Research questions for AFT without definitive answers in the current literature. Questions due to a lack of high-quality evidence are not bolded, while questions due to minimal evidence overall are in bold
| Step | Question to Answer |
|---|---|
| Patient Selection | Does the menopausal status of women affect fat graft retention/outcomes? Do cancer treatments (radiation therapy, chemotherapy, etc.) affect adipocyte viability and fat graft retention? Do hormone replacement therapies affect fat graft outcomes? Are there gender differences, male vs female, between AFT outcomes? |
| Donor Site Preparation | What is the best way to prepare the donor site in order to improve wound healing and decrease scar formation and infection rates? Does a sterile ice pack applied to the donor region for 20 minutes, which adds to the tissue firmness, allow for easier access into the donor site, improve wound healing and decrease scar formation? What is the optimal percentage of lidocaine used in tumescent solution for pain control and adipocyte viability? What is the ideal concentration of epinephrine in the tumescent solution that ensures adequate vasoconstriction while maximizing adipocyte viability? Is lidocaine the best local anesthetic to use in fat graft tumescent solution? What type and size of tumescent solution injection needle ensures equal dispersion of fluid and preserves adipocyte viability? What is the best cannula diameter size to use for autologous fat transfer? Are there any additives to the tumescent solution that improve efficiency of harvest and adipocyte viability? What is the optimal number of cannula holes that produces the greatest adipocyte viability? What is the optimal arrangement of cannula holes for adipocyte viability? For efficiency of harvest? What is the optimal size/area of cannula holes for adipocyte viability and efficiency of harvest? What is the optimal shape of the cannula holes for adipocyte viability and efficiency of harvest? Does the use of compression and closed cell medical grade foam minimize post-harvest bruising of donor area? |
| Harvest of Fat Graft | What is the effect of using lidocaine and other local anesthetics on adipocyte viability? What are the optimal characteristics for liposuction cannulas to preserve adipocyte viability? (number of holes, shape of holes, arrangement of holes, and overall surface area of holes) |
| Harvest Ergonomics | What are the forces and energy exerted on adipocytes and on the surgeon during liposuction/adipocyte retrieval? How do different fat harvesting methods compare in terms of the stress and fatigue they put on the surgeon? What rate of retrieval is optimal for both adipocyte viability and cost-efficiency? |
| Harvest Quality | Is there a threshold of harvested adipose tissue viability that is predictive of graft volume retention? |
| Transfer of Fat to Placement Device | How many transfers between the centrifuged syringe and the injection syringe would ensure homogenization of the adipocytes and adipocyte-derived stem cells while maximizing adipocyte viability? |
| Recipient Site Qualities | What is the best way to prepare the recipient site in order to improve wound healing and decrease scar formation and infection rates? Does a sterile ice pack applied to the recipient site for 20 minutes, which adds to the tissue firmness, allow for easier access into the recipient site, improve wound healing and decrease scar formation? Does the use of compression and closed cell medical grade foam minimize post-harvest bruising of the injection area? What local anesthetic concentration should be used at each injection point to ensure the greatest alleviation of pain and retention of the fat graft? Does injection of epinephrine to the acceptor site affect the fat graft retention? |
| Fat Transfer | What size of syringe is optimal to use for fat graft placement? What are the optimal characteristics for cannulas and needles used to place the fat graft (diameter, number of holes, shape of holes, arrangement of holes, and overall surface area of holes)? Which is better to use for fat injection, needles or cannulas? What is the optimal depth of placement of fat for breast augmentation? What is the optimal speed of injection for fat graft placement? What is the optimal pressure of injection for fat graft placement? What is the optimal volume of fat per recipient potential volume to inject into different locations on the body? |
| Post-procedural Care | What is the optimal post-procedural care regimen for fat graft retention? What are the effects of compression, elevation, and massage on adipocyte viability? |