An exploration of the relationship of fatty tissue, burn injury and scarring
AbstractAdipose-derived stem cells (ADSCs) have been proposed as a treatment modality in burn wound management. While the therapeutic use of ADSCs increases, their mechanisms of action pertaining to wound healing are still poorly understood. Although fat tissue from lipoaspirate may induce wound healing under certain circumstances, in other situations it is possible that ADSCs may cause or exacerbate hypertrophic scarring (HTS). This potentially deleterious effect is considered to be due to excessive angiogenesis and tissue granulation propagated by the presence of the ADSCs. The overstimulation of vascular endothelial growth factor that may occur in burns of a certain depth and state of maturation is likely to cause this hypergranulation. ADSCs, or the stromal vascular fraction (SVF) cells, have been found to be effective in initiating softening and/or transformation in scar consistency and compliance in already established hypertrophic scars and scar contractures. In contrast, in certain phases of acute burn wound injuries, particularly when fat cones are exposed in deeper injuries, the addition of ADSCs may contribute to HTS. Until the mechanisms of action of lipoaspirate components (SVF or ADSCs) are better understood, physicians should proceed with caution before applying lipoaspirate contents to the surface of burn wounds.
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