Clinical Applications of Autologous Fat Grafting in Pathological Hand Conditions

<b>Background:</b> Autologous fat grafting (AFG) is increasingly explored beyond cosmetic applications, with interest in its regenerative potential for hand conditions such as cutaneous systemic sclerosis, thumb base osteoarthritis, Dupuytren contracture, burn scars, trauma and congenital hand deformities. This systematic review evaluates the therapeutic efficacy, techniques and outcomes associated with AFG across pathological hand conditions. <b>Methods:</b> A systematic literature search was conducted in July 2023 using PubMed, Ovid MEDLINE, Embase and Web of Science. Studies were included if they involved autologous fat or stromal vascular fraction (SVF) grafting for therapeutic purposes in hand conditions. Risk of bias (RoB) was assessed using RoB 2.0 for randomised controlled trials (RCTs) and the MINORS tool for non-RCTs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout. <b>Results:</b> Twenty-five studies were included (8 RCTs, 17 non-RCTs), involving a total of 909 patients. Conditions studied included systemic sclerosis (<i>n</i> = 7 studies), thumb base osteoarthritis (<i>n</i> = 7), Dupuytren contracture (<i>n</i> = 6), burn-related scars (<i>n</i> = 2), hand trauma (<i>n</i> = 2) and congenital deformities (<i>n</i> = 2). AFG was most consistently associated with improvements in pain (visual analogue scale [VAS]), joint mobility (range of motion) and functional scores such as the Cochin Hand Function Scale (CHFS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Michigan Hand Questionnaire (MHQ), particularly in systemic sclerosis and thumb base osteoarthritis. Findings in Dupuytren's contracture were mixed, with observational studies reporting early improvements but RCTs showing higher recurrence rates. Outcomes for burn scars, trauma and congenital deformities were less consistent. Techniques for fat harvesting, processing and injection varied widely. <b>Conclusions:</b> AFG shows therapeutic potential across several hand conditions, with the strongest current evidence supporting its use in systemic sclerosis and thumb base osteoarthritis. However, significant methodological heterogeneity and limited high-level evidence remain. Further robust, standardised RCTs are needed to clarify indications, optimise techniques and assess long-term outcomes. <b>Level of Evidence:</b> Level III (Therapeutic).