الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Regenerative medicine encompasses a wide range of approaches, including the use of biologics, stem cell therapy, tissue engineering, cellular reprogramming, and gene therapy to curb various diseases .These approaches gave a new dimension to “translational medicine” where the local milieu of the diseased tissue or organs was modulated into a regenerative environment to aid in the healing process. Among various available regenerative approaches, stem cell therapy has gained significance. Due to its abundance, availability, and accessibility, the use of adipose tissue and its by-products has sharply increased among varied medical specialties and researchers.
Nanofat is one of the richest sources of adipose-derived stem cells and other progenitor cells. Nanofat behaves on the line of adipose tissue-derived mesenchymal stromal cells. At the site of injury, these stromal cells initiate a site-specific reparative response comprised of remodeling of extracellular matrix (ECM), enhanced and sustained angiogenesis, immune system modulation, and cellular turnover. These properties of stromal cells provide a platform for the usage of cellular therapy in various diseases, No observation of volume loss, contour irregularities, and liponecrosis was made by grafting Nanofat.
Stem cells are an important component of regenerative medicine with increased significance and use in clinical applications. The newer concept of “Regenerative Surgery” has a great scope in augmenting and managing soft tissue defects and reconstructive procedures, of which adipose tissue-derived Nanofat is gaining rapid attention.
By concentrating the progenitor cells within the adipose tissue complex, the regenerative capacity of the adipose-based products is enhanced to aid in their applications Nanofat grafting enhances neoangiogenesis without producing any visible scars and provides a favorable outcome in aesthetic medicine for breast, buttocks, and genital augmentation, facial rejuvenation, and facial volume augmentation .The pre-clinical and clinical studies with the usage of Nanofat have demonstrated the regenerative capacity of Nanofat.
The lesser the fat graft is manipulated and the sooner it is injected, the higher the chances of its survival in the target site. Minor complications related to the harvesting are due to the liposuction technique. The possible complications range from bruising, hematoma formation, donor-site pain, infection, contour irregularities, and damage to the underlying structures when the aspiration cannula enters peritoneal or muscular territories.
The aim of this study was clinical assessment of injecting Nano fat in chronic ulcers and evaluating its healing process.
This was a Prospective study that was conducted on 20 patients with chronic ulcers “more than 3 months “of any etiology from all age groups. Patients were divided into group A (Study group): 10 patients meeting inclusion criteria scheduled for surgical intervention for Nano fat injection. group B (Control group): 10 patients meeting inclusion criteria with no plan for surgical intervention.
The results of our present study can be summarized as follows:
● The mean age for group A was 37.8 years, while the mean age for group B was 36.4 years. The range of ages for group A was 24 to 58 years, while the range for group B was 23 to 56 years. Age, gender, and BMI were insignificantly different between the studied groups.
● All patients had traumatic ulcers. Site, size, and duration of ulcer were insignificantly different between the studied groups.
● Collagen formation, re-epithelization, and neovascularization were significantly improved in group A than group B (P value 0.020, 0.006, and 0.023 respectively).
● Vascularity, pigmentation, and height were significantly improved in group A than group B (P value 0.030, 0.004, and 0.035 respectively). Pliability was insignificantly different between the studied groups.
● Time frame for complete healing was significantly delayed in group B than group A (P value < 0.001). The median time for complete healing in group A was 3 weeks, while the median time for group B was 16.5 weeks.
● Complications were insignificantly different between the studied groups.
● Satisfaction was significantly increased in group A than group B (P value 0.023).
● Epidermal thickness of skin biopsies of the study group appeared of various thicknesses in different areas, but were overall significantly increased when compared to the epidermal thickness of untreated chronic skin ulcers (p<0.05) and to the epidermal thickness of control group biopsies (p<0.01).
● Skin biopsies of both the control group and the study group showed a significant decrease in inflammatory cell count (p<0.01 and p<0.001 respectively) as compared to the untreated biopsies of chronic skin ulcers. The study group exhibited a marked decrease in inflammatory cell count (p<0.01) as compared to the control group.
● Skin biopsies of both the control group and the study group revealed a significant increase in the area % of collagen bundles deposition (p<0.001) when compared to the untreated biopsies of chronic skin ulcers. Area % of collagen bundles was found to be more significant in the study group (p<0.05) as compared to the control group.
● Skin biopsies of the study group showed a significant increase in the area % of elastic fibers (p<0.05) when compared to the control group. No significant difference was detected in the area % of elastic fibers between the control group and the untreated skin biopsies.
● Quantification of PCNA immunostaining in both epidermis and dermis revealed that the number of proliferating cell nuclei was significantly higher in the study group as compared to that of the control group and to the untreated skin biopsies (p<0.01 and p<0.05 respectively).