Joris van Dongen

195 tSVF as a treatment for scar remodeling Moreover, the extracellular matrix is able to bind and release growth factors and cytokines as well as to bind and initiate proliferation or differentiation of cells. Hence, the extracellular matrix is able to control and guide the regenerative potential of SVF cells for a longer period of time. The regenerative effect i.e. increased wound closure time might last longer after application of tSVF instead of cSVF due to the presence of the extracellular matrix components. No conclusions regarding the effect of tSVF on the first weeks of wound healing can be drawn from this study due to the intended study design. Yet, this was also not the goal of this clinical study; the goal of this study was scar prevention by simulating the early phase of wound healing. Hence, data of early wound healing is missing: for that aspect, another new designed prospective randomized controlled trial will be initiated. Another limitation of this study is the relatively high loss to follow-up rate, although loss of subjects was compensated. The high loss might be caused by the study design in which healthy subjects had to undergo a punch biopsy of the reduction mammoplasty scar. Although unknown, one might speculate that especially those subjects that could not detect any difference in scar appearance between both scars could have more easily left during follow-up. These subjects might be replaced by subjects with a more visible effect of tSVF on scar appearance which positively interferes with the results. In conclusion, an immediate injection of tSVF significantly improves scar appearance after six months, an effect that is no longer apparent after 1-year follow-up. These results indicate that tSVF definitely accelerates the early phase of wound healing. Future new designed prospective studies are needed to study the exact effect of tSVF on earlier stages of wound healing.