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Fat Grafts Supplemented with Adipose-Derived Stromal Cells in the Rehabilitation of Patients with Craniofacial Microsomia

Tanikawa, Daniela Y. S. M.D.; Aguena, Meire B.Sc., Ph.D.; Bueno, Daniela F. D.D.S., Ph.D.; Passos-Bueno, Maria Rita B.Sc., Ph.D.; Alonso, Nivaldo M.D., Ph.D.

Plastic and Reconstructive Surgery: July 2013 - Volume 132 - Issue 1 - p 141–152
doi: 10.1097/PRS.0b013e3182910a82
Pediatric/Craniofacial: Original Articles
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Background: Although first reports of the clinical use of adipose-derived stromal cells suggest that this approach may be feasible and effective for soft-tissue augmentation, there is a lack of randomized, controlled clinical trials in the literature. Thus, this study aimed to investigate whether a faster protocol for isolation of adipose-derived stromal cells and their use in combination with fat tissue improve the long-term retention of the grafts in patients with craniofacial microsomia.

Methods: Patients with craniofacial microsomia (n = 14) were grafted either with supplementation of adipose-derived stromal cells (experimental group) or without supplementation of adipose-derived stromal cells (control group). The number of viable cells isolated before and after the supplementation of the grafts was calculated, and these cells were examined for mesenchymal cell surface markers using flow cytometry. Computed tomography was performed to assess both hemifaces preoperatively and at 6 months postoperatively.

Results: The average number of viable cells isolated before and after the supplementation of the grafts was 5.6 × 105 and 9.9 × 105 cells/ml of fat tissue (p = 0.015). Flow cytometric analysis revealed that the adipose-derived stromal cells were positive for mesenchymal cell markers (>95 percent for CD73 and CD105). Surviving fat volume at 6 months was 88 percent for the experimental group and 54 percent for the control group (p = 0.003).

Conclusion: These results suggest that this strategy for isolation and supplementation of adipose-derived stromal cells is effective, safe, and superior to conventional lipoinjection for facial recontouring in patients with craniofacial microsomia.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Supplemental Digital Content is available in the text.

São Paulo, Brazil

From the Division of Plastic and Reconstructive Surgery, University of São Paulo School of Medicine; and the Human Genome Research Center, Institute of Biosciences, University of São Paulo.

Received for publication October 31, 2012; accepted January 9, 2013.

This trial is registered under the name “Clinical Trial of Fat Grafts Supplemented with Adipose-Derived Regenerative Cells,” ClinicalTrials.gov identification number NCT01674439 (http://clinicaltrials.gov/ct2/show/NCT01674439).

Presented at IFATS Miami 2011: The 9th Annual Symposium on Adipose Stem Cells and Clinical Applications of Adipose Tissue, in Miami, Florida, November 4 through 6, 2011.

Disclosure:The authors have no financial conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (www.PRSJournal.com).

Nivaldo Alonso, M.D., Ph.D., Division of Plastic and Reconstructive Surgery, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455, Room 1360, São Paulo, Brazil 01246-000, nivalonso@gmail.com

©2013American Society of Plastic Surgeons