| Objective(s):1.Explore the mechanism of fat transplantation promoting wound healing.2.By comparing three commonly used fat treatment methods,select one that is beneficial for wound healing and more suitable for clinical use,providing new ideas for wound treatment.Methods:23 hospitalized patients who underwent surgical repair of wounds from the Burn Department of the Second Affiliated Hospital of Kunming Medical University from December 2021 to December 2022 were selected as the research subjects.Inclusion criteria:(1)Various acute and chronic wounds;(2)Serious cardiovascular,cerebrovascular,liver,kidney,hematopoietic,immune system and other diseases that do not affect treatment have not been combined;(3)Age more than 18 years old.Exclusion criteria:(1)Malignant tumor wounds;(2)Accompanied by untreated osteomyelitis wounds;(3)Wounds with exposed large blood vessels or organs;(4)A wound with a fistula leading to the body cavity or organ;(5)Patients with mental illness and inability to cooperate with treatment;(6)Age less than 18 years old;(5)Pregnancy;(6)Refusing to sign an informed consent form or having already participated in another clinical trial.Before the start of the study,patients were divided into 3 groups using a computer random number table method,and 23 patients were actually included.Using a self control method,each group of wounds was divided into an experimental area and a control area(with a minimum interval of 1cm between the two areas).There was no significant difference in general information among the three groups of patients.All patients voluntarily participate in this clinical study and sign an informed consent form.After wound debridement,three groups of patients were treated with 0.25ml/cm on the wound base of each experimental area ~2Inject Coleman fat,nanofat,and adipose derived stem cell matrix gel(ECM/SVF gel,fat gel)in different proportions,and treat the control area with routine treatment.Afterwards,small skin patches were evenly transplanted to cover the wounds in the experimental and control areas,and bandaged and fixed.By taking photos and recording before and after surgery on 7 ± 1 day and 14 ± 2 day,and using Adobe Photoshop cc software to analyze and calculate the wound area in the experimental and control areas;Power Doppler detection of micro blood flow grading in the anterior area of the wound(refer to Szkudlarek score);The Numeric Rating Scales(NRS)score pain on the wounds in two areas of the patient.After basic wound healing,the Observer Scar Assessment Scale(OSAS)and Patient Scar Assessment Scale(PSAS)were used to score early scars in the experimental and control areas.The obtained data is represented as mean ± standard deviation.SPSS 26.0 statistical software was used for analysis.Use t-tests,rank sum tests,or generalized linear models(GEE)to test based on data information and requirements.Inspection standards: α= 0.05,P<0.05 is defined as a statistically significant difference.Results:1.A total of 23 patients were included,22 patients had complete data,and 1patient did not complete the last ultrasound detection of wound blood flow because of automatic discharge.2.The healing rate of the test zone of the 3 groups was greater than that of their own control zone after surgery,there was no significant difference between the 3 test zones and their own control zones at 7 ± 1 days after surgery,and there was a significant difference between the respective control zones and test zones of the 3groups at 14 ± 2 days after surgery.Because the wounds were treated with skin grafting,the comparison between the test zones of the 3 groups with different treatments found no statistical significance.3.The detection of wound neoformed micro blood flow by power Doppler showed a statistical difference between the 3 groups at 7 ± 1 days after surgery compared with their own control zone,and according to the calculated exp(b)value,we found that at this time,the effect of promoting blood flow in the ECM / SVF gel group was much greater than that in the other two groups.At 14 ± 2 days after operation,there was no statistical difference between the Coleman fat group and the ECM / SVF gel group and the self control group,and the nanofat group still showed a statistical difference.After comprehensive analysis,we believe that the fat gel group promotes wound blood flow healing capacity > the nano fat group > the Coleman fat group.4.Pain scores decreased in all 3 groups postoperatively.There was a statistically significant difference in the reduction of pain scores in the test area of the nanonaps group vs.the ECM / SVF gel group at 7 ± 1 days after surgery.There was no statistical difference in pain scores between the test area of the nanofat group and the fat glue group at 7 ± 1 days after surgery,and there was a statistically significant difference in pain scores between the test area of the nanofat group and the fat glue group compared with the pain scores in the test area of the Coleman fat group,respectively.No significant difference was observed in pain scores between the test and control areas in each group 14 ± 2 days after surgery.5.The Coleman fat group did not show differences for early scars after wound healing between the test and control groups,while the nanofat group and the ECM /SVF gel group showed significant differences between the test and control groups on both patient and Observer Scar evaluation scales.It was illustrated that nano fat and fat glue were helpful to improve the quality of postoperative healing.There were statistically significant differences between the test zones of the nanofat group and ECM / SVF gel group compared with the test zone of the Coleman fat group,and no statistically significant differences were observed between the test zones of the nanofat group and ECM / SVF gel group.Conclusion(s):1.Fat grafting can increase wound blood flow,thereby promoting wound healing.In terms of promoting blood flow hyperplasia,after analysis it was considered that ECM / SVF gel capacity was the strongest,nanofat the second,and Coleman fat the weakest.2.Wound pain can be improved in patients using nano fat and ECM / SVF gel therapy.3.Treatment with nanofat and ECM / SVF gel results in improved wound quality and reduced early scar generation while promoting wound healing.4.ECM / SVF gel is recommended for ischemic wound treatment in the clinic,and nanofat is recommended if the patient is thin or has a large wound. |
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