Tissue engineering applications in plastic surgery

Plastic surgery, a derivative of the Greek word plastikos, is in essence a specialty of forming or molding to repair defects that may arise from traumatic mechanisms, extirpation of malignancies, or congenital malformations [20]. As one of the broadest surgical specialties, plastic surgeons are confronted with defects in all regions of the body including the integument, craniomaxillofacial region, extremities, breast, and trunk. When addressing large defects which are unlikely to heal on their own, surgeons have a wide array of tools for reconstruction, including the use of autogenous grafts, allogeneic substitutes, and synthetic materials. Each of these reconstructive options has a corresponding clinical situation that it addresses best. However, these resources are also accompanied by their inherent disadvantages. When wounds are assessed to be unlikely to heal in a timely fashion because of size or inadequate blood supply, plastic surgeons have over the years devised a plethora of local flaps, and with the advent of microsurgical technology, a host of microvascular free tissue transfers. Autogenous grafts are considered ideal because of their lack of immunogenicity. However, the use of autogenous grafts is tempered by consideration for donor site morbidity and relatively limited quantities. Allogeneic substitutes offer an alternative, but the risks of disease transmission, immunologic rejection, and graft-versus-host disease are not negligible. Finally, synthetic materials are frequently used but are associated with concerns for infection, tissue incorporation, and structural integrity.