Tissue engineering of vascularized adipose tissue for soft tissue reconstruction

The coverage of extensive soft tissue defects following trauma, tumor resection, or excessive debridement presents a major challenge in plastic surgery. Despite success in recent decades with the innovation of microsurgery techniques and the related expansion of soft tissue resources, disadvantages of donor site morbidity and unreliable outcome still limit the enthusiasm for these procedures. The desire for engineered tissues to circumvent these difficulties has inspired numerous investigators across various scientific disciplines. In this respect, adipose tissue has been of increasing interest, due to its comparably basic architecture and high plasticity that make it suitable for universal soft tissue coverage. There is general agreement that adequate adipogenesis may be achieved solely under circumstances of adequate angiogenesis. However, approaches to achieve the ultimate goal of perfused adipose tissue are diverse and varied with a growing cache ranging from deployment of growth factors, matrix, or scaffold systems; injectable composite systems; varying nutrient vessel configurations; chamber spaces; and external tissue expansion-all with and without the application of precursor cells. Major developments in the areas of these assorted approaches will be reviewed as progress toward achieving ideally engineered vascularized adipose tissue is discussed.