The use of fat grafting and platelet‐rich plasma for wound healing: A review of the current evidence

Abstract

Fat grafting is becoming a common procedure in regenerative medicine because of its high content of growth factors and adipose derived stem cells (ADSCs) and the ease of harvest, safety, and low cost. The high concentration of ADSCs found in fat has the potential to differentiate into a wide range of wound‐healing cells including fibroblasts and keratinocytes as well as demonstrating proangiogenic qualities. This suggests that fat could play an important role in wound healing. However retention rates of fat grafts are highly variable due in part to inconsistent vascularisation of the transplanted fat. Furthermore, conditions such as diabetes, which have a high prevalence of chronic wounds, reduce the potency and regenerative potential of ADSCs. Platelet‐rich plasma (PRP) is an autologous blood product rich in growth factors, cell adhesion molecules, and cytokines. It has been hypothesised that PRP may have a positive effect on the survival and retention of fat grafts because of improved proliferation and differentiations of ADSCs, reduced inflammation, and improved vascularisation. There is also increasing interest in a possible synergistic effect that PRP may have on the healing potential of fat, although the evidence for this is very limited. In this review, we evaluate the evidence in both in vitro and animal studies on the mechanistic relationship between fat and PRP and how this translates to a benefit in wound healing. We also discuss future directions for both research and clinical practice on how to enhance the regenerative potential of the combination of PRP and fat.

Multipotent adult progenitor cells grown under xenobiotic-free conditions support vascularization during wound healing

“…Importantly, the above-mentioned biomaterials have been shown to also improve the performance of multiple stem cell types in skin repair, including bone marrow-derived MSCs and epidermal stem cells [41,42]. Perhaps the combination currently most widely explored in clinical practice is the use of adipose tissue-derived stem cells with PRP [43][44][45][46][47][48]. As the nature (e.g., acute or chronic), severity (e.g., due to the presence of underlying disease), and location of wounds (e.g., in a region that requires hair regrowth) can be very diverse, the development of a broad variety of specialized tissue-engineering enhanced cell-based treatments (e.g., the use of adipose tissue-derived follicle stem cells for hair regrowth [49]) is a promising step in wound management and skin regeneration.…”

A Systematic Review of Autologous Fat Grafting in the Treatment of Acute and Chronic Cutaneous Wounds

“…Animal studies were excluded, as were those combining AFG with platelet-rich plasma, as this topic has already been reviewed by our research group. 15 Articles focusing on non-wound etiologies, including esthetic surgery, breast reconstruction, or scar revision, were excluded. The primary search was undertaken in English, and non-English articles not available for translation were excluded.…”

A New Therapeutic Application of Platelet-Rich Plasma to Chronic Breast Wounds: A Prospective Observational Study

“…Several studies [ 8 , 9 , 18 , 19 ] demonstrate the usefulness of PRP application to CWs. The combination of fat grafting and PRP also has significant potential to improve wound healing [ 20 ]. It has likewise been proposed that allogeneic PRP is an effective and safe adjuvant treatment for chronic wounds [ 21 ].…”