Reassembling Adipose Tissue Complexity for Next-Generation Tissue Regeneration

Abstract Repair of complex soft-tissue injury often requires more than volume replacement; it depends on coordinated restoration of vascular supply, matrix organization, immune balance, and tissue structure. Adipose tissue contains living cells, extracellular matrix, and local signals that may contribute to these processes. This review uses a deconstruction–reassembly framework that traces the evolution of adipose-based therapy from a vascularization-dependent living graft to fragmented derivatives, cellular products, acellular signals, and biofabrication substrates. Deconstruction separates selected components and can make delivery more flexible, but it also breaks native tissue organization. Reassembly is achieved through the preservation of existing relationships within tissue units or the reconstruction of relationships lost during processing. Neither greater complexity nor a position on this continuum establishes therapeutic superiority, standardization, or clinical maturity. Established grafts, investigational derivatives, and preclinical constructs differ in the strength and clinical relevance of the supporting evidence. We propose that product choice should start with the function that is missing at the recipient site and the main barrier to repair, such as ischemia, fibrosis, or structural loss. This complexity-matched perspective provides a translational framework for product selection and development in burns, trauma, and soft-tissue reconstruction.