From elective protocols to emergency reality: rethinking adipose tissue harvesting for stromal vascular fraction applications

BACKGROUND: Adipose tissue is a readily accessible source of stromal vascular fraction (SVF) and adipose-derived stem/stromal cells, widely used in regenerative medicine. Current harvesting and processing standards are derived almost exclusively from elective surgical settings performed under controlled physiological conditions. However, expanding applications in trauma and neurosurgery increasingly require adipose tissue procurement in emergency settings, where systemic inflammation, hypoperfusion, and time constraints may alter tissue biology. The biological impact of emergency harvesting remains insufficiently characterized, yet this knowledge is critical for optimizing SVF-based regenerative medicine strategies in emergency surgical environments. OBJECTIVES: To evaluate how emergency adipose procurement may influence SVF quality, cellular yield, viability, and translational feasibility, and to propose an acute-care-adapted framework for clinical integration. METHODS: A comprehensive search of PubMed, EMBASE, and Scopus (inception-January 2026) identified studies addressing harvesting techniques, donor-site variability, enzymatic vs mechanical isolation, time-to-processing effects, cryopreservation, contamination risk, and clinical outcomes. Data were synthesized narratively with emphasis on variables relevant to emergency settings. RESULTS: Harvesting parameters-including cannula diameter and negative pressure-influence total nucleated cell yield and viability. Enzymatic digestion increases cell recovery by approximately 1.5- to 3-fold compared with mechanical fractionation but requires laboratory infrastructure and a longer processing time. Mechanical techniques enable rapid point-of-care application yet produce stromal vascular tissue with greater heterogeneity. Processing delays reduce viable cell counts. Emergency physiology introduces additional upstream modifiers, including cytokine activation and microvascular perturbation, that remain largely unstudied in SVF research. CONCLUSIONS: Emergency adipose harvesting challenges elective-based assumptions underlying current SVF standards. Context-specific comparative studies and standardized emergency-adapted protocols are required to ensure biological robustness and clinical safety in acute surgical environments.