Abstract
Fat tissue (FT) has been used for many years in regenerative surgery as a bioactive material through the lipofilling/fat graft (F-GRF)–nano-fat technique, as a bioactive scaffold when it was enriched with adipose-derived mesenchymal stem cells (AD-MSCs) contained in the stromal vascular fraction (SVF), and as a direct source of AD-MSCs used in wound healing (WH) and scar treatment (ST). This systematic review aims to describe the advances in FT engineering applied to regenerative surgery (from bench to clinic), through the use of AD-MSCs, SVF contained in F-GRF in WH and ST. The work has been performed by assessing in the selected studies autologous graft of AD-MSCs, SVF, and F-GRF compared to any control for ST and WH. The protocol was developed following the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Scopus database, and Cochrane databases has been performed to identify papers on AD-MSCs, SVF, and F-GRF use in WH and ST in which FT was used as bioactive material–scaffold and source of AD-MSCs. Of the 714 articles initially identified, 453 articles focusing on regenerative strategies in WH and ST were selected and, consequently, only 84 articles that apparently related to AD-MSC, SVF, and F-GRF were analyzed. Of these, 61 articles identified as pre-clinical, experimental, and in vitro, and 5 articles identified as a comment and systematic review were excluded. Only 18 original articles which strictly and exclusively focused on autologous AD-MSCs, SVF, and F-GRF in ST and WH were analyzed. The included studies had to match predetermined criteria according to the PICOS (patients, intervention, comparator, outcomes, and study design) approach. The identified studies described microscopic and clinical outcomes in patients treated with AD-MSCs, SVF, and F-GRF. Collected data confirmed the safety and efficacy of FT both as bioactive material–scaffold and source of AD-MSCs in WH and ST without major side effects.Graphical abstract
Highlights
A scientific-clinical need exists for the development of biotechnologies to improve wound healing (WH) during scar treatment (ST)
Most of fat grafts’ regenerative capacity is attributed to adipose-derived mesenchymal stem cells (AD-mesenchymal stem cells (MSCs)), suspended in a fatty tissue cellular matrix—stromal vascular fraction (SVF) [2]. It consists of a mixture of endothelial, smooth muscle cells, pericytes, and leukocytes [3]. Thanks to this regenerative activity, the fat grafting (F-GRF), a biological autologous tissue containing several important cellular components, extracellular matrix (ECM), vessels, and nerves [3], may be considered both as “bioactive material” when it is grafted in the damaged tissue aiming to improve the scar quality (SQ) and the WH and as “bioactive scaffold” when it is enriched with AD-MSCs
Six hundred thirty articles have been excluded for several reasons, including duplicates (n = 189), due to incorrect matching after the title’s/abstract’s screening and allogeneic use (n = 369), and bias due to incorrect matching with the treatment and keywords (n = 72)
Summary
A scientific-clinical need exists for the development of biotechnologies to improve wound healing (WH) during scar treatment (ST). Most of fat grafts’ regenerative capacity is attributed to AD-MSCs, suspended in a fatty tissue cellular matrix—SVF [2]. It consists of a mixture of endothelial, smooth muscle cells, pericytes, and leukocytes [3]. Collected data confirmed the safety and efficacy of fat tissue both as bioactive material–scaffold and source of AD-MSCs in WH and ST without major side effects
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