Injuries, diseases, cancers, and congenital deformities would ultimately destroy the affected parts of the human body, resulting in a dramatic loss of its shape and function. Reconstructive plastic surgery is an excellent surgical technique to provide living tissues to the destroyed areas from another part of the body and restore the body's shape and function. However, some of the top plastic surgeons opine that the techniques available at present are fairly complex and that they often distort the original anatomical shape of the body.
The medical application of stem cells for different methods of tissue engineering and regenerative medicine is gradually increasing, and its growth is expected to be rapid in the coming years. The fact that the stem cells are generated from the patients' somatic tissues, results in a better acceptance by the immune system. This avoids the distressing rejection problems that are observed with organ transplants from other people or cadaveric donors. Autologous donor tissue is not rejected by the recipient since they are identical and have no sensitization to foreign antigens. In addition, the use of autologous cells may also have some therapeutic advantages over allogeneic transplantable tissues.
Thousands of reconstructive plastic surgery treatments are performed each year utilizing tissue-engineered solutions to simplify typical plastic surgeries. These include burn victims, patients with body defects following injuries, different types of cancer reconstruction, and many more. In addition to their clinical applications, many of these engineered new tissues have been used in preclinical models for drug discovery and toxicological testing. Such applications are rising rapidly because the engineered tissues closely mimic the native human tissues in terms of protein structure and mechanical properties.
At the present day, top reconstructive plastic surgeons are performing many more microvascular surgeries and free tissue transplants than they ever did in the past. Composite tissue transplants, which are an even more complex type of surgery, have also become a reality. Examples of these complex types of surgery include face transplants and hand transplants. These procedures need advanced setup, multitudes of requirements, and sophisticated arrangements. Thus, they can only be performed in a few well-established big hospitals across the world. A large part of the world would not be able to afford these procedures.
To reach out and benefit a large part of the world, we need simpler reconstructive surgery techniques with a lot less fuss. Different techniques are being developed with tissue engineering and regenerative medicine, with the main aim of simplifying these complexities. Scientists are gradually making tremendous advances in biomedical sciences to provide the human body with alternative sources of viable, functioning tissues. They are trying to build novel engineered tissues inside the lab that would integrate into the human body seamlessly and enhance its function. These advances are occurring in the fields of nanotechnology, 3D bioprinting, cell biology, biomaterials, and microsurgery with vascularised new constructs. Treatment options are gradually broadening because of these advances.
Across the world, a majority of plastic surgeons work primarily on cancer reconstruction and wound healing. Only a small percentage perform predominantly cosmetic surgery. Worldwide, the need for human body reconstruction is enormous due to the prevalence of cancer and chronic wounds, but the donor tissue sites within the body are limited. The impact of proper wound management on global public health is immense. Chronic wounds in diabetes, for example, often lead to amputations. Studies have shown that such amputations are often associated with a significantly high incidence of early deaths.
Globally, only a limited number of cadaver donors or donor tissues within a person’s own body are available as an option for an organ transplant. Following an organ failure or major tissue destruction, a crisis for suitable donor tissues often occurs, and without any easy solution in sight. To overcome these deficiencies, scientists have tried to adopt different approaches to create new functioning tissues. Amongst the different approaches that are currently available, tissue engineering, along with regenerative medicine, is apparently the most promising.
A paradigm shift in reconstructive plastic surgery would occur once more plastic surgeons start adopting the tissue engineering and regenerative medicine principles even more widely. Adopting these principles would cut the need for donor sites from the same body or the cadavers. It would also significantly reduce the morbidity of treatment, hospital stay, duration of surgeries, and costs of treatment.
At its fundamental core, tissue engineering combines the basic principles of 3 diverse disciplines: physics, engineering, and life sciences. It has developed by leaps and bounds in the last few decades and is still considered to be a relatively new field. Sharing a major commonality with reconstructive plastic surgery, its goal is to restore the form and function of the human body with newly generated tissues. The long-term goal of tissue engineering is to use biotechnology to manufacture autologous, vascularized, physiologically relevant new tissues for the repair and recovery of complex defects in the human body.
Manufacturing through biotechnology is successful when the right combination of cellular source, scaffolding material, and microenvironment are used. The answers to these questions are based on collaboration between biologists, material scientists, and medical professionals. Expansion in the health care industry requires close interaction with other biomedical industries like cellular therapy and other related industries.
Worldwide, different scientific societies, including those on plastic surgery, have realized and stressed the key role that tissue engineering would play in shaping the future of reconstructions in plastic surgery. They observed that tissue engineering is essential to developing new methods and protocols for reconstructive plastic surgery. They also noted that the focus should be on translating laboratory research into clinical practice by conducting successful clinical trials across the world.
Some major governments of the world like that in the United Kingdom have recognized the potential of the impact that regenerative medicine would have on the healthcare of the future. Understanding our current shortcomings, they have emphasized the general lack of coordination in this area at present. To solve this problem, their report proposed several recommendations including the formation of multidisciplinary working groups (scientists, doctors, investors, manufacturing experts, and regulators), as well as government-funded initiatives to advance the future of regenerative medicine.
Although tissue engineering is a promising field, we need to be grounded and be realistic about our goals. Implants in immunocompetent animal models have observed that with our current tissue-engineered organ constructs, the animals experience inflammation, fibrosis, foreign body reactions, and degradation. One of the main problems remains the vascularization of large-volume newly-engineered tissue constructs, without which, these solutions would be a failure. Another problem that appears in modern literature is the potential for tumor growth in these newly engineered constructs.
Tissue engineering is a relatively new field of medicine that has seen rapid growth in the last few decades. These are early days yet, and regenerative medicine would go through a lot of refinements in the future. New developments made by top surgeon-scientists in tissue engineering are being made every day, and we will likely see even more exciting breakthroughs soon.