Incisional Release And Autologous Fat Grafting For The Management Of Perioral Fibrosis In Patients With Scleroderma And Dermatomyositis: An Institutional Review
Tomer Lagziel12, C Scott Hultman1
1Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 2Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Introduction: Scleroderma (SSc) is a rare autoimmune, connective tissue disorder and dermatomyositis an autoimmune inflammatory myopathy with cutaneous complications. Peri-oral fibrosis is a local cutaneous complications of both, negatively impacting functional capabilities and aesthetic satisfaction. Fat grafting has been postulated to aid in the management of SSc fibrosis thanks to stem cell enrichment. This technique’s success has been demonstrated using different graft origin-sites and different injection targets. We aim to demonstrate our SSc patients' success using abdominal fat and perioral target.
Methods: We queried our electronic records for patients with pre-existing SSc who underwent incisional release and fat grafting for perioral fibrosis from 2018-2021. For perioral release, semi-sharp cannula was tunneled under the vermilion border into the vermilion and along the skin. For grafting, cannulas were used to infiltrate the fat with a retrograde filling technique in a radial-fanning manner. Their autoimmune diagnosis, anesthetic risk assessment (ASA), systemic disease complications, and degree of presenting symptoms were reviewed along with their post-operative outcomes.
Results: From 2018-2021, 16 patients diagnosed with SSc were treated at our institution with incisional release and fat grafting for the management of perioral fibrosis and 2 diagnosed with dermatomyositis and treated for facial lipodystrophy. Of the SSc patients, 8 presented with limited SSc and 8 presented with diffuse SSc. The mean patient age was 54.31 years. All SSc patients presented with functional symptoms with the most common concern (n=9) being "decreased mouth opening." Some patients (n=11) also presented with cosmetic concerns with "perioral rhytids" being the most common (n=6). The average length-of-condition was 17.47 years. The mean number of systemic complications from SSc, at the time of presentation, was 3.06. The mean ASA was 2.44. The average amount of fat grafted intra-opertaively was 14.89cc. The average procedure length was 52 minutes. Two patients with SSc required re-grafting. For one patient, this was part of the original treatment plan and for the other due to fat resorption. Dermatomyositis patients saw initial improvement but then had near-complete resorption requiring re-grafting. Patients who followed-up in the clinic or via telemedicine all reported improved functionality and were pleased aesthetically.
Conclusion: Patients with perioral fibrosis due to SSc can benefit from autologous fat-grafting. Incisional release in-combination with fat-grafting can enhance procedure outcomes. This technique provides beneficial functional and aesthetic outcomes. Patients with both diffuse and limited disease are appropriate candidates for this procedure. For patients suffering from dermatomyositis, procedure benefits seem temporary.
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