The Utility of Fat Grafting to Manage Burn Scars: A Systematic Review

Secondary management of thermal injuries remains a challenging and relevant topic for plastic and nonplastic burn surgeons alike. Burn scars are associated with both functional limitations and aesthetic challenges for patients. While various treatment modalities exist for the management of these scars, no gold standard has been established. Fat grafting has been used in various reconstructive contexts, and studies have demonstrated improvement in skin texture and contour following infiltration. This systematic review aims to examine the available evidence on outcomes following fat grafting for the management of burn scars. A search of Medline, EMBASE, and Cochrane Library databases was conducted from their inception until November 2024. Published articles examining outcomes of fat grafting for thermal injury scars were identified, screened, and data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 10 740 articles were screened, yielding 14 eligible studies for data extraction, accounting for 885 patients. All studies reported improvement of scars postoperatively. Nine out of 14 studies used a subjective clinical assessment, 1 study did not report pretreatment measurements, and the other 8 studies all found improved outcomes based on clinician assessment. One study reported Vancouver Scar Scale (VSS) scores and another reported modified VSS scores. Three studies utilized POSAS and the mean difference was an improvement of 7.28 (MCID <1). This review suggests that autologous fat grafting and adipose-derived stem cells show promising results for improving scar quality, function, and patient satisfaction following burn injury. Further studies, particularly prospective in nature, with standardized outcome measurements are needed to substantiate subjective clinical improvement. The authors recommend utilizing POSAS or VSS for future studies investigating burn scar treatments.