From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic; University of Kentucky College of Medicine; Division of Plastic Surgery, Department of Surgery, University of Washington; Division of Plastic Surgery, University of Wisconsin; and Mayo Medical School, Mayo Clinic.
Plast Reconstr Surg. 2020 Mar;145(3):827-841. doi: 10.1097/PRS.0000000000006557.
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.
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.
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.
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.
自体脂肪移植是一种在整形外科学中使用的动态方法，作为一种辅助手段来改善功能和美学形态。然而，目前用于软组织填充的脂肪移植技术存在长期移植物保留率差异巨大的问题，导致效果不理想和需要重复手术。本系统评价确定并批判性评估了各种可用于增强和提高脂肪移植物活力的富集策略的证据。
对 Medline 和 PubMed 数据库进行了全面的文献检索，检索了截至 2017 年 10 月发表的动物和人类研究，使用了与脂肪移植富集剂相关的多个搜索词，包括生长因子、富血小板血浆、脂肪源性和骨髓干细胞、基因治疗、组织工程和其他策略。收集了有关证据水平、技术、并发症和结果的数据。
共确定了 1382 篇文章，其中 147 篇符合纳入标准。大多数富集策略都显示出对脂肪移植物存活的积极益处，特别是生长因子和脂肪源性干细胞的富集。富血小板血浆和脂肪源性干细胞在人类研究中具有最强的证据支持其疗效，并且可能表现出剂量依赖性效应。
更好地了解有助于脂肪移植物存活的富集策略可以帮助优化安全性和效果。目前缺乏对照临床试验，未来的研究应通过对照临床试验来研究影响移植物存活的因素，以确定安全性并获得一致的结果。
