O056 Achieving optimal clinical outcomes in autologous fat grafting (AFG): a systematic review of processing techniques

Abstract

Abstract Introduction AFG is an increasingly popular technique in reconstructive and cosmetic surgery but significant variability in long-term graft retention continues to be a limitation. This results in unreliable clinical outcomes and revision procedures. There is no consensus on the optimal methodology of graft processing. This systematic review identifies the latest evidence base supporting different processing techniques. Methods A systematic literature search was conducted using PubMed, SCOPUS, and the Cochrane electronic databases. Studies comparing AFG processing techniques and reporting long-term patient outcomes (≥3 months) were identified. Data collected included the technical aspects of techniques, cohort characteristics, complication rates, volume retention. Systematic assessment of study quality was also performed. Results Twenty-four studies (2928 patients) providing at least level three evidence were included. Processing techniques evaluated included centrifugation, decantation, washing, filtration, gauze rolling, as well as commercial devices and ASC enrichment methods. There was variable reporting of complications and volume retention rates. Complications were infrequent; palpable cysts (0–18%), cellulitis (0–8%) and fat necrosis (0–36.4%) were the most commonly reported. No significant differences in long-term volume retention between techniques were found in AFG in the breast. In head and neck patients, greater volume retention were documented in ASC enrichment (64.8–95.8%) and commercial devices (41.2%) compared to centrifugation (31.8–76%). Conclusion The quality of AFG research has improved significantly in recent years but has heterogeneity in reporting outcomes. ASC (adipose derived stem/stromal cells) enrichment methods and commercial devices results in superior long-term volume retention in facial but not breast fat grafting. Take-home message Adipose derived stem/stromal cell enrichment methods and commercial devices have superior long term volume retention in facial but not breast autologous fat grafting [level of evidence II]. Randomised control trials are necessary to identify if certain processing methods are superior to others in volume retention and complication rates.