Fat grafting for neuropathic pain after severe burns

Rafi Fredman, Renee E. Edkins, Charles Scott Hultman

Research output: Contribution to journalArticle

Abstract

Background: Chronic neuropathic pain after burn injury is a significant problem that affects up to 29% of burn patients. Neuropathic burn scar pain is a challenge for plastic and burn surgeons, who have limited solutions. Fat grafting, with its mechanical and regenerative qualities, can improve neuropathic pain from various traumatic and postsurgical etiologies, but its effectiveness in neuropathic burn scar pain has yet to be demonstrated. In this study, the possible role of lipotransfer in treating neuropathic burn scar pain is explored, focusing on safety, graft take, and short-term efficacy. Methods: We performed an institutional review board-approved, retrospective case review of 7 patients with chronic, refractory neuropathic pain, who underwent fat grafting to burn scars. These patients had failed conventional therapy, which included pharmacologic, medical, and laser treatment of the burn scars. Each patient had 2 sessions of fat grafting, spaced 2 months apart. The Patient-Reported Outcomes Measurement Information System (PROMIS) was used to assess pain perception, with patients answering the questionnaire before and after fat grafting, to assess subjective outcomes. Results: Six of 7 patients had improvement in neuropathic pain after fat grafting, permitting reduction in their neuropharmacologic regimen. Tinel sign, present in all patients preoperatively, was absent on examination in all patients at follow-up. Three of the 5 patients who completed PROMIS questionnaires had PROMIS scores indicating improvement in pain by 1-year follow-up. One patient had similar preoperative and postoperative PROMIS scores, and 1 patient had an increase in pain at follow-up; however, he had suffered an additional burn to the same extremity. Analysis of pooled mean PROMIS scores reflects a statistically significant improvement in subjective outcomes by 1-year follow-up. Donor-site seroma in 1 patient was the only complication, with no cases of infection, wound breakdown, or graft loss. Conclusions: Adipose tissue can be safely grafted into burn scars and may improve symptoms in patients with refractory neuropathic pain after burn injury. Further translational and clinical research is necessary to elucidate mechanisms of action, indications, optimal type of transfer, and long-term effectiveness.

Original languageEnglish (US)
Pages (from-to)S298-S303
JournalAnnals of plastic surgery
Volume76
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Fingerprint

Neuralgia
Burns
Fats
Cicatrix
Information Systems
Pain
Intractable Pain
Transplants
Seroma
Pain Perception
Translational Medical Research
Research Ethics Committees
Wounds and Injuries
Wound Infection
Chronic Pain
Plastics
Adipose Tissue
Lasers
Extremities
Patient Reported Outcome Measures

Keywords

  • Burn scar
  • Fat grafting
  • Neuropathic pain

ASJC Scopus subject areas

  • Surgery

Cite this

Fat grafting for neuropathic pain after severe burns. / Fredman, Rafi; Edkins, Renee E.; Hultman, Charles Scott.

In: Annals of plastic surgery, Vol. 76, 01.01.2016, p. S298-S303.

Research output: Contribution to journalArticle

Fredman, Rafi ; Edkins, Renee E. ; Hultman, Charles Scott. / Fat grafting for neuropathic pain after severe burns. In: Annals of plastic surgery. 2016 ; Vol. 76. pp. S298-S303.
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