Department of Plastic, Reconstructive and Aesthetic Surgery, Department of Plastic and Reconstructive Surgery, Rangueil Hospital, Toulouse, France.
STROMALab, Université de Toulouse, EFS, ENVT, INSERM U1031, Toulouse, France.
J Tissue Eng Regen Med. 2018 Feb;12(2):e1237-e1250. doi: 10.1002/term.2524. Epub 2017 Dec 7.
Autologous fat grafting is a common procedure for soft-tissue reconstruction but is associated with a graft resorption rate ranging from 20% to 80%. To improve the fat graft survival rate, a new technique, called cell-assisted lipotransfer (CAL), was developed. With CAL, fat is injected along with adipose-derived stromal cells that are assumed to improve fat survival rate. We conducted an evidence-based meta-analysis to evaluate the efficacy and safety of CAL as compared with conventional autologous fat grafting (non-CAL). The databases MEDLINE (via PubMed), Cochrane Library, EBSCO, Web of Science, and EMBASE were searched for reports of clinical trials, case series, and cohorts available from 2008 to 2016. We conducted a meta-analysis of the efficacy of CAL with data analysis concerning fat survival rate. The incidence of complications and the need for multiple procedures were evaluated to determine the safety of CAL. We identified 25 studies (696 patients) that were included in the systematic review; 16 studies were included in the meta-analysis to evaluate the efficacy of CAL. The fat survival rate was significantly higher with CAL than non-CAL (64% vs. 44%, p < .0001) independent of injection site (breast and face). This benefit of CAL was significant for only injection volumes <100 ml (p = .03). The two groups did not differ in frequency of multiple procedures after fat grafting, but the incidence of complications was greater with CAL than non-CAL (8.4% vs. 1.5%, p = .0019). The CAL method is associated with better fat survival rate than with conventional fat grafting but only for small volumes of fat grafting (<100 ml). Nonetheless, the new technique is associated with more complications and did not reduce the number of surgical procedures needed after the first fat grafting. More prospective studies are required to draw clinical conclusions and to demonstrate the real benefit of CAL as compared with common autologous fat grafting.
自体脂肪移植是一种常见的软组织重建方法，但吸收率为 20%至 80%。为了提高脂肪移植的成活率，开发了一种新的技术，称为细胞辅助脂肪转移（CAL）。使用 CAL 时，脂肪与脂肪来源的基质细胞一起注射，这些细胞被认为可以提高脂肪成活率。我们进行了一项基于证据的荟萃分析，以评估 CAL 与常规自体脂肪移植（非 CAL）相比的疗效和安全性。从 2008 年到 2016 年，我们在 MEDLINE（通过 PubMed）、Cochrane 图书馆、EBSCO、Web of Science 和 EMBASE 数据库中搜索了临床试验、病例系列和队列的报告。我们对 CAL 的疗效进行了荟萃分析，并对脂肪成活率进行了数据分析。评估并发症的发生率和多次手术的需求，以确定 CAL 的安全性。我们确定了 25 项研究（696 名患者），这些研究被纳入系统评价；有 16 项研究被纳入荟萃分析以评估 CAL 的疗效。CAL 的脂肪成活率明显高于非 CAL（64%比 44%，p<.0001），与注射部位（乳房和面部）无关。CAL 的这一益处仅在注射体积<100ml 时才具有统计学意义（p=0.03）。两组在脂肪移植后多次手术的频率上没有差异，但 CAL 的并发症发生率高于非 CAL（8.4%比 1.5%，p=0.0019）。CAL 方法比常规脂肪移植具有更高的脂肪成活率，但仅适用于小体积的脂肪移植（<100ml）。尽管如此，新技术与更多的并发症相关，并且不能减少第一次脂肪移植后所需的手术次数。需要更多的前瞻性研究来得出临床结论，并证明与常规自体脂肪移植相比，CAL 的真正益处。
