{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:40:50Z","timestamp":1787164850204,"version":"build-2736575974"},"reference-count":73,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: The treatment of perianal fistulas remains challenging, with low healing and high recurrence rates. Autologous adipose-derived regenerative therapies and platelet-rich plasma (PRP) have emerged as adjuncts to surgical intervention for cryptoglandular and Crohn\u2019s disease (CD)-related perianal fistulas (PAF). This systematic review evaluates the outcomes of these therapies as an add-on to surgical intervention. Methods: A systematic search was conducted in several online databases up to December 2025. Studies with \u226510 patients reporting on the use of intraoperative autologous adipose-derived therapies and\/or PRP for the treatment of cryptoglandular or CD-related PAF, and clinical healing rates, were included. Other outcomes comprised radiologic healing (as defined in the study), recurrence rates and complications. The study quality was assessed with the Effective Public Health Practice Tool. Results: In total, 28 studies on individual cases were included (n = 1017 patients, range 10\u2013219) (17 in cryptoglandular PAF, 8 in CD-related PAF and 3 in both entities). A total of 57% of the studies were rated low quality. In cryptoglandular PAF, reported healing rates with adipose-derived therapies ranged from 50% to 90% across studies of low to good methodological quality. For PRP, three of the four randomized trials demonstrated no superiority over standard care. In CD-related PAF, healing rates after treatment with adipose-derived therapies ranged from 40% to 80%. For PRP, three studies, of which two were low quality, reported highly variable healing rates (33\u201380%). Radiologic healing, reported in 10 studies, ranged from 38 to 76% in cryptoglandular and 33\u201375% in CD-related PAF. Recurrence rates remained &lt;17% for adipose-derived therapies and &lt;31% following treatment with PRP. Major complications occurred in &lt;15% of the patients. Conclusions: High heterogeneity with regard to fistula complexities, outcome definitions and surgical method was observed in the available studies on autologous add-on therapies. This hinders an overall effectiveness analysis. The promising healing rates, low recurrence rates after healing and low complication rates warrant high-quality trials.<\/jats:p>","DOI":"10.3390\/bioengineering13040393","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:11:44Z","timestamp":1774872704000},"page":"393","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intraoperative Autologous Adipose-Derived Therapies and PRP as Add-On in the Surgical Treatment of Cryptoglandular and Crohn\u2019s Disease-Related Perianal Fistula\u2014A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Merel M.","family":"Verweij","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Uguten","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands"},{"name":"Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8515-425X","authenticated-orcid":false,"given":"Michiel T. J.","family":"Bak","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline D. M.","family":"Witjes","sequence":"additional","affiliation":[{"name":"Department of Surgery, IJsselland Hospital, 2906 ZC Capelle aan den IJssel, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarie C.","family":"de Vries","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilse","family":"Molendijk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4366-0653","authenticated-orcid":false,"given":"Joris A.","family":"van Dongen","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1620-1854","authenticated-orcid":false,"given":"Oddeke","family":"van Ruler","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands"},{"name":"Department of Surgery, IJsselland Hospital, 2906 ZC Capelle aan den IJssel, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1002\/bjs.1800640203","article-title":"Anal fistulas at St Mark\u2019s Hospital","volume":"64","author":"Marks","year":"2005","journal-title":"Br. J. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1053\/gast.2002.32362","article-title":"The natural history of fistulizing Crohn\u2019s disease in Olmsted County, Minnesota","volume":"122","author":"Schwartz","year":"2002","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"otad036","DOI":"10.1093\/crocol\/otad036","article-title":"The Impact of Crohn\u2019s Perianal Fistula on Quality of Life: Results of an International Patient Survey","volume":"5","author":"Spinelli","year":"2023","journal-title":"Crohns Colitis 360"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/codi.13330","article-title":"Adoption and success rates of perineal procedures for fistula-in-ano: A systematic review","volume":"18","author":"Kontovounisios","year":"2016","journal-title":"Color. Dis."},{"key":"ref_5","first-page":"104","article-title":"Transanal Advancement Flap Repair: The Current Gold Standard for Cryptoglandular Transsphincteric Perianal Fistulas","volume":"29","author":"Zimmerman","year":"2019","journal-title":"Turk. J. Color. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1007\/DCR.0b013e3181ce8b01","article-title":"Endorectal advancement flap for cryptoglandular or Crohn\u2019s fistula-in-ano","volume":"53","author":"Soltani","year":"2010","journal-title":"Dis. Colon Rectum"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"102045","DOI":"10.1016\/j.eclinm.2023.102045","article-title":"Short-term anti-TNF therapy with surgical closure versus anti-TNF therapy alone for Crohn\u2019s perianal fistulas (PISA-II): Long-term outcomes of an international, multicentre patient preference, randomised controlled trial","volume":"61","author":"Becker","year":"2023","journal-title":"EClinicalMedicine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1093\/ecco-jcc\/jjw169","article-title":"3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn\u2019s Disease 2016: Part 2: Surgical Management and Special Situations","volume":"11","author":"Gionchetti","year":"2017","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1097\/MIB.0000000000000148","article-title":"Disappointing durable remission rates in complex Crohn\u2019s disease fistula","volume":"20","author":"Molendijk","year":"2014","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4350","DOI":"10.1007\/s10620-023-08096-9","article-title":"Perianal Fistulas Are Associated with Persistently Higher Direct Health Care Costs in Crohn\u2019s Disease: A Population-Based Study","volume":"68","author":"McCurdy","year":"2023","journal-title":"Dig. Dis. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2916","DOI":"10.1007\/s10620-020-06647-y","article-title":"Impaired Quality of Working Life in Inflammatory Bowel Disease Patients","volume":"66","author":"Gielen","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.bjps.2015.10.014","article-title":"Stromal vascular fraction: A regenerative reality? Part 2: Mechanisms of regenerative action","volume":"69","author":"Guo","year":"2015","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Zhou, Z., Ouboter, L.F., Peeters, K., Hawinkels, L., Holman, F., Pascutti, M.F., Barnhoorn, M.C., and van der Meulen-de Jong, A.E. (2023). Crohn\u2019s Disease-Associated and Cryptoglandular Fistulas: Differences and Similarities. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020466"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"230","DOI":"10.5966\/sctm.2011-0054","article-title":"Concise review: Adipose-derived stromal vascular fraction cells and platelet-rich plasma: Basic and clinical implications for tissue engineering therapies in regenerative surgery","volume":"1","author":"Gentile","year":"2012","journal-title":"Stem Cells Transl. Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Paganelli, A., Contu, L., Condorelli, A., Ficarelli, E., Motolese, A., Paganelli, R., and Motolese, A. (2023). Platelet-Rich Plasma (PRP) and Adipose-Derived Stem Cell (ADSC) Therapy in the Treatment of Genital Lichen Sclerosus: A Comprehensive Review. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242216107"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"i34","DOI":"10.1093\/ecco-jcc\/jjad212.0018","article-title":"OP 18 Efficacy and safety of darvadstrocel treatment in patients with complex perianal fistulas and Crohn\u2019s Disease: Results from the global ADMIRE-CD II phase 3 study","volume":"18","author":"Serclova","year":"2024","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jclinepi.2009.06.006","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration","volume":"62","author":"Liberati","year":"2009","journal-title":"J. Clin. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1093\/heapro\/dai022","article-title":"Criteria for the systematic review of health promotion and public health interventions","volume":"20","author":"Jackson","year":"2005","journal-title":"Health Promot. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1097\/DCR.0000000000001924","article-title":"Efficacy and Safety of Treatment of Complex Idiopathic Fistula-in-Ano Using Autologous Centrifuged Adipose Tissue Containing Progenitor Cells: A Randomized Controlled Trial","volume":"64","author":"Ascanelli","year":"2021","journal-title":"Dis. Colon Rectum"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1097\/DCR.0000000000003312","article-title":"Addition of Platelet-Rich Plasma to Endorectal Advancement Flap Repair Does Not Enhance the Healing of Cryptoglandular Transsphincteric Fistulas","volume":"67","author":"Bak","year":"2024","journal-title":"Dis. Colon Rectum"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1097\/DCR.0000000000002379","article-title":"Efficacy of Injection of Freshly Collected Autologous Adipose Tissue into Complex Cryptoglandular Anal Fistulas","volume":"66","author":"Dalby","year":"2023","journal-title":"Dis. Colon Rectum"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2814","DOI":"10.1007\/s11605-019-04480-x","article-title":"Autologous Platelet-Rich Plasma in the Treatment of Perianal Fistula in Crohn\u2019s Disease","volume":"24","year":"2020","journal-title":"J. Gastrointest. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1007\/s00384-019-03290-6","article-title":"Platelet-rich plasma (PRP) versus fibrin glue in cryptogenic fistula-in-ano: A phase III single-center, randomized, double-blind trial","volume":"34","author":"Maestre","year":"2019","journal-title":"Int. J. Color. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1007\/s00384-017-2866-9","article-title":"Treatment of transsphincteric fistula-in-ano with growth factors from autologous platelets: Results of a phase II clinical trial","volume":"32","author":"Maestre","year":"2017","journal-title":"Int. J. Color. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1053\/j.gastro.2019.02.005","article-title":"Efficacy of Injection of Freshly Collected Autologous Adipose Tissue Into Perianal Fistulas in Patients With Crohn\u2019s Disease","volume":"156","author":"Dige","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/DCR.0000000000000023","article-title":"Long-term results of mucosal advancement flap combined with platelet-rich plasma for high cryptoglandular perianal fistulas","volume":"57","author":"Vening","year":"2014","journal-title":"Dis. Colon Rectum"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s10151-015-1311-8","article-title":"Treatment of Crohn\u2019s disease-related high perianal fistulas combining the mucosa advancement flap with platelet-rich plasma: A pilot study","volume":"19","author":"Smeets","year":"2015","journal-title":"Tech. Coloproctol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s13287-022-02738-x","article-title":"Three-year outcome of local injection of autologous stromal vascular fraction cells and microfat in refractory perianal fistulas of Crohn\u2019s disease","volume":"13","author":"Guillo","year":"2022","journal-title":"Stem Cell Res. Ther."},{"key":"ref_29","first-page":"156","article-title":"Novel sphincter-preserving therapies for recurrent anal fistulas","volume":"32","author":"Hermann","year":"2021","journal-title":"Turk. J. Color. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1111\/ans.17656","article-title":"Comparison between application of platelet rich plasma and mucosal advancement flap in patients with high transsphincteric anal fistulas: A randomized control trial","volume":"92","author":"Hermann","year":"2022","journal-title":"ANZ J. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6132340","DOI":"10.1155\/2019\/6132340","article-title":"Stem cell therapy: A compassionate use program in perianal fistula","volume":"2019","author":"Herreros","year":"2019","journal-title":"Stem Cells Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1007\/s11605-023-05719-4","article-title":"Autologous Fat Grafting: An Emerging Treatment Option for Complex Anal Fistulas","volume":"27","author":"Huang","year":"2023","journal-title":"J. Gastrointest. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3393\/ac.2022.00486.0069","article-title":"Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: A pilot study","volume":"40","author":"Jeong","year":"2024","journal-title":"Ann. Coloproctol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.surg.2020.12.025","article-title":"Ligation of intersphincteric fistula tract (LIFT) with or without injection of platelet-rich plasma (PRP) in management of high trans-sphincteric fistula-in-ano: Short-term outcomes of a prospective, randomized trial","volume":"170","author":"Madbouly","year":"2021","journal-title":"Surgery"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s10151-018-1755-8","article-title":"Micro-fragmented adipose tissue injection for the treatment of complex anal fistula: A pilot study accessing safety and feasibility","volume":"22","author":"Naldini","year":"2018","journal-title":"Tech. Coloproctol."},{"key":"ref_36","first-page":"115","article-title":"Evaluation of the results of platelet-rich plasma (PRP) treatment in the treatment of complex perianal fistula: A prospective study","volume":"37","author":"Niknami","year":"2022","journal-title":"Acad. J. Health Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1093\/ibd\/izab276","article-title":"Treatment of Fistulizing Perianal Crohn\u2019s Disease by Autologous Microfat Enriched With Adipose-Derived Regenerative Cells","volume":"28","author":"Jensen","year":"2022","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e316","DOI":"10.1111\/codi.13782","article-title":"Surgical treatment of trans-sphincteric anal fistulas with the Fat GRAFT technique: A minimally invasive procedure","volume":"19","author":"Stroumza","year":"2017","journal-title":"Color. Dis."},{"key":"ref_39","first-page":"583","article-title":"Short-term results of adipose-derived stem cell therapy for the treatment of complex perianal fistula A single center experience","volume":"90","author":"Topal","year":"2019","journal-title":"Ann. Ital. Chir."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1093\/ibd\/izae283","article-title":"Autologous Microfragmented Adipose Tissue Injection in Refractory Complex Crohn\u2019s Perianal Fistulas: Long-Term Results at 6.7 Years Mean Follow-up","volume":"31","author":"Laureti","year":"2025","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Bak, M.T.J., Witjes, C.D.M., Dwarkasing, R.S., Arkenbosch, J.H.C., Schouten, W.R., van Veen, J.C., van Dongen, J.A., Fuhler, G.M., van der Woude, C.J., and de Vries, A.C. (2025). Additional Intraoperative Autologous-Derived Platelet-Rich Stroma to Transanal Flap Repair for the Treatment of Cryptoglandular Transsphincteric Fistulas in a Tertiary Referral Center: Long-Term Outcomes of a Prospective Pilot Study. Bioengineering, 12.","DOI":"10.3390\/bioengineering12020105"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/s00053-025-00878-1","article-title":"Improving outcomes of LIFT procedure for treatment of complex transsphincteric fistulas by addition of platelet-rich plasma: A clinical trial","volume":"47","author":"Bananzadeh","year":"2025","journal-title":"Coloproctology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s10151-024-03102-2","article-title":"Long-term outcomes of a bioactive matrix enriched with an autologous platelet concentrate for the treatment of complex anal fistulae","volume":"29","author":"Maya","year":"2025","journal-title":"Tech. Coloproctol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"17562848241263014","DOI":"10.1177\/17562848241263014","article-title":"Effectiveness of autologous emulsified stromal vascular fraction tissue injection for the treatment of complex perianal fistulas in inflammatory bowel diseases patients: A pilot study","volume":"17","author":"Potenza","year":"2024","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2390","DOI":"10.1093\/ibd\/izaf011","article-title":"Intraoperative Autologous Platelet-Rich Stroma Injection as Add-On to Fistula Curettage and Closure of the Internal Orifice Demonstrates a Favorable Outcome in Long-Term in Patients Suffering from Therapy-Refractory Perianal Fistulizing Crohn\u2019s Disease","volume":"31","author":"Bak","year":"2025","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1097\/DCR.0000000000003820","article-title":"Long-term Outcomes of Primary Fistula Closure With Platelet-Rich Plasma: A Prospective Study","volume":"68","year":"2025","journal-title":"Dis. Colon Rectum"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/ibd\/izz051","article-title":"Refractory Complex Crohn\u2019s Perianal Fistulas: A Role for Autologous Microfragmented Adipose Tissue Injection","volume":"26","author":"Laureti","year":"2020","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1097\/DCR.0000000000000352","article-title":"Long-term follow-up after surgery for simple and complex cryptoglandular fistulas: Fecal incontinence and impact on quality of life","volume":"58","author":"Visscher","year":"2015","journal-title":"Dis. Colon Rectum"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1111\/apt.17347","article-title":"Stromal vascular fraction with platelet-rich plasma injection during surgery is feasible and safe in treatment-refractory perianal fistulising Crohn\u2019s disease: A pilot study","volume":"57","author":"Arkenbosch","year":"2023","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1186\/s13287-025-04272-y","article-title":"Efficacy of mesenchymal stem cell-based therapies in the treatment of perianal fistulizing Crohn\u2019s disease: A systematic review and meta-analysis","volume":"16","author":"Guillo","year":"2025","journal-title":"Stem Cell Res. Ther."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Schipper, J.A.M., van Laarhoven, C., Schepers, R.H., Tuin, A.J., Harmsen, M.C., Spijkervet, F.K.L., Jansma, J., and van Dongen, J.A. (2023). Mechanical Fractionation of Adipose Tissue-A Scoping Review of Procedures to Obtain Stromal Vascular Fraction. Bioengineering, 10.","DOI":"10.3390\/bioengineering10101175"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1111\/wrr.13228","article-title":"Comparing mechanical and enzymatic isolation procedures to isolate adipose-derived stromal vascular fraction: A systematic review","volume":"32","author":"Uguten","year":"2024","journal-title":"Wound Repair Regen."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"jjaf231.953","DOI":"10.1093\/ecco-jcc\/jjaf231.953","article-title":"P0772 Updated Results on Treatment of Crohn\u2019s Complex Perianal Fistulas With Micro-fragmented Autologous Adipose Tissue Injection (A Multicenter Randomized Controlled Trial-ATTIC): Quality of Life and Safety","volume":"20","author":"Laureti","year":"2026","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1186\/s13287-021-02644-8","article-title":"Molecular differences of adipose-derived mesenchymal stem cells between non-responders and responders in treatment of transphincteric perianal fistulas","volume":"12","author":"Tencerova","year":"2021","journal-title":"Stem Cell Res. Ther."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s10047-016-0913-x","article-title":"Platelet-rich plasma stimulates human dermal fibroblast proliferation via a Ras-dependent extracellular signal-regulated kinase 1\/2 pathway","volume":"19","author":"Hara","year":"2016","journal-title":"J. Artif. Organs"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"3223","DOI":"10.1177\/03635465241283463","article-title":"Influence of Platelet Concentration on the Clinical Outcome of Platelet-Rich Plasma Injections in Knee Osteoarthritis","volume":"52","author":"Boffa","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1177\/03635465241246524","article-title":"PRP Injections for the Treatment of Knee Osteoarthritis: The Improvement Is Clinically Significant and Influenced by Platelet Concentration: A Meta-analysis of Randomized Controlled Trials","volume":"53","author":"Bensa","year":"2025","journal-title":"Am. J. Sports Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"NP477","DOI":"10.1093\/asj\/sjab431","article-title":"Tissue Stromal Vascular Fraction Improves Early Scar Healing: A Prospective Randomized Multicenter Clinical Trial","volume":"42","author":"Uguten","year":"2022","journal-title":"Aesthetic Surg. J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1186\/s13287-019-1415-6","article-title":"Stromal vascular fraction promotes migration of fibroblasts and angiogenesis through regulation of extracellular matrix in the skin wound healing process","volume":"10","author":"Bi","year":"2019","journal-title":"Stem Cell Res. Ther."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3220","DOI":"10.1002\/term.2213","article-title":"The power of fat and its adipose-derived stromal cells: Emerging concepts for fibrotic scar treatment","volume":"11","author":"Spiekman","year":"2017","journal-title":"J. Tissue Eng. Regen. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"554e","DOI":"10.1097\/01.prs.0000479995.04255.bb","article-title":"Platelet-Rich Plasma Influences Expansion and Paracrine Function of Adipose-Derived Stromal Cells in a Dose-Dependent Fashion","volume":"137","author":"Willemsen","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s13287-018-0851-z","article-title":"Platelet-rich plasma enhances the proliferation of human adipose stem cells through multiple signaling pathways","volume":"9","author":"Lai","year":"2018","journal-title":"Stem Cell Res. Ther."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1007\/s00018-017-2484-2","article-title":"Effect of hypoxia on human adipose-derived mesenchymal stem cells and its potential clinical applications","volume":"74","author":"Choi","year":"2017","journal-title":"Cell. Mol. Life Sci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/iwj.13029","article-title":"The use of fat grafting and platelet-rich plasma for wound healing: A review of the current evidence","volume":"16","author":"Smith","year":"2019","journal-title":"Int. Wound J."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1080\/2000656X.2020.1856678","article-title":"Immediate fat and nanofat-enriched fat grafting in breast reduction for scar management","volume":"55","year":"2021","journal-title":"J. Plast. Surg. Hand Surg."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"451e","DOI":"10.1097\/PRS.0000000000010905","article-title":"Effects of Nanofat in Plastic and Reconstructive Surgery: A Systematic Review","volume":"154","author":"Tran","year":"2024","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s10151-025-03161-z","article-title":"Time to classify: A narrative and scoping review of the old and the new classifications of perianal Crohn\u2019s disease","volume":"29","author":"Pelly","year":"2025","journal-title":"Tech. Coloproctol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/S2468-1253(22)00007-3","article-title":"Classifying perianal fistulising Crohn\u2019s disease: An expert consensus to guide decision-making in daily practice and clinical trials","volume":"7","author":"Geldof","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.cgh.2025.02.009","article-title":"Defining Radiological Healing in Perianal Fistulizing Crohn\u2019s Disease: A TOpClass Global Expert Delphi Consensus","volume":"24","author":"Anand","year":"2025","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1093\/ecco-jcc\/jjab168","article-title":"Fibrosis and MAGNIFI-CD Activity Index at Magnetic Resonance Imaging to Predict Treatment Outcome in Perianal Fistulizing Crohn\u2019s Disease Patients","volume":"16","author":"Bossuyt","year":"2022","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1093\/ecco-jcc\/jjz187","article-title":"ECCO Guidelines on Therapeutics in Crohn\u2019s Disease: Surgical Treatment","volume":"14","author":"Adamina","year":"2020","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/codi.16741","article-title":"European Society of Coloproctology: Guidelines for diagnosis and treatment of cryptoglandular anal fistula","volume":"26","author":"Reza","year":"2024","journal-title":"Color. Dis."},{"key":"ref_73","first-page":"e20250064","article-title":"Using MRI to guide surgical strategy for perianal fistulas: From conventional acquisition to 3D modeling","volume":"59","author":"Neves","year":"2026","journal-title":"Radiol. Bras."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/4\/393\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T08:41:57Z","timestamp":1776242517000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/4\/393"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,28]]},"references-count":73,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["bioengineering13040393"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering13040393","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,28]]}}}