Fat Graft Enrichment Strategies: A Systematic Review

Abstract

Background: Autologous fat grafting is a dynamic modality used in plastic surgery as an adjunct to improve functional and aesthetic form. However, current practices in fat grafting for soft-tissue augmentation are plagued by tremendous variability in long-term graft retention, resulting in suboptimal outcomes and repetitive procedures. This systematic review identifies and critically appraises the evidence for various enrichment strategies that can be used to augment and improve the viability of fat grafts. Methods: A comprehensive literature search of the Medline and PubMed databases was conducted for animal and human studies published through October of 2017 with multiple search terms related to adipose graft enrichment agents encompassing growth factors, platelet-rich plasma, adipose-derived and bone marrow stem cells, gene therapy, tissue engineering, and other strategies. Data on level of evidence, techniques, complications, and outcomes were collected. Results: A total of 1382 articles were identified, of which 147 met inclusion criteria. The majority of enrichment strategies demonstrated positive benefit for fat graft survival, particularly with growth factors and adipose-derived stem cell enrichment. Platelet-rich plasma and adipose-derived stem cells had the strongest evidence to support efficacy in human studies and may demonstrate a dose-dependent effect. Conclusions: Improved understanding of enrichment strategies contributing to fat graft survival can help to optimize safety and outcomes. Controlled clinical studies are lacking, and future studies should examine factors influencing graft survival through controlled clinical trials in order to establish safety and to obtain consistent outcomes.

The application of platelet‐rich plasma for skin graft enrichment: A meta‐analysis

“…8 FGF is another mitogenic and F I G U R E 4 Forest plot: number of skin graft loss F I G U R E 5 Forest plot: cases of haematoma formation, skin graft oedema and weeping occurrence on recipient sites angiogenetic factor for a broad range of cells, and can promote angiogenesis and wound healing. 10 Leucocytes in PRP may interact with platelets, which will increase release of anti-inflammatory factors and further switch inflammatory process towards a regenerative phase. 33,34 To sum up, it is possible that PRP improves local microenvironment of recipient sites by regulating inflammatory reactions and promoting neovascularisation.…”

“…8 These growth factors can promote proliferation of endothelial cells, epithelial cells as well as fibroblasts, and increase angiogenesis. [8][9][10] The potential clinical application of PRP in skin graft might rely on its haemostasis, adhesive, antibacterial and healing properties.…”

Lipotransfer provides effective soft tissue replacement for acquired partial lipodystrophy

“…[32] Overcorrection with larger grafts is discouraged due to increased risk of fat necrosis and cyst formation. [29] Supplementation of fat grafts with adipose derived stem cells (ADSCs) and plateletrich plasma (PRP) has considered to improve angiogenesis and increase fat survival however some studies report equivocal results and further work is required to establish this further [33].…”

Regenerative medicine approaches for the management of respiratory tract fistulas

“…Several parameters such as fat preparation, implantation techniques, and recipient site may affect graft retention [8]. As a result, in the absence of a general consensus on a standardized procedure, the clinical outcome of lipotransfer is not always predictable [9,10].…”