Joris van Dongen

252 Chapter 11 Assessment of quality of included studies The included studies were graded on quality of evidence using the Oxford Center for Evidence-Based Medicine (OCEBM) criteria. 32 Disclosure agreements were reviewed for each study. Outcomes Outcomes of interest were clinical outcomes i.e. skin texture, skin color as well as skin elasticity, histological outcomes and number of complications. No meta-analysis could be performed due to the diversity of the metrics and outcomes. Risk of bias in individual studies The quality of lipografting and ASCs depends on age, comorbidity such as obesity and diabetes mellitus type 2, harvesting and processing techniques of adipose tissue. 33-38 For those reasons, detailed clinical information e.g. demographics, harvesting and processing techniques are included. RESULTS Included studies The literature search yielded 4595 publications (Fig. 1). After abstract screening, 2267 articles were excluded. Seventy-three studies were read in full-text and assessed on eligibility criteria. Thirty-eight studies did not describe an outcome of interest and were therefore excluded. 7,26,30,31,39-72 Fourteen publications were reviews and therefore excluded. 7,73-84 Eight studies were excluded based on the use of lipografting or any substances of adipose tissue in combination with other treatments. 85-92 One study was excluded because it was an animal study. 15 Two studies were excluded based on the treatment of disease-caused lipoatrophy. 93,94 One study was excluded for being a letter to the editor. 95 Quality assessment of included studies Of the nine included studies; two studies scored a level of evidence of 2 21,25 , two studies a level of evidence of 3 19,96 and five studies a level of evidence of 4 (Table 2). 18,20,22-24 In one study, a disclosure agreement of support by a manufacturer was provided. 25