Autologous Fat Grafting – Factors of Influence on the Therapeutic Results

The correction of soft tissue defects has always been a challenge for plastic surgery. In the different stages of its historical development these problems has been solved by a variety of complicated techniques or filler materials some of which proved in time not only to be ineffective but even harmful for the human body. The ideal filler should be physically and chemically stable, long lasting and immobile in body, nonimmunogenic, noninfectious, nonpyogenic and nonallergic, should not require pretesting and should be cheap and easily stored. Some of these characteristics has been defined back in 1953 (Scales, 1953) but still there is no consensus regarding the perfect injectable material. Nowadays, despite of the growing number of alloproducts, the autologous fat grafting is recognized as one of the basic methods for soft tissue defects correction. It represents a three staged procedure of aspiration, purification and reimplantation of fat cells (Mojallal et al, 2004). The considerable presence of adipose tissue in the body and its autogenous origin guarantying advantages as biocompatibility, structure stability and polyvalent usage are reasons for the growing popularity of this intervention and its broading spectrum of indications. Nevertheless there are still a lot of controversies and unsolved questions regarding the autologous fat grafting. Its efficiency is still often doubted due to the variable resorption rates and the unpredictability of the post operative outcomes. In attempts of optimizing the results many surgical techniques have been created (Billings at al., 1989; Mojallal, Foyatier, 2004). The new concepts were built on attempts to avoid excessive pressure changes during harvesting and reimplantation, improving the means of purification from potential local inflammation promotors, and application in a fashion that assures sufficient nutritional sources (Mojallal, Foyatier, 2004; Shiffman, Mirrafati, 2001). Though none of the newly invented techniques is considered optimal a consensus has been reached on some stages of the technical implementation of autologous fat grafting such as manual syringe lipoaspiration and threedimensional reimplantation (Niechajev, Sevcuk, 1994; Coleman, 2001; Jauffret et al., 1994; Lalikos et al., 1997; Moore et al., 1995; Novaes et al., 1995). To date the optimal method of transplant purification still remains unclear as well as the impact on the therapeutic results of factors as combination with other interventions, intraoperative extent of correction and the need of numerous transplantations as methods counteracting the postoperative resorption. At the same time the growing knowledge on adipose tissue and the revealed