The quality and stability of the graft over time are the most difficult factors to control, as reabsorption reaching 50–70% can occur. It is particularly the case in surfaces having an atrophied vascularisation or weakened cicatricial capacities, as the result of smoking or HIV. Patients with HIV may benefit from lipoatrophy treatment, but optimal results may represent an additional challenge.
The first in vitro studies highlighted an acceleration in the proliferation of pre-adipocytes put in contact with a PRF membrane. If the cytokine platelets help accelerate cicatrisation, the deposit of a cicatricial fibrin screen
will have effects on the incorporation of grafted tissue. The presence of a fibrin membrane charged with platelets and leukocytes is therefore the best chemotactic factor and is supported by the proliferation of the endothelial cells.
In future, and to confirm these good results with the adjunct of PRF to fat, it is necessary to obtain an objective evaluation based on the use of imagery (e.g. MRI) and with clinical scale correlations.
Conclusions
A fast neovascularisation of grafted tissue is a significant parameter for cellular survival and limits tissue resorption. Dr Coleman’s technique, which is predominantly carried out using small fat–tissue deposits, is an important factor in the results: if the graft is too big it cannot be vascularised and decreases in size. It is important to consider that fibrin is an excellent trap for the original circulating cells, as well as the immune cells, ending in a better immunisation of the purified graft.
This study allows the opportunity to use concentrated platelets for adipocyte grafts. PRF is a platelet concentrate and can quickly and easily be produced at a minimal cost, using only a natural blood clot without biochemically modifying the blood. Knowing the extent of the uses of the surgical additives containing fibrin in plastic surgery, it shows that in the years to come a biomaterial of cicatrisation such as PRF will enter a wider field of application, even if it is still necessary to carry out further studies to validate its indications.
