Systematic review of the therapeutic roles of adipose tissue in dermatology.
Walocko Frances M,Eber Ariel E,Kirsner Robert S,Badiavas Evangelos,Nouri Keyvan
Journal of the American Academy of Dermatology
BACKGROUND:Adipose tissue has classically functioned as a filler in restoring facial volume. Adipose tissue is also rich in stem cells, which may have a role in regenerative medicine. OBJECTIVE:To summarize the literature on the clinical uses of adipose tissue in scarring, wound healing, and hair growth and determine whether evidence exists for changes in clinical practice in dermatology. METHODS:We utilized the Preferred Reporting Items for Systemic Reviews and Meta-Analyses to conduct the review. The PubMed search engine was used to assess the available literature on adipose tissue in scarring, wound healing, and hair growth. RESULTS:A total of 13 studies matched our inclusion criteria; 6 of the 7 studies on scar treatment, all 3 studies on wound healing, and all 3 studies on hair growth demonstrated improved outcomes with adipose tissue treatments. LIMITATIONS:The literature supporting the use of adipose tissue is limited to case series, cohort studies, and small randomized controlled trials, which have an overall low level of evidence. CONCLUSION:The existing evidence for adipose tissue as a treatment option in scarring, wound healing, and hair growth is not strong enough to justify changes to current clinical practice. The literature does provide evidence for future large randomized clinical trials.
Fat Grafting for Gluteal Augmentation: A Systematic Review of the Literature and Meta-Analysis.
Condé-Green Alexandra,Kotamarti Vasanth,Nini Kevin T,Wey Philip D,Ahuja Naveen K,Granick Mark S,Lee Edward S
Plastic and reconstructive surgery
BACKGROUND:With the increasing demand for gluteal fat augmentation, reports of fatal complications have surfaced. Therefore, the authors proposed to analyze the published techniques and compare different protocols, to identify those of potential concern. METHODS:A systematic review of the literature was performed with a search of 21 terms on the PubMed, MEDLINE, Cochrane, and Scientific Electronic Library Online databases. Nineteen articles meeting our predetermined criteria were analyzed, and data from the different steps of the procedure were classified, allowing evaluation and comparison of techniques. Independent-samples t test and one-way analysis of variance were used for statistical analysis. RESULTS:Seventeen case series and two retrospective studies including 4105 patients were reviewed. Most articles were authored in Colombia, Mexico, and Brazil. Most procedures were performed on adult female patients under general anesthesia. Fat was harvested using a tumescent technique from the lower extremities and the back, with machine-vacuum suction. A mean of 400 ml of decanted lipoaspirate was injected into each gluteal region, mostly subcutaneously and intramuscularly with 60-ml syringes. Most patients rated their results as "excellent." The mean complication rate was 7 percent (6.7 percent minor, 0.32 percent major), with no significant relation to the planes of injection. CONCLUSIONS:Fat grafting is an effective and predictable way to remodel the gluteal region; however, the procedure is not without risks. Avoiding gluteal vessel damage may prevent most feared complications, such as fat embolism. Accurate analysis, systematization of the procedure, and reporting cases in the fat grafting registry may provide the foundation for optimization of outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.
Efficacy and Safety of Autologous Fat Transfer in Facial Reconstructive Surgery: A Systematic Review and Meta-analysis.
Krastev Todor K,Beugels Jip,Hommes Juliette,Piatkowski Andrzej,Mathijssen Irene,van der Hulst Rene
JAMA facial plastic surgery
Importance:The use of autologous fat transfer (AFT) or lipofilling for correcting contour deformities is seen as one of the major breakthroughs in reconstructive plastic surgery. Its applications in facial reconstructive surgery have been of particular interest owing to the prospect of achieving autologous reconstruction by a minimally invasive approach. However, its unpredictability and variable degree of resorption have limited its utility and much skepticism still exists regarding its efficacy. Furthermore, more than 2 decades of clinical research have produced a highly fragmented body of evidence that has not been able to provide definite answers. Objective:To investigate the safety and efficacy of AFT in facial reconstruction through a systematic review and meta-analysis. Data Sources:A literature search was performed in PubMed, Embase, and the Cochrane Library from inception to October 11, 2017. Study Selection:All published studies investigating the efficacy and safety of AFT in facial reconstructive surgery. Data Extraction and Synthesis:Two independent reviewers performed data extraction systematically, adhering to the PRISMA guidelines. Summary measures were pooled in a random-effects model meta-analysis. Main Outcomes and Measures:The patient and surgeon satisfaction, graft survival, number of AFT sessions, and the incidence of AFT-related complications were the main outcomes of interest in this meta-analysis. Results:This systematic review resulted in the inclusion 52 relevant studies consisting of 1568 unique patients. These included 4 randomized clinical trials, 11 cohort studies, and 37 case series. The overall follow-up averaged 1.3 years after AFT. Meta-analysis revealed a very high overall patient satisfaction rate of 91.1% (95% CI, 85.1%-94.8%) and overall surgeon satisfaction rate of 88.6% (95% CI, 83.4%-92.4%). The number of AFT sessions required to achieve the desired result was 1.5 (95% CI, 1.3-1.7) and 50% to 60% of the injected volume was retained at 1 year. Only 4.8% (95% CI, 3.3%-6.9%) of procedures resulted in clinical complications. Conclusions and Relevance:To our knowledge, this study provides the first overview of the current knowledge about AFT in facial reconstructive surgery. Our results confirm that AFT is an effective technique for treating soft-tissue deformities in the head and neck, with low rate of minor complications. Level of Evidence:NA.
Efficacy of autologous fat transfer for the correction of contour deformities in the breast: A systematic review and meta-analysis.
Krastev Todor K,Alshaikh Ghufran A H,Hommes Juliette,Piatkowski Andrzej,van der Hulst Rene R W J
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
BACKGROUND:Autologous fat transfer (AFT), also known as fat grafting or lipofilling, has already become a part of clinical practice for treating contour deformities of the breast, even though evidence regarding its efficacy is still lacking. This is the first meta-analysis on this subject, aimed to facilitate intuitive interpretation of the available data by clinicians, guideline committees and policy makers. METHODS:A literature search was performed on 1 September 2017 in PubMed, EMBASE and the Cochrane Library to identify all relevant studies. A rigorous data extraction and standardisation process allowed pooling of clinical outcome data into a meta-analysis. RESULTS:Eighty-nine studies consisting of 5350 unique patients were included. The mean follow-up was 1.9 years. Meta-analysis revealed a very high overall patient and surgeon satisfaction rate of 94.3% and 95.7%, respectively, which was also confirmed by high satisfaction scores and Breast-Q scores. Overall, only 1.5 sessions were needed to achieve the desired result. Though evidence on the long-term volume retention is lacking, based on the current data it was calculated to be 52.4% at one year. Only 5.0% of procedures resulted in clinical complications and 8.6% of breasts required biopsy due to abnormal clinical or radiological findings. CONCLUSIONS:AFT seems to be an effective procedure in breast reconstruction, reflected by the high patient and surgeon satisfaction and low incidence of clinical and radiological complications. Future research should focus on evaluating the technical and patient factors influencing the rate of fat resorption as well as its oncological safety.
Efficacy of breast reconstruction with fat grafting: A systematic review and meta-analysis.
Herly Mikkel,Ørholt Mathias,Larsen Andreas,Pipper Christian B,Bredgaard Rikke,Gramkow Christina S,Katz Adam J,Drzewiecki Krzysztof T,Vester-Glowinski Peter V
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
BACKGROUND:Breast reconstruction with fat grafting is a new alternative to prosthetic implants and flaps for women with breast cancer. In this study, we investigate the efficacy of fat grafting for breast reconstruction in a meta-analysis. METHODS:The study followed the PRISMA and MOOSE guidelines for systematic reviews and meta-analyses. Studies were included if the patients underwent complete breast reconstruction with fat grafting as the only treatment modality. The number of fat grafting treatments needed to complete a breast reconstruction was modeled in a meta-analysis for five treatment categories: modified radical mastectomy, skin-sparing mastectomy, and breast-conserving surgery; the two mastectomy groups were subdivided into nonirradiated and irradiated. RESULTS:Twenty-one studies were included in the meta-analysis. The studies comprised 1011 breast reconstructions in 834 patients. The estimated numbers of treatments to complete a reconstruction were 2.84-4.66 in the mastectomy groups and 1.72 in the breast-conserving surgery group. The number of fat grafting sessions needed to complete a breast reconstruction was significantly higher for the irradiated patients than for the nonirradiated patients (p < 0.05). There was no significant difference in the number of fat grafting sessions needed to complete a breast reconstruction after a modified radical mastectomy versus a skin-sparing mastectomy. CONCLUSIONS:This study provides an evidence-based foundation for several practical issues related to breast reconstruction with fat grafting. The analysis showed that radiotherapy is the most important factor associated with the number of treatment sessions needed to complete a breast reconstruction and with the rate of complications.
Assessment of the clinical efficacy of cell-assisted lipotransfer and conventional fat graft: a meta-analysis based on case-control studies.
Wang Yu,Wu Yanfei
Journal of orthopaedic surgery and research
BACKGROUND:Cell-assisted lipotransfer is a novel technique for fat grafting. This study aimed to investigate the clinical efficacy of cell-assisted lipotransfer technology compared with conventional fat grafting. METHODS:According to PRISMA guidelines, related articles in PubMed, Embase and Cochrane library were systematically searched. Studies focusing on fat survival rate and/or patient satisfaction rate for fat grafting alone versus cell-assisted lipotransfer were retrieved. Estimated fat survival and patient satisfaction rates were pooled. Subgroup analysis was stratified by the transplant site. Publication bias was conducted. Furthermore, the stability of results was assessed by sensitivity analysis. RESULTS:Nine articles were included in the meta-analysis. Significant heterogeneity was observed among individual studies for fat survival rate assessment (I = 98.3%, P < 0.001). The fat survival rate was significantly higher in the cell-assisted lipotransfer group than in the control group [weighted mean difference = 25.85, 95% confidence interval 5.39-46.31; P = 0.013]. Notably, results remained unchanged in the sensitivity analyses. No significant difference was found in the patient satisfaction rate between the cell-assisted lipotransfer and control groups [odds ratio = 3.69, 95% confidence interval 0.73-18.53; P = 0.113]. In subgroup analysis, a significantly higher patient satisfaction rate was found in cell-assisted lipotransfer fat graft group in the face (odds ratio = 18.85, 95% confidence interval 9.03, 28.68; P < 0.001) and arm (odds ratio = 64.60, 95% confidence interval 58.79, 70.41; P < 0.001) than in the controls. Finally, no significant publication bias was found (P = 0.371). CONCLUSION:This study suggests that cell-assisted lipotransfer is superior to conventional lipoinjection with improved fat survival rate. However, the long-term efficacy should be evaluated in further studies.
Cell-assisted lipotransfer: Friend or foe in fat grafting? Systematic review and meta-analysis.
Laloze J,Varin A,Gilhodes J,Bertheuil N,Grolleau J L,Brie J,Usseglio J,Sensebe L,Filleron T,Chaput B
Journal of tissue engineering and regenerative medicine
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.
Better clinical outcome for autologous fat transplant combined with silicone gel prosthesis for breast augmentation: Evidence from meta-analysis.
Hoon Shim Yoong,Cui Chun Xiao,Cao De Jun,Hong Zhang Ru
Asian journal of surgery
OBJECTIVE:To evaluate the combination of autologous fat transplantation and silicone gel prosthesis implantation for breast augmentation surgery. METHODS:With "autologous fat", "silicone prosthesis", "combined with", "combination", "breast augmentation" and "clinical effect" as search keywords, a thorough literature search was performed throughout the Chinese databases (CBMdisc, Wanfang, CNKI and Chongqing VIP) and English databases (PUBMED and EMBASE) and after cross-referencing and reading, literature conforming with the inclusion and exclusion criteria were analyzed and significant data related to autologous fat transplantation combined with silicone prosthesis in breast augmentation surgery was collected and meta-analyzed. RESULTS:21 full-text articles were included into the meta-analysis study: Autologous fat transplantation combined with silicone gel prosthesis implantation not only enhancedthe long-term postoperative breast shape recovery, but also fundamentally managed the underlying drawbacks of using autologous fat graft transplantation or prosthesis alone, decreasing the rate of procedure related morbidity and complications. CONCLUSION:The application of the combination of autologous fat transplantation with silicone gel prosthesis implantation in breast augmentation surgery has shown good and stable clinical outcome while simultaneously reducing the rate of complication related to the application of either method alone. Hence, this combination is worth exploration and promotion since it offers better manageable clinical outcome at low risk of complication.