Skip to main content
Erschienen in: Aesthetic Plastic Surgery 6/2022

30.03.2022 | Innovative Techniques

Intraoperative Intradermal Application of Stromal Vascular Fraction into the Abdominal Suture Line: Histological Analysis of Abdominal Scar Tissue

verfasst von: Katarina Zivec, Matija Veber, Joze Pizem, Mojca Jez, Kresimir Bozikov, Urban Svajger

Erschienen in: Aesthetic Plastic Surgery | Ausgabe 6/2022

Einloggen, um Zugang zu erhalten

Abstract

Background

Stem cell therapy is a promising new approach to wound healing. Stromal vascular fraction is a heterogeneous collection of cells, including adipose-derived stem cells, which are traditionally isolated using a manual collagenase-based technique. To our knowledge, this is the first human study that histologically assesses the potential of intraoperative intradermal injection of stromal vascular fraction on skin regeneration.

Methods

In this controlled study, 20 patients undergoing deep inferior epigastric perforator flap breast reconstruction and bilateral flank liposuction were included. Stromal vascular fraction was injected intradermally into one side of the abdominal suture line, while the other side served as a control. Outcome measures included analysis of stromal vascular fraction by flow cytometry, histological analysis of scar tissue, and scar photography.

Results

Cell yield for application and cell viability were 55.9 ± 28.5 × 106 and 75.1% ± 14.5%, respectively. Age and body mass index were positively correlated with the number of cells for application and adipose-derived stem cells. Mean vascular density, elastic fiber content, collagen maturity (scar index), epidermal thickness, and number of rete ridges all showed higher values on the treated side. Furthermore, the injected number of adipose-derived stem cells and pericytes positively correlated with vascular density.

Conclusions

It is safe to speculate that intradermal stromal vascular fraction injection at the beginning of the healing process increases vascular density, collagen maturity and organization, elastic fiber content, epidermal thickness, epidermal–dermal anchoring of the scarring skin and is therefore responsible for improved skin regeneration. It is a viable and safe method that can be used as an adjunctive treatment in plastic surgery procedures where suboptimal wound healing is anticipated.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literatur
1.
Zurück zum Zitat Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A (2008) The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg 61(9):1049–1058CrossRef Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A (2008) The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg 61(9):1049–1058CrossRef
2.
Zurück zum Zitat Sen CK, Gordillo GM, Roy S et al (2009) Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 17(6):763–771CrossRef Sen CK, Gordillo GM, Roy S et al (2009) Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen. 17(6):763–771CrossRef
3.
Zurück zum Zitat Kishi K, Okabe K, Shimizu R, Kubota Y (2012) Fetal skin possesses the ability to regenerate completely: complete regeneration of skin. Keio J Med 61(4):101–108CrossRef Kishi K, Okabe K, Shimizu R, Kubota Y (2012) Fetal skin possesses the ability to regenerate completely: complete regeneration of skin. Keio J Med 61(4):101–108CrossRef
4.
Zurück zum Zitat Larson BJ, Longaker MT, Lorenz HP (2010) Scarless fetal wound healing: a basic science review. Plast Reconstr Surg 126(4):1172–1180CrossRef Larson BJ, Longaker MT, Lorenz HP (2010) Scarless fetal wound healing: a basic science review. Plast Reconstr Surg 126(4):1172–1180CrossRef
5.
Zurück zum Zitat Hu MS, Maan ZN, Wu JC et al (2014) Tissue engineering and regenerative repair in wound healing. Ann Biomed Eng 42(7):1494–1507CrossRef Hu MS, Maan ZN, Wu JC et al (2014) Tissue engineering and regenerative repair in wound healing. Ann Biomed Eng 42(7):1494–1507CrossRef
6.
Zurück zum Zitat Moore AL, Marshall CD, Barnes LA, Murphy MP, Ransom RC, Longaker MT (2018) Scarless wound healing: transitioning from fetal research to regenerative healing. Wiley Interdiscip Rev Dev Biol. 7(2):e309CrossRef Moore AL, Marshall CD, Barnes LA, Murphy MP, Ransom RC, Longaker MT (2018) Scarless wound healing: transitioning from fetal research to regenerative healing. Wiley Interdiscip Rev Dev Biol. 7(2):e309CrossRef
7.
Zurück zum Zitat Hu MS, Rennert RC, McArdle A et al (2014) The role of stem cells during scarless skin wound healing. Adv Wound Care (New Rochelle). 3(4):304–314CrossRef Hu MS, Rennert RC, McArdle A et al (2014) The role of stem cells during scarless skin wound healing. Adv Wound Care (New Rochelle). 3(4):304–314CrossRef
8.
Zurück zum Zitat Leung A, Crombleholme TM, Keswani SG (2012) Fetal wound healing: implications for minimal scar formation. Curr Opin Pediatr 24(3):371–378CrossRef Leung A, Crombleholme TM, Keswani SG (2012) Fetal wound healing: implications for minimal scar formation. Curr Opin Pediatr 24(3):371–378CrossRef
9.
Zurück zum Zitat Guo J, Nguyen A, Banyard DA et al (2016) Stromal vascular fraction: a regenerative reality? Part 2: mechanisms of regenerative action. J Plast Reconstr Aesthet Surg 69(2):180–188CrossRef Guo J, Nguyen A, Banyard DA et al (2016) Stromal vascular fraction: a regenerative reality? Part 2: mechanisms of regenerative action. J Plast Reconstr Aesthet Surg 69(2):180–188CrossRef
10.
Zurück zum Zitat Hu MS, Borrelli MR, Lorenz HP, Longaker MT, Wan DC (2018) Mesenchymal stromal cells and cutaneous wound healing: a comprehensive review of the background, role, and therapeutic potential. Stem Cells Int. 2018:6901983CrossRef Hu MS, Borrelli MR, Lorenz HP, Longaker MT, Wan DC (2018) Mesenchymal stromal cells and cutaneous wound healing: a comprehensive review of the background, role, and therapeutic potential. Stem Cells Int. 2018:6901983CrossRef
11.
Zurück zum Zitat Nguyen A, Guo J, Banyard DA et al (2016) Stromal vascular fraction: a regenerative reality? Part 1: current concepts and review of the literature. J Plast Reconstr Aesthet Surg 69(2):170–179CrossRef Nguyen A, Guo J, Banyard DA et al (2016) Stromal vascular fraction: a regenerative reality? Part 1: current concepts and review of the literature. J Plast Reconstr Aesthet Surg 69(2):170–179CrossRef
12.
Zurück zum Zitat Spiekman M, van Dongen JA, Willemsen JC, Hoppe DL, van der Lei B, Harmsen MC (2017) The power of fat and its adipose-derived stromal cells: emerging concepts for fibrotic scar treatment. J Tissue Eng Regen Med 11(11):3220–3235CrossRef Spiekman M, van Dongen JA, Willemsen JC, Hoppe DL, van der Lei B, Harmsen MC (2017) The power of fat and its adipose-derived stromal cells: emerging concepts for fibrotic scar treatment. J Tissue Eng Regen Med 11(11):3220–3235CrossRef
13.
Zurück zum Zitat Gentile P, Orlandi A, Scioli MG, Di Pasquali C, Bocchini I, Cervelli V (2012) Concise review: adipose-derived stromal vascular fraction cells and platelet-rich plasma: basic and clinical implications for tissue engineering therapies in regenerative surgery. Stem Cells Transl Med 1(3):230–236CrossRef Gentile P, Orlandi A, Scioli MG, Di Pasquali C, Bocchini I, Cervelli V (2012) Concise review: adipose-derived stromal vascular fraction cells and platelet-rich plasma: basic and clinical implications for tissue engineering therapies in regenerative surgery. Stem Cells Transl Med 1(3):230–236CrossRef
14.
Zurück zum Zitat Rohrich RJ, Wan D (2019) Making sense of stem cells and fat grafting in plastic surgery: the hype, evidence, and evolving U.S. food and drug administration regulations. Plast Reconstr Surg 143(2):417e–424eCrossRef Rohrich RJ, Wan D (2019) Making sense of stem cells and fat grafting in plastic surgery: the hype, evidence, and evolving U.S. food and drug administration regulations. Plast Reconstr Surg 143(2):417e–424eCrossRef
15.
Zurück zum Zitat Zimmerlin L, Donnenberg VS, Pfeifer ME et al (2010) Stromal vascular progenitors in adult human adipose tissue. Cytometry A 77(1):22–30 Zimmerlin L, Donnenberg VS, Pfeifer ME et al (2010) Stromal vascular progenitors in adult human adipose tissue. Cytometry A 77(1):22–30
16.
Zurück zum Zitat Andia I, Maffulli N, Burgos-Alonso N (2019) Stromal vascular fraction technologies and clinical applications. Expert Opin Biol Ther 19(12):1289–1305CrossRef Andia I, Maffulli N, Burgos-Alonso N (2019) Stromal vascular fraction technologies and clinical applications. Expert Opin Biol Ther 19(12):1289–1305CrossRef
17.
Zurück zum Zitat Blaber SP, Webster RA, Hill CJ et al (2012) Analysis of in vitro secretion profiles from adipose-derived cell populations. J Transl Med 10:172CrossRef Blaber SP, Webster RA, Hill CJ et al (2012) Analysis of in vitro secretion profiles from adipose-derived cell populations. J Transl Med 10:172CrossRef
18.
Zurück zum Zitat Aronowitz JA, Ellenhorn JD (2013) Adipose stromal vascular fraction isolation: a head-to-head comparison of four commercial cell separation systems. Plast Reconstr Surg 132(6):932e–939eCrossRef Aronowitz JA, Ellenhorn JD (2013) Adipose stromal vascular fraction isolation: a head-to-head comparison of four commercial cell separation systems. Plast Reconstr Surg 132(6):932e–939eCrossRef
19.
Zurück zum Zitat Aronowitz JA, Lockhart RA, Hakakian CS (2015) Mechanical versus enzymatic isolation of stromal vascular fraction cells from adipose tissue. Springerplus 4:713CrossRef Aronowitz JA, Lockhart RA, Hakakian CS (2015) Mechanical versus enzymatic isolation of stromal vascular fraction cells from adipose tissue. Springerplus 4:713CrossRef
20.
Zurück zum Zitat Bourin P, Bunnell BA, Casteilla L et al (2013) Stromal cells from the adipose tissue-derived stromal vascular fraction and culture expanded adipose tissue-derived stromal/stem cells: a joint statement of the international federation for adipose therapeutics and science (IFATS) and the international society for cellular therapy (ISCT). Cytotherapy 15(6):641–648CrossRef Bourin P, Bunnell BA, Casteilla L et al (2013) Stromal cells from the adipose tissue-derived stromal vascular fraction and culture expanded adipose tissue-derived stromal/stem cells: a joint statement of the international federation for adipose therapeutics and science (IFATS) and the international society for cellular therapy (ISCT). Cytotherapy 15(6):641–648CrossRef
21.
Zurück zum Zitat Junqueira LCU, Bignolas G, Brentani RR (1979) Picrosirius staining plus polarization microscopy, a specific method for collagen detection in tissue sections. Histochem J 11(4):447–455CrossRef Junqueira LCU, Bignolas G, Brentani RR (1979) Picrosirius staining plus polarization microscopy, a specific method for collagen detection in tissue sections. Histochem J 11(4):447–455CrossRef
22.
Zurück zum Zitat Flanders KC, Major CD, Arabshahi A et al (2003) Interference with transforming growth factor-β/ Smad3 signaling results in accelerated healing of wounds in previously irradiated skin. Am J Pathol 163(6):2247–2257CrossRef Flanders KC, Major CD, Arabshahi A et al (2003) Interference with transforming growth factor-β/ Smad3 signaling results in accelerated healing of wounds in previously irradiated skin. Am J Pathol 163(6):2247–2257CrossRef
23.
Zurück zum Zitat Sultan SM, Stern CS, Allen RJ Jr et al (2011) Human fat grafting alleviates radiation skin damage in a murine model. Plast Reconstr Surg 128(2):363–372CrossRef Sultan SM, Stern CS, Allen RJ Jr et al (2011) Human fat grafting alleviates radiation skin damage in a murine model. Plast Reconstr Surg 128(2):363–372CrossRef
24.
Zurück zum Zitat Koh YJ, Koh BI, Kim H et al (2011) Stromal vascular fraction from adipose tissue forms profound vascular network through the dynamic reassembly of blood endothelial cells. Arterioscler Thromb Vasc Biol 31(5):1141–1150CrossRef Koh YJ, Koh BI, Kim H et al (2011) Stromal vascular fraction from adipose tissue forms profound vascular network through the dynamic reassembly of blood endothelial cells. Arterioscler Thromb Vasc Biol 31(5):1141–1150CrossRef
25.
Zurück zum Zitat Kwon HM, Hur SM, Park KY et al (2014) Multiple paracrine factors secreted by mesenchymal stem cells contribute to angiogenesis. Vascul Pharmacol 63(1):19–28CrossRef Kwon HM, Hur SM, Park KY et al (2014) Multiple paracrine factors secreted by mesenchymal stem cells contribute to angiogenesis. Vascul Pharmacol 63(1):19–28CrossRef
26.
Zurück zum Zitat Rigotti G, Marchi A, Galie M et al (2007) Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg. 119(5):1409–1422 (discussion 1423-1404)CrossRef Rigotti G, Marchi A, Galie M et al (2007) Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg. 119(5):1409–1422 (discussion 1423-1404)CrossRef
27.
Zurück zum Zitat Atalay S, Coruh A, Deniz K (2014) Stromal vascular fraction improves deep partial thickness burn wound healing. Burns 40(7):1375–1383CrossRef Atalay S, Coruh A, Deniz K (2014) Stromal vascular fraction improves deep partial thickness burn wound healing. Burns 40(7):1375–1383CrossRef
28.
Zurück zum Zitat Cuttle L, Nataatmadja M, Fraser JF, Kempf M, Kimble RM, Hayes MT (2005) Collagen in the scarless fetal skin wound: detection with picrosirius-polarization. Wound Rep Regen 13(2):198–204CrossRef Cuttle L, Nataatmadja M, Fraser JF, Kempf M, Kimble RM, Hayes MT (2005) Collagen in the scarless fetal skin wound: detection with picrosirius-polarization. Wound Rep Regen 13(2):198–204CrossRef
29.
Zurück zum Zitat Zerbinati N, Calligaro A (2018) Calcium hydroxylapatite treatment of human skin: evidence of collagen turnover through picrosirius red staining and circularly polarized microscopy. Clin Cosmet Investig Dermatol 11:29–35CrossRef Zerbinati N, Calligaro A (2018) Calcium hydroxylapatite treatment of human skin: evidence of collagen turnover through picrosirius red staining and circularly polarized microscopy. Clin Cosmet Investig Dermatol 11:29–35CrossRef
30.
Zurück zum Zitat Verhaegen PD, van Zuijlen PP, Pennings NM et al (2009) Differences in collagen architecture between keloid, hypertrophic scar, normotrophic scar, and normal skin: an objective histopathological analysis. Wound Rep Regen 17(5):649–656CrossRef Verhaegen PD, van Zuijlen PP, Pennings NM et al (2009) Differences in collagen architecture between keloid, hypertrophic scar, normotrophic scar, and normal skin: an objective histopathological analysis. Wound Rep Regen 17(5):649–656CrossRef
31.
Zurück zum Zitat Hanson SE, Kleinbeck KR, Cantu D et al (2016) Local delivery of allogeneic bone marrow and adipose tissue-derived mesenchymal stromal cells for cutaneous wound healing in a porcine model. J Tissue Eng Regen Med 10(2):E90–E100CrossRef Hanson SE, Kleinbeck KR, Cantu D et al (2016) Local delivery of allogeneic bone marrow and adipose tissue-derived mesenchymal stromal cells for cutaneous wound healing in a porcine model. J Tissue Eng Regen Med 10(2):E90–E100CrossRef
32.
Zurück zum Zitat Beausang E, Floyd H, Dunn KW, Orton CI, Ferguson MW (1998) A new quantitative scale for clinical scar assessment. Plast Reconstr Surg 102(6):1954–1961CrossRef Beausang E, Floyd H, Dunn KW, Orton CI, Ferguson MW (1998) A new quantitative scale for clinical scar assessment. Plast Reconstr Surg 102(6):1954–1961CrossRef
33.
Zurück zum Zitat Beanes SR, Hu FY, Soo C et al (2002) Confocal microscopic analysis of scarless repair in the fetal rat: defining the transition. Plast Reconst Surg 109:160–170CrossRef Beanes SR, Hu FY, Soo C et al (2002) Confocal microscopic analysis of scarless repair in the fetal rat: defining the transition. Plast Reconst Surg 109:160–170CrossRef
34.
Zurück zum Zitat Andjelkov K, Conde-Green A, Mosahebi A (2021) Smoking and physical activity significantly influence stromal vascular fraction cell yield and viability. Aesthet Plast Surg 45(1):315–321CrossRef Andjelkov K, Conde-Green A, Mosahebi A (2021) Smoking and physical activity significantly influence stromal vascular fraction cell yield and viability. Aesthet Plast Surg 45(1):315–321CrossRef
35.
Zurück zum Zitat Dos-Anjos Vilaboa S, Navarro-Palou M, Llull R (2014) Age influence on stromal vascular fraction cell yield obtained from human lipoaspirates. Cytotherapy 16(8):1092–1097CrossRef Dos-Anjos Vilaboa S, Navarro-Palou M, Llull R (2014) Age influence on stromal vascular fraction cell yield obtained from human lipoaspirates. Cytotherapy 16(8):1092–1097CrossRef
36.
Zurück zum Zitat Zuk PA, Zhu M, Mizuno H et al (2001) Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng 7(2):211–228CrossRef Zuk PA, Zhu M, Mizuno H et al (2001) Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng 7(2):211–228CrossRef
37.
Zurück zum Zitat Covarrubias P, Cardenas-Camarena L, Guerrerosantos J et al (2013) Evaluation of the histologic changes in the fat-grafted facial skin: clinical trial. Aesthet Plast Surg 37(4):778–783CrossRef Covarrubias P, Cardenas-Camarena L, Guerrerosantos J et al (2013) Evaluation of the histologic changes in the fat-grafted facial skin: clinical trial. Aesthet Plast Surg 37(4):778–783CrossRef
38.
Zurück zum Zitat Mojallal A, Lequeux C, Shipkov C et al (2009) Improvement of skin quality after fat grafting: clinical observation and an animal study. Plast Reconstr Surg 124(3):765–774CrossRef Mojallal A, Lequeux C, Shipkov C et al (2009) Improvement of skin quality after fat grafting: clinical observation and an animal study. Plast Reconstr Surg 124(3):765–774CrossRef
39.
Zurück zum Zitat Foubert P, Zafra D, Liu M et al (2017) Autologous adipose-derived regenerative cell therapy modulates development of hypertrophic scarring in a red Duroc porcine model. Stem Cell Res Ther 8(1):261CrossRef Foubert P, Zafra D, Liu M et al (2017) Autologous adipose-derived regenerative cell therapy modulates development of hypertrophic scarring in a red Duroc porcine model. Stem Cell Res Ther 8(1):261CrossRef
Metadaten
Titel
Intraoperative Intradermal Application of Stromal Vascular Fraction into the Abdominal Suture Line: Histological Analysis of Abdominal Scar Tissue
verfasst von
Katarina Zivec
Matija Veber
Joze Pizem
Mojca Jez
Kresimir Bozikov
Urban Svajger
Publikationsdatum
30.03.2022
Verlag
Springer US
Erschienen in
Aesthetic Plastic Surgery / Ausgabe 6/2022
Print ISSN: 0364-216X
Elektronische ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-022-02860-4

Weitere Artikel der Ausgabe 6/2022

Aesthetic Plastic Surgery 6/2022 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.