Autologous fat grafting in the treatment of fibrotic perioral changes in patients with systemic sclerosis

Background: Autologous fat tissue grafting (AFTG) has been successfully used in the treatment of different sclerotic conditions, including localised scleroderma. Patients with advanced systemic sclerosis (SSc)-related perioral thickening and mouth opening limitation are candidates to this therapeutic approach. Aims: AFTG of the lips was performed to improve mouth opening in patients with SSc. Materials and Methods: We enrolled in the study 20 patients with diffuse SSc, (median age 35 ±15 years and 11±10 years of disease duration). Two-ml fractions of autologous fat drawn from trochanteric or peri-umbelical areas were injected in 8 different sites around the mouth. Baseline and after treatment mouth opening changes were assessed by measuring inter-incisal distance and oral perimeter, while skin hardness was tested by digital durometer. Pre- and post-treatment modifications of microvascular architecture were assessed by counting capillaries in the inferior lip videocapillaroscopy (VC) images, and by scoring the microvascular density (MVD) in anti-CD34/CD31 immuno-histochemical (IH) stained perioral skin biopsy sections. Similarly, histological sections were examined to evaluate dermo-epidermic junction (DEJ) modifications. Results: Three months after treatment, both the inter-incisal distance and oral perimeter significantly increased (p <0.001). At the same time, a significant skin neovascularization became evident, both considering the VC images (p <0.001) and MVD scores in IH sections (p <0.0001). Finally, some skin histological aspects also improved, as shown by the significant changes in DEJ flattening scores (p <0.0001). Conclusions: The present study suggests that, in patients with SSc, AFTG can improve mouth opening and function, induce a neovascularization, and partially restore the skin structure.