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Amputation Site Soft Tissue Restoration Using Adipose Stem Cell Therapy

Bourne DA & Thomas RD, Schusterman MA, Grahovac T, Bliley J, Haas G, Wyse A, Chow I, Radomsky E, Mermon D, Pasquina P, Marra K, Rubin JP
University of Pittsburgh Medical Center, Department of Plastic Surgery
2017-02-11

Presenter: Debra A Bourne, MD

Affidavit:
This project represents original work of the presenting resident in collaboration with all listed co-authors. This material has not been published in any scientific journal nor previously presented a a major meeting.

Director Name: Vu Nguyen

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction

Background: Nearly 2 million people in America suffer from limb loss. Challenges include skin break down, pain, and poor prosthesis fit. Concentrated adipose stem cells at the site of soft tissue loss may improve padding and prosthesis fit and prevent skin breakdown.

Methods: Five patients suffering from pain and limited function at amputation sites were recruited. Fat grafting enriched with adipose derived stem cells derived from the stromal vascular fracture (SVF) was performed at amputation sites. Outcome measures included: 1) Cell populations of SVF assessed via flow cytometry, 2) Volume retention assessed by CT scan, and 3) Quality of life questionnaires.

Results: The average volume of fat graft was 162.5mL enriched with an average of 6.42x10^4 ± 4.5x10^4 cells of SVF per milliliter. At 6-month follow-up, volume retention was 97.8±20.1% and all patients had subjective improvement of soft tissue volume. SVF cell viability was 77.7±8.7%. No significant complications were reported. There were trends toward improvement in: a) The lower extremity functional scale [from 21±6.6 to 41±2.0, p=0.14], b) Self-reported physical functioning quality of life [from 14.0±15.6 to 28.0±25.1, p<0.13], and c) Freedom from bodily pain [from 60.8±14.9 to 78.6±20.7, p=0.067].

Conclusions: This pilot study demonstrates the utility of autologous stem cell enriched fat grafting to create stable soft tissue coverage in amputated limbs. Results demonstrate improvement in pain and functionality as well as quality of life. SVF enriched fat grafting holds promise as a novel and powerful treatment option for the challenging problems facing men and women with limb amputations.

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