Large Fibrous Connective Tissue Reduces Oxidative Stress to Form a Living Cell Scaffold in Adipose Grafts

This study aimed to investigate the mechanisms by which large fibrous connective (LFC) tissue enhances fat graft survival in fat transplantation. A block fat graft model demonstrated that intact fat containing LFC showed significantly higher survival rates compared with liposuctioned fat. In the center of intact grafts, viable fat cells surrounded the LFC, forming a mesh-like living tissue structure. Proteomics of the extracellular matrix (ECM) adjacent to LFC (ALFC) and distant to LFC (DLFC) revealed significant differences in mitochondrial aspects. Staining of LFC tissue showed that it contains a large number of blood vessels and mitochondria, and exhibits stronger antioxidant capacity (<i>p</i> < 0.05) compared with adipose tissue. By mixing LFC with liposuctioned fat and transplanting into nude mice, histological sections showed that LFC promotes SOD1 expression, enhances respiratory chain RNA expression, and reduces ROS and inflammation. Pure mitochondrial-assisted fat transplantation only reduced short-term graft inflammation without improving long-term survival rates. In conclusion, LFC enhances long-term survival rates by reducing oxidative stress in fat grafts and forming a center for fat cell survival, thereby overcoming distance limitations. This represents a novel mechanism distinct from classical fat survival models and provides a reference for clinical practice.