科研之友
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摘要
Craniofacial malformations can have devastating psychosocial implications for many children and represent a significant socioeconomic burden. The mean total hospital cost per child with a craniofacial malformation has been shown to be more than $20,000 during the first 2 years of life, compared with $2500 for children without craniofacial malformations.(1) In addition, trauma and tumor resections create a large biomedical burden in the craniofacial skeleton of adults. Such oncogenic reconstructions pose difficult reconstructive challenges due to concurrent use of chemotherapy and radiation. Addressing these craniofacial defects often require soft tissue transfer, bone grafting techniques, and other technically challenging operations such as microvascular free-flap procedures that create large secondary donor-site defects. These autogenous techniques are limited in quantity, often lack strength and long-term viability, and fail to restore preoperative form and function. Alternatively, alloplastic materials allow for the creation of a more precise form but often lack in function and can be complicated by infection, mechanical failure, and extrusion.
To address these current shortcomings in craniofacial surgery, physicians as well as biotechnology companies have sought to develop alternate less invasive approaches. With the rapidly expanding field of tissue engineering, surgeons have been eager to apply these principles to craniofacial surgery. Tissue-engineering strategies combine the use of a cell type placed on a scaffold and subsequently implanted in vivo to address a tissue defect or tissue dysfunction. More recently, excitement has surrounded the use of pluripotent and multipotent cell types when using tissue-engineering technologies. Although these pluripotent or "stem'' cells are attractive, it is crucial that physicians and surgeons understand the cell type they are using, assess whether it is the optimal cell type to address the clinical need, and, most importantly, understand the risks of such therapies before using them clinically. Furthermore, craniofacial surgeons must understand methods of cell delivery using different scaffold designs. In this review, we discuss the current clinical need for skeletal and soft tissue engineering faced by craniofacial surgeons, and subsequently, we explore current cell types and scaffold designs being used for tissue-engineering treatment options. We conclude by discussing ways to enhance the vascularity of tissue-engineered constructs as this ultimately allows for a definitive repair.
- 出版日期2012-1
