Double-blind clinical trial to compare autologous fat grafts versus autologous fat grafts with PDGF: no effect of PDGF.

1. Fontdevila J, Guisantes E, Martínez E, Prades E, Berenguer J. Double-blind clinical trial to compare autologous fat grafts versus autologous fat grafts with PDGF: No effect of PDGF. Plast Reconstr Surg. 2014;134:219e–230e. 2. Atashi F, Jaconi ME, Pittet-Cuénod B, Modarressi A. Autologous platelet-rich plasma: A biological supplement to enhance adipose-derived mesenchymal stem cell expansion. Tissue Eng Part C Methods (in press). 3. Kocaoemer A, Kern S, Klüter H, Bieback K. Human AB serum and thrombin-activated platelet-rich plasma are suitable alternatives to fetal calf serum for the expansion of mesenchymal stem cells from adipose tissue. Stem Cells 2007;25:1270–1278. 4. Kakudo N, Minakata T, Mitsui T, Kushida S, Notodihardjo FZ, Kusumoto K. Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts. Plast Reconstr Surg. 2008;122:1352–1360. 5. Li H, Han Z, Liu D, Zhao P, Liang S, Xu K. Autologous platelet-rich plasma promotes neurogenic differentiation of human adipose-derived stem cells in vitro. Int J Neurosci. 2013;123:184–190. 6. Hoareau L, Bencharif K, Girard AC, et al. Effect of centrifugation and washing on adipose graft viability: A new method to improve graft efficiency. J Plast Reconstr Aesthet Surg. 2013;66:712–719. 7. Franzetti M, Adorni F, Oreni L, et al. Changes in the incidence of severe thrombocytopenia and its predisposing conditions in HIV-infected patients since the introduction of highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2014;67:493–498. 8. Dhurve SA, Dhurve AS. Bone marrow abnormalities in HIV disease. Mediterr J Hematol Infect Dis. 2013;5:e2013033. alone or with the adjunct of platelet-rich plasma in patients with human immunodeficiency virus. The use of platelet-rich plasma and/or other growth factors is a growing field of plastic surgery, along with the “regenerative revolution” started from the discovery of adipose-derived stem cells.2 Several authors evaluated the combined use of fat graft and platelet-rich plasma in the past decade. However, despite worldwide efforts, results are still controversial, with contrasting evidence in the literature and a lack of a clear standardization of the techniques used and/ or insufficient description of the adopted procedures. Different experimental settings, such as platelet-rich plasma preparation, activation, and mixing with fat graft, are often underlying the heterogeneous results reported in the different studies. In our opinion, there is an urgent need for standardization in regenerative medicine to elucidate which are the most effective techniques. We would like to congratulate Dr. Fontdevila and colleagues for their work. The authors stated that platelet-rich plasma effects are highly dose dependent, and we agree almost completely on this issue. Nevertheless, we would like to point out an interesting issue raised by the article. Human immunodeficiency virus is often accompanied by thrombocytopenia, which could be considered a contraindication to the use of emoderivates3,4; specifically, a low number of platelets could hamper the efficacy of platelet-rich plasma. Did the authors analyze platelet counts before surgery? What was the platelet concentration obtained after centrifugation? Was platelet-rich plasma prepared with the manual method or was any commercial kit used? We deem that these variables should be cited in the article, especially in this case with a group of human immunodeficiency virus–positive patients. If analyzed in their entirety, they could further strengthen the authors’ findings or lead to additional conclusions. For these reasons, we would like to know their point of view on this issue and encourage them to continue their studies in this emerging field. DOI: 10.1097/PRS.0000000000001094