Malik Dean, Luck Joshua, Smith Oliver J, Mosahebi Afshin
Division of Surgery and Interventional Science, Royal Free Hospital, University College London, London, United Kingdom.
Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.
Plast Reconstr Surg Glob Open. 2020 May 18;8(5):e2835. doi: 10.1097/GOX.0000000000002835. eCollection 2020 May.
There is a growing interest in the regenerative potential of autologous fat. Adipose-derived stem cells, within the stromal vascular fraction of lipoaspirate samples, demonstrate anti-inflammatory, immunomodulatory, and angiogenic properties. This systematic review aimed to determine the efficacy and safety of autologous fat therapies for wound healing, with an evaluation of the quality of evidence provided by the literature.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched Ovid Medline, Embase, and Cochrane Library databases from inception to November 2018. We included all human studies where wounds were treated with lipotransfer, cell-assisted lipotransfer, stromal vascular fraction products, or isolated adipose-derived stem cells. Study screening and data extraction were performed by 2 authors. The quality of evidence was evaluated using the GRADE approach.
The search strategy returned 5027 citations. From these, 10 observational case series were included in the qualitative synthesis; there were no randomized controlled trials. Patient characteristics, wound etiology, and intervention type differed markedly between studies, precluding formal meta-analysis. Autologous fat grafting was associated with satisfactory wound healing in all studies with low complication rates. However, the quality of evidence was consistently very low.
Autologous fat grafting is an emerging therapeutic option for challenging wounds, although there is insufficient evidence to conclusively demonstrate its effectiveness and adverse event profile. Based on the literature to date, it is unclear whether one type of autologous fat therapy is superior. Well-designed, blinded, prospective randomized controlled trials with adequate methodologic details and objective outcome measure reporting are essential.
CRD42017081499.
人们对自体脂肪的再生潜力越来越感兴趣。抽脂样本的基质血管成分中的脂肪来源干细胞具有抗炎、免疫调节和血管生成特性。本系统评价旨在确定自体脂肪疗法对伤口愈合的疗效和安全性，并评估文献提供的证据质量。
按照系统评价和Meta分析的首选报告项目指南，我们检索了从数据库建立至2018年11月的Ovid Medline、Embase和Cochrane图书馆数据库。我们纳入了所有使用脂肪移植、细胞辅助脂肪移植、基质血管成分产品或分离的脂肪来源干细胞治疗伤口的人体研究。研究筛选和数据提取由两名作者进行。使用GRADE方法评估证据质量。
检索策略返回5027条引文。其中，10个观察性病例系列纳入了定性综合分析；没有随机对照试验。各研究之间的患者特征、伤口病因和干预类型差异显著，无法进行正式的Meta分析。在所有研究中，自体脂肪移植与令人满意的伤口愈合相关，并发症发生率低。然而，证据质量一直很低。
自体脂肪移植是治疗具有挑战性伤口的一种新兴治疗选择，尽管没有足够的证据确凿地证明其有效性和不良事件情况。根据迄今为止的文献，尚不清楚一种自体脂肪疗法是否更具优势。精心设计、设盲、前瞻性随机对照试验，并提供充分的方法学细节和客观的结果测量报告至关重要。
PROSPERO注册号：CRD42017081499。
