Soft Tissue Restoration Using Tissue Engineering

ABSTRACT

The correction of soft tissue defects caused by trauma, tumor resection, congenital abnormalities, and aging presents a challenge in plastic surgery. Soft tissue defects run the gamut in terms of volume, from restoring the fullness of the face by removing wrinkles to restoring the breast mound after mastectomy. The limitations of current techniques have served as drivers for the development of adipose tissue as an application area for tissue engineering. Tissue engineering is a growing field that combines bioengineering, the clinical sciences, and the life sciences to repair or regrow tissues. This article discusses the inadequacies of current methods of correcting soft tissue defects and the innovative adipose tissue engineering strategies under pursuit to abrogate these limitations and improve patient outcomes and quality of life.

KEYWORDS

Adipose tissue - biomedical engineering - breast reconstruction - soft tissue augmentation - tissue engineering - tissue scaffolds

REFERENCES

• 1 Elson M L. Soft tissue augmentation: a review.  Dermatol Surg . 1995;  21 491-500
• 2 Patrick Jr W C. Tissue engineering strategies for adipose tissue repair.  Anat Rec . 2001;  263 361-366
• 3 Elson M L. Dermal filler materials.  Dermatol Clin . 1993;  11 361-367
• 4 Patrick Jr W C. Tissue engineering of fat.  Semin Surg Oncol . 2000;  19 302-311
• 5 Klein A W. Injectable collagen. In: Moschella SL, HJ Hurley, eds. Dermatology Philadelphia, PA: WB Saunders 1992: 2455
• 6 Kligman A M, Armstrong R C. Histologic response to intradermal Zyderm and Zyplast collagen in humans.  J Dermatol Surg Oncol . 1986;  12 351-357
• 7 Clark D P, Hawke C W, Swanson N. Dermal implants: safety of products injected for soft tissue augmentation.  J Am Acad Dermatol . 1989;  21 992-998
• 8 Stegman S J, Chu S, Armstrong R C. Adverse reactions to bovine collagen implant: clinical and histological features.  J Dermatol Surg Oncol . 1988;  14 (suppl 1) 39-48
• 9 Cooperman L S, Mackinnon V, Bechler G. Injectable collagen: a six-year clinical investigation.  Aesth Plast Surg . 1985;  9 145-152
• 10 Stegman S J, Tromovitch T A. Injectable collagen. In: Stegman SJ, Tromovitch TA, eds. Cosmetic Dermatologic Surgery Chicago, IL: Year Book Medical Publishers 1984: 131
• 11 Siegle R J, McCoy Jr P J, Shade W, Swanson N A. Intradermal implantation of bovine collagen: humoral response associated with clinical reactions.  Arch Dermatol . 1984;  120 183-187
• 12 Gold M H. The fibrel mechanism of action study: a preliminary report.  J Dermatol Surg Oncol . 1984;  20 586
• 13 Nunery W R, Hetzler K J. Dermal fat grafts as a primary enucleation technique.  Ophthalmology . 1985;  92 1256
• 14 Alster T S, West T B. Human-derived and new synthetic injectable materials for soft-tissue augmentation: current status and role in cosmetic surgery.  Plast Reconstr Surg . 2000;  105(7) 2515-2525
• 15 Devore D P, Kelman D C, Fagien S, Casson P. Autologen: autologous, injectable dermal collagen. In: Bosniak S, ed. Ophthalmic Plastic and Reconstructive Surgery Philadelphia, PA: WB Saunders; 1996
• 16 Devore D P, Hughes E, Scott J B. Effectiveness of injectable filler materials for smoothing wrinkle lines and expressed scars.  Med Prog Technol . 1994;  20 243
• 17 Fagien S. Autologous collagen injections to treat deep glabellar furrows (letter).  Plast Reconstr Surg . 1994;  93 642
• 18 Patrick Jr  C  W, Chauvin  P B. et al . Tissue engineered adipose. In: Patrick CW Jr, Mikos AG, McIntire LV, eds. Frontiers in Tissue Engineering Oxford, UK: Elsevier 1998: 369-382
• 19 Billings Jr E, May Jr W J. Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery.  Plast Reconstr Surg . 1989;  83 368-381
• 20 Ersek R A. Transplantation of purified autologous fat: a three-year follow-up disappointing.  Plast Reconstr Surg . 1991;  87 219-227
• 21 Coleman S R. Facial reconstruction with lipostructure.  Clin Plast Surg . 1997;  24 347-367
• 22 Coleman S R. Long-term survival of fat transplants: controlled demonstrations.  Aesth Plast Surg . 1995;  19 421-425
• 23 Robb G L, Miller M J, Patrick Jr W C. Breast reconstruction. In: Atala A, Lanza R, eds. Methods in Tissue Engineering San Diego, CA: Academic Press 2002: 881-889
• 24 Gilboa D, Borenstein A, Flors S. Emotional and psychological adjustment of women to breast reconstruction and detection of subgroups at risk for psychological morbidity.  Ann Plast Surg . 1990;  25 397-401
• 25 American Society of Plastic Surgery, 2001 National Clearing House of Plastic Surgery Statistics. 2000
• 26 Cohen B E, Casso D, Whetstone M. Analysis of risks and aesthetics in a consecutive series of tissue expansion breast reconstructions.  Plast Reconstr Surg . 1992;  89 840-843
• 27 Bostwick J, Jones G. Why I choose autologous tissue in breast reconstruction.  Clin Plast Surg . 1994;  21 165
• 28 Schusterman M A, Kroll S S, Weldon M E. Immediate breast reconstruction: why the free TRAM over the conventional TRAM?.  Plast Reconstr Surg . 1992;  90 255-261
• 29 Langer R, Vacanti C A. Tissue engineering.  Science . 1993;  260 920-926
• 30 West J L, Hubbell J A. Bioactive polymers. In: Atala A and Mooney D, eds. Synthetic Biodegradable Polymer Scaffolds New York: Springer Verlag 1996
• 31 Mann B K, Gobin A S, Tsai A T, Schmedlen R H, West J L. Smooth muscle cell growth in photopolymerized hydrogels with cell adhesive and proteolytically degradable domains: synthetic ECM analogs for tissue engineering.  Biomaterials . 2001;  22 3045-3051
• 32 Brey E M, Patrick Jr W C. Tissue engineering applied to reconstructive surgery.  IEEE Eng Med Biol . 2000;  19 122-125
• 33 Patrick Jr W C, Chauvin P B, Reece G P. Preadipocyte seeded PLGA scaffolds for adipose tissue engineering.  Tissue Eng . 1999;  5 139-151
• 34 Patrick Jr W C, Zheng B, Johnston C, Reece G P. Long-term implantation of preadipocyte-seeded PLGA scaffolds.  Tissue Eng . 2002;  8(2) 283-293
• 35 Kral J G, Crandall D L. Development of a human adipocytes synthetic polymer scaffold.  Plast Reconstr Surg . 1999;  104(6) 1732-1738
• 36 Von Heimburg D, Zachariah S, Heschel I. Human preadipocytes seeded on freeze-dried collagen scaffolds investigated in vitro and in vivo.  Biomaterials . 2001;  22 429-438
• 37 Von Heimburg D, Zachariah S, Low A, Pallua, N. Influence of different biodegradable carriers on the in vivo behavior of human adipose precursor cells.  Plast Reconstr Surg . 2001;  108(2) 411-420
• 38 Von Heimburg D, Zachariah S, Low A, Pallua N. Influence of different biodegradable carriers on the in vivo behavior of human adipose precursor cells (discussion).  Plast Reconstr Surg . 2001;  108(2) 421-422
• 39 Halberstadt C, Austin C, Rowley J. A hydrogel material for plastic and reconstructive applications injected into the subcutaneous space of a sheep.  Tissue Eng . 2002;  8(2) 309-319
• 40 Heschel I, Luckge C, Rodder M, Garbering C, Rau C. Possible applications of directional solidification techniques in cryobiology. In: Kittel P, ed. Advances in Cryogenic Engineering New York: Plenum Press 1996: 13-19
• 41 Heschel I, Rau G. Method for producing porous structures. Int Patent App PCT/DE 98/03403, November 19, 1997
• 42 Roweton S, Freeman L, Patrick Jr W C, Dempsy K, Zimmerman M. Preadipocyte-seeded absorbable matrices, Johnson & Johnson Excellence in Science Symposium 2000, New Jersey. 
• 43 Andrade J D. Hydrogels for medical and related applications. ACS Symposium Series. Washington DC, 1976: 31
• 44 Peppas N A. Hydrogels in Medicine and Pharmacy. Boca Raton, FL: CRC Press 1987
• 45 Patrick Jr W C, Wu X. Integrin-mediated preadipocyte adhesion and migration on laminin-1 (in press).  Ann Biomed Eng.
• 46 Elisseeff J, McIntosh W, Anseth K. Photoencapsulation of chondrocytes in poly(ethylene oxide)-based semi-interpenetrating networks.  J Biomed Mater Res . 2000;  51 164-171
• 47 Eiselt P, Yeh J, Latvala R K. Porous carriers for biomedical applications based on alginate hydrogels.  Biomaterials . 1999;  20 45
• 48 Halberstadt C R, Mooney D J, Burg K JL. The design and implementation of an alginate material for soft tissue engineering. Sixth World Biomaterial Congress 2000.
• 49 Huss F RM, Kratz G. Mammary epithelial cell and adipocytes co-culture in a 3-D matrix: the first step towards tissue-engineered human breast tissue.  Cells Tissues Organs . 2001;  169 361-367
• 50 Kawaguchi N, Toriyama K, Nicodemou-Lena E. De novo adipogenesis in mice at the site of injection of basement membrane and basic fibroblast growth factor.  Proc Natl Acad Sci USA . 1998;  95 1062
• 51 Passaniti A, Taylor R M, Pili R. A simple, quantitative method for assessing angiogenesis and antiangiogenic agents using reconstituted basement membrane, heparin, and fibroblast growth factor.  Lab Invest . 1992;  67 519
• 52 Toriyama K, Kawaguchi N, Kitoh J. Endogenous adipocytes precursor cells for regenerative soft-tissue engineering.  Tissue Eng . 2002;  8(1) 157-165
• 53 Kimura Y, Ozeki M, Inamoto T, Tabata Y. Time course of de novo adipogenesis in Matrigel by gelatin microspheres incorporating basic fibroblast growth factor.  Tissue Eng . 2002;  8(4) 603-613
• 54 Beahm E, Wu L, Walton R L. Lipogenesis in a vascularized engineered construct. American Society of Reconstructive Microsurgeons 2000, San Diego, CA
• 55 Yuksel E, Weinfeld A B, Cleek R. De novo adipose tissue generation through long-term, local delivery of insulin and insulin-like growth factor-1 by PLGA/PEG microspheres in an in vivo rat model: a novel concept and capability.  Plast Reconstr Surg . 2000;  105(5) 1721-1729