The Effect of Lipotransfer on Facial Scleroderma
Debbie F. Hunt, MBChB MRCS1, L L Bravan, MBChB1, L L Uppal, MBChB1, Chris Denton, MBChB FRCP PhD2, Peter E. Butler, MD FRCS FRCSI FRCS(Plast)1.
1Department of Plastic and Reconstructive Surgery,Royal Free Hospital, London and Centre for Nanotechnology and Regenerative, Medicine University College, London., London, United Kingdom, 2Department of Rheumatology,Royal Free Hospital, London, London, United Kingdom.
Purpose: Scleroderma (SS), is a systemic autoimmune disease causing fibrosis of the skin and other tissues. In diffuse cutaneous disease10-year survival is 55%. Scleroderma commonly affects the face and mouth.
Methods: We report the treatment of oral facial disease in 47 consecutive SS patients. All patients had a Mouth Handicap in Systemic Sclerosis (MHISS) score greater than 20 (scale 0-48), a Rodnan skin of 1 on the face (scale 0-3), with restricted mouth opening. The outcomes were measured using pre and postop functional, volumetric, aesthetic and psychological scores. Mean follow up was 30.3 months.
Functional improvement was documented with MHISS. Aesthetic outcome was rated by a blinded CASS score. Volumetric changes were documented by subtraction 3D photography (3DMD®). Psychological change was measured using the Hospital Anxiety and Depression Scale, the 24 point Derriford Appearance Scale, the Fear of Negative Evaluation Scale and Noticeability and Worry score.
Results: We found a significant improvement in functional scores in all patients (mean 24.8% increase). There was a maintained statistically significant increase in orofacial volume (mean 25% increase) We found a significant improvement in psychological measures (mean 13-33% increase). In 71.4% of patients, a significant improvement in CASS scores was seen.
Conclusion: In summary we have found that lipotransfer is an effective intervention in improving facial scleroderma. It produces significant improvements in functional, volumetric, aesthetic and psychological outcome measures. The mechanism of action of lipotransfer in scleroderma is unclear but warrants further study as it may provide a potential treatment for this incurable disease.
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