The Challenge for Reconstructive Surgeons in the Twenty-First Century: Manufacturing Tissue-Engineered Solutions

These are exciting times in the field of plastic and reconstructive surgery. Meaningful advances in a wide range of basic science and clinical spheres have been made in the field in recent years, with direct translation to patient care. As a community, we are fortunate to be involved in such a vast, complex, increasingly interdisciplinary, rapidly expanding, and intellectually challenging field of surgery. Plastic surgery aims to restore “form and function” following a wide range of congenital or acquired defects, with procedures often transcending anatomic boundaries. This versatility promotes innovation, and with the recent advances in medical imaging (1), microsurgery (2), composite tissue allotransplantation (3, 4), nanotechnology (5), cell biology and biomaterials (6), and 3D printing (7), treatment options for patients are wider than ever before. For centuries, the “reconstructive ladder” was restricted to local flaps and skin grafts. Although these autologous options are reliable, plastic surgeons, with their constant wish to refine techniques, have become increasingly cognizant that there is the real potential for a paradigm shift in reconstructive surgery in the medium term. Tissue-engineered solutions (Figure 1A) offer the potential to alleviate the need for donor sites and their associated morbidity and to reduce hospital stay and associated costs (8).