The effect of processing technique on fat graft survival

Background: Wide variations in fat graft survival have been reported. The authors hypothesize that treating the adipose tissue on Telfa gauze creates a processed lipoaspirate with a more functional adipokine profile that improves fat graft survival. Methods: Suction-assisted lipoaspirate was harvested from humans and was either processed by centrifugation, rolled on Telfa gauze, or left unprocessed. Progenitor cell populations were quantified and characterized by flow cytometry. Glycerol-3-phosphate dehydrogenase assay was used to measure the functional adipocytes. The lipoaspirates were grafted into (n = 45) wild-type mice and harvested to assess fat graft persistence. Vascular endothelial growth factor and platelet-derived growth factor-BB secretions were measured by enzyme-linked immunosorbent assay technique. Results: Centrifuged lipoaspirate had a greater number of progenitor cells per gram of tissue than Telfa-processed and unprocessed lipoaspirate. However, Telfa-processed lipoaspirate had a greater number of functional adipocytes (0.104 U/ ml) than centrifuged (0.080 U/ml) and unprocessed lipoaspirate (0.083 U/ml) on glycerol-3-phosphate dehydrogenase assay (p < 0.05). After 10 weeks of grafting, it had greater fat graft persistence (70.9 ± 6.2 percent) than centrifuged (56.7 ± 5.5 percent) and unprocessed lipoaspirate (42.2 ± 2.7 percent) (p < 0.05). It also maintained a greater secretion of vascular endothelial growth factor and platelet-derived growth factor-BB at weeks 1 and 2 than centrifuged and unprocessed lipoaspirate. Furthermore, CD31 staining demonstrated an increase in vascular density of the Telfa-processed lipoaspirate at week 2 compared with the centrifuged lipoaspirate (37 ± 1 percent and 14 ± 4 percent per high-power field; p < 0.05). Conclusions: Lipoaspirate processing technique has a significant impact on fat graft survival rate. Increasing the number of functional adipocytes by processing the fat on Telfa gauze may augment the secretion of angiogenic and mito-genic adipokines within the graft, thereby improving its survivability. (Plast.