1
|
Berry CE, Abbas DB, Lintel HA, Churukian AA, Griffin M, Guo JL, Cotterell AC, Parker JBL, Downer MA, Longaker MT, Wan DC. Adipose-Derived Stromal Cell-Based Therapies for Radiation-Induced Fibrosis. Adv Wound Care (New Rochelle) 2024; 13:235-252. [PMID: 36345216 DOI: 10.1089/wound.2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Significance: Half of all cancer patients receive radiation therapy as a component of their treatment regimen, and the most common resulting complication is radiation-induced fibrosis (RIF) of the skin and soft tissue. This thickening of the dermis paired with decreased vascularity results in functional limitations and esthetic concerns and poses unique challenges when considering surgical exploration or reconstruction. Existing therapeutic options for RIF of the skin are limited both in scope and efficacy. Cell-based therapies have emerged as a promising means of utilizing regenerative cell populations to improve both functional and esthetic outcomes, and even as prophylaxis for RIF. Recent Advances: As one of the leading areas of cell-based therapy research, adipose-derived stromal cells (ADSCs) demonstrate significant therapeutic potential in the treatment of RIF. The introduction of the ADSC-augmented fat graft has shown clinical utility. Recent research dedicated to characterizing specific ADSC subpopulations points toward further granularity in understanding of the mechanisms driving the well-established clinical outcomes seen with fat grafting therapy. Critical Issues: Various animal models of RIF demonstrated improved clinical outcomes following treatment with cell-based therapies, but the cellular and molecular basis underlying these effects remains poorly understood. Future Directions: Recent literature has focused on improving the efficacy of cell-based therapies, most notably through (1) augmentation of fat grafts with platelet-rich plasma and (2) the modification of expressed RNA through epitranscriptomics. For the latter, new and promising gene targets continue to be identified which have the potential to reverse the effects of fibrosis by increasing angiogenesis, decreasing inflammation, and promoting adipogenesis.
Collapse
Affiliation(s)
- Charlotte E Berry
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Darren B Abbas
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Hendrik A Lintel
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Andrew A Churukian
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Michelle Griffin
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jason L Guo
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Asha C Cotterell
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer B Laufey Parker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Mauricio A Downer
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Derrick C Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
2
|
Tran VVT, Hong KY, Jin X, Chang H. Histological Comparison of Nanofat and Lipoconcentrate: Enhanced Effects of Lipoconcentrate on Adipogenesis and Angiogenesis. Aesthetic Plast Surg 2024; 48:752-763. [PMID: 37648930 DOI: 10.1007/s00266-023-03583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/26/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Nanofat and lipoconcentrate contain adipose-derived stem cells and growth factors, and have wide clinical applications in the regenerative field. This study aimed to investigate the microenvironmental changes associated with nanofat and lipoconcentrate. METHODS Conventional fat, nanofat, or lipoconcentrate (0.2 mL each, n = 5 per group) were injected subcutaneously into the dorsal flanks of athymic nude mice. The graft weights were measured at postoperative week 4; the grafts and their overlying skin were used for histological analyses. RESULTS Weights of the lipoconcentrate grafts were significantly greater than those of the conventional fat (p < 0.05) and nanofat (p < 0.01) grafts. There was no significant difference in inflammation, oil cysts, and fibrosis between the conventional fat and nanofat groups. Histological examination of the lipoconcentrate grafts showed less macrophage infiltration and the formation of fibrosis and oil cysts. Additionally, adipogenesis and angiogenesis were induced more in the lipoconcentrate grafts than in the nanofat grafts (p < 0.01). Lipoconcentrate and nanofat improved dermal thickness (p < 0.001 and p < 0.01, respectively, versus the baseline). CONCLUSION Lipoconcentrate grafts had greater volume and shape retention than conventional fat and nanofat grafts. They had better histological structure and acted as scaffolds for adipogenesis and angiogenesis. Both products showed regenerative effects on dermal thickness; however, only lipoconcentrate grafts had the required volume and regenerative effects, allowing it to serve as a novel adipose-free grafting method for facial rejuvenation and contouring. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Vinh Vuong The Tran
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Xian Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| |
Collapse
|
3
|
Wang HC, Li Z, Li Z, Wang X, Long X. Platelet-Rich Plasma Combined Fat Transplantation for the Treatment of Bleomycin-Induced Murine Scleroderma. Ann Plast Surg 2023; 90:626-630. [PMID: 37311318 DOI: 10.1097/sap.0000000000003579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Low-fat retention induced by inflammation limits the clinical application of fat grafting for treating localized scleroderma (LS) patients. Novel methods to improve the therapeutic outcome are needed. OBJECTIVE The aim of the study is to investigate the effect of platelet-rich plasma (PRP)-assisted fat transplantation on skin fibrosis and adipose survival in the LS model. METHODS The LS model was established by the injection of bleomycin into BALB/C nude mice, which were randomly divided into the following 4 groups: healthy control, LS disease group model, fat transplantation group, and PRP+ fat transplantation group. The mice received a subcutaneous injection at back with phosphate-buffered saline, fat, or 20% PRP+ fat. Factors of immunoregulation, angiogenesis and adipogenesis were measured. RESULTS Platelet-rich plasma-combined fat transplantation significantly attenuated dermis fibrosis by reducing the production of type III collagen. The fat retention in the PRP+ fat transplantation group was 43 ± 4 mg, significantly higher than 22 ± 15 mg in the fat transplantation group (P = 0.0416). The level of tumor necrosis factor α and interleukin 2 showed no significant difference between the groups. The expression of angiogenesis factors, vascular endothelial growth factor, hepatocyte growth factor, platelet-derived growth factor, and CD31, significantly increased in the PRP+ fat transplantation group. The expression of adipogenesis factors, insulin-like growth factor 1 receptor, extracellular signal-regulated kinase, anti-CCAAT-enhancer-binding proteins, and peroxisome proliferator-activated receptor γ, also significantly increased in the PRP+ fat transplantation group. CONCLUSIONS The results demonstrated that PRP-combined fat transplantation attenuated dermis fibrosis and raised fat survival in the LS model by promoting angiogenesis and adipogenesis through insulin-like growth factor 1 receptor/extracellular signal-regulated kinase signaling pathway.
Collapse
Affiliation(s)
- Hayson Chenyu Wang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai
| | - Zhijin Li
- Department of Plastic surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhujun Li
- Department of Plastic surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojun Wang
- Department of Plastic surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Long
- Department of Plastic surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
4
|
Liu M, Shang Y, Liu N, Zhen Y, Chen Y, An Y. Strategies to Improve AFT Volume Retention After Fat Grafting. Aesthetic Plast Surg 2023; 47:808-824. [PMID: 36316460 DOI: 10.1007/s00266-022-03088-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/28/2022] [Indexed: 11/01/2022]
Abstract
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 .
Collapse
Affiliation(s)
- Meiling Liu
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yujia Shang
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- College of Traditional Chinese Materia Medica, Key Laboratory of Structure-Based Drug Design and Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Na Liu
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- College of Traditional Chinese Materia Medica, Key Laboratory of Structure-Based Drug Design and Discovery of Ministry of Education, Shenyang Pharmaceutical University, Shenyang, 110016, China
| | - Yonghuan Zhen
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Youbai Chen
- Department of Plastic and Reconstructive Surgery, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| |
Collapse
|
5
|
Jiang S, Lin J, Zhang Q, Liao Y, Lu F, Cai J. The fates of different types of adipose tissue after transplantation in mice. FASEB J 2022; 36:e22510. [PMID: 36004579 DOI: 10.1096/fj.202200408r] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 11/11/2022]
Abstract
Fat grafting is one of the most commonly applied procedure for soft-tissue repair. However, it remains unclear whether the type of adipose tissue would have any effects on fat graft survival. The present study aimed to determine fates of fat grafting of three different types of fat tissue. In this study, mice were randomly divided into three groups, white adipose tissue (WAT) group, beige adipose tissue (beige AT) group and brown adipose tissue (BAT) group. Before transplantation, donor mice were injected with rosiglitazone or phosphate-buffered saline (PBS). The WAT and BAT were obtained from PBS-treated mice while beige AT was obtained from the rosiglitazone-treated mice. Three types of fat tissue (150 mg each) were transplanted in three groups, respectively, and harvested at 2, 4 or 12 weeks. The BAT and beige AT contained smaller adipocytes and expressed higher level of uncoupling protein-1 gene. The retention rate of the transplanted fat was significantly higher for beige than for white fat, but was significantly lower for brown than for white fat. Transplanted brown fat was characterized by upregulated inflammation and high endoplasmic reticulum stress. By contrast, fat grafts in beige AT group showed the best adipogenic capacity, moderate inflammation level and superior angiongenesis. In vitro, under hypoxic condition, fewer apoptotic cells were found in beige adipocyte group than that in brown and white adipocyte group. Conditioned medium from brown adipocytes induced M1 polarization of RAW 264.7 macrophages while that from beige adipocytes effectively promoted M2 polarization. Therefore, we suggest that beige AT provides a new potential choice for fat grafting because of low inflammation and superior survival but BAT might not be ideal for fat grafting due to its poor survival.
Collapse
Affiliation(s)
- Shenglu Jiang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China.,Department of Basic Medical Sciences, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, P. R. China
| | - Jiayan Lin
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Qian Zhang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Yunjun Liao
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Junrong Cai
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P. R. China
| |
Collapse
|
6
|
Tutak FN, Kıvrak EG. The Effect of Human Umbilical Cord-Derived Lyophilized Stem Cells on Fat Graft Viability: An Experimental Study. Aesthetic Plast Surg 2022; 46:1973-1982. [PMID: 35303121 DOI: 10.1007/s00266-022-02836-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/24/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The extended use of autologous adipose tissue has increased the importance of the viability of fat graft cells. This experimental animal study assesses the effects of lyophilized mesenchymal stem cells on the viability and survival of autologous fat grafts. METHODS For this prospective treatment control study, 27 male Wistar albino rats were divided into three groups, each containing nine animals. In Group 1 (control), an incision was made in the right inguinal region, and the skin was closed with 4/0 prolene sutures. In Groups 2 and 3, fat pads collected from the right groin of the rats were lipoaspirated and placed on the sternum as a subcutaneous fat graft. The skin was then closed with 4/0 prolene sutures. Saline was added to the fat grafts of the Group 2 (sham) rats, and placenta-derived mesenchymal stem cell lyophilizate (MSC-L) was administered to the fat graft in the Group 3 (treatment) rats. After three months of treatment, the adipose tissue harvested from Group 1 and the fat grafts taken from Groups 2 and 3 were assessed histopathologically, stereologically and biochemically. RESULTS Adipose tissue volume was lower in Group 2 than in Groups 1 and 3, and the adipose tissue treated with MSC-L in Group 3 was better preserved than that in Group 1. Connective tissue and vascular volumes were greater in Group 3 than those in the other groups. The normal structures of adipocytes, fibrous tissues and vessels were better preserved in Group 3 than in Group 2, and a large number of new blood vessels were noted to have formed in Group 3. Damaged cystic cells, areas of calcification and degenerated adipocytes were noted in Group 2, while the G3PDH levels increased significantly more in Group 3 than in Group 2. CONCLUSION It was shown that MSC-L treatment plays an active role in maintaining the volume and survival of fat grafts by promoting neovascularization in this animal experimental study. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.
Collapse
Affiliation(s)
- Fatma Nilay Tutak
- Division of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Adiyaman University, Adiyaman, Turkey.
| | - Elfide Gizem Kıvrak
- Division of Histology and Embryology, Medical Faculty, Adiyaman University, Adiyaman, Turkey
| |
Collapse
|
7
|
Chen B, Zhu X, Guo J, Peng L, Zhang D. Effect of Adipose-Derived Stem Cell on Collagen Deposition in Nude Mouse Model of Scleroderma. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.3050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Systemic sclerosis is an autoimmune disease featured by uncontrolled fibrosis and collagen deposition. This study aimed to investigate the impact of adipose-derived stem cells (ADSCs) transplantation on collagen in scleroderma. After establishment of scleroderma model using Bleomycin,
the animals received subcutaneous injection of 0.3 ml fat (group B) or 0.3 ml fat+1×106 ADSCs (group C), or 1×106 ADSCs alone (group D). Mice treated with PBS were taken as control group (group A). One month after operation, the skin tissue at injection site
was collected for H&E staining, and immunohistochemistry to determine the content of TGF-β1 and type III collagen. Compared to control group, group B, C, and D exhibited improvement in collagen deposition and reduction in TGF-β1 content and type III collagen. Combined
graft of fat and ADSCs exerted more significant effect compared to single ADSCs treatment. In conclusion, fat and ADSCs transplantation improves collagen deposition in nude mice with scleroderma and the combined treatment exerts a higher efficacy, suggesting that ADSCs need adipose carrier
and microenvironment. These findings provide a novel insight into the treatment of scleroderma.
Collapse
Affiliation(s)
- Bo Chen
- Department of Burns and Plastic Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
| | - Xiongxiang Zhu
- Department of Burns and Plastic Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
| | - Jingdong Guo
- Department of Burns and Plastic Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
| | - Liang Peng
- Department of Burns and Plastic Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
| | - Dongmei Zhang
- Department of Burns and Plastic Surgery, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, 518000, China
| |
Collapse
|
8
|
Fat Grafting: Basic Science, Techniques, and Patient Management. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e3987. [PMID: 35317456 PMCID: PMC8932485 DOI: 10.1097/gox.0000000000003987] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
In this review, a summary of the rich history of autologous fat grafting is provided, and a comprehensive summary of the science and theory behind autologous adipocyte transplantation, as well as the techniques commonly used is described. These include recipient site preparation, harvesting, processing, and engraftment. In addition, important considerations for preoperative and postoperative management are discussed to maximize graft retention. Special considerations in grafting to the breast, face, and buttocks are also summarized.
Collapse
|
9
|
Rayes J, Sparavalo S, Wong I. Biological Augments for Acetabular Chondral Defects in Hip Arthroscopy-A Scoping Review of the Current Clinical Evidence. Curr Rev Musculoskelet Med 2021; 14:328-339. [PMID: 34778917 PMCID: PMC8733143 DOI: 10.1007/s12178-021-09721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW A wide array of joint-preserving surgical techniques exists in the management of acetabular chondral defects (ACDs). The purpose of this review is to summarize the clinical outcomes of the recent biologics used to treat ACDs during hip arthroscopy. RECENT FINDINGS Increasing evidence is available for different biological solutions used in the hip. Studies have shown promising outcomes with minimal complications when using biologics as augmentation to microfracture (MF), including different scaffolds or stem cells, or to enhance autologous chondrocyte implantation (ACI). However, data so far is scarce, and more trials and longer follow-ups are needed to better delineate the appropriate indications and benefits for each technique. Presently, the level of evidence is low, but in general, biologics appear safe and trend toward beneficial compared to standard surgical techniques. Augmented MF is recommended for small to medium ACDs, and matrix-assisted ACI or three-dimensional ACI is recommended for medium to large defects.
Collapse
Affiliation(s)
- Johnny Rayes
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, 5955 Veteran's Memorial Lane, Room 2106 VMB, Halifax, Nova Scotia, B3H 2E1, Canada
| | - Sara Sparavalo
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, 5955 Veteran's Memorial Lane, Room 2106 VMB, Halifax, Nova Scotia, B3H 2E1, Canada
| | - Ivan Wong
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, 5955 Veteran's Memorial Lane, Room 2106 VMB, Halifax, Nova Scotia, B3H 2E1, Canada.
| |
Collapse
|
10
|
Sun Y, Cao Y, Zhao R, Xu F, Wu D, Wang Y. The Role of Autologous PRP on Deep Partial-Thickness Burn Wound Healing in Bama Pigs. J Burn Care Res 2021; 41:657-662. [PMID: 32020201 DOI: 10.1093/jbcr/iraa012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In this study, we aimed to evaluate the therapeutic effects of autologous platelet-rich plasma (PRP) on deep partial-thickness burns in Bama pigs. Deep partial-thickness burn wounds were created on the back of Bama pigs. The reepithelialization time was compared between the PRP and control groups. The mean score of Ki67 (+) cells and α-SMA (+) vessels, the mean thickness of epidermis and dermis of the healing wounds were determined via H&E staining and immunohistochemical assay. The levels of the growth factors epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) were examined by ELISA. Our data showed that the time to wound reepithelialization was shorter in the PRP group compared with the control group. The thickness of the epidermis was larger in the PRP group compared with the control group. On the 7th and 14th days after the treatment, the mean score of Ki67 (+) cells and α-SMA (+) vessels were higher in the PRP group compared with the control group. The PRP group showed higher levels of growth factors (EGF, bFGF, and VEGF) compared with the control group by ELISA. The results indicated that PRP could improve wound healing process of deep partial-thickness burns in Bama pigs. The PRP increased the thickness of epidermis of the healed wounds, cell proliferation, and angiogenesis. We demonstrated that applying PRP had a greater potential for the treatment of deep partial-thickness burns.
Collapse
Affiliation(s)
- Yanwei Sun
- Department of Burns & Plastic Surgery, Zibo Central Hospital Affiliated to Shandong University, Zibo, Shandong Province, PR China
| | - Yongqian Cao
- Department of Burns & Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, PR China
| | - Ran Zhao
- Department of Burns & Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, PR China
| | - Famei Xu
- Department of Pathology, Zibo Central Hospital Affiliated to Shandong University, Zibo, Shandong Province, PR China
| | - Dan Wu
- Department of Burns & Plastic Surgery, Zibo Central Hospital Affiliated to Shandong University, Zibo, Shandong Province, PR China
| | - Yibing Wang
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, PR China
| |
Collapse
|
11
|
Soares RM, Prazeres Lopes S. Plasma rich in growth factors (PRGF -ENDORET®) to rescue necrotized orbital dermis-fat grafts. Orbit 2021; 41:558-562. [PMID: 34425734 DOI: 10.1080/01676830.2021.1966811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE We report on the clinical course of three patients treated with topical plasma rich in growth factors (PRGF) to rescue dermal-fat grafts (DFG) with graft ulceration (GU). MATERIALS AND METHODS A retrospective, case-series study of three patients diagnosed with GU in DFG and treated with PRGF. Drops were applied four times per day and treatment was maintained until the GU resolved. Data were collected from medical records and anterior segment photos. RESULTS All patients showed a favorable response to topical PRGF having accomplished full resolution of the GU within a mean of 30 days of treatment (range: 21-35 days). During the full extent of follow-up, no side-effects, signs of rejection or necrosis were reported and every patient was pleased with the final aesthetic result. CONCLUSION Our results suggest that PRGF could be an effective treatment for dermal graft ulceration in patients who underwent DFG surgery/implantation, mainly due to its low morbidity when compared to traditional procedures.
Collapse
Affiliation(s)
- Ricardo Machado Soares
- Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
| | - Sandra Prazeres Lopes
- Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
| |
Collapse
|
12
|
Crowley JS, Liu A, Dobke M. Regenerative and stem cell-based techniques for facial rejuvenation. Exp Biol Med (Maywood) 2021; 246:1829-1837. [PMID: 34102897 DOI: 10.1177/15353702211020701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This review discusses the most novel ideas and modalities being incorporated into facial rejuvenation. Recent innovative techniques include the use of regenerative stem cell techniques and regeneration supportive modalities such as nano-technology or gene therapies. This review aims to investigate approaches that are less well known and lacking established evidence in order to proactively study these techniques prior to them becoming popularized. These applications and relevant research were reviewed in the context of both surgical and non-surgical modalities in clinical practice. Future directions include the concept of "precision cosmetic medicine" utilizing gene editing and cellular therapies to tailor rejuvenation techniques based on each individual's genetic make-up and therefore needs.
Collapse
Affiliation(s)
- J Sarah Crowley
- Department of Surgery, Division of Plastic Surgery, UC San Diego School of Medicine, San Diego, CA 92103-8890
| | - Amy Liu
- Department of Surgery, Division of Plastic Surgery, UC San Diego School of Medicine, San Diego, CA 92103-8890
| | - Marek Dobke
- Department of Surgery, Division of Plastic Surgery, UC San Diego School of Medicine, San Diego, CA 92103-8890
| |
Collapse
|
13
|
Irmak F, Sizmaz M, Sirvan SS, Karsidag S, Ozagari A. The Effects of Vasonatrin Peptide on Fat Graft Viability: An Experimental Study. Facial Plast Surg 2021; 38:81-87. [PMID: 34100270 DOI: 10.1055/s-0041-1730387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Vasonatrin peptide (VNP) is a synthetic peptide that possesses vasodilatory, natriuretic, and anti-inflammatory properties. The authors aimed to analyze the effects of VNP on fat graft survival. Twenty Sprague-Dawley rats are randomly divided into two groups of 10. Fat grafts are harvested from the right inguinal region. After preparation, fat grafts are placed to the interscapular region. The first group of rats were administered VNP after their fat injection, while the second group received tail-vein injections of an equal volume of sterile saline following their fat injection. Experiment and control groups are evaluated according to their level of degeneration of adipocytes, fat necrosis, vacuolization, cyst formation in adipocytes, fibrosis of the fat tissue, capillary density, and CD31 immunohistochemical staining. Degeneration, vacuolization, and cyst formation in adipocytes were lower in the experiment group. Increased capillary density in the experiment group was demonstrated by CD31 antibody staining and by counting capillary density under a microscope. The average percentage of change in weight of the fat grafts in the experiment group was lower than that in the control group. The results indicate that VNP has some beneficial effects on fat graft survival by multiple independent mechanisms that influence both local and systemic homeostasis.
Collapse
Affiliation(s)
| | - Mert Sizmaz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selami Serhat Sirvan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Semra Karsidag
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Aysim Ozagari
- Department of Pathology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
14
|
Liu W, Shi K, Zhu X, Zhao H, Zhang H, Jones A, Liu L, Li G. Adipose Tissue-derived Stem cells in Plastic and Reconstructive Surgery: A Bibliometric Study. Aesthetic Plast Surg 2021; 45:679-689. [PMID: 31980863 DOI: 10.1007/s00266-020-01615-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Due to the evolving nature of the applications of adipose tissue-derived stem cells (ADSCs) and the rapidly growing body of scientific literature, it is difficult to generate a manual compilation and systematic review of ADSCs in plastic and reconstructive surgery. METHODS Bibliographic records were retrieved from the Web of Science Core Collection and analyzed with CiteSpace. RESULTS We retrieved 691 publications and their references. We identified 52 research categories. Interdisciplinary studies were common. The journals clustered into 13 subnetworks. The top institutions were Stanford University; University of Pittsburgh; University of Tokyo; University of California, Los Angeles; University of California, Davis; New York University; Tulane University; and University of Michigan. National Institutes of Health and National Natural Science Foundation of China provided the most generous financial support. Studies clustered into 22 topics. Emerging trends may include improvement of fat grafting, and application of ADSCs in wound healing, scleroderma, and facial rejuvenation. CONCLUSION The present study provides a panoramic view of ADSCs in plastic and reconstructive surgery. Analysis of journals, institutions, and grants could help researchers in different ways. Researchers may consider the emerging trends when deciding the direction of their study. 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 .
Collapse
Affiliation(s)
- Wenhui Liu
- Department of Plastic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Ke Shi
- Department of Plastic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Xuran Zhu
- Department of Plastic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Hongyan Zhao
- Department of Plastic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Hui Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Andrew Jones
- Center for Regenerative Medicine, Oregon Health and Science University, Portland, 97239, USA
| | - Linbo Liu
- Department of Plastic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Guangshuai Li
- Department of Plastic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.
| |
Collapse
|
15
|
Hong P, Xu X, Hu X, Yang H, Wu Y, Chen J, Li K, Tang Z. Therapeutic potential of small extracellular vesicles derived from lipoma tissue in adipose tissue regeneration-an in vitro and in vivo study. Stem Cell Res Ther 2021; 12:222. [PMID: 33789709 PMCID: PMC8011093 DOI: 10.1186/s13287-021-02291-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To explore the adipogenic effects of the small extracellular vesicles derived from the lipoma tissues (sEV-LT), and to find a new cell-free therapeutic approach for adipose tissue regeneration. METHODS Adipose tissue-derived stem cells (ADSCs) and small extracellular vesicles derived from the adipose tissues (sEV-AT) were isolated from human adipose tissue, while sEV-LT were isolated from human lipomatous tissue. ADSCs were characterized by using flow cytometric analysis and adipogenic and osteogenic differentiation assays. sEV was identified by electron microscopy, nanoparticle tracking, and western blotting. ADSCs were treated with sEV-LT and sEV-AT, respectively. Fluorescence confocal microscopy was used to investigate whether sEV-LT and sEV-AT could be taken by ADSCs. The proliferation and migration abilities and adipogenic differentiation assay of ADSCs were evaluated by CCK-8 assays, scratch test, and oil red O staining test, and the expression levels of adipogenic-related genes C/EBP-δ, PPARγ2, and Adiponectin in ADSCs were assessed by real-time quantitative PCR (RT-PCR). The sEV-LT and sEV-AT transplantation tubes were implanted subcutaneously in SD rats, and the neotissues were qualitatively and histologically evaluated at 2, 4, 8, and 12 weeks after transplantation. Hematoxylin and eosin (H&E) staining was subsequently used to observe and compare the adipogenesis and angiogenesis in neotissues, while immunohistochemistry was used to examine the expression and the distribution of C/EBP-α, PPARγ, Adiponectin, and CD31 at the 4th week. RESULTS The in vitro experiments showed that both sEV-LT and sEV-AT could be taken up by ADSCs via endocytosis. The scratch experiment and CCK-8 experiment showed that the migration area and proliferation number of ADSCs in sEV-LT group and sEV-AT group were significantly higher than those in the non-sEV group (p < 0.05). Compared with sEV-AT group, sEV-LT group had larger migration area and proliferation number of ADSCs (p < 0.05). Oil red O staining and RT-PCR experiments showed that, compared with the non-sEVs group, the lipid droplets and the mRNA expression levels of adipogenesis-related genes PPARγ2 and Adiponectin of ADSCs in sEV-LT group and sEV-AT group were significantly upregulated (p < 0.05); however, there was no statistical significance in the expression level of C/EBP-δ (p > 0.05). In addition, no significant difference in the amount of lipid droplets and adipogenesis-related genes between the sEV-LT groups and sEV-AT was seen (p > 0.05). At 2, 4, 8, and 12 weeks, the adipocyte area and the number of capillaries in neotissues in the sEV-LT groups and sEV-AT groups were significantly increased compared with the Matrigel group (p < 0.05); however, there was no dramatic difference between sEV-LT groups and sEV-AT groups (p > 0.05). At the 4th week, neotissues in the sEV-LT groups and sEV-AT groups all showed upregulated expression of C/EBP-α, PPARγ, Adiponectin, and CD31 protein, while neotissues in the Matrigel group only showed positive expression of CD31 protein. CONCLUSIONS This study demonstrated that sEV-LT exerted promotion effects on adipose tissue regeneration by accelerating the proliferation, migration, and adipogenic differentiation of ADSCs in vitro and recruiting adipocytes and promoting angiogenesis in vivo. The sEV-LT could serve as an alternative cell-free therapeutic strategy for generating adipose tissue, thus providing a promising application prospect in tissue engineering.
Collapse
Affiliation(s)
- Pengyu Hong
- Department of Oral & Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Xiaoyang Xu
- Department of Oral & Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Xin Hu
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Hao Yang
- Department of Oral & Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Yue Wu
- Department of Oral & Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Juan Chen
- Department of Oral & Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Kun Li
- Department of Oral & Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, 410008, Hunan, China.
| | - Zhangui Tang
- Department of Oral & Maxillofacial Surgery, Xiangya Stomatological Hospital & School of Stomatology, Central South University, Changsha, 410008, Hunan, China.
| |
Collapse
|
16
|
Li J, Chen W, Shi X, Yu P. Comparison of the Effects of Repeated Applications of Platelet-Rich Plasma versus Platelet-Poor Plasma on Fat Graft Survival in Nude Mice. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6613783. [PMID: 33644228 PMCID: PMC7902144 DOI: 10.1155/2021/6613783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/16/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
Abstract
Autologous fat grafting has been widely used for soft tissue filling in plastic surgery. Platelet-rich plasma (PRP) could play a wide role in health and disease because of containing a variety of growth factors and cytokines. Although previous studies have described the positive effect of autologous PRP mixed with fat grafts, only minimal improvements in fat graft survival have been reported. The present study is aimed at comparing the effects of PRP and platelet-poor plasma (PPP) on the survival and quality of fat grafting. We built a 180-day nude mouse model implanted with a fat graft supplemented with PRP, PPP, or saline, respectively. The above reagents (PRP, PPP, or saline) were injected two additional times after the initial engraftment. The survival ratio of the fat grafts and the capillary density in the PRP group were significantly higher than those in the PPP group and the saline group (control group) at 15, 30, 90, and 180 days posttransplantation (P < 0.05). The survival ratio of the PPP group was higher than that of the saline group (P < 0.05), but the capillary density in the PPP group was not significantly different from that in the saline group at any time point (P > 0.05). We hence conclude that the repeated application of PRP or PPP three times can enhance the survival of fat grafts within 180 days. Moreover, the effect of PRP is superior to that of PPP.
Collapse
Affiliation(s)
- Junjie Li
- Department of Aesthetic Plastic Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, China
| | - Wei Chen
- Department of Aesthetic Plastic Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, China
| | - Xiao Shi
- Department of Anesthesia, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Pijun Yu
- Department of Aesthetic Plastic Surgery, Shanghai Eighth People's Hospital, Shanghai 200235, China
| |
Collapse
|
17
|
Liang Z, Huang D, Nong W, Mo J, Zhu D, Wang M, Chen M, Wei C, Li H. Advanced-platelet-rich fibrin extract promotes adipogenic and osteogenic differentiation of human adipose-derived stem cells in a dose-dependent manner in vitro. Tissue Cell 2021; 71:101506. [PMID: 33607525 DOI: 10.1016/j.tice.2021.101506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/01/2023]
Abstract
Advanced platelet-rich fibrin (A-PRF) is an autogenous biological material obtained from peripheral blood. A-PRF extract (A-PRFe) contains a high concentration of various cytokines that are increasingly appreciated for their roles in improving stem cell repairing function during tissue regeneration. However, the optimal A-PRFe concentration to stimulate stem cells is unknown. This study aimed to identify the optimal concentrations of A-PRFe to promote adipogenic and osteogenic differentiation of human adipose-derived stem cells (ASCs). We produced A-PRFe from A-PRF clots by centrifuging fresh peripheral blood samples and isolated and identified ASCs using surface CD markers and multilineage differentiation potential. Enzyme-linked immunosorbent assay (ELISA) showed the concentrations of several cytokines, including b-FGF, PDGF-BB, and others, increased gradually, peaked on day 7 and then decreased. Cell proliferation assays showed A-PRFe significantly stimulated ASC proliferation, and proliferation significantly increased at higher A-PRFe doses. The degree of adipogenic and osteogenic differentiation increased at higher A-PRFe concentrations in the culture medium, as determined by oil red O and alizarin red staining. Reverse transcription polymerase chain reaction (RT-PCR) showed that expression levels of genes related to adipogenic/osteogenic differentiation (PPARγ2, C/EBPα, FABP4, Adiponectin, and ALP, OPN, OCN, RUNX2), paracrine (HIF-1α, VEGF, IGF-2) and immunoregulation (HSP70, IL-8) function were higher in groups with a higher concentration of A-PRFe than in lower concentration groups. This study demonstrates that A-PRFe is ideal for use in ASC applications in regenerative medicine because it improves biological functions, including proliferation, adipogenic/osteogenic differentiation, and paracrine function in a dose-dependent manner.
Collapse
Affiliation(s)
- Zhijie Liang
- Department of Wound Repair Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China; Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Donglin Huang
- Department of Plastic and Aesthetic Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| | - Wenhai Nong
- Department of Orthopaedics, the People's Hospital of Binyang County, Binyang, Guangxi, China
| | - Jinping Mo
- Department of Orthopaedics, the People's Hospital of Binyang County, Binyang, Guangxi, China
| | - Dandan Zhu
- Department of Wound Repair Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| | - Mengxin Wang
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Maojian Chen
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Changyuan Wei
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Hongmian Li
- Department of Plastic and Aesthetic Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China.
| |
Collapse
|
18
|
Xu PC, Xuan M, Cheng B. Effects and mechanism of platelet-rich plasma on military drill injury: a review. Mil Med Res 2020; 7:56. [PMID: 33220706 PMCID: PMC7680596 DOI: 10.1186/s40779-020-00285-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023] Open
Abstract
Military drill injury is a significant part of military medical research. The increase of training intensity and changes in training methods lead to differences in injury types. The ideal therapeutic modality should allow rapid healing at a reasonable cost and minimize impact on patients' life. Platelet -rich plasma (PRP), a platelet concentrate, is rich in a variety of growth factors and widely used clinically as a minimally invasive treatment. It plays an important role in injury repair and rehabilitation. In this article, we review the therapeutic role of PRP in military drill injury and its possible underlying mechanisms, with a focus on plantar fasciitis, stress fractures and other common injuries, in order to provide basic support for military reserve.
Collapse
Affiliation(s)
- Peng-Cheng Xu
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command of Chinese PLA, No. 111 Liuhua Road, Yuexiu District, Guangzhou, 510010, Guangdong Province, China
| | - Min Xuan
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command of Chinese PLA, No. 111 Liuhua Road, Yuexiu District, Guangzhou, 510010, Guangdong Province, China
| | - Biao Cheng
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command of Chinese PLA, No. 111 Liuhua Road, Yuexiu District, Guangzhou, 510010, Guangdong Province, China.
| |
Collapse
|
19
|
Tedesco M, Bellei B, Garelli V, Caputo S, Latini A, Giuliani M, Cota C, Chichierchia G, Romani C, Foddai ML, Cristaudo A, Morrone A, Migliano E. Adipose tissue stromal vascular fraction and adipose tissue stromal vascular fraction plus platelet-rich plasma grafting: New regenerative perspectives in genital lichen sclerosus. Dermatol Ther 2020; 33:e14277. [PMID: 32888384 DOI: 10.1111/dth.14277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 12/14/2022]
Abstract
Lichen sclerosus (LS) is a chronic relapsing, inflammatory skin disorder usually involving the anogenital region of both sexes lacking a resolutive therapy. This study compared adipose tissue derived-stromal vascular fraction (AD-SVF) and AD-SVF-enriched platelet-rich plasma (PRP) therapy in the management of genital LS patients. Additionally, in vitro evaluation of cells and growth factors contained in the injected SVF has been evaluated as possible predictive factors for treatment outcome. The study population was 40 patients diagnosed with LS who were symptomatic despite medical treatment. Patients (age 43-78 years) randomized into two groups using a 1:1 allocation ratio, were evaluated clinically and assessing dermatology life quality index (DLQI) before and 6 months after treatment. Both procedures demonstrated a strong safety profile with no complications linked to the therapy. After 6 months, both treatments allowed for a significant improvement respect to baseline. Combinatory therapy demonstrated decreased efficacy in late stage patients. No correlations have been found between clinical and biological findings. AD-SVF and AD-SVF plus PRP are safe and effective regenerative approaches for genital LS patients. Clinical results support the preferential use of combinatory therapy for early stage patients confirming a synergic effect of AD-SVF and PRP. In contrast, AD-SVF plus PRP is discouraged for late stage patients.
Collapse
Affiliation(s)
- Marinella Tedesco
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Valentina Garelli
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Silvia Caputo
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Alessandra Latini
- Lichen Sclerosus Unit, Department of Dermatology STI, Environmental Health, Tropical and Immigration, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Massimo Giuliani
- Lichen Sclerosus Unit, Department of Dermatology STI, Environmental Health, Tropical and Immigration, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Carlo Cota
- Department of Dermatology, IRCCS INRCA, Ancona, Italy.,Dermophatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Giuseppina Chichierchia
- Immunohaematology and Trasfusion Medicine, IRCCS Regina Elena National Cancer Institute, Rome, Italy.,Musculo-Skeletal Tissue Bank, IRCCS Regina Elena National Cancer Institute, Rome, Lazio, Italy
| | - Claudia Romani
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Maria Laura Foddai
- Immunohaematology and Trasfusion Medicine, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Cristaudo
- Lichen Sclerosus Unit, Department of Dermatology STI, Environmental Health, Tropical and Immigration, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Director San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Emilia Migliano
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| |
Collapse
|
20
|
Smith OJ, Leigh R, Kanapathy M, Macneal P, Jell G, Hachach-Haram N, Mann H, Mosahebi A. Fat grafting and platelet-rich plasma for the treatment of diabetic foot ulcers: A feasibility-randomised controlled trial. Int Wound J 2020; 17:1578-1594. [PMID: 32633854 DOI: 10.1111/iwj.13433] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
Chronic, nonhealing diabetic foot ulcers (DFU) are increasing in prevalence and are often unresponsive to conventional therapy. Adipose tissue, containing adipose-derived stem cells, and platelet rich plasma (PRP) are regenerative therapies rich in growth factors which may provide a solution to chronic wound healing. This study aimed to assess the feasibility of conducting a definitive randomised controlled trial (RCT) to investigate the efficacy of these therapies for the treatment of DFU. This was a single centre, feasibility, three-arm, parallel group RCT. Eligible DFU patients were randomised on a 1:1:1 basis to three intervention arms: control (podiatry); fat grafting; fat grafting with PRP. The intervention was delivered once and patients were followed-up for 12 weeks. The primary objective was to assess measures of trial feasibility. Clinical outcomes and health-related quality of life (HRQoL) were also evaluated. Three hundred and thirty four patients were screened and 32 patients (9.6%) were deemed eligible with 18 enrolled in the trial (6 per arm) over 17 months. All participants completed the trial with no withdrawals or crossover. Participant engagement was high with most HRQoL questionnaires returned and only 4.8% follow-up appointments missed. There were five adverse events (AEs) related to the trial with no serious AEs. Five (28%) of the wounds healed. There was no difference between any of the groups in terms of clinical outcomes. This feasibility study demonstrated that a multi-centre RCT is safe and feasible with excellent patient engagement. We have highlighted crucial information regarding methodology and recruitment, which will guide future trial design. Registration number: NCT03085550 clinicaltrials.gov. Registered 01/03/2017.
Collapse
Affiliation(s)
- Oliver J Smith
- Department of Plastic Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Richard Leigh
- Department of Podiatry, Royal Free Hospital, London, UK
| | | | - Peter Macneal
- Department of Plastic Surgery, St George's Hospital, London, UK
| | - Gavin Jell
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Haroon Mann
- Department of Trauma and Orthopaedics, Royal Free Hospital, London, UK
| | - Ash Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| |
Collapse
|
21
|
Abstract
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.
Collapse
|
22
|
Effect of Platelet-Rich Fibrin on Fat Grafting in Animal Models: A Meta-Analysis. Aesthetic Plast Surg 2020; 44:570-578. [PMID: 31844940 DOI: 10.1007/s00266-019-01563-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/28/2019] [Indexed: 12/22/2022]
Abstract
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.
Collapse
|
23
|
Li Y, Mou S, Xiao P, Li G, Li J, Tong J, Wang J, Yang J, Sun J, Wang Z. Delayed two steps PRP injection strategy for the improvement of fat graft survival with superior angiogenesis. Sci Rep 2020; 10:5231. [PMID: 32251339 PMCID: PMC7089949 DOI: 10.1038/s41598-020-61891-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/28/2020] [Indexed: 12/21/2022] Open
Abstract
Platelet-rich plasma (PRP) has been widely used to improve the fat retention rate in autologous fat transplantation since it possesses a good angiogenesis capability in vivo. However, due to the short half-life of growth factors released from PRP and its uneven distribution in injected fat tissue, the strategy of PRP in fat transplantation needs further improvement. Since the capillaries started to grow into fat grafts in 1 week and vascular growth peaks in the second week after transplantation, we hypothesized that delayed two-steps PRP injection into the interior of grafts, accompanied with the extent of neovascularization might theoretically promote microvessel growth inside transplanted adipose tissue. 24 nude mice were divided into three groups: Blank group (0.35 mL fat mixed with 0.15 mL saline, N = 8), Single step group (0.35 mL fat mixed with 0.15 mLPRP, N = 8), and Two steps group (0.35 mL fat (day 0) + 0.075 mL PRP (day 7) + 0.075 mL PRP (day 14), N = 8). At 6 and 14 weeks post-transplantation, grafts were dissected, weighted, and assessed for histology, angiogenesis, fat regeneration and inflammation level. The weight and volume of the fat samples revealed no statistical difference among the three groups at 6 weeks after fat transplantation. The weight and volume of the Two steps group fat samples showed significantly higher compared to that in Blank and Single step groups at 14 weeks after fat transplantation (weight: 137.25 ± 5.60 mg versus 87.5 ± 3.90 mg,106.75 ± 2.94 mg, respectively; volume: 0.13 ± 0.01 mL versus 0.08 ± 0.01 mL, 0.09 ± 0.01 mL, respectively). Histological assessments indicated that delayed two-steps PRP injection strategy helps to improve adipose tissue content and reduce the composition of fibrous connective tissue at 14 weeks after fat transplantation. At 6 weeks and 14 weeks after transplantation, CD31 immunofluorescence indicated that delayed two-steps PRP injection strategy helps to improve angiogenesis and significantly higher compared to that in Blank and Single step groups (6 weeks: 28.75 ± 4.54 versus 10.50 ± 2.06, 21.75 ± 1.85; 14 weeks: 21.75 ± 2.86 versus 9.87 ± 2.08, 11.75 ± 1.47, respectively). Preadipocyte count indicated delayed two-steps PRP injection strategy might promote fat regeneration and significantly higher compared to that in Blank and Single step groups at 14 weeks (129.75 ± 6.57 versus 13.50 ± 3.50, 17.12 ± 6.23, respectively). In this study, we demonstrated that the novel delayed two-steps PRP injection strategy remarkably enhanced the long-term fat retention rate and improved the neovascularization extent in the interior of the fat graft. Platelet-rich plasma, Delayed two-steps injection, Angiogenesis, Fat transplantation.
Collapse
Affiliation(s)
- Yuan Li
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
- Department of Plastic Surgery, Wuhan Third Hospital (Tongren Hospital of WuHan University), Wuhan, 430060, China
- Wuhan Clinical Research, Center for Superficial Organ Reconstruction, Wuhan, 430022, China
| | - Shan Mou
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
- Wuhan Clinical Research, Center for Superficial Organ Reconstruction, Wuhan, 430022, China
| | - Peng Xiao
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
- Wuhan Clinical Research, Center for Superficial Organ Reconstruction, Wuhan, 430022, China
| | - Guining Li
- Wuhan Clinical Research, Center for Superficial Organ Reconstruction, Wuhan, 430022, China
- Department of Transfusion, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Jialun Li
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
- Wuhan Clinical Research, Center for Superficial Organ Reconstruction, Wuhan, 430022, China
| | - Jing Tong
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
- Wuhan Clinical Research, Center for Superficial Organ Reconstruction, Wuhan, 430022, China
| | - Jiecong Wang
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China
- Wuhan Clinical Research, Center for Superficial Organ Reconstruction, Wuhan, 430022, China
| | - Jie Yang
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
- Wuhan Clinical Research, Center for Superficial Organ Reconstruction, Wuhan, 430022, China.
| | - Jiaming Sun
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
- Wuhan Clinical Research, Center for Superficial Organ Reconstruction, Wuhan, 430022, China.
| | - Zhenxing Wang
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
- Wuhan Clinical Research, Center for Superficial Organ Reconstruction, Wuhan, 430022, China.
| |
Collapse
|
24
|
Cai Y, Yu Z, Yu Q, Zheng H, Xu Y, Deng M, Wang X, Zhang L, Zhang W, Li W. Fat Extract Improves Random Pattern Skin Flap Survival in a Rat Model. Aesthet Surg J 2019; 39:NP504-NP514. [PMID: 31001623 DOI: 10.1093/asj/sjz112] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adipose tissue and its derivatives, including adipose-derived stem cells, stromal vascular fraction (SVF), and SVF-gel, have been utilized in the treatment of many ischemic disorders. However, the utilization of these products is limited in clinical applications by concerns related to the presence of cells in these derivatives. OBJECTIVES This study aimed to isolate a cell-free fat extract (FE) from fat tissue and to evaluate its proangiogenic ability in vitro as well as its protective effects on skin flap survival in vivo. METHODS FE was isolated from human fat via a mechanical approach. The concentrations of several growth factors in the FE were determined by enzyme-linked immunosorbent assay. The proangiogenic ability of FE was evaluated utilizing assays of the proliferation, migration, and tube formation in human umbilical vein endothelial cells in vitro. The protective effects of FE on the survival of random pattern skin flaps were investigated by subcutaneous injection into rats. RESULTS Enzyme-linked immunosorbent assay results revealed that FE contained proangiogenic growth factors that promoted proliferation, migration, and tube formation in human umbilical vein endothelial cells in vitro. In addition, FE reduced skin flap necrosis and increased survival, as demonstrated by macroscopic measurements and blood flow analysis. Histological analysis revealed that FE treatment increased the capillary density. CONCLUSIONS FE is a cell-free, easy-to-prepare, and growth-factor-enriched liquid derived from human adipose tissue that possesses proangiogenic activity and improves skin flap survival by accelerating blood vessel formation. FE may be potentially used for treating ischemic disorders.
Collapse
Affiliation(s)
- Yizuo Cai
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Ziyou Yu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Qian Yu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Hongjie Zheng
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Yuda Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Mingwu Deng
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Xiangsheng Wang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Lu Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Wenjie Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Wei Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| |
Collapse
|
25
|
Kim SJ, Kim SM, Kim CK, Jo DI, Kim SH. A novel cannula for uniform mixing of liquid substances. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2019. [DOI: 10.14730/aaps.2019.01788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
26
|
Abstract
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.
Collapse
Affiliation(s)
- Shaoheng Xiong
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, No. 15 Changle Western Road, Xi'an, Shaanxi, China
| | - Chenggang Yi
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, No. 15 Changle Western Road, Xi'an, Shaanxi, China.
| | - Lee L Q Pu
- Division of Plastic Surgery, University of California Davis Medical Center, 2335 Stockton Boulevard, Suite 6008, Sacramento, CA 95817, USA.
| |
Collapse
|
27
|
Abstract
Fat grafting is as a unique regenerative filler with soluble factors and progenitor cells that may remodel scar tissue in an easy yet effective way. A combination of microfat grafting, lipococoncentrate injection, scar subcision, and platelet-rich plasma supplementation may be used to treat the majority of facial scars. The lipoconcentrate technique condenses the lipoaspirate to a progenitor cell-rich fluid of low volume by a combination of centrifugation and emulsification steps. In this article, the authors' methods for scar treatment by fat grafting are discussed. Choice of technique for facial scars, precise indications, and contraindications are introduced.
Collapse
Affiliation(s)
- Norbert Pallua
- Aesthetic Elite International - Private Clinic, Königsallee 88, Düsseldorf 40212, Germany.
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Rämistrasse 100, Zurich 8091, Switzerland
| |
Collapse
|
28
|
Kim HS, Kim BR, Youn SW. Pedicled Fat Transposition vs Free-Fat Grafting for Lower Blepharoplasty With Volume Preservation-Reply. JAMA FACIAL PLAST SU 2019; 21:464-465. [PMID: 31246230 DOI: 10.1001/jamafacial.2019.0480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hyung Su Kim
- Seoul H Dermatology Clinic, Seoul, Republic of Korea
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
29
|
Lei X, Liu H, Pang M, Zheng Z, Tan X, Cheng B. Effects of Platelet-Rich Plasma on Fat and Nanofat Survival: An Experimental Study on Mice. Aesthetic Plast Surg 2019; 43:1085-1094. [PMID: 30919033 DOI: 10.1007/s00266-019-01355-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/05/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nanofat and fat graft survival is an important clinical problem. The authors of this study investigated whether PRP has an impact on fat and nanofat graft survival and vascularization in a mouse model. MATERIALS AND METHODS Fat was harvested from a 50-year-old healthy woman by vacuum suction, and nanofat was obtained by emulsification and centrifugation procedures. PRP was collected after two rounds of centrifugation from an autologous blood sample. Twenty male nude mice were divided into four treatment groups: PRP/nanofat, PRP/fat, saline/nanofat and saline/fat. After 1 month and 3 months, the grafts were extracted and weighed. The microstructure of the fat and nanofat was examined with a scanning electron microscope. HE and immunohistochemical staining was applied to observe neovascularization. Western blot analysis was used to analyse the expression of CD31 and VEGF. RESULTS In fat tissue, fat cells had normal connections; the fat structure was complete and fibre networks were visible. In nanofat, the extracellular matrix vascular components were visible and their structures were intact. At 1 month and 3 months, the graft weights in the PRP/fat group were significantly higher than those in the other groups. Further, a higher degree of neovascularization was observed in the PRP/nanofat group, and the expression of CD31 and VEGF in the PRP/nanofat group was higher than that in the other groups. CONCLUSION PRP can promote nanofat and fat graft survival and vascularization. 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 .
Collapse
|
30
|
El Rayes J, Bou Sader R, Moutran M, Rassi S, Boueri W. Biologically Enhanced Hamstring Tendon Transfer for Treatment of Acute Rupture of Posterior Tibialis Tendon in an Athlete: Case Report. J Foot Ankle Surg 2019; 58:647-652. [PMID: 30448181 DOI: 10.1053/j.jfas.2018.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Indexed: 02/03/2023]
Abstract
We report the case of a 32-year-old basketball player who presented with an acute flatfoot deformity after performing a unipodal power jump. Rupture of the posterior tibial tendon within the foot was diagnosed and then treated by hamstring tendon transfer combined with application of autologous biologic preparations. The functional outcome at 18 months was good. To our knowledge, this is the first reported case of posterior tibial tendon rupture treated by hamstring tendon transfer.
Collapse
Affiliation(s)
- Johnny El Rayes
- Surgeon, Department of Orthopedic Surgery, Bellevue University Medical Center, Mansourieh, Lebanon.
| | - Roula Bou Sader
- Radiologist, Department of Radiology, Bellevue University Medical Center, Mansourieh, Lebanon
| | - Michel Moutran
- Surgeon, Department of Plastic Surgery, Bellevue University Medical Center, Mansourieh, Lebanon
| | - Sahar Rassi
- Pathologist, Institut National de Parthologie INP, Hadeth, Lebanon
| | - Wissam Boueri
- Surgeon, Department of Orthopedic Surgery, Sports Medicine, Bellevue University Medical Center, Mansourieh, Lebanon
| |
Collapse
|
31
|
Atashi F, André-Lévigne D, Colin DJ, Germain S, Pittet-Cuénod B, Modarressi A. Does non-activated platelet-rich plasma (PRP) enhance fat graft outcome? An assessment with 3D CT-scan in mice. J Plast Reconstr Aesthet Surg 2019; 72:669-675. [DOI: 10.1016/j.bjps.2018.12.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/23/2018] [Accepted: 12/21/2018] [Indexed: 12/25/2022]
|
32
|
Liang ZJ, Lu X, Zhu DD, Yi XL, Wu FX, He N, Tang C, Wei CY, Li HM. Ginsenoside Rg1 Accelerates Paracrine Activity and Adipogenic Differentiation of Human Breast Adipose-Derived Stem Cells in a Dose-Dependent Manner In Vitro. Cell Transplant 2019; 28:286-295. [PMID: 30675799 PMCID: PMC6425106 DOI: 10.1177/0963689719825615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Augmenting the biological function of adipose-derived stromal cells (ASCs) is a promising approach to promoting tissue remodeling in regenerative medicine. Here, we examined the effect of ginsenoside Rg1 on the paracrine activity and adipogenic differentiation capacity of human breast ASCs (hbASCs) in vitro. hbASCs were isolated and characterized in terms of stromal cell surface markers and multipotency. Third-passage hbASCs were cultured in basic media only or basic media containing different concentrations of G-Rg1 (0.1-100 μM). Cell proliferation was assessed by CCK-8 assay. Paracrine activity was assessed using ELISA. Gene expression was measured by qRT-PCR. Adipogenic differentiation capacity was evaluated by Oil red O staining. We found that hbASCs differentiated into adipocytes, osteoblasts, and chondrocytes in appropriate induction culture medium. hbASCs showed expression of CD29, CD44, CD49d, CD73, CD90, CD105, and CD133 but not CD31 and CD45 surface markers. G-Rg1 increased hbASC proliferation and adipogenic differentiation capacity at lower concentrations (0.1-1 μM) and had the opposite effects at higher concentrations (10-100 μM), while enhanced paracrine activity was observed in all experimental groups compared with control group, and the activation effect of lower concentration G-Rg1 was greater than at higher concentration. These results indicate that G-Rg1 can enhance the proliferation, paracrine activity, and adipogenic differentiation capacity of hbASCs within a certain concentration range. Therefore, the use of G-Rg1 may be beneficial to ASC-assisted fat graft regeneration and soft tissue engineering.
Collapse
Affiliation(s)
- Zhi-Jie Liang
- 1 Department of Breast Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.,2 Department of Breast and Thyroid Surgery, The Fifth Affiliated Hospital of Guangxi Medical University &The First People's Hospital of Nanning, Nanning, China
| | - Xiang Lu
- 3 Department of Hematology, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| | - Dan-Dan Zhu
- 4 Department of Plastic and Aesthetic Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| | - Xiao-Lin Yi
- 4 Department of Plastic and Aesthetic Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| | - Fang-Xiao Wu
- 4 Department of Plastic and Aesthetic Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| | - Ning He
- 4 Department of Plastic and Aesthetic Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| | - Chao Tang
- 5 Department of Plastic and Aesthetic Surgery, The Mengxiang Plastic Hospital, Nanning, China
| | - Chang-Yuan Wei
- 1 Department of Breast Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Hong-Mian Li
- 4 Department of Plastic and Aesthetic Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| |
Collapse
|
33
|
Sadeghinia A, Davaran S, Salehi R, Jamalpoor Z. Nano-hydroxy apatite/chitosan/gelatin scaffolds enriched by a combination of platelet-rich plasma and fibrin glue enhance proliferation and differentiation of seeded human dental pulp stem cells. Biomed Pharmacother 2019; 109:1924-1931. [DOI: 10.1016/j.biopha.2018.11.072] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 12/26/2022] Open
|
34
|
Smith OJ, Jell G, Mosahebi A. The use of fat grafting and platelet-rich plasma for wound healing: A review of the current evidence. Int Wound J 2018; 16:275-285. [PMID: 30460739 DOI: 10.1111/iwj.13029] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/16/2018] [Indexed: 12/17/2022] Open
Abstract
Fat grafting is becoming a common procedure in regenerative medicine because of its high content of growth factors and adipose derived stem cells (ADSCs) and the ease of harvest, safety, and low cost. The high concentration of ADSCs found in fat has the potential to differentiate into a wide range of wound-healing cells including fibroblasts and keratinocytes as well as demonstrating proangiogenic qualities. This suggests that fat could play an important role in wound healing. However retention rates of fat grafts are highly variable due in part to inconsistent vascularisation of the transplanted fat. Furthermore, conditions such as diabetes, which have a high prevalence of chronic wounds, reduce the potency and regenerative potential of ADSCs. Platelet-rich plasma (PRP) is an autologous blood product rich in growth factors, cell adhesion molecules, and cytokines. It has been hypothesised that PRP may have a positive effect on the survival and retention of fat grafts because of improved proliferation and differentiations of ADSCs, reduced inflammation, and improved vascularisation. There is also increasing interest in a possible synergistic effect that PRP may have on the healing potential of fat, although the evidence for this is very limited. In this review, we evaluate the evidence in both in vitro and animal studies on the mechanistic relationship between fat and PRP and how this translates to a benefit in wound healing. We also discuss future directions for both research and clinical practice on how to enhance the regenerative potential of the combination of PRP and fat.
Collapse
Affiliation(s)
- Oliver J Smith
- Department of Plastic Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Gavin Jell
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Ash Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| |
Collapse
|
35
|
Sayadi LR, Obagi Z, Banyard DA, Ziegler ME, Prussak J, Tomlinson L, Evans GRD, Widgerow AD. Platelet-Rich Plasma, Adipose Tissue, and Scar Modulation. Aesthet Surg J 2018; 38:1351-1362. [PMID: 29617719 DOI: 10.1093/asj/sjy083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Level of Evidence: 4.
Collapse
Affiliation(s)
- Lohrasb R Sayadi
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Zaidal Obagi
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Derek A Banyard
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Mary E Ziegler
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Jordyne Prussak
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Luke Tomlinson
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Gregory R D Evans
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| | - Alan D Widgerow
- Department of Plastic Surgery Center for Tissue Engineering, University of California, Irvine, Orange, CA
| |
Collapse
|
36
|
Chaparro Tapias TA, Díaz Díaz AL, Secondi R, Coy Villamil H, Sánchez España JC. Platelet-rich plasma to rescue an ulcerated orbital dermal fat graft. Eur J Ophthalmol 2018; 29:654-658. [DOI: 10.1177/1120672118805299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Central graft ulceration is a rare complication of an orbital dermal fat graft caused by diminished blood supply to the implant. This study reports on the efficacy and safety of the use of a single subconjunctival injection of autologous platelet-rich plasma to rescue an ulcerated orbital dermal fat graft. Methods: Three patients, who had undergone autologous dermal fat graft to treat their anophthalmic socket, were given a 2-mL subconjunctival platelet-rich plasma injection in the exposed graft margins. Demographic and clinical features, treatment protocol, clinical course, complications and follow-up time are reported. In the preoperative examination, all the patients presented a primary epithelial defect of the dermal fat graft. Results: There were no major complications such as necrosis or infection. One patient presented a small conjunctival granuloma at 1-month follow up. Mean postoperative follow-up duration was 13 (range: 10–16) months. By 1 month, the chronic epithelial defect had resolved with the graft integrated within the orbital tissues in all cases. All patients were referred for artificial prosthesis placement. Conclusion: Although further work is needed, our findings suggest that a single subconjunctival platelet-rich plasma injection could be an effective, safe and economic alternative to surgery to rescue an ulcerated orbital dermal fat graft.
Collapse
Affiliation(s)
| | | | - Roberto Secondi
- Facolta di Medicina e Psicologia, Universita degli Studi di Roma La Sapienza, Rome, Italy
| | | | | |
Collapse
|
37
|
Review: Proposed Methods to Improve the Survival of Adipose Tissue in Autologous Fat Grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1870. [PMID: 30324057 PMCID: PMC6181489 DOI: 10.1097/gox.0000000000001870] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/01/2018] [Indexed: 01/13/2023]
Abstract
In 2009, the American Society of Plastic Surgeons Task Force on Autologous Fat Grafting (AFG) determined that autologous fat grafting was a safe procedure with a relatively low rate of complications. This consensus opinion unleashed a wave of popularity as plastic surgeons discovered the procedures' efficacy in a wide variety of cosmetic and reconstructive indications. Frequently reported cosmetic applications include soft-tissue augmentation of breast, buttocks, hips, face, and hands, whereas reconstructive applications include adjunct for breast reconstruction contour problems, plantar fat pad improvement, and correction of various posttraumatic and surgical contour deformities. Recognition of other regenerative effects of fat grafting expanded the use AFG for improvement of hypertrophic scar tissue, postradiation sequelae, lipodystrophy, hyperpigmentation, senile skin changes, and actinic damage. The popularity of AFG is supported by a remarkably low risk of complications, minimal scars, and readily available donor sites. Despite recognition of the advantages of AFG, there still is no consensus regarding optimal techniques of harvest, graft preparation, and injection. Further, the yield of permanent volume falls within a very wide range. In this article, we review the basic science of fat grafting, proposed methods offered to improve engraftment, and reported outcomes of AFG procedures.
Collapse
|
38
|
|
39
|
Yu Q, Cai Y, Huang H, Wang Z, Xu P, Wang X, Zhang L, Zhang W, Li W. Co-Transplantation of Nanofat Enhances Neovascularization and Fat Graft Survival in Nude Mice. Aesthet Surg J 2018; 38:667-675. [PMID: 29161346 DOI: 10.1093/asj/sjx211] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Autologous fat grafting is commonly used for soft-tissue augmentation and reconstruction. However, this technique is limited by a high rate of graft absorption. Thus, approaches to improve fat graft survival that promote neovascularization are of great interest. Nanofat has several beneficial features that may render it more suitable for clinical applications than other stem-cell based approaches. OBJECTIVES We aimed to determine whether nanofat could enhance new vessel formation and improve the long-term retention of fat grafts. METHODS Nanofat was processed via mechanical emulsification and filtration. Fat grafts were transplanted subcutaneously under the scalps of nude mice with different nanofat volumes or without nanofat. The grafted fat was dissected 12 weeks after transplantation. Graft weight and volume were measured, and histological evaluations, including capillary density measurement, were performed. RESULTS The co-transplantation of fat with nanofat showed higher graft weight and volume retention, better histological structure, and higher capillary density compared to that in controls. However, there were no significant differences between the two nanofat volumes utilized. CONCLUSIONS Nanofat can enhance neovascularization and improve fat graft survival, providing a potential clinically viable approach to fat graft supplementation in plastic and reconstructive surgery.
Collapse
Affiliation(s)
- Qian Yu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Yizuo Cai
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - He Huang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Zhenxing Wang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Peng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Xiangsheng Wang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Lu Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Wenjie Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Wei Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| |
Collapse
|
40
|
Xiong BJ, Tan QW, Chen YJ, Zhang Y, Zhang D, Tang SL, Zhang S, Lv Q. The Effects of Platelet-Rich Plasma and Adipose-Derived Stem Cells on Neovascularization and Fat Graft Survival. Aesthetic Plast Surg 2018; 42:1-8. [PMID: 29302732 DOI: 10.1007/s00266-017-1062-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 12/13/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adipose-derived stem cell (ADSCs)-assisted and platelet-rich plasma (PRP)-assisted lipofilling aim to enhance angiogenesis and cell proliferation and are promising techniques for lipofilling. This study aimed to compare the outcomes of ADSCs-assisted and PRP-assisted lipofilling. METHODS Adipose tissue and human venous blood were obtained from women with early breast cancer. Human ADSCs were isolated and amplified in vitro. PRP was extracted through double centrifugation. The effect of PRP on ADSCs proliferation was evaluated. In the in vivo study, 1 ml of adipose tissue with saline (control group), PRP (PRP group), or ADSCs (ADSCs group) was injected subcutaneously into the dorsum of nude mice. At 2, 4, 8, and 12 weeks after injection, tissues were assessed for volume retention and ultrasound abnormality. For histological assessment, hematoxylin and eosin staining were performed. RESULTS Cytokines in PRP and blood were comparable. Regarding the in vitro assay, PRP significantly improved ADSCs proliferation, and the effect was dose-dependent. Concerning the in vivo study, for each time point, ADSCs-assisted lipofilling showed superior volume maintenance. Similarly, the PRP group showed improved angiogenesis and fat survival, as compared with the control group. The angiogenic effect of PRP was inferior to that of ADSCs at most time points. No significant difference was observed at 12 weeks after lipofilling. Complication rates were comparable between the PRP group and ADSCs group. CONCLUSIONS PRP-assisted and ADSCs-assisted lipofilling can significantly improve the cosmetic results of grafted fat. PRP-assisted lipofilling, which is considered convenient and clinically available, is a promising technique to improve neovascularization and fat survival. 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 .
Collapse
|
41
|
Luck J, Smith OJ, Mosahebi A. A Systematic Review of Autologous Platelet-Rich Plasma and Fat Graft Preparation Methods. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1596. [PMID: 29632775 PMCID: PMC5889438 DOI: 10.1097/gox.0000000000001596] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/16/2017] [Indexed: 12/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Joshua Luck
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Oliver J Smith
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Afshin Mosahebi
- Department of Plastic & Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| |
Collapse
|
42
|
Zhang Y, Xiao LL, Li JX, Liu HW, Li SH, Wu YY, Liao X, Rao CQ. Improved fat transplantation survival by using the conditioned medium of vascular endothelial growth factor transfected human adipose-derived stem cells. Kaohsiung J Med Sci 2017; 33:379-384. [DOI: 10.1016/j.kjms.2017.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/13/2017] [Indexed: 12/28/2022] Open
|
43
|
Chatel H, Hersant B, Bosc R, La Padula S, Meningaud JP. Midface rejuvenation surgery combining preperiosteal midcheek lift, lower blepharoplasty with orbital fat preservation and autologous fat grafting. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:283-288. [PMID: 28684338 DOI: 10.1016/j.jormas.2017.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/30/2017] [Accepted: 06/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to describe a technique for midface rejuvenation combining lower blepharoplasty, midcheek lift and autologous fat transfer. METHODS All patients who underwent a midface rejuvenation procedure performed by the same surgeon and using a classic subciliary blepharoplasty surgical approach were identified. The technique combined three distinct procedures: lower blepharoplasty with use of a transposition flap of orbital adipose tissue in the medial and central compartment to reduce the subpalpebral bags and attenuate the palpebrojugual sulcus; midcheek lift in the preperiosteal plane with trans-osseous fixation exerting traction on the soft tissues of the cheek along several vectors; autologous fat transfer to offset the loss of volume in the target area. RESULTS Between January 2011 and December 2015, 14 patients were operated with the described technique. Long-term results were good and stable over time. Two complications in the form of ectropion were observed in the series but resolved with daily massages. CONCLUSIONS The combination of lower blepharoplasty, midcheek lift and autologous fat transfer appear to enable treatment of midface ageing. The results were satisfactory and durable, and the procedure was well tolerated. The procedures could be combined with others for the treatment of the upper and lower face during the same surgical procedure.
Collapse
Affiliation(s)
- H Chatel
- Department of Plastic, Reconstructive and Maxillo-facial Surgery, Henri-Mondor Hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - B Hersant
- Department of Plastic, Reconstructive and Maxillo-facial Surgery, Henri-Mondor Hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - R Bosc
- Department of Plastic, Reconstructive and Maxillo-facial Surgery, Henri-Mondor Hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - S La Padula
- Department of Plastic, Reconstructive and Maxillo-facial Surgery, Henri-Mondor Hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - J P Meningaud
- Department of Plastic, Reconstructive and Maxillo-facial Surgery, Henri-Mondor Hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| |
Collapse
|
44
|
Gersch RP, Glahn J, Tecce MG, Wilson AJ, Percec I. Platelet Rich Plasma Augments Adipose-Derived Stem Cell Growth and Differentiation. Aesthet Surg J 2017; 37:723-729. [PMID: 28333339 DOI: 10.1093/asj/sjw235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Adipose-derived stem cells (ASCs) are a powerful tool for cosmetic surgery and regenerative medicine. The use of autologous platelet rich plasma (PRP), particularly in combination with ASC-based therapy, has significantly expanded in recent years. Unfortunately, the mechanisms and optimal dosing responsible for the beneficial effects of PRP remain poorly understood. Here we investigate the effect of PRP on ASC growth and differentiation. OBJECTIVES To assess the impact of different PRP feeding and cryopreservation protocols on ASC isolation, expansion, and differentiation. METHODS Human PRP was isolated using the Magellan System (Arteriocyte). Fresh PRP (fPRP), flash frozen PRP (ffPRP), and cryopreserved PRP (cPRP) were added to human ASCs isolated from healthy patients. A panel of PRP supplementation protocols was analyzed for ASC adherence, proliferation, and osteogenesis. RESULTS The fresh and cryopreserved PRP groups demonstrated reduced cell adherence compared to control (non-PRP) groups (P < 0.001), while the flash frozen PRP groups showed cell adherence equivalent to or better than controls. After 7 days of growth, ASC populations for fPRP and ffPRP Single Administration protocols were significantly higher than other feeding protocols and controls. This benefit was lost in cPRP groups. Optimized ffPRP protocols showed potential for spontaneous osteogenesis. CONCLUSIONS Addition of ffPRP improves initial ASC adherence while a single administration of either fresh or flash frozen PRP without additional cell manipulation significantly augments subsequent ASC proliferation. The potential for spontaneous osteogenic differentiation upon PRP exposure invokes the need for additional molecular studies of PRP activity prior to further expansion to clinical applications.
Collapse
Affiliation(s)
- Robert P Gersch
- From the Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Joshua Glahn
- From the Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Michael G Tecce
- From the Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Anthony J Wilson
- From the Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Ivona Percec
- From the Department of Surgery, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
45
|
Blumenschein AR, Freitas-Junior R, Moreira MAR, Cysneiros MAPC, Pereira RN, Tufanin AT, Soares LR. Is the combination of fat grafts and platelet rich plasma effective in rats? Acta Cir Bras 2017; 31:668-674. [PMID: 27828600 DOI: 10.1590/s0102-865020160100000005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/15/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To investigate if the association of fat grafts and platelet-rich plasma (PRP) improves graft viability in female rats. METHODS: This is an experimental, randomized and blinded study, which involved 47 rats. Fat was harvested from the inguinal region and grafted to the cranial region. The experimental group consisted of PRP-enriched fat grafts (n=22) whilst the control group consisted of fat graft only (n=25). After a 100-day period, the animals were euthanised and the fat grafts were analyzed using scores from 0 (absent) to 4 (abundant), in optical microscopy by two independent and blinded pathologists. RESULTS: Regarding fat graft cell viability, the PRP group scored moderate/abundant in 63% of cases and the fat graft only group scored absent/slight in 72% of cases (p=0.03). The PRP group also presented lower fat necrosis scores when compared to the fat graft only group (p=0.03). Tumors (dermoid cysts) within the fat grafts were observed in three animals in which the grafts were mixed with PRP. CONCLUSION: Platelet-rich plasma improves the viability and integration of fat grafts in rats, but more studies are needed to fully understand the exact mechanisms that lead to this improvement and assess the safety of the method for use in humans.
Collapse
Affiliation(s)
- Alexandre Roriz Blumenschein
- MSc, Mastology Program, Teaching Hospital, Universidade Federal de Goiás (UFG), Brazil. Conception and design of the study, acquisition of data, manuscript writing, critical revision, final approval of the manuscript
| | - Ruffo Freitas-Junior
- PhD, Mastology Program, Teaching Hospital, UFG, Goiania-GO, Brazil. Conception and design of the study, critical revision, final approval of the manuscript
| | - Marise Amaral Rebouças Moreira
- PhD, Department of Pathology and Imaging, School of Medicine, UFG, Goiania-GO, Brazil. Acquisition of data, critical revision, final approval of the manuscript
| | | | - Roseana Netto Pereira
- MD, Mastology Program, Teaching Hospital, UFG, Goiania-GO, Brazil. Acquisition of data, manuscript writing, critical revision
| | - Andrea Thomazine Tufanin
- MSc, Mastology Program, Teaching Hospital, UFG, Goiania-GO, Brazil. Conception and design of the study, acquisition of data, critical revision
| | - Leonardo Ribeiro Soares
- MD, Mastology Program, Teaching Hospital, UFG, Goiania-GO, Brazil. Acquisition of data, manuscript writing, critical revision
| |
Collapse
|
46
|
Leukocyte-Reduced Platelet-Rich Plasma Alters Protein Expression of Adipose Tissue-Derived Mesenchymal Stem Cells. Plast Reconstr Surg 2017; 138:397-408. [PMID: 27064225 DOI: 10.1097/prs.0000000000002388] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Application of platelet-rich plasma and stem cells has become important in regenerative medicine. Recent literature supports the use of platelet-rich plasma as a cell culture media supplement to stimulate proliferation of adipose tissue-derived mesenchymal stem cells. The underlying mechanism of proliferation stimulation by platelet-rich plasma has not been investigated so far. METHODS Adipose tissue-derived mesenchymal stem cells were cultured in α-minimal essential medium supplemented with platelet-rich plasma or fetal calf serum. Cell proliferation was assessed with cell cycle kinetics using flow cytometric analyses after 48 hours. Differences in proteome expression of the adipose tissue-derived mesenchymal stem cells were analyzed using a reverse-phase protein array to quantify 214 proteins. Complementary Ingenuity Pathways Analysis and gene set enrichment analysis were performed using protein data, and confirmed by Western blot analysis. RESULTS A higher percentage of adipose tissue-derived mesenchymal stem cells in the S phase in the presence of platelet-rich plasma advocates the proliferation stimulation. Ingenuity Pathways Analysis and gene set enrichment analysis confirm the involvement of the selected proteins in the process of cell growth and proliferation. Ingenuity Pathways Analysis revealed a participation in the top-ranked canonical pathways PI3K/AKT, PTEN, ILK, and IGF-1. Gene set enrichment analysis identified the authors' protein set as being part of significantly regulated protein sets with the focus on cell cycle, metabolism, and the Kyoto Encyclopedia of Genes and Genomes transforming growth factor-β signaling pathway. CONCLUSIONS The present study provides evidence that platelet-rich plasma stimulates proliferation and induces a unique change in the proteomic profile of adipose tissue-derived mesenchymal stem cells. The interpretation of altered expression of regulatory proteins represents a step forward toward achieving good manufacturing practice-compliant criteria for cell-based strategies.
Collapse
|
47
|
Discussion: Homeotic and Embryonic Gene Expression in Breast Adipose Tissue and in Adipose Tissues Used as Donor Sites in Plastic Surgery. Plast Reconstr Surg 2017; 139:693e-694e. [PMID: 28234839 DOI: 10.1097/prs.0000000000003071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Gennai A, Zambelli A, Repaci E, Quarto R, Baldelli I, Fraternali G, Bernardini FP. Skin Rejuvenation and Volume Enhancement with the Micro Superficial Enhanced Fluid Fat Injection (M-SEFFI) for Skin Aging of the Periocular and Perioral Regions. Aesthet Surg J 2017; 37:14-23. [PMID: 27241362 DOI: 10.1093/asj/sjw084] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Adipose-derived stromal and stem cells (ADSC) in autologous fat promises regenerative advantages, and injected into the dermal and subdermal layers, enhances rejuvenation and volume. However, extremely superficial fat injection with current techniques is limited. OBJECTIVES Efficacy and viability evaluation of fat harvested with extremely small side port (0.3 mm) cannulae without further tissue manipulation for the correction of aging/thin skin in the periocular and perioral regions. METHODS Micro-superficial enhanced fluid fat injection (M-SEFFI) harvests adipose tissue with a multi-perforated cannula (0.3 mm), and autologous platelet rich plasma (PRP) is added. The tissue is injected into the dermal region of the periocular and perioral zones. Efficacy and viability were evaluated by histological and cell culture analysis. Clinical assessment included retrospective evaluation according to 1 = no effect, 2 = fair effect, 3 = good effect, 4 = excellent effect. RESULTS Between June 2014 and July 2015, 65 patients (7 men; mean age 49.7 years) were treated with M-SEFFI. No intraoperative complications or visible lumpiness were recorded. Analysis demonstrated mature, viable adipocytes with a strong stromal component. Following PRP addition, there was a greater proliferation noted in the M-SEFFI compared to the SEFFI (0.5 mm). Mean follow-up was 4.1 months. Clinical assessment by surgeons and patients at 1 month was 3.52 and 3.74, and 6 months 3.06 and 2.6 respectively. CONCLUSIONS M-SEFFI is effective and viable for lump free skin rejuvenation and volume enhancement, through the extraction of smoother ADSC rich, autologous fat tissue that does not require further tissue manipulation, to correct skin aging. LEVEL OF EVIDENCE 4 Therapeutic.
Collapse
Affiliation(s)
- Alessandro Gennai
- Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy
| | - Alessandra Zambelli
- Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy
| | - Erica Repaci
- Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy
| | - Rodolfo Quarto
- Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy
| | - Ilaria Baldelli
- Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy
| | - Giulio Fraternali
- Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy
| | - Francesco P Bernardini
- Dr Gennai is a plastic surgeon in private practice in Bologna and Milan, Italy. Drs Zambelli and Bernardini are oculoplastic surgeons in private practice in Genova, Italy. Dr Repaci is a Researcher and Dr Quarto is the Chairman, Department of Experimental Medicine, University of Genova, Genova, Italy. Dr Baldelli is a Plastic Surgeon, Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy. Dr Fraternali is a Pathologist, Department of Pathology, University of Genova, Genova, Italy
| |
Collapse
|
49
|
Autologous Fat Grafting for Treating Blepharoplasty-induced Lower Eyelid Retraction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1190. [PMID: 28293531 PMCID: PMC5222676 DOI: 10.1097/gox.0000000000001190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/01/2016] [Indexed: 12/05/2022]
Abstract
Autologous fat grafting for blepharoplasty-induced lower eyelid retraction offers potential for a long-term solution while avoiding the morbidity associated with posterior lamellar spacer grafts. By combining traditional methods of lifting the retracted lower eyelid with autologous fat grafting, both functional and aesthetic concerns can be successfully addressed in these patients.
Collapse
|
50
|
Gentile P, Scioli MG, Bielli A, Orlandi A, Cervelli V. Concise Review: The Use of Adipose-Derived Stromal Vascular Fraction Cells and Platelet Rich Plasma in Regenerative Plastic Surgery. Stem Cells 2016; 35:117-134. [PMID: 27641055 DOI: 10.1002/stem.2498] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/30/2016] [Indexed: 12/14/2022]
Abstract
Tissue engineering has emerged at the intersection of numerous disciplines to meet a global clinical need for technologies to promote the regeneration of tissues. Recently, many authors have focused their attention on mesenchymal stem/stromal cells (MSCs) for their capacity to differentiate into many cell lineages. The most widely studied cell types are bone marrow mesenchymal stem cells and adipose-derived stem cells (ASCs), which display similar results. Biomaterials, cells, and growth factors are needed to design a regenerative plastic surgery approach in the treatment of organ and tissue defects, but not all tissues are created equal. The aim of this article is to describe the advances in tissue engineering through the use of ASCs, platelet rich plasma, and biomaterials to enable regeneration of damaged complex tissue. Stem Cells 2017;35:117-134.
Collapse
Affiliation(s)
- Pietro Gentile
- Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy.,Plastic and Reconstructive Surgery, Catholic University "Our Lady of Good Counsel", Tirane, Albania
| | | | - Alessandra Bielli
- Anatomic Pathology Institute, University of Rome "Tor Vergata", Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology Institute, University of Rome "Tor Vergata", Rome, Italy
| | - Valerio Cervelli
- Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Rome, Italy
| |
Collapse
|