Tissue Repair, Regeneration, and Engineering in Plastic Surgery

C. Randall Harrell, M.D.

Eser Yuksel, M.D.

Technological innovations in biotechnology and biomaterials have advanced rapidly over the past decade. This is especially true in a new area of medicine called regenerative medicine. Regenerative medicine is the replacement of damaged body parts.[1] The regenerative process includes a wide range of scientific discovery and uses the latest techniques such as stem cell transplantation and artificial tissues.[1] This new field involves many medical subspecialties that include cell biologists, biochemists, physicists, biomaterial engineers, geneticists, nanotechnologists, and endocrinologists.

Through extensive collaborations, clinicians and scientists are able to help a variety of patients. One example is the use of tissue engineering to help patients who have suffered tissue loss from burns, skin ulcers, decubitus ulcers, bone loss, cartilage, or nerve damage. Another example is the use of synthetic materials as dermal fillers to help patients reverse the signs of aging. The ability to regenerate lost tissue such as skin has been made possible by advances in cell biology. The discoveries of new growth factors and hormones have enabled us to grow living human cells in tissue culture and still retain a high degree of tissue function. Some of these tissues are grown on bioabsorbable scaffolds seeded with cells and signaling molecules. This advance in cell growth has enhanced our ability to grow many types of cells on tissue scaffolds.

Current advances are the development of biocompatible biomaterials that will stimulate new tissue in growth. The use of stem cells will allow the growth of particular cell types. With this type of technology it is possible to trigger stem cells to differentiate to skin, cartilage, tendons, bone, and many other tissues. The discovery of embryonic stem cells derived from human fetal tissue, placentas, or even fat cells from liposuction will become more important in the future for these and other medical applications.

The ability to incorporate new advances into patients' care is fundamental to the science and art of plastic surgery. Plastic surgeons historically have used autologous skin grafts to help with wound management. Since that time, great progress has been made in the production of keratinocyte and epidermal grafts (Epicel or autologous epidermal skin sheets) and bilayered (Integra artificial skin, Dermagraft, Transcyte, Apligraf) skin substitutes. The pioneering work in the area of tissue engineering of skin substitutes is the result of extensive research and development in cell biology, collagen scaffolds, and biocompatible tissue equivalents. This effort has resulted in injectable new biomaterials for soft tissue augmentation and injectable or preformed scaffolds for hard tissue augmentation. Plastic surgeons will be on the forefront of regenerative medicine using new products for a variety of reconstructive and aesthetic indications including improving rhytids and contour deformities and reconstructing or augmenting bone and cartilage.

This edition of Seminars in Plastic Surgery is dedicated to the use of such biomaterials for these purposes. It contains a set of articles dealing with a broad range of issues relevant to current practice. We are grateful to each author who contributed to this issue of Seminars in Plastic Surgery. We encouraged each to offer practical information that can be applied by all plastic surgeons to enhance their practice and benefit our patients.

REFERENCE

• 1 Stocum D L. Regenerative biology and medicine: an overview.  Cellscience Reviews. 2004;  1 1-20