The Adjuvant Use of Stromal Vascular Fraction and Platelet-Rich Fibrin for Autologous Adipose Tissue Transplantation

Autologous adipose transplantation is rapidly gaining popularity for the restoration of soft tissue defects and lipoatrophy as well as for aesthetic improvements (e.g., facial reconstruction and rejuvenation). However, the current technique is crude that suffers from serious demerits, particularly the long-term unpredictability of volume maintenance due to resorption of the grafted adipose tissue and limited adipogenesis. We hypothesized that the adjuvant use of patient-derived adipose stromal vascular fraction (SVF) and platelet-rich fibrin (PRF) may enhance the overall outcome of autologous fat grafting in plastic and reconstructive surgery. Autologous SVF, with a mean cell number of (4.8 +/- 3.79) x 10(7) cells/mL and a mean cell viability of 71.8%, and autologous PRF, with sustained release of multiple angiogenic growth factors, were created before surgical use. The following adipose tissue implants were injected subcutaneously into a rabbit ear's auricula according to the following study design: 2 mL adipose granules and 0.2 mL normal saline solution (AG + NS group), 2 mL adipose granules and 0.2 mL SVF (AG + SVF group), 2 mL adipose granules and 0.2 mL PRF (AG + PRF group), or 2 mL adipose granules combined with 0.1 mL SVF and 0.1 mL PRF (AG + SVF + PRF group). Histological examinations showed that the implanted adipose granules were well engrafted in the AG + SVF + PRF group, with a higher microvessel density 4 weeks postimplantation compared with the other three groups (p < 0.01). Twenty-four weeks postimplantation, the resorption rates of implanted tissue in each group were 49.39% +/- 9.47%, 27.25% +/- 4.37%, 36.41% +/- 8.47%, and 17.37% +/- 6.22%, respectively, and were significantly different (p < 0.01). The results demonstrated that the efficacy of adipose tissue implantation can be enhanced by using autologous PRF and SVF as therapeutic adjuvants, offering a clinically translatable strategy for soft tissue augmentation and reconstruction.