Highlights:
* Puregraft has significantly higher tissue viability. The grafts prepared by both gravity and centrifugation left substantially more non-viable debris in the graft. Puregraft offers patients more viable fat without unnecessary debris.
* Puregraft has significantly less pro-inflammatory content. Free lipids, red and white blood cells, and other debris can all lead to inflammation, which suppresses healing and graft take. In addition, free lipids can form lipid cysts. Puregraft tissue has <1% of free lipids. Centrifugation and gravity left >12% and >8% respectively. Additionally, Puregraft tissue has <5% of blood cells remaining in the graft, while both gravity and centrifugation had 30-50%.
* Puregraft allows the physician to control the graft hydration, providing versatility based on surgical technique.

Background:
Successful long-term volume retention of an autologous fat graft is problematic. The presence of contaminating cells, tumescent fluid, and free lipid in the graft contributes to disparate outcomes. Better preparation methods for the fat graft before transplantation may significantly improve results.
Methods:
Subcutaneous fat from 22 donors was divided and processed using various graft preparation methods: (1) no manipulation control, (2) gravity separation, (3) Coleman centrifugation, and (4) simultaneous washing with filtration using a commercially available system (Puregraft; Cytori Therapeutics, Inc., San Diego, Calif.). Fat grafts from various preparation methods were examined for free lipid, aqueous liquid, viable tissue, and blood cell content. Adipose tissue viability was determined by measuring glycerol release after agonist induction of lipolysis.
Results:
All test graft preparation methods exhibited significantly less aqueous fluid and blood cell content compared with the control. Grafts prepared by washing with filtration exhibited significantly reduced blood cell and free lipid content, with significantly greater adipose tissue viability than other methods.
Conclusion:
Washing with filtration within a closed system produces a fat graft with higher tissue viability and lower presence of contaminants compared with grafts prepared by alternate methods. (Plast. Reconstr. Surg. 131: 873, 2013.)

The data shown here demonstrates that application of the Cytori LipoBank™ practices and procedures allowed recovery of approximately 86% of the volume and 85-90% of the adipocytes present in the tissue prior to cryopreservation. Importantly, thawed tissue retained normal tissue responsiveness to physiologic stimuli. In other words, the thawed tissue was healthy and viable.

As the frequency of fat grafting to the breast has increased, some investigators have raised the possibility that this procedure may potentially increase the risks associated with breast cancer. Their concerns included not only interference with cancer detection, but also promotion of tumor formation or recurrence mediated by mechanisms such as aromatase expression, angiogenesis, and tumor stromal cells. However, published clinical studies describing outcomes of fat grafting to the breast in more than 2000 patients have not reported any increase in new or recurrent cancers. The reason for this apparent disconnect may lie in the small sample sizes and relatively short follow-up, but it may also reside in the considerable gap between laboratory studies or theoretical considerations suggesting potential risks and the actual clinical practice. This review discusses potential risks of current and novel approaches to autologous fat grafting to the breast within the context of both the underlying science and clinical practice.

This paper demonstrates the great distinction between fat grafting and adipose derived stem cell therapy, and emphasizes that the two are often confused clinically. (ex. “stem cell face lifts”). The authors have conducted a thorough review of current literature and have subsequently outlined how each should be distinguished in terms of indications, harvesting, processing, applications, outcomes and complications. Similarly, the authors emphasize that considering ADRC therapy is still an emerging field, there needs to be a careful distinction between evidence-based data and anecdote.

This retrospective study of 49 patients assesses the clinical and aesthetic results of autologous fat grafting (as an adjunct to another reconstructive procedure for post-mastectomy reconstruction, as reviewed by two independent blinded plastic surgeons. Results show vast improvement in volume, contour, and fullness at avg. 2.4 years follow-up. It should be noted that 51.5% of the cases required more than one injection procedure with minimal side-effects (41.2% needed a second procedure, 8.9% needed a third). The authors acknowledge the need for supplemental long-term follow-up for safety and efficacy.

Cytori customer and author Dr. Karaaltin introduces a case report describing the first application of successful ADRC therapy (using Celution), for a diabetic foot wound resistant to other treatments. The result of a single treatment at the unhealed wound site showed accelerated wound healing and complete closure four weeks after the treatment.

This article looks at three burn patients treated with fat injections for hemifacial hypertrophic scars and keloids. Subsequent to two injections (13 months apart), six-month follow-up shows improvement in skin texture, appearance, thickness, collagen deposition, and local vascularity. The authors speculate that the improvements in scar quality are likely due to the tissue regeneration promoted by the adipose-derived stem cells present in the graft.

The article compares two groups of HIV-positive patients that received either lipofilling or nonabsorbable fillers as treatment for facial wasting induced by antiretroviral medication. The authors conclude that lipofilling offers a safe alternative and better aesthetic results when compared to nonabsorbable facial fillers at one-year follow-up.

This paper describes a study in which 73 patients affected with neuropathic post-mastectomy pain syndrome and severe scar retraction were treated with fat grafts. The results show a significant decrease in pain after the procedure in most patients at 13 months follow-up. The authors liken the results to the similarly positive effects seen in fat grafts as treatment for irradiated tissue, in terms of scar softness and tissue differentiation.

This case report demonstrates a novel use for fat grafting in which a patient underwent an autologous fat grafting procedure as a correction for a labia majora deformity due to failed oncological reconstruction surgery. The patient received a second fat grafting procedure at 4 months due to volume loss. Overall, results showed an improved appearance while preserving normal sensitivity.

Since the 1980s, there has been an increased interest in autogenous fat grafting for breast augmentation. However, concerns over graft survival and interference with breast cancer screening have limited its application.

Since its introduction, refinements in harvesting and grafting techniques have improved results. The available literature consists primarily of case reports and series. There are no controlled trials, and outcomes thus far have not been measured in a standardized way. The limited data relating to breast cancer screening did not note a significant interference. Concerns have been raised that the placement of mature adipocytes and adipocyte-derived stem cells into the hormonally-active environment of the breast may potentiate breast cancer, but there are no clinical trials that investigate this possibility and a consensus regarding the basic science is still developing. Large multicenter, controlled, prospective trials are necessary to further investigate the many issues relating to the application of autogenous fat grafting for augmentation of the breast.

Injective transfer of autologous aspirated fat is a popular option for soft tissue augmentation, but several issues require attention, including unpredictability and a low survival rate due to partial necrosis. In this study, histologic features and yield of adipose-derived stromal (stem) cells (ASCs) were compared between human aspirated fat and excised whole fat. Aspirated fat contained fewer large vascular structures, and ASC yield was lower in aspirated fat. Aspirated fat was transplanted subcutaneously into severe combined immunodeficiency mice with (cell-assisted lipotransfer; CAL) or without (non-CAL) vascular stromal fractions containing ASCs isolated from adipose tissue. The CAL fat survived better (35% larger on average) than non-CAL fat, and microvasculature was detected more prominently in CAL fat, especially in the outer layers. DiI-labeled vascular stromal fraction cells were found between adipocytes and in the connective tissue in CAL fat, and some of these cells were immunopositive for von Willebrand factor, suggesting differentiation into vascular endothelial cells. Another experiment that used vascular stromal fractions taken from green fluorescent protein rats also suggested that ASCs differentiated into vascular endothelial cells and contributed to neoangiogenesis in the acute phase of transplantation. These findings may partly explain why transplanted aspirated fat does not survive well and suggest clinical potential of the CAL method for soft tissue augmentation.

Background. Autologous fat transfer for soft tissue augmentation has been increasing in recent years. Graft longevity may vary greatly from patient to patient, requiring repeat procedures, often using frozen adipose tissue. Storage usually involves placing syringes of fat directly into a –20°C freezer. However, the viability of fat frozen in this way is controversial. Objective. This study tested methods for the optimal storage of adipose tissue harvested by tumescent liposuction. Materials and Methods. Aliquots of washed adipose tissue were frozen directly at –20°C or mixed with cryoprotectants, frozen at 1°C/min, and subsequently stored in liquid nitrogen vapor phase. Aliquots were subsequently thawed, and adipocyte viability was determined by staining and culture methods. Results. Viability of adipocytes frozen at –20°C was very low when analyzed by staining, and no cultures could be established from any of the specimens. In contrast, viable adipocytes were recovered from samples that were controlled-rate frozen in the presence of cryoprotectants and stored in nitrogen vapor. Conclusion. Our results indicate that fat frozen at –20°C is not viable and thus provides no advantage over inert fillers. The methods here described could readily be transferred to the clinical setting after further laboratory study.

Abstract: Current practice of autologous fat transfer for soft tissue augmentation is limited by poor long-term graft retention. Adipose-derived regenerative cells (ADRCs) contain several types of stem and regenerative cells, which may help improve graft retention through multiple mechanisms. Using a murine fat transplantation model, ADRCs were added to transplanted fat to test whether ADRCs could improve the long-term retention of the grafts. This study showed, at both 6 and 9 months after transplantation, ADRCs not only increased graft retention by 2-fold but also improved the quality of the grafts. ADRC-supplemented grafts had a higher capillary density, indicating ADRCs could promote neovascularization. Further cell tracking and gene expression studies suggest ADRCs may promote angiogenesis and adipocyte differentiation and prevent apoptosis through the expression of various growth factors, including VEGFA and IGF-1. Taken together, these results suggest a potential clinical utility of ADRCs in facilitating autologous fat transfer for soft tissue augmentation.