Almadori, Aurora;
(2023)
Fat grafting in the treatment of dermal fibrosis and scarring.
Doctoral thesis (Ph.D), UCL (University College London).
Abstract
Background: An effective cure for dermal fibrosis is lacking. We aimed at assessing the effect of fat grafting in three main fibrotic skin conditions: Systemic Sclerosis (SSc), Lichen Sclerosus (LS), and Radiation-induced Fibrosis in head and neck (RIF). Method: For each condition, we performed retrospective and/or prospective cohort studies including validated outcome measures: grading scales assessing disease severity and function (Mouth Handicap in Systemic Sclerosis-MHISS for SSs; Vulvar Architecture Severity Scale-VASS for LS; Patient Outcomes of Surgery Head/Neck-POS H&N for RIF); patient reported outcome measures (PROMs) for symptoms and quality of life (Hospital Anxiety and Depression Scale-HADS, Derriford Appearance Scale-DAS, Brief Fear of Negative Evaluation Scale-BFNES, Visual Analogue Scale-VAS for all; Female Sexual Function Index-FSFI, Female Sexual distress Scale-FSDS and Romantic Relationship Assessment Scale-RAS for LS; University of Washington Quality of Life-UW QOL and Short Form Health Survey 36-SF 36 for RIF); 3D imaging to assess the fat survival rate. Results: Clinical and quality of life scores showed an overall improvement in the three conditions. In SSc, mouth function (MHISS) significantly improved (p<0.0001). In LS, VASS and FSFI, and FSDS improved (p<0.05, p<0,0008, p<0,0001 respectively). In RIF, POS improved (p<0.001). Most of the psychological measures significantly improved: in SSc, HADS (p<0.0001), DAS (p<0.0001), BFNE (p<0.0001), VAS (p<0.0001); in LS, VAS for itching (p<0,0001), burning (p<0,0026), soreness (p<0,0001), pain 0,0001), HADS (p<0,0001), and RAS (p<0.05). In RIF improvements were reported in WQL (p<0.001), DAS (p<0.0001), VAS (p<0.001), and SF-36 (p< 0.0001). Volumetric assessment was completed for SSc patients and results showed that there was overall a survival of the injected fat. Volume was retained variably in different facial areas: cheeks (93.7%), nasolabial folds (81.9%), nose (67.4%), chin (68.2%), upper lips (35.5%) and lower lips (27.3%). Conclusions: Fat grafting ameliorates skin fibrosis and its associated tissue function, with a positive impact on patients’ quality of life.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Fat grafting in the treatment of dermal fibrosis and scarring |
| Language: | English |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10184679 |
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