2017-18 HSC Section 4 Green Book

Plastic and Reconstructive Surgery • June 2015

stem cells. 53 In addition, the two landmark studies published in The Lancet last year demonstrate the ability to culture both cartilage for nasal recon- struction and vaginal tissue for vaginal reconstruc- tion using biodegradable scaffolds. The excellent long-term results of these studies signal a practi- cal shift to customized biocompatible tissue and organs for reconstructive purposes. 43,66 Acellular dermal matrix is also finding increasing use in the fields of hand surgery and eyelid, ear, and airway reconstruction. 67–69 Finally, three-dimensional con- siderations and technologies are at the forefront of current research. Properties such as matrix chemistry and structure, pore size and mechani- cal integrity, and tension and mechanotransduc- tion have all emerged as critical determinants of biomaterial design and behavior. 4,5 We are moving toward an era of ex vivo cultured autologous tissue and three-dimensionally printed, patient-specific organs, and the regenerative properties of these constructs must be maximized to ensure optimal clinical efficacy. CONCLUSIONS Biomaterials include a diverse array of medi- cal products ranging from gels and cellular matri- ces to stem cell–enhanced grafts and engineered organs. As the ever-increasing number of compa- nies produce variations on the existing technolo- gies, focus must shift on three-dimensional design for optimal function. Biomaterials such as acellular dermal matrix have proven beneficial in difficult- to-treat applications, such as breast and abdominal wall reconstruction and in the setting of contami- nated fields; however, more prospective data are needed determine their true efficacy and whether in fact animal-derived matrix is superior to human- derived matrix in these settings. The high costs of many of the materials will continue to challenge us as surgeons to seek more cost-effective solutions; in the meantime, biomaterials can serve as a safe alternative when native tissue is lacking. Gregory R. D. Evans, M.D.

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Department of Plastic Surgery University of California, Irvine 200 South Manchester Avenue, Suite 650 Orange, Calif. 92868-3224 gevans@uci.edu

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