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.
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