Adipose Tissue and Its Derivatives as a Regenerative Alternative to Neurotization for Nerve Regeneration and Flap Reinnervation: A Scoping Review of Clinical Evidence

Sensory loss following reconstructive flap surgery and peripheral nerve injury remains a significant clinical challenge. Neurotization—the surgical coaptation of sensory nerves to restore flap sensation—has been proposed as a solution, but its adoption remains controversial due to methodological heterogeneity in outcomes research, technical demands, and inconsistent results. Adipose tissue and its derivatives, including adipose-derived mesenchymal stem cells (AD-MSCs), stromal vascular fraction (SVF), microfat, nanofat, and exosomes, have emerged as promising regenerative therapies capable of promoting nerve regeneration through neurotrophic factor secretion, Schwann cell-like differentiation, and immunomodulation. However, the clinical evidence supporting their use as an alternative to neurotization for nerve repair and flap reinnervation has not been systematically synthesized. This scoping review aims to map the existing clinical evidence on the use of adipose tissue and its derivatives as a regenerative alternative to neurotization for promoting nerve regeneration during peripheral nerve repair surgery and for enhancing reinnervation of reconstructive flaps.