Use of platelet-rich fibrin and platelet-rich plasma in combination with fat graft: which is more effective during facial lipostructure?

Autologous Platelet-rich Fibrin as a Three-dimensional Structural Scaffold in the Healing of Contracted Orbital Sockets

PURPOSE

Evaluation of platelet-rich fibrin as an adjuvant in surface healing of contracted orbital sockets.

METHODS

Prospective, interventional, and comparative study of 25 patients with moderate to severe contracted sockets conducted over 2 years (February 2020-February 2022). Group 1 underwent a dermis-fat graft with fornix forming sutures supplemented by a platelet-rich fibrin membrane, while group 2 received a dermis-fat graft with fornix forming sutures only. Patients over 18 years were evaluated as per prefixed inclusion and exclusion criteria. Assessments were conducted at 1, 3, and 12 months postsurgery, focusing on wound evaluation, socket epithelialization, postoperative pain, prosthesis rehabilitation, and complications, if any. Wound evaluation and pain intensity were assessed utilizing the wound evaluation score and visual analog scale, respectively. Socket epithelization was documented clinically at every visit.

RESULTS

The study showed a mean age of 38.8 ± 8.8 years, with a 2:1 male-to-female ratio. Group 1 consistently scored higher on wound evaluation score than group 2 at all follow-up points. In group 1, 81.8% achieved a maximum wound evaluation score at 4 weeks and 100% at 3 and 12 months, compared to group 2's 42.8%, 50%, and 57.1%, respectively (p < 0.05). Postoperative contracture occurred in 3 group 2 patients at the final follow-up, with 6 showing unsatisfactory appearance. Group 1 demonstrated significantly lower pain intensity on postoperative day 1 (p = 0.03), and greater epithelization at 4 weeks.

CONCLUSION

platelet-rich fibrin appears to be an effective solution for enhancing wound healing during socket reconstruction, attributed to its sustained release of growth factors and mesenchymal stem cells.

Effectiveness and Safety of Different Methods of Assisted Fat Grafting: A Network Meta-Analysis

OBJECTIVE

Numerous studies have proposed the utilization of stromal vascular fraction (SVF), adipose-derived stem cells (ADSCs), and platelet products as auxiliary grafting techniques to improve the survival rate of fat grafts. This study aimed to evaluate the efficacy and safety of various fat grafting methods since 2010 through a network meta-analysis, aiming to identify the most effective technique for fat grafting.

METHODS

Clinic trials on assisted fat grafting were searched from Pubmed, Embase, Web of Science, and the Cochrane Library, spanning the period from January 1, 2010 to March 2024. The risk of bias in the included trials was meticulously assessed using the Cochrane risk of bias tool. The survival rate of fat grafts served as the primary evaluation metric for effectiveness, while complications were employed as the indicator for safety.

RESULTS

The study incorporated 31 clinic trials, involving a total of 1656 patients. The findings indicated that the survival rate with assisted fat grafting significantly surpassed that of simple fat grafting (SUCRA, 10.43%). Notably, ADSC-assisted fat grafting exhibited the highest survival rate (SUCRA, 82.17%), followed by Salvia miltiorrhiza (SM)-assisted fat grafting (SUCRA, 69.76%). In terms of safety, the most prevalent complications associated with fat grafting were fat sclerosis and fat necrosis. Adc-assisted fat grafting was correlated with the lowest incidence of complications (SUCRA, 41.00%), followed by simple fat grafting (SUCRA, 40.99%). However, PRP-assisted (SUCRA, 52.86%) and SVF-assisted fat grafting (SUCRA, 65.14%) showed higher complication rates.

CONCLUSION

Various methods of assisted fat grafting can significantly enhance the survival rate, but they often fail to effectively mitigate the incidence of complications. Compared to other methods, adipose mesenchymal stem cells-assisted fat grafting consistently yielded a higher survival rate of grafts and fewer complications. Consequently, this approach represents a relatively effective method for assisting in fat grafting at present.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Improving Autologous Fat Grafting in Regenerative Surgery through Stem Cell-Assisted Lipotransfer

Autologous fat transplantation -i.e., lipofilling- has become a promising and popular technique in aesthetic and reconstructive surgery with several application such as breast reconstruction, facial and hand rejuvenation. However, the use of this technology is still limited due to an unpredictable and low graft survival rate (which ranges from 25%-80%). A systematic literature review was performed by thoroughly searching 12 terms using the PubMed database. The objective of this study is to present the current evidence for the efficacy of adjuvant regenerative strategies and cellular factors, which have been tested to improve fat graft retention. We present the main results (fat retention rate, histological analysis for pre-clinical studies and satisfaction/ complication for clinical studies) obtained from the studies of the three main fat grafting enrichment techniques: platelet-rich plasma (PRP), the stromal vascular fraction (SVF) and adipose-derived stem cells (ADSCs) and discuss the promising role of recent angiogenic cell enrichment that could induce early vascularization of fat graft. All in all, adding stem or progenitor cells to autologous fat transplantation might become a new concept in lipofilling. New preclinical models should be used to find mechanisms able to increase fat retention, assure safety and transfer these technologies to a good manufacturing practice (GMP) compliant facility, to manufacture an advanced therapy medicinal product (ATMP).

Strategies to Improve AFT Volume Retention After Fat Grafting

BACKGROUND

Autologous fat grafting has gained increasing popularity used in plastic surgery as a strategy to improve functional and aesthetic outcome. However, variable augmentation results have concerned surgeons in that volume loss of grafted fat reported fluctuates unsteadily.

AIM

An optimal technique that clinically maximizes the long-term survival rate of transplantation is in urgent need to be identified.

METHOD

The PubMed/MEDLINE database was queried to search for animal and human studies published through March of 2022 with search terms related to adipose grafting encompassing liposuction, adipose graft viability, processing technique, adipose-derived stem cell, SVF and others.

RESULTS

45 in vivo studies met inclusion criteria. The principal of ideal processing technique is effective purification of fat and protection of tissue viability, such as gauze rolling and washing-filtration devices. Cell-assisted lipotransfer including SVF, SVF-gel and ADSCs significantly promotes graft retention via differentiation potential and paracrine manner. ADSCs induce polarization of macrophages to regulate inflammatory response, mediate extracellular matrix remodeling and promote endothelial cell migration and sprouting, and differentiate into adipocytes to replace necrotic cells, providing powerful evidence for the benefits and efficacy of cell-assisted lipotransfer.

CONCLUSION

Based on the current evidence, the best strategy can not be decided. Cell-assisted lipotransfer has great potential for use in regenerative medicine. But so far mechanically prepared SVF-gel is conducive to clinical promotion. PRP as endogenous growth factor sustained-release material shows great feasibility.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Supplementation of Facial Fat Grafting to Increase Volume Retention: A Systematic Review

BACKGROUND

For decades, facial fat grafting has been used in clinical practice for volume restoration. The main challenge of this technique is variable volume retention. The addition of supplements to augment fat grafts and increase volume retention has been reported in recent years.

OBJECTIVES

The aim of this systematic review was to investigate which supplements increase volume retention in facial fat grafting as assessed by volumetric outcomes and patient satisfaction.

METHODS

Embase, Medline, Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to November 30, 2020. Only studies assessing volume after facial fat grafting with supplementation in human subjects were included. Outcomes of interest were volume or patient satisfaction. The quality of the studies was assessed with the Effective Public Health Practice Project tool.

RESULTS

After duplicates were removed 3724 studies were screened by title and abstract. After reading 95 full-text articles, 27 studies were eligible and included for comparison. Supplementation comprised of platelet-rich plasma, platelet-rich fibrin, adipose tissue-derived stromal cells or bone marrow-derived stromal cells, cellular or tissue stromal vascular fraction, or nanofat. In 13 out of 22 studies the supplemented group showed improved volumetric retention and 5 out of 16 studies showed greater satisfaction. The scientific quality of the studies was rated as weak for 20 of 27 studies, moderate for 6 of 27 studies, and strong for 1 study.

CONCLUSIONS

It remains unclear if additives contribute to facial fat graft retention and there is a need to standardize methodology.

LEVEL OF EVIDENCE: 4

Use of platelet-rich fibrin in fat grafts during facial lipostructure

BACKGROUND

This review was designed to discuss the safety and efficacy of using platelet-rich fibrin (PRF) in fat grafts during facial lipostructure.

METHODS

From January 2018 to December 2021, 650 fat grafts for facial lipostructure were performed in the authors' department. According to their wishes, we divided the patients into two groups: 498 patients were treated with autologous fat injection (control group), and 152 patients were treated with autologous fat injection combined with PRF. All of the patients were monitored for at least six months. The effects were evaluated via physician assessment and patient satisfaction rates, and the incidences of complications were compared.

RESULTS

All the cases had a degree of improvement after treatment. The patient satisfaction rate was 55.3% in the PRF group and 43.4% in the control group. In all, 68.4% of the patients in the PRF group and 58.2% in the control group indicated that one-stage surgery was sufficient to achieve the desired effect. According to the evaluation conducted by the plastic surgeon, 59.2% of patients in the PRF group and 47.0% in the control group achieved a perfect effect. A total of 76.3% of patients in the PRF group and 63.9% in the control group reported that one surgery achieved satisfactory results. The difference between the PRF and control groups was statistically significant.

CONCLUSION

Using an autologous fat graft during facial lipostructure is beneficial and safe when combined with PRF. The combination may enhance the effect and satisfaction rate. Further research and prospective clinical studies are needed to understand the role of PRF in fat grafting.

Platelet Rich Fibrin Membrane Grafting After Laser Excision for Oral Mucosal Lesions

Platelet rich fibrin (PRF) is a novel surgical biomaterial which has shown immense healing and regenerative potential with diverse clinical applications. Surgical excision is a routinely employed treatment modality for mucosal oral lesions with or without grafting or repair of the base of the wound. We proposed a hypothesis that covering of the base of excised lesion with this platelet rich fibrin membrane can accelerate the rate of physiological healing process and regeneration. To evaluate the role, efficacy, advantages and adverse effects if any, of placement of PRF membrane grafts over surgical excision sites of oral mucosal lesions. Platelet rich fibrin membrane graft was prepared as per recommendation and established protocols. Patients were selected for surgical excision of localized, superficial oral mucosal lesions after meticulous clinical and radiological considerations and informed consent was taken. After laser excision with safe margins, the base of wound was covered with PRF membrane graft, stitched in place by 3-0 vicryl sutures. The operated site was clinically evaluated at regular intervals and a healing score was calculated and statistically tabulated on the basis of various parameters of healing. A total of 34 patients were included in the study with a male preponderance (21 males and 13 females). Satisfactory and clinically acceptable wound healing was observed in most of the patient with minimal morbidities. Surgical site demonstrated good healing score and clinically complete healing with good epithelialisation was achieved in all patients. Platelet rich fibrin membrane is an effective grafting biomaterial after excision of oral mucosal lesions as it enhances the rate of healing with minimal complications. We recommend further multicentre studies with higher sample size to explore its utility and clinical applications in different avenues of oral and head neck surgery.

Assessing the effect of PRP addition to facial micro-lipofilling for patients suffering from Scleroderma: A prospective routine care analysis

BACKGROUND

Combining fat graft with platelet derived products is now common practice in regenerative surgery. We proposed to assess the safety and efficacy of Platelet-Rich Plasma (PRP) addition to a micro-lipofilling protocol for facial treatment of patients suffering from Systemic Sclerosis (SSc).

OBJECTIVE

Main objective was to evaluate the improvement of the Mouth Handicap In Systemic Sclerosis (MHISS) scale score at 6 months post-therapy.

METHOD

Included SSc patients had a MHISS score equal or up to 20. Surgery was performed under general anesthesia. Micro-fat and PRP (CCA-NA from DEPA Classification) were mixed in a 70/30 ratio, before injection in peri-oral sites according to a specific protocol. Efficacy criteria were recorded at baseline, 3 and 6 months. Moreover, we compared this cohort (current study) to a former (2015) non-enriched micro-lipofilling cohort in the same indication, using the same protocol.

RESULTS

Thirteen women patients with mean age of 53.2 years (±14.3) have been included. At baseline, mean MHISS score was 29.5 (±8.7) and significantly decreased to 22.5 (±7.8) at 6 months (P=0.016), corresponding to a 22.0% of improvement from baseline, with a mean decrease of 6.5 points (±7.5) at 6 months. Patients received a mean volume of 30.8ml PRP-micro-fat (±8.1ml).

CONCLUSION

PRP addition appeared beneficial, however, controlled studies are required to determine its superiority to facial micro-lipofilling.

Clinical evaluation of autologous fat graft for facial deformity: a case series study

Objectives

The use of fat grafts in maxillofacial sculpturing is currently a common technique. Unlike fillers, autologous fats unite with facial tissues, but long-term results may still be unsatisfactory. Sharing long-term follow-ups can be helpful in making outcomes more predictable.

Materials and Methods

The data from patients who were admitted from 2014 to 2016 for fat augmentation were collected. In all cases, fat grafts were injected by blunt cannula using a tunneling technique in different planes. A fan shape order for the malar, periorbital, nasolabial fold, mandibular angle and body, and perioral area was established.

Results

Autologous fat was used for different sites of the maxillofacial regions. Of 15 patients, two patients were not satisfied due to fat graft resorption. For this, further injections were performed six months after the first injection using preserved fat grafts. One patient continued to be dissatisfied. There were no other complications related to fat transplants.

Conclusion

Fat transplantation is a safe, reliable, and non-invasive method for facial contour and facial soft tissue defect restoration. Additional methods such as mesenchymal stem cells along with fat injection increase the survival rate of transferred fat.

Comparison of Conventional and Platelet-Rich Plasma-Assisted Fat Grafting: A Systematic Review and Meta-analysis

BACKGROUND

Autologous fat grafting (FG) is a popular technique for soft-tissue augmentation, but the fat survival rate is unpredictable. Platelet-rich plasma (PRP) has emerged as an adjuvant to enhance fat graft survival.

OBJECTIVES

This literature review and meta-analysis aimed to investigate the effect of PRP on the survival rate of fat grafting.

METHODS

A comprehensive systematic literature search was done to identify clinical studies on PRP and fat cotransplantation in PubMed, Cochrane Library, Web of Science, and EMBASE databases up to May 2020. The reference lists of selected articles were reviewed to identify any additional related articles. A meta-analysis was conducted to compare PRP + FG and conventional FG in terms of fat graft survival rate, patient satisfaction rate, and recovery time after surgery.

RESULTS

Eleven studies consisting of 1125 patients were analyzed. Patients were followed up from 3 to 24 months post-FG. The fat survival rate varied from 20.5% to 54.8% in FG alone and from 24.1% to 89.2% in the PRP + FG groups. The survival rate was significantly higher and recovery time was significantly lower in the PRP + FG group than in the FG alone group. However, there was no significant difference in the patient satisfaction rate between the groups.

CONCLUSIONS

This study demonstrates that PRP-enhanced fat transplantation has better efficacy than conventional fat grafting. Further studies are required to provide the optimum concentration of PRP and the long-term efficacy of the technique. There is not enough evidence to compare the rate of complications with PRP and fat cotransplantation and conventional fat grafting.

Platelet-Rich Plasma: Evolving Role in Plastic Surgery

BACKGROUND

The use of platelet-rich plasma has emerged as one of the most desired nonsurgical treatments for facial rejuvenation and hair restoration. It has grown to encompass a wide variety of applications within the field of plastic surgery, including its use in combination with microneedling, laser, and fat-grafting procedures.

METHODS

In this article, the authors aim to (1) describe the preparation process of platelet-rich plasma; (2) discuss the proposed science behind platelet-rich plasma with regard to its evolving role in hair restoration and facial rejuvenation; and (3) highlight the recent literature examining its widespread use.

RESULTS

Based on the available literature, there is a therapeutic advantage to the use of platelet-rich plasma as a single treatment modality for alopecia and skin rejuvenation and in combination with laser skin treatment and fat grafting. There is, however, a considerable amount of variability in the processing, preparation, and treatment modalities.

CONCLUSIONS

Despite a lack of standardized protocols for platelet-rich plasma preparation and a scarcity of large-scale studies with long-term follow-up, there is convincing evidence with objective measurement modalities that display positive outcomes after treatment for skin rejuvenation, hair regrowth, wound healing, and fat graft take.

Level of Evidence on Platelet-rich Plasma in Plastic Surgery

Background:

Despite the increased popularity of platelet-rich plasma (PRP) in plastic surgery, there is no detailed analysis on the level of evidence on PRP use in plastic surgery. As the number of applications of PRP in plastic surgery increases, it is important for plastic surgeons to understand the scientific and validated evidence behind its use. Therefore, we performed a literature review to identify current level of evidence on platelet-rich plasma in plastic surgery.

Methods:

We performed a computerized search of platelet-rich plasma in plastic surgery using the MEDLINE, Cochran Library, and EMBASE databases. Data regarding the type of study, PRP application, and outcomes were collected. Then, the level of evidence was assigned using the American Society of Plastic Surgeons Level of Evidence Rating.

Results:

Our search identified 105 articles, and about 78.1% of studies were lower-quality studies: 37 level-III articles (35.2%), 32 level-IV articles (30.5%), and 13 level-V articles (12.4%). There were only 6 level-I articles and 17 level-II studies. Level-I studies were on facial rejuvenation using a laser, carpal tunnel release, cleft lip repair, trauma wounds, breast reconstruction using latissimus dorsi, and hair regrowth.

Conclusions:

Our review of the literature shows that the level of evidence on PRP use in plastic surgery is low (21.9%). Nevertheless, we believe level-III to level-V studies are still valuable, as performing high-level quality studies in plastic surgery is difficult due to variability in surgical techniques, experiences, and materials.

Comparison of the Efficacy and Safety of Cell-Assisted Lipotransfer and Platelet-Rich Plasma Assisted Lipotransfer: What Should We Expect from a Systematic Review with Meta-Analysis?

Due to the high absorption rate of traditional autologous fat grafting, cell-assisted lipotransfer (CAL) and platelet-rich plasma (PRP)-assisted lipotransfer were developed. The purpose of this article was to evaluate the efficacy and safety of CAL and PRP in promoting the survival of autologous fat grafting through systematic review and meta-analysis. We searched Pubmed, Cochrane Library, Web of Science, and EMBASE for clinical studies on CAL and PRP-assisted lipotransfer published from January 2010 to January 2020. Then a meta-analysis was performed to assess the efficacy of CAL and PRP-assisted lipotransfer through data analysis of fat survival rate. We also assessed the incidence of complications and multiple operations to analyze their safety. A total of 36 studies (1697 patients) were included in this review. Regardless of the recipient area, CAL and PRP-assisted lipotransfer significantly improved the fat survival rate (CAL vs non-CAL: 71% vs 48%, P < 0.0001; PRP vs non-PRP: 70% vs 40%, P < 0.0001; CAL vs PRP: 71% vs 70%, P = 0.7175). However, in large-volume fat grafting, such as breast reconstruction, both increased the incidence of complications and did not decrease the frequency of multiple operations after lipotransfer. Further prospective studies are needed to evaluate the clinical benefits of CAL and PRP-assisted lipotransfer.

Cocktail Protocol for Preparation of Platelet-Rich Fibrin Glue for Autologous Use

Background

Biomaterials containing platelets have been used to promote healing of ulcers and burns, as well as in implantology and maxillofacial and plastic surgery to achieve wound healing and tissue repair. Commercial devices to prepare autologous biomaterials involve diverse preparation methods that can have high production costs and low yields. Hence, we designed a protocol for preparation of large amounts of autologous platelet-rich fibrin (PRF) glue using conventional processing techniques for blood components.

Methods

Autologous whole blood collected 72 h before surgery was processed to prepare platelet concentrates and cryoprecipitate. In a closed system, calcium was added to the cryoprecipitate to release autologous thrombin and generate a firm fibrin clot. The fibrin clot, platelets and calcium were then placed in a conical flask in which a PRF glue formed. The protocol was validated through determination of pre- and post-platelet counts and fibrinogen amounts in the product.

Results

Platelets were recovered with 68% efficiency during the preparation. Essentially no platelets or fibrinogen were found in the supernatant of the PRF glue, suggesting that nearly all had been incorporated in a PRF glue having a relatively large (8 cm × 10 cm) size.

Conclusion

The protocol described here is a cost-effective, simple and closed system that can be used to produce large-size PRF glue to promote repair of major surgical defects.

Platelet-Rich Fibrin Improves Fat Graft Survival Possibly by Promoting Angiogenesis and Adipogenesis, Inhibiting Apoptosis, and Regulating Collagen Production

BACKGROUND

Platelet-rich fibrin (PRF) can promote fat graft survival, but limited data are currently available, and the underlying mechanism of this effect has not yet been explained.

OBJECTIVES

The aim of this study was to explore the mechanism by which PRF promotes fat graft survival, from the aspects of angiogenesis, adipogenesis, cellular apoptosis, and collagen production.

METHODS

Nude mice were randomly assigned to a PRF group (subcutaneously injected with PRF and fat in the ratio of 1:5 by volume) and a control group (subcutaneously injected with normal saline and fat in the ratio of 1:5 by volume). On days 0, 3, 7, 14, 21, and 28 after transplantation, graft samples (n = 12) were obtained for quantification of target growth factors. In weeks 1, 2, 3, and 4 after transplantation, graft samples (n = 12) were obtained for the following evaluations. The volume and weight retention rates were calculated; gene and protein expression of vascular endothelial growth factor A (VEGF-A), peroxisome proliferator-activated receptor γ (PPAR-γ), COL1-A1, and BAX were evaluated; hematoxylin & eosin staining, Masson's trichrome staining, α smooth muscle actin staining, and perilipin-1 staining were performed to evaluate graft survival.

RESULTS

After transplantation, the concentrations of growth factors produced by the fat increased to varying degrees, and the addition of PRF made these concentration changes ever greater. Compared with the control group, the PRF group had a higher volume and weight retention rate, a higher expression level of VEGF-A and PPAR-γ, a lower expression level of COL1-A1 and BAX, a higher vessel density, less fibrosis, and more viable adipocytes.

CONCLUSIONS

PRF can promote autocrine function of the grafted fat to produce more growth factors. It greatly increased fat retention rate, possibly by promoting vascularization and adipogenic differentiation, inhibiting cellular apoptosis, and regulating collagen production.

Fat Graft Enrichment Strategies: A Systematic Review

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Effect of Platelet-Rich Fibrin on Fat Grafting in Animal Models: A Meta-Analysis

BACKGROUND

Autologous fat grafting has been widely used in plastic and reconstructive surgery, but one of the main reasons for limiting its application is the high resorption rate. Platelet-rich fibrin (PRF) is a new generation of platelet concentrate that has recently been used to improve the survival rate of fat grafts. The purpose of this study was to evaluate the effect of PRF on fat grafting.

METHODS

Animal studies in four databases (PubMed, Cochrane library, Ovid, and Wan fang database) were searched up to July 2019. A meta-analysis was performed to compare PRF + fat grafting and fat grafting alone or platelet-rich plasma (PRP) + fat grafting in animal models.

RESULT

Six studies with 83 animals (123 fat graftings) were included in our meta-analysis. The fat survival rate (mean difference (MD) 0.14, P < 0.00001) and the microvessel density (MVD) (standardized mean difference 4.20, P = 0.02) of the PRF + fat group were significantly higher than that of the fat alone group. There was no significant difference between the PRF + fat group and PRP + fat group in the fat survival rate (MD 0.05, P = 0.06).

CONCLUSION

This study found that PRF combined with fat grafting may have an effect on improving the survival rate and MVD of fat grafts. However, when comparing the effects of PRF and PRP on the fat survival rate, there is currently no clear evidence to prove the difference between them. More preclinical and clinical studies are necessary to further clarify the effect of PRF on fat grafting in humans.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Effects of Facial Lipografting on Skin Quality: A Systematic Review

BACKGROUND

Autologous lipografting for improvement of facial skin quality was first described by Coleman in 2006. The current dogma dictates that adipose tissue-derived stromal cells that reside in the stromal vascular fraction of lipograft contribute to skin rejuvenation (e.g., increased skin elasticity), a more homogenous skin color, and softening of skin texture. Nowadays, many studies have been reported on this "skin rejuvenation" effect of autologous fat grafting. This systematic review was undertaken to assess the efficacy of autologous lipografting on skin quality.

METHODS

The MEDLINE, Embase, Cochrane Central, Web of Science, and Google Scholar databases were searched for studies evaluating the effect of autologous lipografting on facial skin quality (May 11, 2018). Outcomes of interest were skin texture, color, and elasticity in addition to histologic outcomes and number of complications.

RESULTS

Nine studies were included, with 301 patients treated in total. No meta-analysis could be performed because of heterogeneity of the metrics and outcomes. Eight studies reported increased skin elasticity; improvement in skin texture; and a more homogeneous skin color after treatment with lipografting, cellular stromal vascular fraction, or nanofat. One study reported no increased skin elasticity after lipografting. Histologic improvement was seen after lipografting and adipose tissue-derived stromal cell injections. However, in general, the level of evidence of the included studies was low. No serious complications were reported.

CONCLUSION

Autologous facial lipografting and cellular stromal vascular fraction and adipose tissue-derived stromal cell injections hardly seem to improve facial skin quality but can be considered a safe procedure.

The Role of Platelet Concentrates in Facial Fat Grafting

Autologous fat grafting is increasingly being used as a method for the repair of facial soft tissue defects and facial rejuvenation, given its low risk of adverse effects and high efficacy. However, the unpredictability of graft retention is a limitation of this procedure. In addition, there is no standard procedure to date for autologous fat grafting. Different methods have been developed to increase the retention of grafted fat. For instance, platelet concentrates have been used to directly deliver bioactive factors to grafted fat. Platelet concentrates also provide incidental therapeutic benefits by enhancing the persistence of fat grafted in the face via the release of growth factors and cytokines. In this review, we describe current strategies for improving the survival of facial fat grafts, mainly focusing on the application of growth factors/cytokines and platelet concentrates to fat grafting.

An Overview of Principles and New Techniques for Facial Fat Grafting

Facial fat grafting is a small-volume procedure and is primarily performed for facial rejuvenation, contouring, or regenerative surgery. The unsatisfying retention rate after fat grafting, however, led to unpredictable outcomes, subsequent multiple procedures, and even some complications. A variety of methods have been proposed to enhance the results of facial fat grafting, including several established surgical principles and many possible new techniques. Adding stem cells, fat preparations, and platelet concentrates may improve the survival after fat grafting but randomized controlled clinical studies are needed to determine their safety and efficacy as well as clinical indications for each technique.

Role of platelet-rich fibrin in enhancing the viability of autologous microlobular fat graft: an animal-based experimental study

BACKGROUND Tissue fat has been used as a fat graft in plastic reconstructive surgery since ancient times by surgeons. However, an issue with this usage is that fat gets absorbed by up to 30–50%, especially centrifuged fats. The aim of this study was to compare the survival of microlobular fat, centrifuged fat, microlobular fat with plateletrich fibrin (PRF), and centrifuged fat with PRF. METHODS Subcutaneous fat was taken from the stomach area and divided into two parts, microlobular fat and centrifuged fat, and processed by adding PRF as follows: 1) microlobular fat without PRF; 2) microlobular fat with PRF; 3) centrifuged fat without PRF; and 4) centrifuged with PRF. These fat grafts were implanted into rabbit earlobes. Each procedure was performed repeatedly nine times for a total of 36 repetitions for all groups. RESULTS Microscopic evaluation revealed the highest number of adipocytes in the microlobular fat with PRF group (mean = 1,932) and the highest number of fibroblasts (mean = 600.5) compared to those in other treatment groups, although the difference was not statistically significant. There was more neovascularization in the microlobular fat group (mean = 228.5), but it was not statistically significant. CONCLUSIONS Addition of PRF to microlobular fat graft enhances the number of adipocytes and fibroblasts, including the enhancement of neovascularization.

Increased Angiogenic and Adipogenic Differentiation Potentials in Adipose-Derived Stromal Cells from Thigh Subcutaneous Adipose Depots Compared with Cells from the Abdomen

BACKGROUND

Adipose-derived stromal cells (ADSCs) may play a pivotal role by differentiating into multilineage cells or by secreting growth factors or cytokines in cell-assisted lipotransfer, which participates in adipose tissue regeneration. The angiogenic potential of various ADSCs from different anatomical regions remains uncertain.

OBJECTIVES

The authors sought to offer appropriate choices of sources of adipose-derived stromal cells for cell-assisted lipotransfer and tissue engineering.

METHODS

ADSCs were harvested from subcutaneous adipose depots in the abdomen and thighs. The expression of adipocyte-specific markers was evaluated, and Oil Red O staining was performed to assess the capacity for adipogenic differentiation. Angiogenic differentiation potential was evaluated by detecting the expression of vascular endothelial growth factor, vascular endothelial growth factor 2, and CD31. A tube formation assay was also performed to analyze the angiogenic differentiation capacity.

RESULTS

ADSCs from the thigh showed more significant angiogenic and adipogenic potential. More lipogenesis was identified in ADSCs from the thigh, and this was accompanied by the enhancement of adipocyte markers. Angiogenesis was more vigorous in the thigh-derived stromal cells, and ADSCs from the thigh depot showed more junctions and longer tubule formation on Matrigel in vitro.

CONCLUSIONS

Thigh-derived ADSCs exhibited greater capacity for adipogenic and angiogenic differentiation and would be a better option for cell-assisted lipotransfer and tissue engineering.

Advances in surgical applications of growth factors for wound healing

Growth factors have recently gained clinical importance for wound management. Application of recombinant growth factors has been shown to mimic cell migration, proliferation, and differentiation in vivo, allowing for external modulation of the healing process. Perioperative drug delivery systems can enhance the biological activity of these growth factors, which have a very short in vivo half-life after topical administration. Although the basic mechanisms of these growth factors are well understood, most have yet to demonstrate a significant impact in animal studies or small-sized clinical trials. In this review, we emphasized currently approved growth factor therapies, including a sustained release system for growth factors, emerging therapies, and future research possibilities combined with surgical procedures. Approaches seeking to understand wound healing at a systemic level are currently ongoing. However, further research and consideration in surgery will be needed to provide definitive confirmation of the efficacy of growth factor therapies for intractable wounds.

The Efficacy of Platelet-Rich Plasma in the Field of Hair Restoration and Facial Aesthetics—A Systematic Review and Meta-analysis

As a promising alternative to traditional treatment, platelet-rich plasma (PRP) is being used to encourage hair growth through the release of growth factors and cytokines. In addition to hair restoration, PRP’s multifactorial capabilities can also be used to treat aging skin, facial scarring, and acne. The purpose of this review is to critically examine the success of PRP in the field of dermatology, with specific attention to the role of PRP in hair restoration. Where possible, meta-analyses were used to evaluate the efficacy of PRP. In androgenetic alopecia (AGA) patients, 3 monthly PRP injections (1 session administered every month for 3 months) exhibited greater efficacy over placebo as measured by change in total hair density (hair/cm2) over the treatment period (mean difference: 25.61, 95% CI: 4.45 to 46.77; P = .02). The studies included in the meta-analysis used a half-head design, which may have influenced the results because of the effects PRP can induce. Controlled studies suggest that 2 to 4 sessions of PRP combined with traditional therapies and procedures can help minimize acne scarring and facial burns, improve aesthetic results, and decrease recovery time. However, data for these indications are lacking and are less robust in design. In conclusion, to achieve an improvement in hair restoration in patients with mild AGA, 3 initial monthly PRP injections should be given. Only upon completion of rigorous, randomized, controlled studies can standardized and effective PRP protocols for treating dermatology conditions such as acne scarring, facial burns, and aging skin be determined.

Concentrated Growth Factor Enhanced Fat Graft Survival: A Comparative Study

BACKGROUND

Concentrated growth factors (CGFs) belong to a new generation biomaterials that concentrate large number of growth factors and CD34 stem cells in small volume of plasma.

OBJECTIVE

The purpose of this study was to evaluate the impact of the new technique, CGF, on fat graft survival, which compared with platelet-rich plasma (PRP) and platelet-rich fibrin (PRF).

MATERIALS AND METHODS

Nude mice received fat graft were divided into PRP group, PRF group, CGF group, and saline. The grafts were volumetrically and histologically evaluated at 4, 8, and 12 weeks after fat grafting. In vitro growth factor levels in PRP, PRF, and CGF were compared using enzyme-linked immunoassay method. Cell count and real-time polymerase chain reaction were used to evaluate the impact of CGF in medium on human adipose-derived stem cell (hADSC) proliferation and vascular differentiation, respectively.

RESULTS

Fat graft weight was significantly higher in the CGF group than those in the other groups, and histologic evaluation revealed greater vascularity, fewer cysts, and less fibrosis. Adding CGF to the medium maximally promoted hADSC proliferation and expressing vascular endothelial growth factor and PECAM-1.

CONCLUSION

In this preliminary study, CGF treatment improved the survival and quality of fat grafts.

Clinical Application of Platelet-Rich Fibrin in Plastic and Reconstructive Surgery: A Systematic Review

BACKGROUND

Platelet-rich fibrin (PRF) has been applied in the clinical field for more than a decade, but largely in oral surgery and implant dentistry. Its utilization in plastic and reconstructive surgery is limited and lacking a comprehensive review. Hence, this article focuses on the various clinical applications of PRF pertaining to the plastic and reconstructive field through a systematic review.

METHODS

In this review, articles describing the clinical application of PRF in plastic and reconstructive surgery were screened using predetermined inclusion and exclusion criteria. The articles were summarized and divided into groups based on the utilization of PRF. The effects and complications of PRF were analyzed and concluded.

RESULTS

Among the 634 articles searched, 7 articles describing 151 cases are eligible. PRF was applied on 116 (76.8%) wounds to facilitate tissue healing, and the complete wound closure rate was 91.4% (106/116). Otherwise, PRF was applied in 10 (6.6%) cases of zygomaticomaxillary fracture to reconstruct orbital floor defects and in 25 (16.6%) cases of facial autologous fat grafts to increase the fat retention rate successfully. There is no report of PRF-related complications.

CONCLUSIONS

PRF could facilitate wound healing, including the healing of soft tissues and bony tissues, and facilitate fat survival rate. Further studies are needed to test the mechanism of PRF and expand its scope of application in plastic and reconstructive surgery.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Autologous Fat Transfer for Facial Rejuvenation: A Systematic Review on Technique, Efficacy, and Satisfaction

Background

Parallel to the steady decline in surgical aesthetic procedures to the face, dermal fillers seem to have gained a more prominent place in facial rejuvenation over the last couple of years. As a dermal, facial filler, autologous fat transfer (AFT) seems to have real potential because of the biocompatibility of adipose tissue besides being a procedure with few and primarily minor complications. This systematic review aims to evaluate the available evidence regarding the safety and effectiveness of AFT for facial rejuvenation.

Method

A systematic review after the Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analysis (PRISMA) statement was conducted. MEDLINE, Embase, and Cochrane Library were searched up to December 2016, with no language restrictions imposed. Case series, cohort studies, and randomized controlled trials (RCTs) reporting on relevant outcomes were included.

Results

Eighteen clinical articles were included, reporting on 3,073 patients in total over a mean follow-up period of 13.9 months. Meta-analysis showed an overall complication rate of 6% (95% CI 3.0-14.0), with hematoma/ecchymosis (5%), fat necrosis/oil cysts (2%), and irregular fat distribution and scars (both 2%) being among the most reported. No major complications were reported, and the overall patient satisfaction rate was 81%.

Conclusion

Although the evidence in this systematic review is still limited and plagued by heterogeneity between studies, AFT seems to be a promising method in facial rejuvenation with fewer complications than other fillers and high patient satisfaction rates. Further large-cohort, preferably multicenter, RCTs should substantiate these results through quantifiable volumetric assessment tools and validated patient questionnaires, while adhering to predetermined nomenclature in terms of complications.

A Systematic Review of Autologous Platelet-Rich Plasma and Fat Graft Preparation Methods

BACKGROUND

The addition of platelet-rich plasma (PRP) to adipose tissue may improve fat graft survival, although graft retention rates vary markedly between studies. To what extent this outcome heterogeneity reflects differing methodological factors remains unknown. This systematic review aims to synthesize and critically review methodological approaches to autologous PRP and fat cotransplantation in both human and animal studies.

METHODS

In accordance with PRISMA guidelines, Ovid MEDLINE, Scopus, and Cochrane Library databases were searched from inception to April 2017. Data were extracted from all in vivo studies involving autologous PRP and fat cotransplantation. A secondary aim was to assess reporting of technical detail; authors were not contacted to provide missing data.

RESULTS

From 335 articles, 23 studies were included in the qualitative synthesis. Some 21 were performed in humans and 2 in rabbits. Six studies were randomized control trials; the remainder reported on observational data. Methods of PRP extraction and activation varied markedly between studies. Fat graft preparation was comparatively more consistent. Methods of PRP and fat mixing differed significantly, especially with regards to relative volume/volume ratios.

CONCLUSIONS

Our study represents the first systematic review of methodological factors in autologous PRP and fat cotransplantation. It demonstrates that technical factors in graft preparation and administration vary significantly between in vivo studies. Such methodological heterogeneity may explain observed differences in experimental and clinical outcomes. Reporting of key procedural information is inconsistent and often inadequate. These issues make meaningful evaluation of the PRP-enhanced fat grafting literature difficult and may limit its translation into clinical practice.

An overview of platelet products (PRP, PRGF, PRF, etc.) in the Iranian studies

Aim

The aim of the study was to carry out a review of published studies on various platelet products in Iranian studies.

Materials & methods

Electronic databases were searched for relevant articles. Two review authors independently extracted data via a tested extraction sheet, and disagreements were resolved by a meeting with a third review author.

Results

Bone disorders (25%), wound and fistula (16%), dental and gingival disorders (14%) and osteoarthritis (11%) have more relative frequency based on different fields.

Conclusion

The necessity of pursuing standard protocols in the preparation of platelet products, stating the precise content of platelets and growth factors, and long-term follow-up of study subjects were the most important points in Iranian studies.

Apprising the diverse facets of Platelet rich fibrin in surgery through a systematic review

CONTEXT

Comprehensive reviews on clinical applications of Platelet rich fibrin (PRF) in surgery are limited despite its extensive utilization resulting in a dearth of knowledge on its effectiveness. Hence this article focuses on shedding light to the various applications of PRF pertaining to surgery through a systematic review.

OBJECTIVE

The systematic review is aimed at evaluating the value of PRF in different areas of surgery.

DATA SOURCES

A systematic review of articles sourced from MEDLINE-pubmed (2008-2017(July)) was done. Additional articles were searched through GOOGLE SCHOLAR and SCIENCE DIRECT. Search terms such as Platelet rich fibrin; Platelet rich fibrin, surgery; Platelet concentrate; second generation concentrate; Applications of PRF in surgery were used.

STUDY SELECTION

Systematic reviews, Randomized control trials, Pilot studies and Case reports were included. Non English articles, in-vitro and animal studies were excluded.

DATA EXTRACTION

Independent sourcing of articles by 3 authors using a set of predefined criteria.

DATA SYNTHESIS

Out of the 25 articles covering various surgical procedures that met the inclusion criteria, positive outcomes were noted in most. Although categorization into one specific type of study was not done, the overall success rate with PRF usage was 78%.No differences between test and control groups were observed in 2 studies and 3 studies showed no significant improvements with the usage of PRF.

LIMITATIONS

The systematic review did not categorize the study designs while evaluating success rates which might be considered as a shortcoming as case reports were also included.

CONCLUSIONS

The future propositions are vast and point towards innovative applications of this bio-material possibly in transplant and burn cases if a method of obtaining large amounts can be devised. However since we rely on evidence-based results, further long term studies are needed in distinct areas of applications to decisively prove its effectiveness.

Platelet-rich plasma-enriched autologous fat graft in regenerative and aesthetic facial surgery: Technical note

The goal of adding platelet-rich plasma (PRP) to autologous fat graft is to increase the survival rate of the graft. After their activation, platelets release some important growth factors. As a result, PRP may increase the proliferation and differentiation of Adipose-derived stem cells (ASCs) into adipocytes, improve fat graft vascularisation, and may block the apoptosis of grafted adipocytes. The other benefit expected from the addition of PRP to fat graft is the improvement of cutaneous trophicity above the grafted areas. An exhaustive review of the literature retrieved 11 clinical studies on humans and 7 on animals. A statistically significant increase of the survival rate of fat grafts has been found in 9 comparative studies. Our synthesis allowed us to set up the following protocol: addition of 20% of PRP activated with calcium hydrochloride to fat grafts. It may enhance the results of autologous facial fat graft in regenerative and aesthetic facial surgery.

Current Evidence for Clinical Efficacy of Platelet Rich Plasma in Aesthetic Surgery: A Systematic Review

Background

Platelet rich plasma (PRP) has attracted attention in a number of surgical fields due to a wide variety of potential clinical benefits. Yet PRP has not gained wide popularity in aesthetic surgery as a result of uncertainty surrounding objective clinical evidence.

Objectives

We aim to describe the current applications, define preparation and activation, explore effectiveness, and propose a classification system to facilitate comparisons across studies.

Methods

A comprehensive review of the literature regarding the use of platelet rich plasma in aesthetic surgery was performed. Data gathered included: PRP application, study type, subject number, centrifugation, anticoagulation, activation, PRP composition, and outcomes.

Results

Thirty-eight reports were identified. Applications included injection into aging skin (29%), scalp alopecia (26%), lipofilling (21%), fractional laser (13%), and facial surgery (11%). The majority of studies (53%) were case series without controls. Leucocytes were sparsely defined (32%). The concentration of injected and/or baseline platelets was rarely clarified (18%). The mechanism of activation was described in 27 studies (71%), while anticoagulation was uncommonly elucidated (47%). While most studies (95%) claim effectiveness, objective measures were only utilized in 17 studies (47%).

Conclusions

Current studies produce context-dependent results with a lack of consistent reporting of PRP preparation, composition, and activation in aesthetic applications, making meaningful meta-analysis unrealistic. Thus the method of PRP preparation warrants increased attention. We recommend a set of descriptors, FIT PAAW (described below), to produce scientifically grounded conclusions, facilitating a clearer understanding of the situations in which PRP is effective.

Level of Evidence

4

Platelet-Rich Fibrin Improves the Viability of Diced Cartilage Grafts in a Rabbit Model

BACKGROUND

Diced cartilage may be wrapped with synthetic or biological materials before grafting to a recipient site. These materials have unique advantages and disadvantages, and a gold standard is not available.

OBJECTIVES

The authors investigated the effects of platelet-rich fibrin (PRF) on the survival of cartilage grafts in a rabbit model.

METHODS

In this experimental study, diced cartilage pieces from the ears of 9 male rabbits were left unwrapped or were wrapped with PRF, oxidized regenerated cellulose, or fascia. Specimens then were placed into subcutaneous pockets prepared on the backs of the rabbits. The animals were sacrificed 2 months after the procedure, and the grafts were excised for macroscopic and histopathologic examination.

RESULTS

The cartilage graft wrapped with PRF showed superior viability compared with the cartilage graft wrapped with oxidized regenerated cellulose. No significant differences were found among the other groups. The groups were not significantly different in terms of rates of inflammation, fibrosis, or vascularization.

CONCLUSIONS

PRF enhances the viability of diced cartilage grafts and should be considered an appropriate biological wrapping material for cartilage grafting.

A systemic review of autologous fat grafting survival rate and related severe complications

OBJECTIVE

Clinical application of autologous fat grafting (AFG) is quickly expanding. Despite the widely acceptance, long-term survival rate (SR) of AFG remains a question not yet solved. Meanwhile, although rare, severe complications related to AFG including vision loss, stroke even death could be seen in the literature.

DATA SOURCES

A comprehensive research of PubMed database to June 2013 was performed according to guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology. Articles were screened using predetermined inclusion and exclusion criteria.

STUDY SELECTION

Data collected included patient characteristics, surgical technique, donor site, recipient site, graft amount, and quantified measurement methods. Patient cohorts were pooled, and SR was calculated. All the severe complications were also summarized according to the different clinical characteristics.

RESULTS

Of 550 articles, 16 clinical articles and 10 animal studies met the inclusion criteria and provided quantified measurement methods. Totally, 596 patients were included. SR varied from 34% to 82% in breast and 30-83% in the facial area. Nude mice were applied to investigate human fat grafting SR (38.3-52.5% after 15 weeks). Rabbits were commonly used to study animal AFG SR (14.00-14.56% after 1-year). Totally, 21 severe complications were reported, including death (2), stroke (10), vision loss (11, 8 of which accompanied with stroke), sepsis (3), multiple abscess (1) and giant fat necrotic cyst (2). Ten of these complications happened within 10 years.

CONCLUSIONS

There is no unified measurement method to evaluate fat graft SR until now and no clinical evidence to show better SR according to different donor and recipient cite. Body mass index change between pre- and postoperation may be the bias factor in evaluating fat SR. Fat embolisms of the ophthalmic artery and the middle cerebral artery are the most severe complication of AFG and still lack of effective treatment.

Treatment of Oral Mucosal Lesions by Scalpel Excision and Platelet-Rich Fibrin Membrane Grafting: A Review of 26 Sites

PURPOSE

One of the preferred treatment options for oral mucosal lesions (eg, leukoplakia and lichen planus) is excision, with or without the use of a coverage agent. Platelet-rich fibrin (PRF) membranes are popular fibrin scaffolds with entrapped platelets that release various growth factors and cytokines to support and enhance wound healing. The aim of the present report was to describe the technique, postoperative wound care, and clinical results of PRF membrane grafting after excision of superficial potentially malignant oral lesions.

MATERIALS AND METHODS

Autologous PRF membrane was fabricated and grafted over 26 wounds created by excision of small, superficial, potentially malignant lesions of oral mucosa (or fiberotomy in cases of oral submucous fibrosis) and assessed clinically at 7, 15, 30, and 60 days.

RESULTS

Healing was satisfactory in all cases, with minimal and manageable complication at 1 site.

CONCLUSION

The results of the present study suggest that PRF membrane is a successful coverage agent that aids in the healing of superficial oral mucosal wounds. Additional comparative studies are required to establish its efficacy compared with that of other agents.

Lymphedema fat graft: an ideal filler for facial rejuvenation

Lymphedema is a chronic disorder characterized by lymph stasis in the subcutaneous tissue. Lymphatic fluid contains several components including hyaluronic acid and has many important properties. Over the past few years, significant research has been performed to identify an ideal tissue to implant as a filler. Because of its unique composition, fat harvested from the lymphedema tissue is an interesting topic for investigation and has significant potential for application as a filler, particularly in facial rejuvenation. Over a 36-month period, we treated and assessed 8 patients with lymphedematous limbs who concurrently underwent facial rejuvenation with lymphedema fat (LF). We conducted a pre- and post-operative satisfaction questionnaire survey and a histological assessment of the harvested LF fat. The overall mean general appearance score at an average of 6 months after the procedure was 7.2±0.5, demonstrating great improvement. Patients reported significant improvement in their skin texture with a reading of 8.5±0.7 and an improvement in their self-esteem. This study demonstrates that LF as an ideal autologous injectable filler is clinically applicable and easily available in patients with lymphedema. We recommend the further study and clinical use of this tissue as it exhibits important properties and qualities for future applications and research.

Platelet-rich plasma mixed-fat grafting: a reasonable prosurvival strategy for fat grafts?

BACKGROUND

One of the most interesting developments in practical applications of fat grafting in recent years is the use of prosurvival strategies to improve maintenance of volume. Platelet-rich plasma (PRP) plays a decisive role in the repair and regeneration of different tissues via the activation and secretion of a great variety of growth factors and other cytokines stored in the alpha-granules of the platelets. This review aimed to assess the efficacy of PRP mixed-fat grafting as a prosurvival strategy for fat grafts.

METHODS

Online searches of the Cochrane Library and MEDLINE until January 2014 were conducted. The review included studies with at least one clinical end point in which the effect of PRP on the absorption and viability of the fat graft could be assessed.

RESULTS

The review comprised 6 preclinical studies with a control group and 9 clinical studies of humans. It also included comparative studies performed with other prosurvival strategies for fat grafts, such as combination with the stromal vascular fraction and second-generation PRP, also called "platelet-rich fibrin." The results indicate that PRP may have a dose-dependent positive effect on fat grafts and suggest low complication rates.

CONCLUSIONS

The development of new growth factor delivery systems or cell therapies to enrich fat grafts is an area that merits further research.