Emerging Opportunities for Cell Transplantation in Reconstructive Microsurgery

Plastic surgery and, especially, reconstructive microsurgery are disciplines centered on problem solving. We routinely approach a clinical problem by deconstructing that problem into key variables, develop a strategy based on principles (like an understanding of blood flow), and then execute a plan that may leverage a variety of surgical tools (such as perforator dissection or microsurgery). There is often no single solution. As an example, a lower extremity wound may be amenable to coverage with a dermal regeneration template, a locoregional perforator-based flap, or a free flap. As a result, plastic surgeons are uniquely positioned to help solve many problems facing medicine, even if in areas that are not traditionally plastic surgical in nature.

One of these areas may be cell transplantation. Fat grafting and nonvascularized bone grafting are two forms of cell transplant that currently fall within the scope of plastic surgery. However, it may be that other types of cell transplant pose an opportunity for innovation and development. For example, transplant of therapeutic (pancreatic) islet cells have exhibited significant promise in reversing diabetes but progress has been hindered in part by poor engraftment. Many transplanted cells are lost in the early-transplant period due to inadequate oxygenation.[1] With the evolution of contemporary bioengineering approaches, such as three-dimensional “bioprinting”[2] and decellularization,[3] it is conceivable that these approaches could help to solve the problem of islet cell transplant by helping make the treatment more reliable through improved graft survival. These approaches may require microsurgery to immediately revascularize a tissue-engineered construct. Similarly, more modern strategies to encapsulate cells (or isolate cells from the immune system)[4] may require biodevices that would best work in a more vascularized and perhaps prefabricated recipient tissue bed.[5] As tissue engineering becomes more sophisticated, so does its requirement for cross collaboration between specialties. Particularly for clinical translation, reconstructive microsurgeons may have the opportunity to play a pivotal role in the development and more widespread use of cell transplantation.

• References

• 1 Suszynski TM, Avgoustiniatos ES, Papas KK. Oxygenation of the intraportally transplanted pancreatic islet. J Diabetes Res 2016; 2016: 7625947
• 2 Lee SJ, Lee JB, Park YW, Lee DY. 3D bioprinting for artificial pancreas organ. Adv Exp Med Biol 2018; 1064: 355-374
• 3 Citro A, Moser PT, Dugnani E. , et al. Biofabrication of a vascularized islet organ for type 1 diabetes. Biomaterials 2019; 199: 40-51
• 4 Papas KK, De Leon H, Suszynski TM, Johnson RC. Oxygenation strategies for encapsulated islet and beta cell transplants. Adv Drug Deliv Rev 2019; DOI: 10.1016/j.addr.2019.05.002.
• 5 Epple C, Haumer A, Ismail T. , et al. Prefabrication of a large pedicled bone graft by engineering the germ for de novo vascularization and osteoinduction. Biomaterials 2019; 192: 118-127