title: In search of the optimal processing technique for fat grafting.
abstract: OBJECTIVE
  Unpredictability in graft retention remains a significant drawback of fat grafting. Processing of fat grafts has been the focus of several studies to improve graft survival. The objective of this study was to systematically review the outcomes of different fat graft processing techniques with the goal of (1) deriving clinically oriented insights and (2) identifying gaps in knowledge to stimulate future research.
  
  
  METHODS
  PubMed, EMBASE, and Cochrane Databases were searched to identify studies that compared different fat graft processing techniques. Outcome measures of interest were any subjective or objective measures of fat graft survival or reports of adverse events.
  
  
  RESULTS
  A total of 2056 abstracts were generated from the literature searches; 13 studies met the criteria for data extraction and analysis. Processing methods assessed included decantation, washing, gauze filtration, and centrifugation. Each processing method was found to be better than other methods, depending on the outcome measure used to study graft survival. As well, several studies found statistical equipoise in the outcome measures when analyzing the results of the different techniques. Adverse events were rarely reported and did not correlate with any processing method in particular.
  
  
  CONCLUSIONS
  No firm concluding recommendation can be made to deem 1 processing technique superior to the others. However, it would seem that techniques, which use a combination of gentle washing and centrifugation, strike the optimal balance of preserving adipocyte viability while removing bulk of the contaminants.
authors.affiliation: From the *Faculty of Medicine and Divisions of †Otolaryngology-Head & Neck Surgery and ‡Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University; and §Dalhousie Pediatric Craniofacial Group, IWK Health Centre, Halifax, Nova Scotia, Canada.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Matthew
authors.initials: M
authors.lastname: Brace
authors.forename: S Mark
authors.initials: SM
authors.lastname: Taylor
authors.forename: Michael
authors.initials: M
authors.lastname: Bezuhly
authors.forename: Paul
authors.initials: P
authors.lastname: Hong
mesh_terms: D017667:Adipocytes / Q000637:transplantation*; D002469:Cell Separation / Q000379:methods; D002470:Cell Survival / Q000502:physiology; D002498:Centrifugation; D006085:Graft Survival; D006801:Humans; D007507:Therapeutic Irrigation; D014021:Tissue Preservation / Q000379:methods; D020858:Tissue and Organ Harvesting / Q000379:methods*