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Fat Grafting

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In recent years a few studies have been completed suggesting that several intrinsic factors can be affected through fat grafting to prevent or reverse the effects of sitting surface pressure. Marangi et al. (2014) in his study of 42 people who showed early signs of pressure injury development, found increased skin and subcutaneous thickness, increased vascularization and increased intact continuous fascia superficialis in the high-risk sitting surface areas following fat grafting to these areas and 3 months post. Currently, there are two studies regarding fat grafting which are specific to the SCI population.

Table: Fat Grafting for Pressure Injury Prevention

Discussion

Di Caprio et al. (2016) found that using the participants own body fat and injecting it into the high risk areas noted for that participant, resulted in; 1) a decrease in recurrence of the development of pressure injuries, 2) improvements in the characteristics of the tissue in the area and, 3) the anatomical shaping of the area was restored. The participants were followed for 12 months, so the long term effects were not clear. However, this study suggests that fat injections into those high risk areas, may be considered as a preventative strategy for some people when all other strategies have been unsuccessful.

Similarly, participants who had unsuccessful flap surgeries in the study by Previnaire et al. (2016) had success with reducing the recurrence of stage 3 and 4 pressure injuries following fat grafting. This study also suggests that this preventative strategy is an option for those when all other strategies have not been successful. This study also suggests that pressure management strategies continue to be required to manage sitting pressures, as noted with the 2 participants who did not continue with these strategies and developed stage 1 & 2 pressure injuries.

Conclusions

There is level 4 evidence (from two pre-post studies; Di Caprio et al. 2016; Previnaire et al. 2016) showing that fat grafting using the participants own body fat may be considered as a prevention strategy for some people when all other prevention strategies have been unsuccessful.

  • Fat grafting may have potential as a prevention strategy for those people where other strategies have not been successful; ongoing pressure management strategies are still required post grafting.