Autologous Fat Grafting in the Upper Extremity: A Systematic Review
Eric Chang, MD1, Joseph Mark Firriolo, MD2, Clifford T Pereira, M.D.3, Lee L.Q. Pu, MD, PhD, FACS2 and Prosper Benhaim, MD4, (1)University of California, Los Angeles, Santa Monica, CA, (2)University of California, Davis, Sacramento, CA, (3)University of California Davis, Sacramento, CA, (4)Division of Plastic Surgery, University of California, Los Angeles, Los Angeles, CA
Introduction: Autologous fat grafting is a burgeoning field with a myriad of applications in the upper extremity. We hypothesized that systematic review of fat grafting in the upper extremity would exhibit the successful use of fat not only as a biological filler, but also as a tissue with remarkable regenerative capacity due to its rich population of adipose-derived stem cells (ADSCs).
Materials and Methods: We performed a systematic review of Pubmed, Embase, Cochrane Library, and Google Scholar for relevant, English-language articles (published 2000-2023), using the search terms "fat graft", "fat grafting", "hand", "hand surgery", "upper extremity", and "upper extremity surgery". Original clinical studies, level IV evidence and greater, were included in our analyses if they investigated an application of fat grafting in the hand/upper extremity.
Results: Fifty articles were included in final analyses; we identified nine broad therapeutic applications. Eight articles evaluated fat grafting for osteoarthritis. Of note, ‘liparthroplasty’ for basilar thumb arthritis has demonstrated improvements in function/pain and shown success in preserving the thumb carpometacarpal joint. Proposed mechanisms include anti-inflammatory and chondroprotective effects of ADSCs and mechanical properties of fat within the joint (i.e. cushioning and lubrication).
Seven articles (14%) used fat grafting in the treatment of scleroderma-related hand pathology, with success in regulating vascular manifestations of disease, specifically Raynaud phenomenon, digital ulcers, and hand pain.
Six articles (12%) exhibited benefits in skin quality following fat grafting in scar- and burn-related complications. The filling properties of fat were found to be beneficial in ten articles: this includes the use of fat to mask muscle atrophy in compression neuropathy, addressing post-traumatic fingertip contour abnormalities, decreasing the morbidity of radial forearm flap donor sites, and addressing age-related volume loss in the dorsal hand.
Neuromas/neuropathic pain were reviewed in six articles. Five articles investigated the use of fat grafting in congenital hand anomalies. Three articles discussed Dupuytren's contracture treatment. Two articles showed uses in flexor tendon injuries. One article each applied fat grafting to lymphedema and post traumatic proximal radioulnar synostosis.
Conclusions: The applications of fat grafting in the upper extremity are broad and ever growing. Fat grafting is a worthy addition to the hand surgeon’s armamentarium, both for its regenerative and mechanical effects, which help to address difficult surgical problems in a relatively non-invasive fashion. Higher level clinical studies and further investigation into the underlying mechanisms are both indicated.
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