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Page 12 of 14 Mirastschijski et al. Plast Aesthet Res 2020;7:70 I http://dx.doi.org/10.20517/2347-9264.2020.147

population initiates the secretion of proinflammatory mediators with increased and differential AMP
expression in the female reproductive tract [51,52] . While β-defensin-1 is constitutively expressed by mucosal
[53]
epithelia, β-defensin-2 and -3 are found during inflammation and infection . Less β-defensin-2 was found
in migrating cells from a bioengineered skin construct composed of human foreskin cells in comparison
[54]
to full-thickness skin graft sampled from the thigh . Because foreskin derived cells are frequently used
as human skin cells in experimental studies, further research is needed with comparison of cellular
performance between genital and non-genital cutaneous cells.

In summary, genitalia comprise epithelial and connective tissues with varying morphology and
inflammatory responses to trauma. Lack of skeletal anchorage, abundance of connective tissue with high
content of elastic fibres and presence of superficial fasciae provide different biomechanics and scarring
behaviour of genital skin in comparison to other body parts. Reconstructive procedures should take the
characteristics of genital tissues into consideration when planning defect closure with functional restoration
of micturition and sexuality. As a consequence, complex surgical interventions of the genitalia and adjacent
body areas should exclusively be performed by experienced specialists, preferably in an interdisciplinary
setting.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Mirastschijski U, Jiang D, Rinkevich Y, Karim R, Sorg H
Performed data acquisition, as well as provided administrative, technical, and material support:
Mirastschijski U, Jiang D
Writing and editing of the manuscript, advice and intellectual support: Mirastschijski U, Jiang D, Rinkevich
Y, Karim R, Sorg H
Editing of figures, tables and photographs: Mirastschijski U, Jiang D, Karim R

Availability of data and materials
Not applicable.

Financial support and sponsorship
Rinkevich Y was supported by the Human Frontier Science Program Career Development Award
(CDA00017/2016), the German Research Foundation (RI 2787/1-1 AOBJ: 628819), the Fritz-Thyssen-
Stiftung (2016-01277), and the European Research Council Consolidator Grant (ERC-CoG 819933).

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Tissue specimens were obtained after information and written patient’s consent. The study was approved
by the local ethical committees (Ethics Committee of the Medical Chamber of Bremen, No. 336/12 and No.
RA/RE 336; and of Bavaria, 2018-157).

Consent for publication
Written informed consent for anonymous publication of photographs are routinely obtained from every
patient undergoing plastic surgery and are stored in the patients’ files.

Copyright
© The Author(s) 2020.