Fat grafting for the prevention of pressure ulcers: a case series

Background: Pressure sores tend to recur and become chronic, especially in high-risk groups such as paraplegics, who may present multiple wounds and have long life expectancies. Here, we assess the outcomes achieved with fat grafting as a new preventive strategy for pressure sores. Methods: From 2010 to 2013, seven paraplegic patients presenting stage I or stage II pressure ulcers were treated with the injection of 115 to 620 cm³ of fat that was previously filtered and washed with saline solution. Patients were followed up at 2 and 4 weeks and at 3, 6, and 12 months after surgery. Results: Our experience was encouraging. There was an increase in the thickness of the subcutaneous fat layer and in the degree of padding of the underlying bony protrusions, as a type of natural cushion, which restored the physiological sliding on the underlying fascial planes. A general improvement in the skin characteristics was noted, which reduced the risk of new recurrences. In addition, the fat allowed for satisfactory restoration of the anatomical profile. There were no major complications. Only two cases required new lipofilling due to partial resorption of the graft. Conclusions: Fat grafting may prevent the evolution of lesions and reduce the risk of recurrence. This strategy may avoid the necessity of using assisted scarring devices or more aggressive surgical approaches. Level of Evidence: Level IV, therapeutic study