Regenerative Tissue-Engineering: Recent Advances in The Next Frontier in Plastic Surgery.

Updated: Jun 9

Tissue engineering refers to the practice of combining cells, scaffolds, and biologically active substances to form functioning human organs and tissues. This combination of functioning, newly-constructed organoids aims to improve, maintain, and restore diseased organs and injured tissues. It has an immense potential to improve current techniques of reconstruction and better plastic surgery results.

 

A before and after picture of a thumb in an active male patient which regenerated completely with the use of Biomaterials by Dr Srinjoy Saha in Kolkata India.
Case study 1. Complete regeneration of the thumb using tissue scaffolds - Before and After Pictures.

Recent Advances in Tissue-Engineering for Reconstructions in Plastic Surgery.


1. Fingertip Regeneration.

In a major scientific development, the entire fingertip of the thumb of the right hand of an active young man was regenerated using growth factor injections and a porous tissue scaffold. Instead of performing traditional flap surgeries by cutting normal healthy tissues in other parts of the body like the other fingers, hand or abdomen, this method focused only on treating the damaged tip of the thumb. It allowed the patient to use the rest of his hand and other fingers normally immediately after the surgery. The patient performed tasks with his injured hand even as the destroyed thumb tip slowly regenerated over the next few weeks. The resulting benefits to the young man were remarkable, as his destroyed thumb finally obtained normal looks, sensation, and nails, while regaining full function over the regenerated fingertip. Please see the pictures in case 1 above for before-and-after comparison in appearances. To read about this patient’s story, and how it saved a budding sportsman from ruining his sporting career, click here: Fingertip Regeneration: A Patient's Story.


2. Soft-Tissue Regeneration Over Barren Skull Bones.

In another major clinical breakthrough, new soft tissues were developed over a large area of barren skull bones by combining the body’s cells, a porous synthetic tissue scaffold, and activated growth factor infusions. Previously, doctors and scientists had not been able to regrow new soft tissues over bare-bones and cartilages, which lack sufficient blood supply that encourages new tissue growth. But, altering the nature of the tissue scaffold and making some major tweaks in established procedures allowed new soft tissues to grow over such barren areas. The benefit of this procedure was enormous, as it shortened the length of the surgeries, reduced its dangers, lowered treatment costs, and increased patient safety. Please see the pictures in case 2 below for before-and-after comparison, which shows how immensely this technique helped the patient while reducing the chances of complications. To know more about this patient's story and how this scientific breakthrough saved the life of a grieving mother, click here: Upper Face Regeneration: The Inside Story of a Breakthrough Plastic Surgery. A new scientific article has also been published open access in a major international surgical journal. Open science with creative commons attribution is a major step towards creating a better world where good science is inclusive and openly shared.


Before and after pictures over an extensive injury over the forehead and upper face with exposed skull bones. Dr Srinjoy Saha used tissue scaffold to regenerate soft tissues over these areas safely and effectively.
Case study 2. Complete regeneration of soft tissues over an extensive area of barren skull bones: Before and after comparison in pictures.

Why is Tissue Engineering Important for Bettering and Advancing Reconstructions in Plastic Surgery?

Tissue engineering can help in producing living ‘spare parts’ for patients who have lost an important organ, tissue, or a part thereof. Prominent examples of tissue-engineered body parts include knee cartilage and artificial skin. This amazing technology in reconstructive plastic surgery has developed a lot in recent years. Plastic surgeons who are ahead of the curve compared to others, are now employing these avant-garde techniques to benefit their patients enormously.


How is Tissue Engineering Vital to the Reconstructive and Plastic Surgery of the Future?

The human body cannot regenerate organs and tissues. Instead of regeneration, it focuses on repair. Congenital diseases, traumatic injuries, and cancers are some of the main reasons for human bodies losing viable organs and tissues. When tissues die by a process called necrosis, it is not possible to bring them back to life. However, if it is not properly repaired or removed then it can affect other areas of the body, surrounding tissues, bone, skin, and organs also get affected.


Recent advances in tissue engineering are helpful in such situations. It recreates functional tissues that help in restoring, replacing, or repairing damaged human organs and tissue. Tissue engineering also includes research on regenerative medicine and stem cell behavior. Stem cells can grow into different types of cells and can help repair different areas of the body. Growth factors stimulate the regeneration of new cells and stimulate adult cells to participate in the healing process.


3D applied models produced by tissue engineering allow researchers to generate artificial models of different diseases, like heart disease and cancer. A 3D model architecture allows tumor architecture to be premeditated in a more precise environment. It provides a setting for the trial of potential new drugs on these tumors.


Tissue engineering also shares a common purpose with reconstructive plastic surgery. Its long-term aim is to manufacture vascularized, physiological-relevant solutions to mend and repair complex defects. Plastic surgeons are already adept at fat grafting for clinical use in different clinical settings. Thus, plastic surgeons have the singular ability to safely harvest subcutaneous adipose tissues, an abundant source of adult stem cells in the body. Interspersed between the adult fat cells lie the stromal vascular fraction, or SVF, consisting of multipotent stem cells, preadipocytes, endothelial cells, and precursor stromal cells. All these precursor cells have huge clinical potential in regenerative medicine application in different diseases and can be used for treating different parts of the body.


What are the Different Types of Tissue Engineering Applications for Reconstructive and Plastic Surgery?

Tissue engineering is an interdisciplinary modern field that combines the principles of engineering, life sciences, and physics. There are 3 main components of tissue engineering. These are:

1. Reparative stem cell technology that can shape a functional matrix, like adipose matrix or human collagen.

2. A proper framework for cell transplantation, like tissue scaffolds laying down new human collagen matrix.

3. Various growth factors like vascular endothelial growth factor that increases blood circulation and help form the desired tissues.


A good bio-manufacturing unit will depend on the right blend of cell source, perfect microenvironment, and appropriate scaffold. These practices play a huge role in plastic and reconstructive surgery. To manage tissue defects forming after cancer, chronic diseases, and injuries, there are different procedures of reconstruction. They include Autologous, Synthetic, Allogeneic, and Tissue-engineered amongst others. Each of these are described below.


What is Tissue-Engineered Reconstruction?

It is a biomedical engineered product that uses an amalgamation of engineering, biomaterials, stromal cell populations, and appropriate physicochemical and biochemical factors. The aim is to reinstate, maintain, replace, or improve different types of biological tissues. Some of the advantages and disadvantages of using the tissue-engineered solution are as follows:

Pros:

· This amazing solution is bio-compatible.

· Provides high-quality retention of shape and size.

· Does not require any donor site morbidity.

· Provides good bio-functionality.

· This solution does not involve any immunological concerns.

· It provides mechanical stability.

· May provide an indefinite expansion of tissues and cells.

Cons:

· Till now, its use is limited and is therefore costly.

· The wound edges often have inadequate vascularity, hampering tissue growth. Diabetic foot ulcers are a classic example.

· The approach may entail tumorigenic potential, though USFDA approved products are generally safe.

· It is hard to engineer mature tissues which are also physiologically relevant.


What is Autologous Reconstruction?

In autologous reconstruction, a reconstructive plastic surgeon makes use of living tissue from another part of the body to recreate the lost tissues. For example, they may use lower abdominal skin and fatty tissues to recreate a breast rather than using an implant. This approach is quite complex but it also provides a lot of benefits to people. Some of the advantages and disadvantages that are associated with autologous reconstructive solutions are:

Pros:

· It does not involve any immunological complications.

· It is biologically compatible.

· Does not require any ethical constraints.

· Contains fewer legal restrictions.

Cons:

· It requires complicated surgical techniques.

· Results in large donor site morbidity.

· Greater risks and complications are associated with this process.

· Overall, it utilizes a huge amount of resources and specialized manpower, and thus it is costly.


What is Implant-based Reconstruction?

In implant-based reconstructions, a plastic surgeon uses materials that are prepared artificially. These are designed in such a way that it imitates a natural product. Some of their advantages and disadvantages are as follows:

Pros:

· It is cost-effective as compared to other reconstructive solutions for handling tissue defects.

· This approach helps in maintaining structural integrity.

· It evades concerns over disease transmission.

Cons:

· Causes extrusion and infection.

· This treatment may not allow biological growth inside the body.

· This solution does not help in restoring all of the dedicated tissue/organ functions.

· Some substances may inflame an immune/ inflammatory/ fibrotic response.


What is Allogeneic Reconstruction a.k.a. Organ Transplantation?

This approach includes the transplantation of tissues, organs, or cells to a recipient from a non-identical donor. Nowadays, cadaveric transplants are increasing enormously. There are different names of this treatment i.e., allograft, homograft, or allogeneic transplant. Most of the human organs and tissue transplants are allografts. Some of the advantages and disadvantages of using the allogeneic reconstructive solution are as follows:

Pros:

· It does not require any donor site morbidity.

· It is a great way of getting healthy tissue.

· The donor cells possibly will have good viability.

· Provides a larger quantity of available tissue.

Cons:

· Involves a huge risk of disease transmission.

· Often, it is a temporary solution, as immune cells in the host can reject the transplanted tissues later.

· Requires tissue typing and tissue matching with enzyme-linked immunosorbent assay.

· Involves bigger legal hurdles.

· Comes with numerous psychological and ethical challenges.


What Are the Most Important Safety Concerns With Tissue-Engineered Reconstruction?

To be successful, one should have the option to create tissues in-vitro that would morphologically and practically behave like human tissues. While embryonic stem cells have a huge potential, there are plenty of dangers associated with them and are thus not in clinical use. Adult stem cells like the pre-adipose stromal cells found in the stromal vascular fraction of the adipose matrix are generally safer. Induced pluripotent stem cells, or iPS cells, are derived from adult fibroblasts in the skin. They are undergoing extensive animal studies at present and the future clinical use of these cells has great potential. Compared to these technologies, recent studies show that new advances in stromal cell enriched treatments are safer. For example, a significant time-dependent increase of fat graft survival rates is seen after adding a stromal vascular fraction to it. A successful approach would necessitate administrative, ethical, monetary, and clinical oversight with measured thoughts and applications of these futuristic treatments. All the current difficulties that the clinicians and researchers face need to be addressed successfully. This will encourage effective translation of tissue-engineered research solutions from the laboratory to the clinics.


What is the Likely Financial Future of the Market Size for Tissue-Engineering?

The prospect of tissue engineering to better reconstruction in plastic surgery is full of potential and promise. This hugely evolving market is anticipated to rise to $17 billion by 2023, a gigantic boost of 150% from $7 billion in 2016.


So, To Wrap Things Up: A Conclusion.

Avant-garde plastic surgery reconstruction utilizing bio-engineered tissues can change our current clinical treatments and make them better. Tissue engineering offers an extraordinary potential to decrease patient morbidity and mortality in the future. A properly organized interface between the clinicians, researchers, and the industry is necessary. Such an interface will move this potential into the real world and benefit all mankind.


Suggested further reading of excellent scientific articles:

  • Guo J, Nguyen A, Banyard DA, Fadavi D, Toranto JD, et al. Stromal vascular fraction: a regenerative reality? Part 2: mechanisms of regenerative action. J Plast Reconstr Aesthet Surg 2016;69:180-8.

  • Nguyen A, Guo J, Fadavi D, Banyard D, Toranto J, et al. Stromal vascular fraction - a regenerative reality? Part 1 - current concepts and review of the literature. J Plast Reconstr Aesthet Surg 2016;69:170-9.

  • Takahashi K, Yamanaka S. Induction of pluripotent stem cells from mouse embryonic and adult fibroblast cultures by defined factors. Cell 2006;126:633-76.

  • Pereira Lopes FR, Camargo de Moura Campos L, Dias Corrêa J Jr, Balduino A, Lora S, et al. Bone marrow stromal cells and resorbable collagen guidance tubes enhance sciatic nerve regeneration in mice. Exp Neurol 2006;198:457-68.

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Disclaimer:

This article and the information contained within it are for educational purposes only. It is not be construed or used as a medical opinion or a medical advice. This article is not intended to replace the advice of a trained, licensed medical professional in your area. If you are located in and around Kolkata and desire more information from one of India's top plastic surgeons, please schedule an appointment at one of our plastic surgery clinics in Kolkata, India.


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