Division of Plastic Surgery, Weill Cornell Medical College, 525 E 68th Street, Payson 709A, New York, NY, 10065, USA.
Aesthetic Plast Surg. 2014 Feb;38(1):207-221. doi: 10.1007/s00266-013-0255-5. Epub 2013 Dec 31.
A central tenet of reconstructive surgery is the principle of "replacing like with like." However, due to limitations in the availability of autologous tissue or because of the complications that may ensue from harvesting it, autologous reconstruction may be impractical to perform or too costly in terms of patient donor-site morbidity. The field of tissue engineering has long held promise to alleviate these shortcomings. Scaffolds are the structural building blocks of tissue-engineered constructs, akin to the extracellular matrix within native tissues. Commonly used scaffolds include allogenic or xenogenic decellularized tissue, synthetic or naturally derived hydrogels, and synthetic biodegradable nonhydrogel polymeric scaffolds. Embryonic, induced pluripotent, and mesenchymal stem cells also hold immense potential for regenerative purposes. Chemical signals including growth factors and cytokines may be harnessed to augment wound healing and tissue regeneration. Tissue engineering is already clinically prevalent in the fields of breast augmentation and reconstruction, skin substitutes, wound healing, auricular reconstruction, and bone, cartilage, and nerve grafting. Future directions for tissue engineering in plastic surgery include the development of prevascularized constructs and rationally designed scaffolds, the use of stem cells to regenerate organs and tissues, and gene therapy.
重建外科的一个基本原则是“用相似的组织来替代”。然而，由于自体组织的可用性有限，或者由于采集自体组织可能带来的并发症，自体重建可能不切实际，或者对患者供体部位的发病率来说过于昂贵。组织工程学领域长期以来一直有望缓解这些不足。支架是组织工程构建物的结构构建块，类似于天然组织中的细胞外基质。常用的支架包括同种异体或异种去细胞组织、合成或天然衍生的水凝胶以及合成可生物降解的非水凝胶聚合物支架。胚胎、诱导多能和间充质干细胞也具有巨大的再生潜力。化学信号，包括生长因子和细胞因子，可被利用来增强伤口愈合和组织再生。组织工程学已经在乳房增大和重建、皮肤替代物、伤口愈合、耳廓重建以及骨、软骨和神经移植物等领域得到了广泛的临床应用。未来整形外科学中组织工程学的发展方向包括开发预血管化构建物和合理设计的支架、利用干细胞来再生器官和组织，以及基因治疗。
