (MSCs) that are capable of differentiating into adipogenic, osteogenic, chondrogenic, and myogenic cells. However, autologous bone marrow procurement has potential limitations. An alternate source of autologous adult stem cells that is obtainable in large quantities, under local anesthesia, with minimal discomfort would be advantageous. In this study, we determined if a population of stem cells could be isolated from human adipose tissue. Human adipose tissue, obtained by suction-assisted lipectomy (i.e., liposuction), was processed to obtain a fibroblast-like population of cells or a processed lipoaspirate (PLA). These PLA cells can be maintained in vitro for extended periods with stable population doubling and low levels of senescence. Immunofluorescence and flow cytometry show that the majority of PLA cells are of mesodermal or mesenchymal origin with low levels of contaminating pericytes, endothelial cells, and smooth muscle cells. Finally, PLA cells differentiate in vitro into adipogenic, chondrogenic, myogenic, and osteogenic cells in the presence of lineage-specific induction factors. In conclusion, the data support the hypothesis that a human lipoaspirate contains multipotent cells and may represent an alternative stem cell source to bone marrow-derived MSCs.
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            Human adipose tissue is a source of multipotent stem cells.

            Much of the work conducted on adult stem cells has focused on mesenchymal stem cells (MSCs) found within the bone marrow stroma. Adipose tissue, like bone marrow, is derived from the embryonic mesenchyme and contains a stroma that is easily isolated. Preliminary studies have recently identified a putative stem cell population within the adipose stromal compartment. This cell population, termed processed lipoaspirate (PLA) cells, can be isolated from human lipoaspirates and, like MSCs, differentiate toward the osteogenic, adipogenic, myogenic, and chondrogenic lineages. To confirm whether adipose tissue contains stem cells, the PLA population and multiple clonal isolates were analyzed using several molecular and biochemical approaches. PLA cells expressed multiple CD marker antigens similar to those observed on MSCs. Mesodermal lineage induction of PLA cells and clones resulted in the expression of multiple lineage-specific genes and proteins. Furthermore, biochemical analysis also confirmed lineage-specific activity. In addition to mesodermal capacity, PLA cells and clones differentiated into putative neurogenic cells, exhibiting a neuronal-like morphology and expressing several proteins consistent with the neuronal phenotype. Finally, PLA cells exhibited unique characteristics distinct from those seen in MSCs, including differences in CD marker profile and gene expression.
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              Autologous fat graft in scar treatment.

              Regenerative medicine is an emerging and rapidly evolving field of research and therapy, thanks to new discoveries on stem cells. Adipose tissue is a connective tissue which contains a reserve of mesenchymal stem cells. Clinical improvements in trophic characteristics of teguments after autologous fat graft are well described in literature. In this paper, we present our observation after 6 years of autologous fat graft experience in scar remodeling.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                December 2020
                : 46
                : 4
                : 475-482
                Affiliations
                [1] Bogotá orgnameUniversidad Nacional de Colombia orgdiv1Fundación Hospital la Misericordia orgdiv2Servicio de Cirugía Plástica Colombia
                [2] Bogotá orgnameUniversidad Nacional de Colombia Colombia
                Article
                S0376-78922020000500012 S0376-7892(20)04600400012
                10.4321/s0376-78922020000500012
                fc019df6-a3c5-481f-b7be-938e488f6a9f

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 11 October 2020
                : 19 August 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 8
                Product

                SciELO Spain

                Categories
                Pediátrica

                Pediatric scars,Fat grafts,Scars,Lipoinjertos,Cicatrices,Cicatrices pediátricas

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