Application of Autological Adipose Tissue and its Products in the Treatment of Infected Wounds of Different Genesis

Abstract

Introduction. Transplantation of autologous adipose tissue and its products to stimulate the wound process is a rapidly developing area of ​​regenerative medicine. Adaptation of the technology to the conditions of infected wound treatment is a great challenge.The aim of the study was to determine the most effective and safe technologies for obtaining, processing and transplanting autologous adipose tissue used to treat infected wounds.Material and methods. The authors searched for relevant papers published in 2011 to 2021 in electronic databases PubMed, eLIBRARY, Embase, Cyberleninka, Web of Science. The analysis included 30 sources: 5 RCTs, 16 clinical studies, 3 case reports, 1 systematic review, 2 literature reviews, and 4 sources published before 2011 due to their fundamental and practical significance for the scope of the issue.Results and discussions. Although the lipoaspiration procedure in patients with infected wounds is described as standard conventional one, it still has a number of significant features that distinguish it from the standard technology of aesthetic surgery. To treat lipoaspirate, both enzymatic and mechanical options were used with the same frequency. The main technique of introducing adipose tissue products was local intradermal injections into the edges and under the wound bed; in a few cases, applications on the wound surface were used, or a combination of these options. As recorded, the cellularity index of adipose tissue products ranged from (min) 1x104/ml to (max) 50x106/ml. It should also be noted that a unified terminology for adipose tissue products used for wound treatment has not yet been adopted, but the most common term is stromal-vascular adipose tissue fraction.Conclusions. Systematization of literature data on the use of autologous adipose tissue products for wound treatment has shown that at present this technology is safe, provided with an accessible instrumental base, has positive results and is being actively developed. Further randomized clinical trials, involving extensive and multiple wounds, are required to determine the minimum effective and maximum tolerable dose in the treatment of wounds with adipose tissue products. In addition, it is promising to develop new means and approaches for delivering adipose tissue products in the treatment of infected wounds of various origins.