From microsurgery to tissue engineering...
Plastic surgery is the fastest developing surgical specialty. Our patients are often overwhelmed by a waterfall of uncontrolled information offered through the media and internet. Very frequently it is impossible for lay persons to get objective information on a reconstructive or aesthetic procedure and which surgeon has a specific expertise and reputation in a certain field of plastic surgery.
Reconstructive surgery of bones and soft tissues is a specific surgical specialty that focuses on restoring the normal anatomical structures and function of a human body after loss, trauma or destruction. When reconstruction is indicated, the aim of the procedure is to restore like-with-like or to reconstruct the normal anatomy as precise as possible, as was given by nature. As spare body parts are not available off the shelf (at least not for the moment), either prosthetic material or the transplant of body-own tissues is used for the reconstruction. The latter comprises an interesting domain of free tissue transfers. It can generate fascinating results – but it comes with important surgical complexities. Free tissue transplantations are complex, require specific technical skills that can only be developed after a long and difficult training. They also require prolonged operative sessions where specific microsurgical complications, although rare, can be involved and need intensive follow-up. Although there is scientific agreement that free tissue transfers provide the best type of reconstruction, insurance companies throughout the world often do not or only poorly reimburse these procedures. This is why for example, in breast reconstruction, prosthetic implants rather than autologous tissue transplants, as performed in the DIEP flap technique, are still mostly used.
The second consequence of this poor financial reimbursement of reconstructive surgery is that plastic surgeons leave this interesting area in medicine and move to the more lucrative and much less cumbersome business of aesthetic surgery and medicine. With only a few surgeons performing reconstructive surgery on a routine basis and a very limited amount of objective information available to professionals and to the public at large, the potential of this surgery is insufficiently known and widely underestimated. Thus reconstructive surgery research is virtually never supported and, in sharp contrast to aesthetic plastic surgeons, reconstructive surgeons do not have the same financial means to invest into basic research.
But the specialty of reconstructive surgery is going through its next revolution. Cell therapy is slowly developing and will take the upper hand over tissue transplantation in the next few decennia. We are now able to develop and produce small amounts of bone, cartilage and collagen to reconstruct specific areas in the body. We will soon be able to clone and reproduce organs. All this underlines the importance of training surgeons in these microsurgically highly complex techniques.
At the moment, plastic surgery research focuses on the potency of stem cell regeneration to develop tissues like skin, fat, vessels, nerves and muscle. The first application, stem cell enhanced lipofilling is being applied today for structural fat grafting of the body. It is our dream to regenerate or create a part of the human in a laboratory that we can use for reconstruction. Tissues and techniques under development in different laboratories around the world will soon be responsible for a breakthrough in reconstructive surgery.
The G20 Research Meeting
Are silicone breast implants history?
Why do we implant bags of silicone into our bodies, with all the recent controversies, when we could use our own excess fat instead, to reconstruct a breast after cancer surgery or for cosmetic breast augmentation? In fact cosmetic and reconstructive surgeons have wanted to do exactly that for many years and enabling this simple, but elusive goal, will usher in a completely new era of regenerative plastic surgery.
The technique of lipo-filling is widely used throughout the world today involving lipo-suction of small fat clusters for reinjection after purification for breast reconstruction and augmentation purposes. Despite all the positive advantages that come with using one’s own fat tissue, including the elimination of immunosuppressive drugs, the fact that often as much as 50 – 60% of fat transferred re-absorbs within 6 to 12 months post implantation, remains. One major reason for this is the lack of blood supply and thus growing blood vessels, or neo-angiogenesis, is a key focus of research today.
It turns out, for instance, that our fat contains one of the largest and most easily accessible sources of stem cells which, when mixed back with the fat graft, have been shown by research to help in the process of growing blood vessels to keep the graft alive.
“It is hard to say how far away this new dramatic revolution in tissue replacement will be, but we are getting ever closer and, once we are able to unlock the secret of neo-angiogenesis, the gates to the creation of patient-own fat grafts will be widely opened, ushering in a whole new era of tissue transplantation” says Phillip Blondeel, professor of plastic and reconstructive surgery and chairman of the G20 Forum for regenerative plastic surgery to be held in Montreux, Switzerland on 3rd and 4th September.
The G20 forum (www.G20regenerativeplasticsurgery.com) is bringing together the leaders in their respective fields both from a clinical and research background, to review status of knowledge and create practical clinical and scientific research collaborations to accelerate adoption into clinical practice.
Click here to find out more about different ways on how to make an appointment with Professor Blondeel