Enhancing Skin Regeneration During Expansion: A Multicenter Randomized Controlled Trial of Stromal Vascular Fraction and Fat Grafting.

Background: Skin regeneration via mechanical stretching is used in reconstructive surgery but is often limited by the skin's inherent growth capacity. This multicenter randomized controlled trial evaluated the efficacy of autologous stromal vascular fraction (SVF) transplantation and fat grafting in enhancing skin regeneration during tissue expansion.

Methods: Patients aged 18-60 undergoing skin expansion were randomized to receive SVF transplantation, fat grafting, or serve as controls. Participants were also categorized into well-regenerated and poorly regenerated subgroups based on skin texture assessments. Assessments occurred every four weeks over 12 weeks, with safety follow-up up to two years. The primary outcome was skin thickness change at 12 weeks; secondary outcomes included intermediate skin thickness and the expansion index (EI).

Results: Seventy-two patients were enrolled; after six were lost to follow-up, 66 remained: 23 in the Control group, 21 in the Adipose group, and 22 in the SVF group. At 12 weeks, the Adipose and SVF groups showed significant increases in skin thickness compared to the Control group (p < 0.05). In well-regenerated skin, treatments maintained thickness; in poorly regenerated skin, treatments increased and maintained thickness through 12 weeks. Both treatment groups had greater increases in EI at 12 weeks compared to controls (p < 0.001). No severe adverse events were observed during the two-year follow-up.

Conclusion: Autologous SVF transplantation and fat grafting effectively promote skin regeneration during tissue expansion, maintaining skin thickness in well-regenerated skin and counteracting thinning in poorly regenerated skin. Adipose-derived treatments offer a effective strategy for enhancing skin regeneration in tissue expansion.