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Table of contents
- Seth Gordhandas Sunderdas Medical College
- Flaps and Reconstructive Surgery E-Book
- DEPARTMENT OF PLASTIC & RECONSTRUCTIVE SURGERY AND BURNS | KING EDWARD MEMORIAL HOSPITAL
With the help of biofabricated protein synthesizing producer cells in a 3D microvascularly connected defined container it can become possible to treat systemic or local diseaeses.
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Ravnic et al. They postulated that it would be possible to integrate vascularization and encapsulation in bioprinted tissues. This would lend other future prospects, such as pancreas-on-a-chip or organoids on a chip [ 31 ].
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Our own group is actively investigating the value of bioprinting to generate such arterialized 3D prevascularized containers which can then be loaded with protein producing cells. These cells are supposed to continuously express functional substances and address specific functions in the recipient organism. This interdisciplinary approach is a fine example of how we can combine the knowledge, skills and expertise of plastic surgical microvascular techniques with the science of bioengineering and biology. Therefore, it seems promising to help our patients better than today with customized solutions to overcome morbidities that are rarely curable today.
In summary, all the findings from regenerative medicine and tissue engineering are now more and more merging into the new field of biofabrication. This might well enrich our daily clinical practice of to the benefit of our patients by combining the art of plastic surgery with basic science [ 32 , 33 ].
Figure 3. Figure 4. Future applications of 3D bioprinting envision a precise specialdeposition of cells and molecules into 3D scaffolds to mimick natural tissue conditions and to facilitate artificial tissue replacement, such as in this artistic rendering an ear or a noise for example, using tools of biofabrication. Figure 5. Designed and wrote the manuscript, performed literature research, produced the figures and finalized the manuscript: R.
Discussed the content, read and corrected and proofread the final manuscript: A. Weigand, H. Wajant, R. An, J. Sun, A. Drug treatment, after care and secondary interventions following lower leg reconstruction by free tissue transfer.
Seth Gordhandas Sunderdas Medical College
Chirurg ; Lower extremity salvage with microvascular free flaps. J S C Med Assoc ; Severe lower-extremity injury. The rationale for microsurgical reconstruction.
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Orthop Rev ; Management of hypovascularized wounds not responding to conventional therapy by means of free muscle transplantation. Vasa ; Outcomes of microvascular reconstruction of single-vessel lower extremities: limb salvage versus amputation. J Reconstr Microsurg ; Reconstruction of the vascular compromised lower extremity - report of the consensus workshop at the Handchir Mikrochir Plast Chir ; Extended skin and soft tissue defects after vascular wounds: plastic surgical concepts. Zentralbl Chir ; The nutrient omentum free flap: revascularization with vein bypasses and greater omentum flap in severe arterial ulcers.
J Vasc Surg ; Nutrient free flaps with vascular bypasses for extremity salvage in patients with chronic limb ischemia. J Cardiovasc Surg Torino ; Distal pedal bypasses combined with free microsurgical flaps in chronic limb ischaemia for problematic wounds. Int Wound J ; The free "emergency" rectus abdominis flap transfer for coverage of complex hand injuries.
Langenbecks Arch Chir Suppl Kongressbd ; A paradigm shift in flap selection protocols for zones of the lower extremity using perforator flaps.
Limb salvage in the patient with severe peripheral vascular disease: the role of microsurgical free-tissue transfer. Plast Reconstr Surg ; Free microsurgical flap-plasty in reconstructive therapy of diabetic foot ulcer. Zentralbl Chir ; Suppl Surgically-induced angiogenesis as basic principle in treatment ov hypovascularized wounds--the nutritive flap. Microvascular reconstruction of the lower extremity in the elderly.
Clin Plast Surg ; Intraoperative hemodynamic evaluation of the latissimus dorsi muscle flap: a prospective study. Plastic reconstructive microsurgery in the elderly patient. Bioreactors in regenerative medicine--from a technical device to a reconstructive alternative? The arteriovenous av loop in a small animal model to study angiogenesis and vascularized tissue engineering.
Flaps and Reconstructive Surgery E-Book
J Vis Exp ; Acceleration of vascularized bone tissue-engineered constructs in a large animal model combining intrinsic and extrinsic vascularization. Tissue Eng Part A ; Axial prevascularization of porous matrices using an arteriovenous loop promotes survival and differentiation of transplanted autologous osteoblasts. Tissue Eng ; Evaluation of blood vessel ingrowth in fibrin gel subject to type and concentration of growth factors. J Cell Mol Med ; Vascular tissue engineering: effects of integrating collagen into a PCL based nanofiber material.
Biomed Res Int ; Novel approach towards aligned PCL-Collagen nanofibrous constructs from a benign solvent system. Materials Basel ; BMC Cell Biol ; Successful human long-term application of in situ bone tissue engineering. Biofabrication: reappraising the definition of an evolving field. Especially, the patient should be explained that the risk of relapsing scars after surgical treatment is possible. If the deficiency of tissue cannot be corrected by simple excision and closure or Z-plasty, the surgeon will have to employ a skin graft or Z-plasty [ 9 ].
These techniques, however, depend on a certain quality of the local adjacent skin tissue. This can be a problem in extended scarring after burns or other traumatic causes such as degloving injuries.
If skin grafts or Z-plasty are not considered to solve the scar problem, regional axial flaps with direct cutaneous territory should be used [ 10 ]. The prerequisite is an axial flap such as the forehead flap, the radial forearm flap, or a dorsal arm flap. As can be appreciated from the anatomical requirements, their use is limited to few locations. However, if adjacent random flaps can be dissected, this tissue will provide random or cutaneous flaps of the closest proximity.
Typically, this works well in the proximal extremities and the trunk.
DEPARTMENT OF PLASTIC & RECONSTRUCTIVE SURGERY AND BURNS | KING EDWARD MEMORIAL HOSPITAL
If no adjacent tissue is available, vascularized pedicled muscle or fascia flaps carrying fasciocutaneous or myocutaneous territories can be applied [ 6 ], [ 11 ]. As these operations require extensive dissection, their use is justified only in cases of severe functional or aesthetic impairment. Typical examples are pedicled groin flaps for the hand and pedicled transverse rectus abdominis myocutaneous TRAM flaps for the groin or thorax.
All the above-mentioned procedures entail single-step operations, except for the pedicled groin flap. Therefore, multistage procedures such as the skin expander or serial excisions with staged scar release are useful only if the soft tissue to be expanded is superior to the other options and if the patient is willing to undergo multiple procedures.
Although expanders require a lot of effort and endurance from the patient, the aesthetic result is mostly superior to other options. Expanders typically provide quality skin with the best tissue and color match for the reconstruction of the scalp, face chest, and extremities. Expanders can be used to preexpand pedicled flaps in the chest area before transposition, for example, to the head, neck, or face. Typical examples for the latter are preexpanded supraclavicular flaps or super thin posterior thorax flaps [ 12 ]. Only if all of the above solutions fail or cannot be applied that free flaps come into consideration [ 13 ].
Due to their versatility, free flaps have almost entirely replaced the unsuccessful reconstructive attempts that had dominated the first three quarters of the 20th century. Flap geometry and staged tubed pedicles as well as flap delay were replaced by new options to provide vast quantities of tissue that could be transferred to the most distant locations of the human body.
Free flaps provide all sorts of the desired tissue quality, including skin, fat, fascia, muscle, tendon, and bone Table 2. Due to the availability of various vascular patterns, the size and design can be tailored to the individual requirements.