Restoration of form and function requires apposition of tissues in the form of flaps to reconstitute local perfusion. Successful reconstruction relies on flap survival and its integration with the recipient bed. The flap's precariously perfused hypoxic areas undergo adaptive microvascular changes both internally and in connection with the recipient bed. A cell‐mediated, coordinated response to hypoxia drives these adaptive processes, restoring a tissue's normoxic homeostasis via de novo vasculogenesis, sprouting angiogenesis, and stabilizing arterialization. As cells exert prolonged and coordinated effects on site, their use as biological agents merit translational consideration of sourcing angio‐competent cells and delivering them to territories enduring microcirculatory acclimatization. Angio‐competent cells abound in adipose tissue: a reliable, accessible, and expendable source of adipose‐derived cells (ADC). When subject to enzymatic digestion and centrifugation, adipose tissue separates its various ADC: A subset of buoyant oil‐dense adipocytes (the tissue's parenchymal component) accumulates on a supra‐natant layer, whereas the mesenchymal component remains in the infra‐natant sediment, containing the tissue's stromal vascular fraction (SVF), where angio‐component cells abound. The SVF can be further manipulated, selected, or culture expanded into more specific stromal subsets (herein defined as adipose stromal cells, ASC). While promising clinical applications for ADC await clinical proof and regulatory authorization, basic science investigation is needed to elucidate the specific ADC mechanisms that influence microvascular growth, remodeling, and function following flap surgery. The objective of this article is to share the clinical perspectives of reconstructive plastic surgeons regarding the use of ADC‐based therapies to help with flap tissue integration, revascularization, and wound healing. Specifically, the focus will be on considering the potential for ADC as therapeutic agents and how their clinical application motivates basic science opportunities.

中文翻译：

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脂肪源性细胞治疗增强微血管健康和功能的临床观点：重建手术的意义和应用

形式和功能的恢复需要以皮瓣形式放置组织以重建局部灌注。成功的重建依赖于皮瓣存活及其与受体床的整合。皮瓣的不稳定灌注缺氧区域在内部和与受体床相关的情况下都会发生适应性微血管变化。细胞介导的、对缺氧的协调反应驱动这些适应性过程，通过新生血管生成、萌芽血管生成和稳定动脉化来恢复组织的正常氧稳态。由于细胞在现场发挥长期和协调的作用，它们作为生物制剂的使用值得考虑寻找血管活性细胞并将它们输送到经久不衰的微循环适应区域。脂肪组织中富含血管活性细胞：一种可靠、可获取且可消耗的脂肪衍生细胞 (ADC) 来源。当进行酶消化和离心时，脂肪组织会分离其各种 ADC：漂浮的油致密脂肪细胞子集（组织的实质成分）积聚在上清液层中，而间充质成分则保留在下清液沉积物中，含有组织的基质血管部分 (SVF)，其中血管成分细胞比比皆是。SVF 可以进一步操作、选择或培养成更具体的基质亚群（本文定义为脂肪基质细胞，ASC）。虽然 ADC 有希望的临床应用等待临床证明和监管授权，但需要基础科学研究来阐明影响微血管生长、重塑、和皮瓣手术后的功能。本文的目的是分享整形外科医生关于使用基于 ADC 的疗法帮助皮瓣组织整合、血运重建和伤口愈合的临床观点。具体来说，重点将放在考虑 ADC 作为治疗剂的潜力以及它们的临床应用如何激发基础科学机会。