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Horch et al. Towards the future of plastic surgery

Figure 3: 3D negative imprint of angio- and vasculogenesis network Figure 4: Future applications of 3D bioprinting envision a precise
sprouting out from arterio-venous loop in an isolated chamber after specialdeposition of cells and molecules into 3D scaffolds to
6 weeks 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
tissue loss and tissue replacement. Therefore it is of
no wonder that plastic surgeons who were engaged in
replacing lost tissue were amongst the initial founders
of what has then be termed tissue engineering (TE)
and hence have been involved into all kinds of research
in TE and regenerative medicine. Basically the initial
idea of TE was to build appropriate scaffolds and then
seed cells on such matrices to transplant them into the
recipient area. In the laboratory considerable results
have been obtained in generating replacement tissue
but have not found their way into daily clinical practice
yet. The main obstacle has turned out to be the lack of
initial vascularization especially in large constructs [19] .
These suffer from sufficient initial blood supply after
transplantation to nourish inherent or adherent cells
right from the beginning of their inset. One possible
way to overcome this problem is the prevascularization Figure 5: 3D bioprinted ear frame work with bioink that can contain
of such scaffolds utilizing microsurgically created living cells to be positioned into the printed construct
arterio-venous (av-) loops to three-dimensionally
vascularize large constructs before the designated and proteins together with biodegradable matrices
cells are inoculated [Figure 3]. These prevascularized [Figures 4 and 5], generally now perceived as the new
constructs can then be successfully transplanted [20-23] . field of “biofabrication” [29] . It has been postulated by
Methods derived from such approaches have been researchers that bioprinting would now be on the cusp
successfully implemented into the clinical scenario [24-27] . of entering the translational phase where laboratory
For the first time in the literature we were able to research practices can be scaled up into manufacturing
successfully apply av-loops in two patients, fill in the products specifically designed for individual patients [30] .
patient´s own bone marrow stem cells, along with In addition to tissue replacement such modalities
a hydroxyl-apatite powder and fibrin sealant and could help to also fight systemic conditions, such as
we then have seen a permanent replacement and diabetes mellitus or malignant diseases. With the help
restoration of large human bone defects [28] . This is a of biofabricated protein synthesizing producer cells
very promising approach that offers a way from bench in a 3D microvascularly connected defined container
to bedside already in selected cases. Latest advances it can become possible to treat systemic or local
now include the integration of 3D bioprinting of cells diseaeses. The advantage of such containers with 3D
Plastic and Aesthetic Research ¦ Volume 4 ¦ October 31, 2017 187