title: A systemic review of autologous fat grafting survival rate and related severe complications.
abstract: OBJECTIVE
  Clinical application of autologous fat grafting (AFG) is quickly expanding. Despite the widely acceptance, long-term survival rate (SR) of AFG remains a question not yet solved. Meanwhile, although rare, severe complications related to AFG including vision loss, stroke even death could be seen in the literature.
  
  
  METHODS
  A comprehensive research of PubMed database to June 2013 was performed according to guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology. Articles were screened using predetermined inclusion and exclusion criteria.
  
  
  METHODS
  Data collected included patient characteristics, surgical technique, donor site, recipient site, graft amount, and quantified measurement methods. Patient cohorts were pooled, and SR was calculated. All the severe complications were also summarized according to the different clinical characteristics.
  
  
  RESULTS
  Of 550 articles, 16 clinical articles and 10 animal studies met the inclusion criteria and provided quantified measurement methods. Totally, 596 patients were included. SR varied from 34% to 82% in breast and 30-83% in the facial area. Nude mice were applied to investigate human fat grafting SR (38.3-52.5% after 15 weeks). Rabbits were commonly used to study animal AFG SR (14.00-14.56% after 1-year). Totally, 21 severe complications were reported, including death (2), stroke (10), vision loss (11, 8 of which accompanied with stroke), sepsis (3), multiple abscess (1) and giant fat necrotic cyst (2). Ten of these complications happened within 10 years.
  
  
  CONCLUSIONS
  There is no unified measurement method to evaluate fat graft SR until now and no clinical evidence to show better SR according to different donor and recipient cite. Body mass index change between pre- and postoperation may be the bias factor in evaluating fat SR. Fat embolisms of the ophthalmic artery and the middle cerebral artery are the most severe complication of AFG and still lack of effective treatment.
authors.forename: Nan-Ze
authors.initials: NZ
authors.lastname: Yu
authors.forename: Jiu-Zuo
authors.initials: JZ
authors.lastname: Huang
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Wang
authors.forename: Ru
authors.initials: R
authors.lastname: Zhao
authors.forename: Ming
authors.initials: M
authors.lastname: Bai
authors.affiliation: Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing 100730, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Long
mesh_terms: D000818:Animals; D006801:Humans; D000273:Adipose Tissue / Q000637:transplantation; D064592:Autografts; D015996:Survival Rate