A review of fat grafting as a potential method to reverse some of the changes to the skin and soft tissue resulting from radiation treatment for cancer has found that the approach has some promise. However, there are key limitations to the research conducted to date that will need to be addressed. These findings come from a paper published in Plastic and Reconstructive Surgery (April 2021; 147(4):819-838). The authors note that findings from some recent studies have suggested that using fat grafting to make take advantage of the regenerative properties of adipose stem cells (ASCs) could benefit patients with chronic radiation-induced skin injuries. “Preliminary evidence suggests that fat grafting can make skin feel and look healthier, restore lost soft tissue volume and help alleviate pain and fibrosis in patients with radiation-induced skin injury after cancer treatment,” said the paper’s senior author Dr. J. Peter Rubin in a press release. Dr. Rubin is President-Elect of the American Society of Plastic Surgeons (ASPS) and Chair of the Department of Plastic Surgery at the University of Pittsburgh Medical Center in Pittsburgh. He is one of the authors of a new review of the clinical evidence on fat grafting for radiation-induced skin and soft tissue injury. In their review, the researchers found evidence that suggests fat grafting increases skin softness and pliability, induces volume restoration, improves hair growth in areas of alopecia, reduces pain, and improves cosmetic and functional outcomes. In studies of breast cancer patients included in the review, the researchers found evidence that fat grafting procedures have reduced pain and other symptoms of radiation-induced skin injury, as well as more normal-appearing skin cells. Some of the studies also showed reduced risks and better outcomes of breast reconstruction after mastectomy in patients treated with fat grafting. In studies of patients with radiation-induced skin injury after treatment for head and neck cancer, fat grafting was reported to lead to improvements in voice, breathing, swallowing and movement. The investigators also note that good outcomes have also been reported in patients with radiation-induced skin injury in the area around the eyes or in the limbs. However, they recognized there are significant limitations within the research available. “The good news is, fat grafting has the potential to really help patients with discomfort and disability caused by radiation-induced skin damage,” said Dr. Rubin. “However the available evidence has a lot of shortcomings, including small sample sizes, lower-quality research designs and a lack of comparison groups.” He noted that variations in how fat cells were collected and processed, as well as the timing and ‘dose’ of fat grafting, made it difficult for the research team to compare results between studies. They also describe unanswered questions regarding potential risks related to ASC injection and concerns that fat grafting might affect cancer follow-up. In light of these limitations the researchers make several recommendations in their paper for further research clarifying the impact of fat grafting on these types of injuries. These recommendations include approaches to clinical assessment and imaging studies, a recommendation for testing skin biomechanics and circulation and cellular-level analyses. They also note that standardized measures will be needed. “We hope our review will inform efforts to establish the benefits of specific types of fat grafting procedures in specific groups of patients,” said Dr. Rubin. “To do that, we’ll need studies including larger numbers of patients, adequate control groups and consistent use of objective outcome measures.”
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