Table 3.

Clinical studies of lipografting as treatment of wound healing.

Reference	Study Type	Study Population	Intervention	Follow Up	Results	Complications
van Abeelen et al. 2014	Case report	Patient with recurrent leaks from her stoma and skin excoriation.	Intervention: multiple layer lipografting around the stoma. Co-intervention: Tegaderm™ foil.	Results were evaluated after 12 months.	No clinical recurrence occurred.	No complications reported.
Del Berne et al. 2014	Prospective, non-controlled, non-blinded, non-randomized	Patients with Systemic Sclerosis and digital ulcers (n = 9, 15 ulcers). Age of the ulcer was 2–8 months.	Intervention: lipografting at the border of the ulcer. Co-intervention: Iloprost (intravenously), calcium channel blockers, Bosentan, Sildenafil, Aspirin and debridement.	Results were evaluated after 3 months. Another 6 months to 2 years of follow-up was used to evaluated any ulcer recurrence.	10 of the 15 ulcers healed completely in 8 to 12 weeks. In 2 patients (3 ulcers) amputation was needed. In 2 patients, the ulcer size decreased with 50%. All patient, except of 2, reduced their analgesics therapy.	No complications reported.
Caviggioli et al. 2012	Case report	Patient with a posttraumatic leg ulcer.	Intervention: 5 mL of centrifuged adipose tissue. Co-intervention: wound debridement, calcium alginate dressing.	Results were evaluated after 1 week, 2 weeks, 1, 3, 6 and 12 months.	Complete wound closure was obtained after 1 month. Patient satisfaction was excellent.	Not mentioned.
Cervelli et al. 2009	Prospective, controlled, non-blinded, non-randomized	Patients with lower-extremity chronic ulcers and vascular disease (n = 20).	Intervention: lipografting in the bed around the margins of the ulcers. Co-intervention: PRP injection (25 interventions in total). Control: medication-based collagen and hyaluronic acid.	Results were evaluated after 2 and 5 weeks and 3, 6 and 12 months.	16 of the 20 ulcers re-epithelialized after 9.7 weeks on average in the intervention groups compared to 5 of 10 ulcers re-epithelialized in the control group after 8.4 weeks on average. 13 patients needed 1 treatment, 5 patients needed 2 treatments. In 4 patients of the intervention group ulcer recurrence occurred.	Not mentioned.
Cervelli et al. 2010	Prospective, non-controlled, non-blinded, non-randomized	Patients with ulcers or substance loss of the lower limb (n = 30).	Intervention: lipografting in the wounds. Co-intervention: PRP injection, hyaluronic acid.	Results were evaluated every week until 1 month postoperative, then follow-up was done 3, 6 and 12 months postoperative. Biopsies were taken intra-operative and 15 days postoperative.	Complete healing occurred in 57% of the patients after 3 months. Postoperative biopsies showed an increased cell proliferation as compared to intra-operative biopsies. No quantitative data was shown.	2 infections.
Cervelli et al. 2011	Prospective, controlled, non-blinded, non-randomized	Patients with post-traumatic lower extremity ulcers (n = 40).	Intervention 1: SVF enriched lipografting into the bed of the ulcer and peri-lesional. Intervention 2: PRP enriched lipografting into the perilesional area. Control 1: hyaluronic acid into the bed of the ulcer. Control 2: PRP gels into the bed of the ulcer.	Results were evaluated up to 16 weeks postoperative. Biopsies were taken from a small sample size (numbers not mentioned) preoperative and 3, 7 and 16 weeks postoperative.	After 9.7 weeks, re-epithelialization of the wound occurred for 97.9% ± 1.5% for intervention 1, 87.8% ± 4.4% for control 1 *, 97.8% ± 1.5% for intervention 2 and 89.1% ± 3.8% for control 2. * No biopsy comparison data between the four groups was presented.	2 hematoma, 1 infection, 1 edema, 1 edema and infection, 1 edema and hematoma, 1 edema, infection and hematoma.
Klinger et al. 2010	Retrospective, non-controlled	Patients with chronic ulcers within the scar area (n = 8). Non-healed ulcers for 15.4 weeks on average.	Intervention: lipografting in the dermal-subdermal junction of the scar and edge and central region of the ulcer.	Results were evaluated after 2 weeks.	Complete re-epithelialization occurred in all patients after 2 weeks. Patient satisfaction was excellent. Results were stable after 1-year follow-up.	No complications reported.
Stasch et al. 2015	Prospective, non-controlled, non-blinded, non-randomized	Diabetic patients with non-healing lower limb ulcers (n = 25). Age of the ulcer was >2 months.	Intervention: sublesional lipografting into the bottom of the ulcer and the wound edges. Co-intervention: debridement, VAC dressing, sterile silicone wound dressing, Octenisept® and Suprasorb H® plates.	Time until wounds closed and time until wounds closed by 50% was measured. Photographic evaluation of the healing process.	22 of the 25 ulcers healed completely after 68 days on average. Mean wound size reduction of 50% was achieved 4 weeks postoperative. One patient needed a repeated lipografting session and complete wound healing was achieved within another 4 weeks.	No complications reported.

PRP = platelet-rich plasma, SVF = stromal vascular fraction, VAC = vacuum assisted closure. * Results were significant when p < 0.05.