autologous fat grafting

自体脂肪移植
  • 文章类型: Systematic Review
    伤口发育和愈合涉及复杂的遗传和分子过程,带来了重大的临床管理挑战。本研究的目的是评估常用脂肪提取物的功效和安全性(自体脂肪,基质血管分数和脂肪干细胞)在伤口愈合中,特别是对于难治性伤口,目的是为临床使用提供证据。经过系统的审查,我们的研究包括21项随机对照试验。根据人体脂肪产品的分类,我们的荟萃分析显示,使用人体脂肪产品可以加快愈合速度,缩短愈合时间,实现更彻底的愈合,与常规治疗相比,结果指标差异具有统计学意义。对各种研究的组织学发现的分析表明,脂肪提取物可以促进上皮形成,胶原沉积和血管化,从而促进组织再生和减少炎症反应。使用脂肪提取物后降低患者疼痛水平有潜在的益处。此外,我们分析并总结了不良事件,表明在伤口治疗中使用人体脂肪制品是安全有效的。我们的研究结果支持人体脂肪产品的效率,并在伤口处理的临床实践中证明了高度的安全性。
    Wound development and healing involve intricate genetic and molecular processes, posing significant clinical management challenges. The objective of this study was to assess commonly used fat extracts\' efficacy and safety (autologous fat, stromal vascular fraction and adipose-derived stem cells) in wound healing, particularly for refractory wounds, with the goal of providing evidence in clinical use. After a systematic review, 21 randomised controlled trials were included in our study. Based on the classification of human fat products, our meta-analysis revealed that the use of human fat products could speed healing rate, shorten healing time and achieve more complete healing, with statistically significant differences in outcome indicators when compared to conventional treatments. The analysis of histological findings across various studies indicated that fat extracts can promote epithelialization, collagen deposition and vascularization, thereby facilitating tissue regeneration and reducing inflammatory reactions. There were potential benefits to reducing patient pain levels after using adipose extracts. Furthermore, we analysed and summarised adverse events indicating the safe and effective clinical use of human fat products in wound treatment. Our research findings supported the efficiency of human fat products and demonstrated a high degree of safety in the clinical practice of wound management.
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  • 文章类型: Journal Article
    背景:自体脂肪移植(AFG)已成为乳房重建中的一种有用技术。利用病人自己的脂肪从腹部或大腿等部位,AFG满足各种重建需求。然而,AFG在乳腺癌患者中的肿瘤安全性已成为一个有争议的问题.对其对癌症复发和滞留的影响的担忧导致了重大的临床辩论和彻底调查的需要。方法:确定自体脂肪移植(AFG)对接受重建的乳腺癌幸存者局部区域复发(LRR)的影响。全面搜索数据库,包括PubMed,Medline,WebofScience,Cochrane图书馆于2023年11月至2024年3月进行。此搜索符合PRISMA指南,旨在确定AFG在癌症治疗后乳房重建背景下的所有相关研究。进行了荟萃分析。结果:在审查的研究中,40符合纳入标准,总患者队列为14,078。分析显示,AFG与LRR的增加没有显着关联。结论:根据现有文献,AFG是乳腺癌患者的安全重建选择,不会增加局部区域复发的风险。然而,需要进一步的结构良好的长期前瞻性研究,因为现有研究的异质性很高,需要标准化。
    Background: Autologous fat grafting (AFG) has emerged as a useful technique in breast reconstruction. Utilizing a patient\'s own fat from areas like the abdomen or thighs, AFG serves various reconstruction needs. Nevertheless, the oncological safety of AFG in breast cancer patients has become a contentious issue. Concerns about its influence on cancer recurrence and detention have led to significant clinical debate and the need for thorough investigation. Methods: To determine the impact of autologous fat grafting (AFG) on loco-regional recurrence (LRR) in breast cancer survivors undergoing reconstruction, a comprehensive search of databases including PubMed, Medline, Web of Science, and Cochrane libraries was conducted from November 2023 through March 2024. This search adhered to the PRISMA guidelines and aimed to identify all the relevant studies on AFG in the context of breast reconstruction post cancer treatment. A meta-analysis was performed. Results: Out of the studies reviewed, 40 met the inclusion criteria, with a total patient cohort of 14,078. The analysis revealed that AFG had no significant association with increased rates of LRR. Conclusions: According to the available literature, AFG is a safe reconstructive option for breast cancer patients and does not increase the risk of loco-regional recurrence. Nevertheless, further well-structured long-term prospective studies are required, since heterogeneity of available studies is high and requires standardization.
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  • 文章类型: Journal Article
    背景:已提出自体脂肪转移(AFT)作为瘢痕组织及其相关症状的可能治疗方法。然而,其有效性的证据尚未确定。这项荟萃分析的目的是使用经过验证的疤痕测量工具评估现有的关于自体脂肪转移治疗烧伤后和创伤后疤痕的有效性和安全性的证据。
    方法:本研究于2023年11月使用以下电子数据库进行了系统的文献综述:MEDLINE,Scopus,开放存取期刊目录(DOAJ),pubmed,谷歌学者。包括以下关键术语:(脂肪移植或自体脂肪转移)和(身体疤痕或身体烧伤或身体创伤)和(功效或安全性或满意度)。我们根据预定的质量标准评估文章。提取期间包括以下数据:患者人口统计学,AFT指示,AFT会话的数量,后续期,以及患者和观察者疤痕评估量表(POSAS)评分的变化,其中包含患者和观察者的成分。
    结果:本研究包括1326名患者和23篇发表的文章。共有14项前瞻性研究,7个回顾性研究,并对2项随机临床试验进行了评价。这23篇文章来自全球各地,最早发表于1992年,最近发表于2022年。
    结论:我们的研究结果表明,从患者和观察者的角度来看,瘢痕特征都有显著增强。总的来说,AFT有望成为与疤痕相关的疾病的有价值的治疗选择,因为它可以提高疤痕质量。有助于改善患者的预后和满意度。
    方法:本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述,请参阅目录或在线作者说明www。springer.com/00266.
    BACKGROUND: Autologous fat transfer (AFT) has been proposed as a possible treatment for scar tissue and its associated symptoms. Its effectiveness\'s evidence is yet unidentified though. The aim of this meta-analysis is to evaluate the currently available evidence on the efficacy and safety of autologous fat transfer in treating post-burn and post-traumatic scars using a validated scar measurement tool.
    METHODS: This study performed a systematic literature review in November 2023 using the following electronic databases: MEDLINE, SCOPUS, Directory of Open Access Journals (DOAJ), PUBMED, and Google Scholar. The following key terms were included: (Fat grafting OR Autologous fat transfer) AND (body scars OR body burns OR body wounds) AND (Efficacy OR Safety OR satisfaction). We evaluated articles according to predefined quality criteria. The following data were included during the extraction period: patient demographics, indications for AFT, the number of AFT sessions, follow-up periods, and changes in the Patient and Observer Scar Assessment Scale (POSAS) scores, which contain both the patient and observer components.
    RESULTS: This study included 1326 patients and 23 published articles. A total of 14 prospective studies, 7 retrospective studies, and 2 Randomized clinical trials studies were evaluated. These 23 articles came from diverse global locations; the earliest was published in 1992, and the most recently published in 2022.
    CONCLUSIONS: Our findings demonstrated significant enhancements in scar characteristics from both patient and observer perspectives. Overall, AFT holds promise as a valuable treatment option for scar-related conditions as it enhances scar quality ,contributing to improved patient outcomes and satisfaction.
    METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.
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  • 文章类型: Journal Article
    这项研究的目的是分析所有关于自体脂肪移植(AFG)和脂肪干细胞(ADSC)应用的现有研究,以提出循证建议。特别是在急性烧伤和烧伤相关疤痕的临床治疗中。
    我们对PubMed进行了系统搜索,Cochrane,和EMBASE,以及手动搜索以前的评论\'参考列表。使用RoB2.0和ROBINS-I评估偏倚风险(RoB),在适当的地方。
    选择了六项符合条件的研究(2项随机临床试验[RCT],1个回顾性队列,和3项实验研究),受试者范围从3到100。只有一项研究评估了AFG在急性烧伤中的应用。改善伤口愈合,血管化,疤痕特征,在一些研究中通常观察到组织结构,由分子标记支持,而一项研究报告结果不显著。据报道,患者主观满意度有所改善。治疗区域的功能结果改善最小。然而,研究异质性主要来自治疗方案。由于潜在的偏差,谨慎的结果解释,特别是在选择和混淆领域,和有限的临床试验是重要的注意。需要更多的研究来评估。
    AFG和ADSC具有作为烧伤相关疤痕的有价值的治疗选择的潜力,有大量证据支持,但需要进一步精心设计的RCT。由于证据有限,急性烧伤的疗效有待进一步评估。
    UNASSIGNED: The objective of this study was to analyze all available research on the application of autologous fat grafting (AFG) and adipose-derived stem cells (ADSC) to present evidence-based recommendations, particularly in the clinical treatment of acute burns and burn-related scars.
    UNASSIGNED: We conducted a systematic search of PubMed, COCHRANE, and EMBASE, as well as a manual search of previous reviews\' reference lists up. The risk of bias (RoB) was assessed using RoB 2.0 and ROBINS-I, where appropriate.
    UNASSIGNED: Six eligible studies were selected (2 randomized clinical trials [RCT], 1 retrospective cohort, and 3 experimental studies) with subjects ranging from 3 to 100. Only one study evaluated the use of AFG for acute burns. Improvements in wound healing, vascularization, scar characteristics, and tissue architecture were generally observed in some studies, supported by molecular markers, while one study reported nonsignificant results. Subjective patient satisfaction was reported to have improved. Functional outcomes improvement in the treated regions was minimal. However, study heterogeneity arose mainly from treatment protocols. Cautious results interpretation due to potential bias, especially in selection and confounding domains, and limited clinical trials are important to note. More studies are needed to evaluate.
    UNASSIGNED: AFG and ADSC hold potential as valuable treatment options for burn-related scars, supported by a body of evidence, but further well-designed RCT are needed. The efficacy of acute burn settings is yet to be further evaluated since evidence is limited.
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  • 文章类型: Journal Article
    自体脂肪移植(AFG)是一种越来越多地用于乳房美容和重建手术的技术。在这个过程中,脂肪通过吸脂术从身体的一个部位吸出并注入乳房。AFG的程序和过程在过去的几十年中不断发展,导致更广泛的使用,虽然没有标准的方法。自体脂肪移植通常被认为是安全的程序,但由于与脂肪坏死有关的明显肿块的发展,可能会导致诊断成像的更高利用率。影像学检查结果取决于手术技术,但通常包括双侧,对称,当AFG用于原发性隆乳时,乳房后油囊肿和散在的营养不良和/或粗钙化。当AFG用于改善美容畸形的特定区域时,会出现更多的局灶性发现,疤痕,或乳腺癌手术后的疼痛。和任何引起脂肪坏死的原因一样,随着时间的推移,成像特征往往会显得更加良性,随着与油囊肿相关的边缘钙化的发展,并且在某些情况下,超声波上的油囊肿内容物的回声向无回声转移。本文回顾了AFG程序,uses,并发症,和成像发现。
    Autologous fat grafting (AFG) is a technique that is increasingly utilized in breast cosmetic and reconstructive surgery. In this procedure, fat is aspirated by liposuction from one area of the body and injected into the breast. The procedure and process of AFG has evolved over the last few decades, leading to more widespread use, though there is no standard method. Autologous fat grafting is generally considered a safe procedure but may result in higher utilization of diagnostic imaging due to development of palpable lumps related to fat necrosis. Imaging findings depend on surgical technique but typically include bilateral, symmetric, retromammary oil cysts and scattered dystrophic and/or coarse calcifications when AFG is used for primary breast augmentation. More focal findings occur when AFG is used to improve specific areas of cosmetic deformity, scarring, or pain following breast cancer surgery. As with any cause of fat necrosis, imaging features tend to appear more benign over time, with development of rim calcifications associated with oil cysts and a shift in echogenicity of oil cyst contents on ultrasound towards anechoic in some cases. This article reviews the AFG procedure, uses, complications, and imaging findings.
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  • 文章类型: Journal Article
    乳房切除术具有重大的社会心理影响,激励患者进行乳房再造。最初,硅胶植入物用于重建乳房。然而,多年来,乳房植入物一直是连续危机的主题。的确,破裂,硅胶出血,包膜挛缩保持局部。2019年,由于发现了乳房植入物相关的间变性大细胞淋巴瘤(BIA-ALCL),BIOCELL纹理乳房植入物被禁止并召回。最近,媒体已经描述了乳房植入物疾病。为了应对这些问题并回应一些患者对自然重建的期望,整形外科医生已经开发了乳房重建的自体解决方案。自从泰勒对血管体的研究以来,显微外科的发展和最近的脂肪移植,自体乳房重建已经知道了一个巨大的扩展。自体乳房重建允许更自然的感觉和纹理。这篇叙述性综述旨在为读者提供全面和最新的循证概述,以了解全乳房切除术后自体乳房重建的最新技术。
    我们对2010年1月至2022年12月发表的文献进行了叙述性回顾。使用具有不同组合的MeSH术语来识别包含的文章。在由三位作者独立筛选文章标题和摘要后,66篇论文被纳入这篇综述。
    在这篇评论中,作者描述和讨论了不同的自体乳房重建技术。
    自体重建提供了非常令人满意的,耐用,结果可靠,并发症发生率相对较低。深腹壁下穿支(DIEP)皮瓣,背阔肌肌皮瓣和自体脂肪移植是最常见的自体乳房重建类型。
    UNASSIGNED: Mastectomies have a significant socio-psychological impact, motivating patients to undergo breast reconstruction. Initially, silicone implants were used to reconstruct the breast. However, breast implants have been the subject of successive crises throughout the years. Indeed, rupture, silicone bleeding, and capsular contracture remain topical. In 2019, the BIOCELL textured breast implants was banned and recalled due to the discovery of the breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). More recently, the breast implant illness has been depicted in the media. To cope with these issues and to respond to some patients\' expectations for a natural reconstruction, plastic surgeons have developed autogenous solutions for breast reconstruction. Since Taylor\'s research on angiosomes, the development of the microsurgery and more recently fat grafting, autogenous breast reconstruction has known a tremendous expansion. Autologous breast reconstruction allows a more natural feeling and texture. This narrative review aims to provide to the readers a comprehensive and updated evidence-based overview of state of the art about autologous breast reconstruction after total mastectomy.
    UNASSIGNED: We conducted a narrative review of the literature searching for papers published between January 2010 and December 2022. The MeSH terms with different combinations were used to identify articles for inclusion. After screening article titles and abstracts independently by three authors, 66 papers were included in this review.
    UNASSIGNED: In this review, the authors describe and discuss the different autogenous techniques in breast reconstruction.
    UNASSIGNED: Autologous reconstructions provide very satisfactory, durable, and reliable results with relatively low complication rates. Deep inferior epigastric perforator (DIEP) flaps, latissimus dorsi flaps and autologous fat grafting are the most common type of autogenous breast reconstructions.
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  • 文章类型: Meta-Analysis
    乳房自体脂肪移植的体积保留是不可预测的,体积保留率及相关影响因素尚未进行系统综述。因此,本系统评价和荟萃分析旨在评价乳腺自体脂肪移植的体积保留率及相关影响因素,这是重建或审美的目的。使用PubMed进行文献检索,Embase,科克伦图书馆,和WebofScience数据库从研究开始到2022年12月。对所有结果进行敏感性分析。进行Begg测试以测试出版偏差。根据人群进行亚组分析,制备脂肪的方法,体积测量方法,脂肪移植的数量,注射脂肪移植量。本系统综述和荟萃分析共纳入25项研究。随访时间3~36个月。结果显示,最新随访点的合并体积保留率为54%[95%置信区间(CI):48.5%-59.5%]。基于脂肪的制备方法,离心的汇集率为51.5%(95CI:41.5%-61.5%),高于沉降[38.7%(95CI:30.9%-46.5%)]。此外,离心后获得的基质血管部分的富集与较高的体积保留率相关(加权平均差:17.36,95CI:8.84~25.87).我们的发现可能为临床上评估乳房自体脂肪移植的体积保留率提供指导。需要进一步的研究来验证我们的发现。
    The volume retention of breast autologous fat grafting is unpredictable, and the volume retention rate and related influencing factors have not been systematically reviewed. Therefore, this systematic review and meta-analysis aimed at evaluating the volume retention rate and related influencing factors of breast autologous fat grafting, which is for reconstructive or esthetic purposes. Literature search was conducted using the PubMed, Embase, Cochrane Library, and Web of Science databases from inception of study to December 2022. Sensitivity analysis was performed for all outcomes. Begg\'s test was performed to test publication bias. Subgroup analysis was performed based on population, method of fat preparation, method of volume measurement, number of fat grafting, and injected fat grafting volume. A total of 25 studies were included in this systematic review and meta-analysis. The follow-up time ranged from 3 to 36 months. Results showed that the pooled volume retention rate at the latest follow-up point was 54% [95% confidence interval (CI): 48.5%-59.5%]. Based on the fat preparation methods, the pooled rate was 51.5% (95%CI: 41.5%-61.5%) for centrifugation, which was higher than that for sedimentation [38.7% (95%CI: 30.9%-46.5%)]. In addition, the enrichment of stromal vascular fraction obtained after centrifugation was found to be associated with higher volume retention rate (weighted mean difference: 17.36, 95%CI: 8.84-25.87). Our findings may provide guidance for evaluating the volume retention rate of breast autologous fat grafting in clinical settings. Further studies are needed to verify our findings.
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  • 文章类型: Case Reports
    在这项研究中,我们报告了一例罕见的军刀政变,皮肤下的左额骨增生,在磁共振成像筛查和术前评估期间检测到。一名27岁女性,有13年的前额和头皮进行性软组织凹陷病史,并在疾病进入静止期之前用传统中草药治疗。患者接受了连续的长脉冲激光治疗和自体脂肪移植,结果令人满意。据我们所知,这是第一次在患有encoupdesabre的患者中发现软组织病变下的骨性增生。
    In this study, we report a rare case of en coup de sabre with hyperplasia of the left frontal bone beneath skin lesion, which is detected during magnetic resonance imaging screening and preoperative evaluation. A 27-year-old woman with 13-year history of progressive soft tissue depression in the forehead and scalp, and was treated by traditional Chinese herb before the disease went into stationary stage. The patient underwent serial long-pulsed laser treatments and autologous fat grafting with satisfactory outcome. To our knowledge, this is the first time that bony hyperplasia beneath the soft tissue lesion was found in a patient with en coup de sabre.
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  • 文章类型: Journal Article
    背景:自体脂肪移植是一种广泛采用的方法来优化乳房重建和隆乳的结果。尽管脂肪坏死是众所周知的自体脂肪移植的结果,它在文献中的定义仍然不一致。2014年底,美国食品和药物管理局发布了一份指南草案,以限制未来的自体脂肪移植-该声明在2017年底被允许修改。在不断发展的指南和自体脂肪移植结果数据的背景下,文献中脂肪坏死的语言和描述不一致。
    方法:从开始到2022年8月11日,查询了五个数据库中报告自体脂肪移植用于乳房重建或增大后脂肪坏死的研究。根据FDA发布的指南对研究进行时间分层:2015年之前、2015年-2017年和2018年-2022年。
    结果:61篇文章符合纳入标准。在2015年之前,21项研究中有6项(28.6%)提供了明确的脂肪坏死定义。相比之下,2015-2017年期间没有明确的脂肪坏死定义(0/13研究,p=0.03)。尽管与2015年前相比,2018-2022年期间的年度出版物有所增加(5.4与1.9,分别p=0.04),这与透明脂肪坏死报告的增加不匹配(14.8%的研究,p=0.45)。在所有时期,只有16.4%的文章提供了明确的定义,表现出广泛的异质性。
    结论:尽管自体脂肪移植越来越受欢迎,脂肪坏死的定义和描述仍然不一致,特别是在改变FDA指南的背景下。这限制了目前报道脂肪坏死结果的文献的可靠解释和应用。
    方法:本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述,请参阅目录或在线作者说明www。springer.com/00266.
    BACKGROUND: Autologous fat grafting is a widely adopted approach to optimize outcomes in breast reconstruction and augmentation. Although fat necrosis is a well-known consequence of autologous fat grafting, it remains inconsistently defined in the literature. In late 2014, the Food and Drug Administration released a draft guidance to restrict future autologous fat grafting-a statement that was permissively modified in late 2017. In the context of evolving guidelines and autologous fat grafting outcome data, the language and descriptions of fat necrosis are inconsistent in the literature.
    METHODS: Five databases were queried for studies reporting fat necrosis following autologous fat grafting for breast reconstruction or augmentation from inception to August 11, 2022. Studies were temporally stratified according to released FDA guidelines: pre-2015, 2015-2017, and 2018-2022.
    RESULTS: Sixty-one articles met inclusion criteria. Prior to 2015, 6 of 21 studies (28.6%) offered clear definitions of fat necrosis. In contrast, the 2015-2017 period demonstrated an absence of clear fat necrosis definitions (0/13 studies, p = 0.03). Though the 2018-2022 period exhibited a rise in annual publications compared with the pre-2015 period (5.4 vs. 1.9, respectively, p = 0.04), this was not matched by a rise in clear fat necrosis reporting (14.8% studies, p = 0.45). Across all periods, only 16.4% of articles offered clear definitions, which exhibited wide heterogeneity.
    CONCLUSIONS: Despite the increasing popularity of autologous fat grafting, fat necrosis remains inconsistently defined and described, especially in the context of changing FDA guidelines. This limits the reliable interpretation and application of the current literature reporting fat necrosis outcomes.
    METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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  • 文章类型: Systematic Review
    背景:肿瘤患者自体脂肪移植的有效性和安全性存在争议。头颈部肿瘤患者解剖结构复杂,综合治疗后需要对头颈部进行重建修复。关于在头颈部癌症患者中使用自体脂肪填充剂的有限的其他美学和功能研究尚不清楚。本研究系统评价了自体脂肪填充剂在头颈部的附加功能,系统回顾了头颈部肿瘤综合治疗后自体脂肪移植的相关问题,包括当前的适应症,技术,潜在的并发症,移植物存活,患者满意度。
    方法:使用PubMed进行了系统的文献综述,科克伦图书馆,EMBASE,和WebofScience(最后访问时间为2023年1月9日)。
    结果:共有249例自体脂肪填充剂在10篇临床出版物中报道。观察主要基于主观医师和患者评估指标,所有研究都报道了自体脂肪填充剂对头颈癌治疗后的美学和功能的有益影响。
    结论:自体脂肪填充剂可有效改善头颈部肿瘤的美观和功能,由于原始研究的局限性,未来需要大样本的研究来支持这一点.PROSPERO注册号是CRD42020222870。
    方法:本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述,请参阅目录或在线作者说明www。springer.com/00266.
    The efficacy and safety of autologous fat grafting for use in oncology patients are controversial. Patients with head and neck cancer have complex anatomy and require reconstructive repair of the head and neck after comprehensive treatment. The limited additional aesthetic and functional studies on the use of autologous fat fillers in patients with head and neck cancer are unclear. This study systematically evaluates the additional function of autologous fat fillers in the head and neck and systematically reviews issues related to autologous fat grafting after comprehensive head and neck cancer treatment, including current indications, techniques, potential complications, graft survival, and patient satisfaction.
    A systematic literature review was performed using PubMed, The Cochrane Library, EMBASE, and Web of Science (last accessed on January 9, 2023).
    A total of 249 cases of autologous fat fillers in patients with head and neck cancer were reported in 10 clinical publications. Observations were based mainly on subjective physician and patient evaluation indicators, and all studies reported the beneficial effects of autologous fat fillers on aesthetics and function after treatment for head and neck cancer.
    Autologous fat fillers are effective in improving the aesthetics and function of head and neck cancer, and due to the limitations of the original study, future studies with large samples are needed to support this. PROSPERO registration number is CRD42020222870.
    This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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