DOI: 10.7910/dvn/bac2xa
title: The Latest Regenerative Medicine Applications in Plastic and Reconstructive Surgery.

description: The face is a fundamental structure of our body that expresses all our emotions and forms an important part of our identity. Injuries to the face are among the most devastating for patients, both medically and psychologically. Despite its importance, many facial injuries cannot be repaired surgically due to extensive damage or other irreparable conditions. In difficult scenarios like these, plastic surgeons have grown new tissues with the patient’s cells to cover up those defects, instead of trying to perform complicated plastic and reconstructive surgeries. The increased complexity of microcirculation and the necessity to promote regeneration in tissues that have suffered from traumatic injury or a pathological process led to an increase in interest in the development of regenerative medicine. The practice of using a patient's cells to promote healing falls within the ambit of Regenerative Medicine. This relatively new field includes the use of stem cells, tissue scaffolds, and growth factors. The fundamental factors necessary are a source of viable cells, a robust scaffold, an effective method of combining cells with scaffold, and a constellation of growth factors to support the growth of newly regenerative tissues. Regenerative medicine and tissue engineering research is a highly complex field traversing through multiple disciplines. Effective coordination between different scientists, clinicians, and departments is necessary to achieve a properly functioning regenerative science program. Simultaneously, there has been a rapid surge in the development of new biomaterials, tissue engineering approaches, and cell-based therapies. A wide range of biomaterials has been used for tissue engineering applications such as scaffolds for skin replacement, trachea replacements, cartilage grafts, vascular grafts, and ligament reconstruction, etc. The use of these biomaterials has simplified clinical practice to a great extent and benefitted the patients. Tissue Engineering is an area of research that uses living cells to replace or repair damaged tissues. The process involves taking a patient’s cells, growing them in the lab, and implanting them back into the patient. This approach helps overcome problems with transplant rejection and the need for anti-rejection drugs. The process of cellular tissue engineering involves the use of scaffolding to grow cells. Scientists have been using tissue scaffolds for years, and they have developed several methods to grow a variety of tissues, such as skin, bone, ligaments, and cartilage. For example, to develop skin that can be used to treat severe burns or replace lost skin due to trauma or cancer, they have implanted autologous tissue-derived cells (and not just stem cells) onto a tissue scaffold. A sufficient number of cells are necessary for the synthesis of a new tissue matrix. Tissue scaffolds, biomolecules, and a supportive microenvironment provide a vital stimulus for the proliferation, orientation, and differentiation of the cells. For this newly regenerated matrix to be durable, it must go through three stages: growth, induction, and maintenance of maturation. Autologous (from the same person) cells are preferred due to their lack of evoking any immunogenic reaction. Other than that, cells can also be sourced from the same species (allogenic) or different species (xenogenic). Furthermore, cells may also be classified based on their unique capabilities for further differentiation and multiplication. Stem cells are found in embryos and umbilical cords, as well as in bone marrow and adipose tissue (body fat). Usually, the stem cells in embryos are pluripotent, while those in an adult bone marrow are multipotent. Adult somatic cells have fully developed functions. They cannot divide and grow as fast as stem cells, which makes them less useful for tissue engineering. Progenitor cells are cells that can become a more specialized cell type than their originating cell type. Progenitor cells are more differentiated than stem cells and are therefore called multipotent rather than pluripotent. Tissue Scaffolds are a necessary component of any regenerative medicine and tissue engineering strategy. A suitable framework for cell growth and development provides cells with the structure they need to migrate, multiply and differentiate. It also provides cells with the ability to reorganize and form a functional 3D network. There are two main classifications of tissue scaffolds: natural and synthetic. The development of biologic scaffolds can be done in vitro through a bioreactor or in vivo by implanting the construct into the body. Functionalized and intelligent biomaterials containing biomolecular properties on their surface aim to orchestrate and optimize cell attachment to the surfaces. This allows for more vigorous growth and synthesis of new tissues. Advances in biomanufacturing technologies engineering, materials science, and tissue engineering have allowed the design and development of more complex self-organization of regenerative tissues, along with further advancements through computer modeling, bioprinting and nanotechnology. The size of the tissue scaffolds is largely limited by the lack of effective vascularization. The most successful research in this field focuses on understanding the components of native tissues and their micro-architecture. A good understanding is fundamental to creating an accurate reproduction of functional tissues. The desirable properties necessary in a tissue scaffold includes: • Biocompatibility. • Mechanical stability. • Efficient pore size that would enable sufficient vascularization while fulfilling the metabolic needs of the cells. • Non-immunogenic. • 3D architecture that allows for cell growth and migration. • Microenvironments conducive to migration, maturation, and reproduction of cells. • Suitability for sterilization to allow clinical use. • Easy to be mass-produced by the industry. Regenerative medicine with newly engineered tissues has the potential to change reconstructive plastic surgery. For this approach to work, scientists must be able to create new tissues in a lab that is similar to natural tissue in function and appearance. Basic scientific research in cell and gene therapies has led to the development of a variety of cell and gene therapy products. However, this has not yet resulted in plenty of commercial products that are available for clinical use. To translate newly regenerated tissue constructs from the laboratory into actual clinical practice, an effective multidisciplinary approach is required. Ethical considerations and regulatory issues add to the challenges of these translational activities. Conclusion: Regenerative medicine offers great potential to reduce patient morbidity and mortality, but a coordinated and lasting link between physicians, scientists, and the industry is needed to change from potential to reality.