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Regenerative medicine is the science of replacing, engineering or regenerating human cells, tissues or organs to restore or establish normal form and function. This broadly encompasses the use of cells, tissues, drugs, synthetic biomaterials and devices to help patients heal more effectively from trauma, cancer therapy, other disease processes and birth anomalies. Regenerative medicine therapies can have goals of both healing damaged tissues and forming new tissue.
While many clinicians and scientists across all fields of medicine have been involved in regenerative medicine research and clinical advances over the last two decades, plastic surgeons have been especially instrumental in moving new therapies into the clinical arena and having a leadership role in new scientific discoveries.
Areas of ongoing research and clinical care:
Burn care: Plastic surgeons have been pioneers in the use of protein scaffolds to generate the dermal layer, or innermost layer of the skin, following burn injury.
Nerve regeneration: Plastic surgeons, in the practice of hand and upper extremity surgery, as well as lower extremity surgery, are forging new paths in the science of regenerating nerves and restoring optimal function after nerve injury. These therapies involve the use of special growth factors to stimulate nerve healing, as well as special biomaterials to serve as guides to direct the growth of nerve fibers.
Breast reconstruction: Breast reconstruction is a vital part of cancer therapy for many women. Plastic surgeons are achieving better outcomes through the use of decellularized tissue scaffolds to regenerate new tissue layers over implants in breast cancer survivors.
Wound care: Complex wounds that are difficult to heal represent a major focus for tissue engineering and regenerative medicine strategies. Skin substitutes, composed of living cells grown in a laboratory, are used to heal these types of wounds. Additionally, growth factors are being explored for improving wound healing. One of the most significant breakthroughs in regenerative therapy for wound healing has been the use of negative pressure devices. Discovered by a plastic surgeon, these devices use negative pressure and micro-mechanical forces to stimulate wound healing.
Fat grafting and adipose stem cell therapy: A significant advance in surgical regenerative medicine has been the development and refinement of techniques to transfer fat tissue in a minimally invasive manner. This allows the regeneration of fat tissue in other parts of the body, using a patient’s own extra fat tissue. This technique is revolutionizing many reconstructive procedures, including breast reconstruction. Importantly, fat tissue is an important source of adult mesenchymal stem cells. Discovered by plastic surgeons, adipose derived stem cells are easy to isolate from fat tissue and hold tremendous promise for treating many disorders across the body.
Scar treatment: Plastic surgeons are experts in the biology of scar formation and the molecular signals that impact healing. Regenerative therapies are being developed using energy-based devices, such as laser and intense pulsed light, to improve the healing of scars.
Hand and face transplantation: The ultimate in “Tissue replacement therapy,” hand and face transplantation represents a life-restoring therapy for patients with severe trauma or other disease processes that result in loss of the hands or face. Most people aren’t aware of this fact, but the very first successful human organ transplant was performed by a plastic surgeon. Dr. Joseph Murray performed the first kidney transplant in 1954. Plastic surgeons have been building up on his legacy in developing this new field of hand and face transplantation. This field also blends elements of cell therapy in order to control the immune response and reduce the need for toxic immunosuppressive drugs.
Bioprosthetic interfaces – connecting humans and machine: This very interesting area of regenerative practice is directed at methods of connecting severed nerve endings with powered artificial limbs. This often involves “rerouting” the severed nerve endings to different muscles so that sensors over the skin can detect the signals and transmit them to a computer that controls the artificial limb.
Bone regeneration: For patients suffering extensive face or a limb trauma, large segments of bone may be missing. Plastic surgeons are using calcium-based scaffolds and biomaterials derived from bone to form new bone tissue for reconstructive purposes.
“Custom made tissue flaps.” For deformities that involve complex structures such as a major part of the nose, plastic surgeons are engineering new replacement parts at another site on the body. In a process called “flap prefabrication,” the structure is assembled using tissue grafts and then transferred to the deformity after healing.
Generation of new skin by tissue expansion: Another technique pioneered by plastic surgeons is the use of gradual expansion of implanted balloon devices to generate new skin tissue that can cover a deformity. This technique is revolutionizing breast reconstruction and the treatment of many birth anomalies.