Literature Review to Optimize the Autologous Fat Transplantation Procedure and Recent Technologies to Improve Graft Viability and Overall Outcome: A Systematic and Retrospective Analytic Approach.
OBJECTIVE
Investigation and evaluation of the current methods and steps of autologous fat transplantation to optimize the viability of fat grafts and procedure outcome in quest of a more standardized protocol.


METHODS
A thorough literature search was performed across the CNKI, Wan Fang, PubMed, Ovid and EMBASE databases from the year 1970 to December 2014, collecting and classifying all of the autologous fat transplantation-related reports and articles, and after screening, a critical retrospective analysis was performed on the included data.


RESULTS
A total of 65 articles were included in the study. However, there were limited numbers of cases dealing with procedure-related steps such as the selection of donor sites, fat acquisition, graft treatment and methodology of transplant, resulting in a significant lack of evidence support, furthermore urging the need for more standardized protocol for the steps of autologous fat transplant to improve graft viability and overall outcome while decreasing procedure-related morbidity.


CONCLUSIONS
No good evidence was obtained to optimize the donor site, acquisition, processing and transplantation steps of the whole process of autologous fat transplantation. Tissue engineering and stem cell research have the potential to revolutionize the future of reconstructive surgery by replacing tissue, obviating the need for donor site morbidity. However, the use of stem cell therapies to expand and grow tissue for reconstruction must occur in the context of risk management. Balancing ease of harvest with yield and efficacy has been a delicate and often difficult trade-off which has prompted the scientific community to investigate alternative sources. However, there is much hope in the evaluation and implementation of multimodality approaches for autologous fat transplant, including thriving technologies such as ultrasound-assisted, water jet-assisted, nanotechnology-assisted liposuction in combination with revolutionary fat treatment technologies such as the VASER system.


METHODS
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Yoong Hoon
YH
Shim
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. zhangruhong2016@163.com.
Ru Hong
RH
Zhang
D000273:Adipose Tissue / Q000637:transplantation*; D064592:Autografts; D002681:China; D004954:Esthetics; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D060053:Transplant Donor Site; D014182:Transplantation, Autologous / Q000379:methods*; D016896:Treatment Outcome
Donor site selection; Fat acquisition; Fat transplant; Graft treatment; Retrospective analysis