Autologous Fat Grafting for Third-Degree Hand Burns: A Case Report With Patient and Observer Scar Assessment (POSAS)-Based Evaluation

Wound management remains a fundamental component of plastic and reconstructive surgery [1]. Among the available treatment options, autologous fat grafting has gained attention due to its ability to support soft-tissue regeneration, enhance revascularization, and modulate immune responses through the secretion of bioactive molecules, cytokines, and growth factors [2]. It also provides anti-inflammatory, proangiogenic, and regenerative effects, which are particularly valuable in treating conditions affecting the hand and upper extremity [1,3]. Human adipose tissue represents a highly suitable implantable biomaterial owing to its rich reservoir of bioactive substances, such as extracellular matrix constituents, diverse growth factors, and stem or progenitor cell populations [2]. The present case illustrates how the use of autologous fat grafts as a biological dressing in a patient with a third-degree thermal burn and extensor tendon exposure in the hand resulted in favorable wound bed evolution and effective preparation for subsequent skin grafting. We present the case of a 47-year-old female patient with a 25 cm² soft-tissue defect on the dorsum of the left hand secondary to a third-degree thermal burn caused by contact with a metal sheet, with tendon exposure of the extensor mechanism of two fingers. The defect was managed using decanted autologous fat grafts, without centrifugation, serving as a "bioactive scaffold." Tissue quality was evaluated pre- and postoperatively using the POSAS (Patient and Observer Scar Assessment) scale and photographic comparison. The treatment resulted in defect contraction and healthy granulation tissue formation, with satisfactory clinical progression documented through images and scar assessment scores. Positive changes were observed in the POSAS scale, with improvements in vascularity, pigmentation, elevation, surface roughness, tissue flexibility, and wound surface area, including significant contraction of the wound and reductions in pain and pruritus. No complications were reported. Vascularity improved by 70% compared to the initial assessment, while pigmentation, volume, and roughness each improved by 50%. Flexibility showed a 60% improvement. The functional capacity of the hand was evaluated at the fourth postoperative month, showing a QuickDASH score of 2.3/100, indicating adequate hand rehabilitation [4]. Autologous fat grafting represents a safe, accessible, abundantly sourced, low-morbidity, simple technique to obtain, and a cost-effective surgical option for the treatment of complex wounds, particularly in the hand [5]. Its regenerative, angiogenic, and anti-inflammatory properties promote high-quality tissue formation, enhanced granulation, and wound contraction, ultimately improving both functional and aesthetic outcomes. In the clinical case presented, fat grafting enabled effective tendon coverage and preparation of the wound bed for skin grafting, as confirmed by objective improvements in POSAS scores. These findings highlight its potential for broader clinical application and integration into wound care protocols.