Atrophic Scars: Reinforcing the Flap Mattress Using Adipocyte Transfer in Paraplegic Patients at Risk of Pressure Ulcer Recurrence

Atrophic scars may be defined as depressive areas on the skin, due to a defect of fatty tissue under the skin. This situation may lead to adherence to the depth (fascia, bone, tendon) to be a source of functional impairment. Most of the atrophic scars are secondary to acne localized over the face. Multiple techniques were proposed to restore the volume and uniformize the surface, like laser, injection of fat, microneedling, microdermabrasion, dermal fillers, and surgical techniques such as subcision and platlet rich plasma (PRP). On the basis of level 1 evidence currently available, it appears that PRP can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser and decrease the duration of laser-related side effects including edema and erythema (Goutos). Regenerative surgery, including fat harvesting, centrifugation, and isolation of adipocyte stem cells, has been promoted since years and should be repeated when injected fat progressive crush is observed. The clinical case presented here is a paraplegic patient presenting a pressure sore in the left ischiatic area. The flap was successful but the depth of the transplanted fatty tissue was decreasing after some years. A first fat injection was programmed.