Cell‐assisted lipotransfer: Friend or foe in fat grafting? Systematic review and meta‐analysis

Abstract

Autologous fat grafting is a common procedure for soft-tissue reconstruction but is associated with a graft resorption rate ranging from 20% to 80%. To improve the fat graft survival rate, a new technique, called cell-assisted lipotransfer (CAL), was developed. With CAL, fat is injected along with adipose-derived stromal cells that are assumed to improve fat survival rate. We conducted an evidence-based meta-analysis to evaluate the efficacy and safety of CAL as compared with conventional autologous fat grafting (non-CAL). The databases MEDLINE (via PubMed), Cochrane Library, EBSCO, Web of Science, and EMBASE were searched for reports of clinical trials, case series, and cohorts available from 2008 to 2016. We conducted a meta-analysis of the efficacy of CAL with data analysis concerning fat survival rate. The incidence of complications and the need for multiple procedures were evaluated to determine the safety of CAL. We identified 25 studies (696 patients) that were included in the systematic review; 16 studies were included in the meta-analysis to evaluate the efficacy of CAL. The fat survival rate was significantly higher with CAL than non-CAL (64% vs. 44%, p < .0001) independent of injection site (breast and face). This benefit of CAL was significant for only injection volumes <100 ml (p = .03). The two groups did not differ in frequency of multiple procedures after fat grafting, but the incidence of complications was greater with CAL than non-CAL (8.4% vs. 1.5%, p = .0019). The CAL method is associated with better fat survival rate than with conventional fat grafting but only for small volumes of fat grafting (<100 ml). Nonetheless, the new technique is associated with more complications and did not reduce the number of surgical procedures needed after the first fat grafting. More prospective studies are required to draw clinical conclusions and to demonstrate the real benefit of CAL as compared with common autologous fat grafting.

Langzeitevaluation nach autologer Fetttransplantation zur Brustvergrößerung

“…In einer weiteren Studie wurde aus der Differenz zwischen dem Umfang oberhalb der Areolen und dem Unterbrustumfang eine geschätzte Einheilungsrate von 60 % mit und 40 % ohne Stammzellzusatz abgeschätzt [41]. In einer Übersichtsarbeit über CAL (Cell-assisted Lipotransfer) zeigte sich, dass die Einheilungsrate im Vergleich zu non-CAL zwar signifikant höher ist, dies jedoch vor allem auf geringe Transplantationsvolumina < 100 ml zutrifft [42].…”

The Development of Facial Lipofilling from a Historical Point of View

“…Yet, the number of procedures needed was not decreased by CAL, while resulting in more complications, especially in large volume transfers, for example, breast augmentation. 93 Improved understanding of three steps (harvesting, processing, and injecting) has led to increased graft survival when taking into account that overfilling of the target side will never lead to more retention of grafted lipoaspirate.…”

Introduction of ligated vessels promote the retention and regeneration of free fat: constructing a fat flap in tissue engineering chamber

“…Since Neuber [1] first reported autologous fat transplantation, several technical and basic science landmark progress of autologous fat transplantation has been made including tumescent liposuction [1], structure lipotransfer [2], three zone theory [3,4], cell assisted lipotransfer (CAL) [5,6] and SVF-gel [7]. Nevertheless, the varying retention rate [8,9] after transplantation remains to be solved and when applied to large defects like breast reconstruction, a high number of grafting procedures are required [10]. Although there is no widely accepted or optimal procedure to achieve predictable results [11], early revascularization was considered as the key to achieve a successful fat graft and adipose-derived stromal cells were certificated to promote the early revascularization as the theoretical basement of cell assisted lipotransfer.…”