Smith Oliver J, Kanapathy Muholan, Khajuria Ankur, Prokopenko Max, Hachach-Haram Nadine, Mann Haroon, Mosahebi Ash
Royal Free Hospital Wound Healing Group, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK.
Division of Surgery and Interventional Science, University College London, London, UK.
Syst Rev. 2017 Jun 6;6(1):111. doi: 10.1186/s13643-017-0505-8.
The use of fat grafting as a reconstructive surgical option is becoming much more common. Adipose-derived stem cells found in fat grafts are believed to facilitate wound healing via differentiation into fibroblasts and keratinocytes and the release of pro-healing growth factors. Several small studies have shown a positive effect of fat grafting in healing of wounds of a variety of aetiologies. When fat is combined with autologous platelet-rich plasma (PRP), there may be enhanced healing effects. This may be due to the pro-angiogenic and anti-inflammatory effects of PRP. We aim to synthesise the current evidence on combination fat grafting and PRP for wound healing to establish the efficacy of this technique.
METHODS/DESIGN: We will conduct a comprehensive literature search in the MEDLINE, EMBASE, CENTRAL, Science Citation Index, and Google Scholar databases (up to July 2017) to identify studies on fat grafting and PRP for wound healing. All primary studies and systematic reviews of these studies will be included, except case reports and case series with fewer than three patients, to evaluate the outcome of fat grafting and PRP on wound healing either on its own or when compared to other studies. Primary outcome measures are expected to be the proportion of total wounds healed at 12 weeks and the average wound healing time (time for 100% re-epithelialisation). Expected secondary outcome measures are the proportion of wounds achieving 50% wound healing, the type of wound benefitting most from fat grafting, economic evaluation, health-related quality of life, and adverse events. Subgroup analysis will be performed for the proportions of wounds healed based on wound aetiology.
This review will provide robust evidence of the efficacy of fat grafting and PRP for wound healing. This is an emerging technique, and this review is expected to guide clinical practice and ongoing research aimed at improving wound care.
PROSPERO CRD42016049881.
脂肪移植作为一种重建手术选择的应用正变得越来越普遍。脂肪移植中发现的脂肪来源干细胞被认为可通过分化为成纤维细胞和角质形成细胞以及释放促进愈合的生长因子来促进伤口愈合。几项小型研究表明脂肪移植对多种病因的伤口愈合有积极作用。当脂肪与自体富血小板血浆（PRP）联合使用时，可能会增强愈合效果。这可能归因于PRP的促血管生成和抗炎作用。我们旨在综合目前关于脂肪移植与PRP联合用于伤口愈合的证据，以确定该技术的疗效。
方法/设计：我们将在MEDLINE、EMBASE、CENTRAL、科学引文索引和谷歌学术数据库（截至2017年7月）中进行全面的文献检索，以识别关于脂肪移植和PRP用于伤口愈合的研究。将纳入所有这些研究的原始研究和系统评价，但不包括病例报告和患者少于3例的病例系列，以评估脂肪移植和PRP单独或与其他研究相比对伤口愈合的结果。主要结局指标预计为12周时愈合的总伤口比例和平均伤口愈合时间（100%重新上皮化的时间）。预期的次要结局指标为伤口达到50%愈合的比例、从脂肪移植中获益最大的伤口类型、经济评估、健康相关生活质量和不良事件。将根据伤口病因对愈合伤口的比例进行亚组分析。
本综述将为脂肪移植和PRP用于伤口愈合的疗效提供有力证据。这是一项新兴技术，预计本综述将指导临床实践和旨在改善伤口护理的正在进行的研究。
PROSPERO CRD42016049881。
