Regenerative Properties of Autologous Fat Grafting in a Complicated Radiation-Induced Wound.

ABSTRACT

INTRODUCTION: Delayed wound healing and ulceration in radiated tissue is a surgical challenge. Autologous fat grafting can reverse skin changes secondary to radiation such as fibrosis, scarring, contracture, and pain. Adipose-derived stem cells are thought to contribute to the regenerative properties of fat. OBJECTIVE: In this case report, the authors discuss the role of fat grafting as a means for effective wound healing in a patient with a chronic nonhealing radiation-induced skin wound. CASE REPORT The patient is a 79-year-old male with a history of medically complicated obesity who presented with a fluoroscopic radiation-induced wound that developed 11 years after non-ST-elevation myocardial infarction for which he underwent placement of 6 stents via percutaneous transluminal coronary angiography. The wound was complicated by several infections and remained refractory to multiple interventions despite topical steroid use, regular wound dressing changes, debridements, and hyperbaric oxygen therapy. In consideration of the patient's body mass index of greater than 50 kg/m2 and modest weight loss attempts, surgical intervention involving wide local resection and flap closure was not thought to be a solution. Fat grafting was performed 19 months after initial presentation, with near-complete healing evident 10 months after the procedure. CONCLUSIONS: Chronic nonhealing wounds can provide a tremendous burden to the patient in terms of time, costs, and morbidity. Despite enduring a prolonged 19-month course involving multiple failed interventions and several wound-related infections, the patient achieved wound healing via fat grafting. Earlier intervention with fat grafting may prove helpful to patients who do not show evidence of healing via other modalities and for whom flap surgery is not an option.