Stromal Vascular Fraction in Bone Healing: A Systematic Review of Clinical Evidence and Potential Implications in Skull Base Reconstruction and Cranioplasty

Background: Bone healing following pathology or surgery is a complex, multiphase process involving coordinated cellular and molecular activities. Various stimulation strategies have been used to enhance bone repair. Recently, stromal vascular fraction (SVF)—a heterogeneous, adipose-derived cell mixture containing pericytes, smooth muscle cells, and adipose-derived stem cells with regenerative, immunomodulatory, and angiogenic properties—has been explored in clinical settings to promote accelerated bone regeneration. Methods: Following the PRISMA guidelines, a systematic search was conducted in PubMed, Embase, and Web of Science. Eligible studies were English-language clinical investigations involving patients with bone defects treated with SVF, either alone or combined with other interventions, reporting outcomes related to bone repair. Results: Ten clinical studies (5 case reports, 4 prospective cohorts, and one randomized clinical trial) involving 214 patients (46.3% male) were included. Radiologic and histologic assessments consistently showed enhanced bone regeneration in SVF-treated sites, including increased ossification, bone volume, mineral content, and defect closure. Quantitative comparisons, where available, favored SVF in bone dimensions, fusion rates, and implant success. Stromal vascular fraction therapy was well tolerated, with no serious adverse events and only minor, self-limited complications reported. Conclusion: Findings indicate that SVF is a promising and safe adjunct in clinical bone regeneration, with consistent evidence of enhanced bone repair across diverse anatomic sites. These findings support the therapeutic potential of SVF and underscore the need for further high-quality, controlled studies to establish standardized protocols and investigate areas of application.