Comparison of Pain Reduction in Chronic Wounds Treated With and Without Autologous Fat Grafting: A Randomized Controlled Trial

Chronic wounds are a common problem, particularly in patients with diabetes, vascular diseases, or post-traumatic injuries, and are associated with significant pain, delayed healing, and increased healthcare costs. Pain in chronic wounds can be both background and procedural, affecting quality of life and sometimes leading to psychosocial complications. Current treatments include surgical and non-surgical interventions, such as tulle dressings, interactive dressings, skin substitutes, and negative pressure wound therapy. However, these approaches may be costly, require frequent dressing changes, or have limited availability, particularly in lower-middle-income countries.

Autologous fat grafting has emerged as a promising technique to promote wound healing due to the high content of stem cells and growth factors in adipose tissue. Recent studies suggest that fat grafting not only accelerates tissue regeneration but may also reduce pain associated with chronic wounds. Limited data exist regarding its efficacy specifically for pain reduction in chronic wounds.

This randomized controlled trial will enroll 62 adult patients (ages 20-60) with chronic wounds persisting for more than 3 months and with a baseline mean VAS pain score >3. Participants will be randomly assigned to one of two groups: Group A (fat grafting plus standard wound care) or Group B (standard wound care alone). Wound cleansing will be performed in both groups using povidone-iodine. In Group A, autologous fat will be harvested using the Coleman technique, processed into nano-fat through sequential filtering and centrifugation, and injected into the wound bed and margins. In Group B, wounds will be managed with standard tulle gauze dressings. Dressings in both groups will be changed every 48-72 hours.

Pain will be assessed using the Visual Analog Scale three times daily for 21 days, and the mean daily pain score will be calculated. Wound healing percentage, wound size, and any complications, including infection, will be documented. Rescue analgesia (IV Toradol 0.5 mg/kg) will be provided if the VAS score exceeds 3. Data will be analyzed using SPSS v26, with appropriate statistical tests applied to compare pain reduction and wound healing between groups.

The study aims to provide evidence on the effectiveness and safety of autologous fat grafting for reducing pain and improving outcomes in patients with chronic wounds, potentially informing future clinical practice and management strategies for this patient population.