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Tian J, Jin MJ, Gao Y. Application of three-dimensional printing in plastic surgery: a bibliometric analysis. Front Surg 2024; 11:1435955. [PMID: 39157290 PMCID: PMC11327138 DOI: 10.3389/fsurg.2024.1435955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/16/2024] [Indexed: 08/20/2024] Open
Abstract
Recent years have seen the publication of numerous papers on the application of three-dimensional (3D) printing in plastic surgery. Despite this growing interest, a comprehensive bibliometric analysis of the field has yet to be conducted. To address this gap, we undertook a bibliometric study to map out the knowledge structure and identify research hotspots related to 3D printing in plastic surgery. We analyzed publications from 1995 to 2024, found in the Web of Science Core Collection (WoSCC), utilizing tools such as VOSviewer, CiteSpace, and the R package "bibliometrix". Our analysis included 1,057 documents contributed by 5,545 authors from 1,620 organizations across 71 regions, and these were published in 400 journals. We observed a steady growth in annual publications, with Europe, Asia, North America, and Oceania leading in research output. Notably, Shanghai Jiao Tong University emerged as a primary research institution in this domain. The Journal of Craniofacial Surgery and Journal of Oral and Maxillofacial Surgery have made significant contributions to the field, with Thieringer, Florian M being the most prolific and frequently cited author. Key areas of focus include medical education and surgical procedures, with "3D printing", "virtual surgical planning" and "reconstructive/orthognathic surgery" highlighted as future research hotspots. Our study provides a detailed bibliometric analysis, revealing the evolution and progress of 3D printing technologies in plastic surgery. As these technologies continue to advance, their impact on clinical practice and patient lives is expected to be profound.
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Affiliation(s)
- Jie Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Jia Jin
- Department of Plastic and Cosmetic Surgery, Shinrong Plastic Surgery Hospital, Chongqing, China
| | - Yang Gao
- Department of Plastic and Cosmetic Surgery, Shinrong Plastic Surgery Hospital, Chongqing, China
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2
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Mayer HF, Coloccini A, Viñas JF. Three-Dimensional Printing in Breast Reconstruction: Current and Promising Applications. J Clin Med 2024; 13:3278. [PMID: 38892989 PMCID: PMC11172985 DOI: 10.3390/jcm13113278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Three-dimensional (3D) printing is dramatically improving breast reconstruction by offering customized and precise interventions at various stages of the surgical process. In preoperative planning, 3D imaging techniques, such as computer-aided design, allow the creation of detailed breast models for surgical simulation, optimizing surgical outcomes and reducing complications. During surgery, 3D printing makes it possible to customize implants and precisely shape autologous tissue flaps with customized molds and scaffolds. This not only improves the aesthetic appearance, but also conforms to the patient's natural anatomy. In addition, 3D printed scaffolds facilitate tissue engineering, potentially favoring the development and integration of autologous adipose tissue, thus avoiding implant-related complications. Postoperatively, 3D imaging allows an accurate assessment of breast volume and symmetry, which is crucial in assessing the success of reconstruction. The technology is also a key educational tool, enhancing surgeon training through realistic anatomical models and surgical simulations. As the field evolves, the integration of 3D printing with emerging technologies such as biodegradable materials and advanced imaging promises to further refine breast reconstruction techniques and outcomes. This study aims to explore the various applications of 3D printing in breast reconstruction, addressing current challenges and future opportunities.
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Affiliation(s)
- Horacio F. Mayer
- Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), Buenos Aires C1053ABH, Argentina; (A.C.); (J.F.V.)
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3
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Wang ZH, Peng JH, Liu YC, Zhu QH, Sun C, Xie H, Wang S. CCNB1 may as a biomarker for the adipogenic differentiation of adipose-derived stem cells in the postoperative fat transplantation of breast cancer. Gland Surg 2024; 13:45-58. [PMID: 38323233 PMCID: PMC10839700 DOI: 10.21037/gs-23-493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024]
Abstract
Background Adipose-derived stem cells (ADSCs) are closely associated with the survival rate of transplanted fat in breast reconstruction after breast cancer surgery. Nevertheless, the intrinsic mechanisms regulating ADSCs adipogenic differentiation remain ambiguous. The aim of our study was to explore the relevant genes and pathways to elucidate the potential mechanisms of adipogenic differentiation in ADSCs. Methods The Gene Expression Omnibus (GEO) dataset GSE61302 was downloaded and analyzed to identify differentially expressed genes (DEGs). Key genes and signaling pathways were obtained through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional and enrichment analysis. Protein-protein interaction (PPI) network and hub gene analyses were performed with the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database and Cytoscape software. Finally, the transcription levels of hub genes in the adipogenic differentiated group and undifferentiated group of ADSCs were compared via real-time quantitative polymerase chain reaction (RT-qPCR). Results In total, 1,091 DEGs were identified through bioinformatics analysis of the adipogenic differentiated group and undifferentiated group. If was then found that the 10 downregulated key genes, CCNB1, NUSAP1, DLGAP5, TTK, CCNB2, KIF23, BUB1B, CDC20, CDCA8, and KIF11 may play important roles in the adipogenic differentiation of ADSCs. Subsequent in vitro experimental verification also revealed that the messenger RNA (mRNA) expression levels of cyclin B1 in adipogenic differentiated cells and undifferentiated cells were significantly different at the early stage (P<0.05), but there was no significant difference at the late stage (P>0.05). Conclusions As a key gene, CCNB1 might be a potential biomarker in the adipogenic differentiation of ADSCs at the early stage.
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Affiliation(s)
- Zheng-Hui Wang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing-Hui Peng
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yin-Cheng Liu
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Quan-Hua Zhu
- Women & Children Central Laboratory and Laboratory of Breast Disease Department, Jiangsu Women and Children Health Hospital, Nanjing, China
| | - Chang Sun
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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4
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Cevik J, Seth I, Hunter-Smith DJ, Rozen WM. A History of Innovation: Tracing the Evolution of Imaging Modalities for the Preoperative Planning of Microsurgical Breast Reconstruction. J Clin Med 2023; 12:5246. [PMID: 37629288 PMCID: PMC10455834 DOI: 10.3390/jcm12165246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Breast reconstruction is an essential component in the multidisciplinary management of breast cancer patients. Over the years, preoperative planning has played a pivotal role in assisting surgeons in planning operative decisions prior to the day of surgery. The evolution of preoperative planning can be traced back to the introduction of modalities such as ultrasound and colour duplex ultrasonography, enabling surgeons to evaluate the donor site's vasculature and thereby plan operations more accurately. However, the limitations of these techniques paved the way for the implementation of modern three-dimensional imaging technologies. With the advancements in 3D imaging, including computed tomography and magnetic resonance imaging, surgeons gained the ability to obtain detailed anatomical information. Moreover, numerous adjuncts have been developed to aid in the planning process. The integration of 3D-printing technologies has made significant contributions, enabling surgeons to create complex haptic models of the underlying anatomy. Direct infrared thermography provides a non-invasive, visual assessment of abdominal wall vascular physiology. Additionally, augmented reality technologies are poised to reshape surgical planning by providing an immersive and interactive environment for surgeons to visualize and manipulate 3D reconstructions. Still, the future of preoperative planning in breast reconstruction holds immense promise. Most recently, artificial intelligence algorithms, utilising machine learning and deep learning techniques, have the potential to automate and enhance preoperative planning processes. This review provides a comprehensive assessment of the history of innovation in preoperative planning for breast reconstruction, while also outlining key future directions, and the impact of artificial intelligence in this field.
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Affiliation(s)
- Jevan Cevik
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, VIC 3199, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, VIC 3199, Australia
| | - Ishith Seth
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, VIC 3199, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, VIC 3199, Australia
| | - David J. Hunter-Smith
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, VIC 3199, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, VIC 3199, Australia
| | - Warren M. Rozen
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, VIC 3199, Australia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, VIC 3199, Australia
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5
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Supper P, Semmler L, Placheta-Györi E, Teufelsbauer M, Harik-Chraim E, Radtke C. [Update and Trends in Breast Reconstruction After Mastectomy]. HANDCHIR MIKROCHIR P 2023; 55:253-261. [PMID: 37487507 PMCID: PMC10415025 DOI: 10.1055/a-2082-1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 02/15/2023] [Indexed: 07/26/2023] Open
Abstract
Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. It has become more difficult to advise patients due to the expansion of oncologic options for mastectomy, radiation therapy and the variety of reconstructive techniques. The goal of reconstruction is to achieve oncologically clear margins and a long-term aesthetically satisfactory result with a high quality of life. Immediate reconstruction preserves the skin of the breast and its natural form and prevents the psychological trauma associated with mastectomy. However, secondary reconstructions often have a higher satisfaction, since here no restitutio ad integrum is assumed. Alloplastic, i. e., implant-based, breast reconstruction and autologous breast reconstruction are complementary techniques. This article provides an overview of current options for breast reconstruction including patients' satisfaction and quality of life following breast reconstruction. Although immediate reconstruction is still the preferred choice of most patients and surgeons, delayed reconstruction does not appear to compromise clinical or patient-reported outcomes. Recent refinements in surgical techniques and autologous breast reconstruction include stacked-flaps, as well as microsurgical nerve coaptation to restore sensitivity, which lead to improved outcomes and quality of life. Nowadays Skin-sparing and nipple-sparing mastectomy, accompanied by improved implant quality, allows immediate prosthetic breast reconstruction as well as reemergence of the prepectoral implantation. The choice of breast reconstruction depends on the type of mastectomy, necessary radiation, individual risk factors, as well as the patient's habitus and wishes. Overall, recent developments in breast reconstruction led to an increase in patient satisfaction, quality of life and aesthetic outcome with oncological safety.
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Affiliation(s)
- Paul Supper
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Lorenz Semmler
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Eva Placheta-Györi
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Maryana Teufelsbauer
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Elissa Harik-Chraim
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Christine Radtke
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
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6
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Zhang J, Zeng Z, Chen Y, Deng L, Zhang Y, Que Y, Jiao Y, Chang J, Dong Z, Yang C. 3D-printed GelMA/CaSiO 3 composite hydrogel scaffold for vascularized adipose tissue restoration. Regen Biomater 2023; 10:rbad049. [PMID: 37274616 PMCID: PMC10234763 DOI: 10.1093/rb/rbad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/24/2023] [Accepted: 04/23/2023] [Indexed: 06/06/2023] Open
Abstract
The increased number of mastectomies, combined with rising patient expectations for cosmetic and psychosocial outcomes, has necessitated the use of adipose tissue restoration techniques. However, the therapeutic effect of current clinical strategies is not satisfying due to the high demand of personalized customization and the timely vascularization in the process of adipose regeneration. Here, a composite hydrogel scaffold was prepared by three-dimensional (3D) printing technology, applying gelatin methacrylate anhydride (GelMA) as printing ink and calcium silicate (CS) bioceramic as an active ingredient for breast adipose tissue regeneration. The in vitro experiments showed that the composite hydrogel scaffolds could not only be customized with controllable architectures, but also significantly stimulated both 3T3-L1 preadipocytes and human umbilical vein endothelial cells in multiple cell behaviors, including cell adhesion, proliferation, migration and differentiation. Moreover, the composite scaffold promoted vascularized adipose tissue restoration under the skin of nude mice in vivo. These findings suggest that 3D-printed GelMA/CS composite scaffolds might be a good candidate for adipose tissue engineering.
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Affiliation(s)
| | | | - Yanxin Chen
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325000, China
| | - Li Deng
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325000, China
| | - Yanxin Zhang
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325000, China
| | - Yumei Que
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325000, China
| | - Yiren Jiao
- Joint Centre of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325000, China
| | - Jiang Chang
- Correspondence address. E-mail: (J.C.); (Z.D.); (C.Y.)
| | - Zhihong Dong
- Correspondence address. E-mail: (J.C.); (Z.D.); (C.Y.)
| | - Chen Yang
- Correspondence address. E-mail: (J.C.); (Z.D.); (C.Y.)
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7
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Moroni S, Casettari L, Lamprou DA. 3D and 4D Printing in the Fight against Breast Cancer. BIOSENSORS 2022; 12:568. [PMID: 35892465 PMCID: PMC9394292 DOI: 10.3390/bios12080568] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
Breast cancer is the second most common cancer worldwide, characterized by a high incidence and mortality rate. Despite the advances achieved in cancer management, improvements in the quality of life of breast cancer survivors are urgent. Moreover, considering the heterogeneity that characterizes tumors and patients, focusing on individuality is fundamental. In this context, 3D printing (3DP) and 4D printing (4DP) techniques allow for a patient-centered approach. At present, 3DP applications against breast cancer are focused on three main aspects: treatment, tissue regeneration, and recovery of the physical appearance. Scaffolds, drug-loaded implants, and prosthetics have been successfully manufactured; however, some challenges must be overcome to shift to clinical practice. The introduction of the fourth dimension has led to an increase in the degree of complexity and customization possibilities. However, 4DP is still in the early stages; thus, research is needed to prove its feasibility in healthcare applications. This review article provides an overview of current approaches for breast cancer management, including standard treatments and breast reconstruction strategies. The benefits and limitations of 3DP and 4DP technologies are discussed, as well as their application in the fight against breast cancer. Future perspectives and challenges are outlined to encourage and promote AM technologies in real-world practice.
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Affiliation(s)
- Sofia Moroni
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK;
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy;
| | - Luca Casettari
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy;
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8
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Cobianchi L, Peloso A. Editorial: Scaffold Technology, Tissue and Organ Engineering: New Horizons in Surgery. Front Surg 2022; 9:914080. [PMID: 35662828 PMCID: PMC9157762 DOI: 10.3389/fsurg.2022.914080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Correspondence: Lorenzo Cobianchi
| | - Andrea Peloso
- Department of Visceral and Transplantation Surgery, University of Geneva Hospitals, Geneva, Switzerland
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9
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Dong X, Premaratne ID, Sariibrahimoglu K, Limem S, Scott J, Gadjiko M, Berri N, Ginter P, Spector JA. 3D-printed poly-4-hydroxybutyrate bioabsorbable scaffolds for nipple reconstruction. Acta Biomater 2022; 143:333-343. [PMID: 35240316 DOI: 10.1016/j.actbio.2022.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/03/2023]
Abstract
Nearly all autologous tissue techniques and engineered tissue substitutes utilized for nipple reconstruction are hindered by scar contracture and loss of projection of the reconstructed nipple. The use of unprocessed costal cartilage (CC) as an internal support for the reconstructed nipple has not been widely adopted because of the excessively firm resultant construct. Herein we use a 3D-printed Poly-4-Hydroxybutyrate (P4HB) bioabsorbable scaffold filled with mechanically processed patient-derived CC to foster ingrowth of tissue in vivo to protect the regenerated tissue from contractile forces as it matures. After 6 months in vivo, newly formed spongy fibrovascular cartilaginous tissue was noted in processed CC filled 3D-printed scaffolds, which maintained significantly greater projection than reconstructions without scaffolds. Interestingly, 3D-printed P4HB scaffolds designed with an internal 3D lattice of P4HB filaments (without CC) displayed the fastest material absorption and vascularized adipose-fibrous tissue as demonstrated by SEM and histological analysis, respectively. Using 3D-printed P4HB scaffolds filled with either processed CC, a 3D P4HB lattice or no fills, we have engineered neo-nipples that maintain projection over time, while approximating the biomechanical properties of the native human nipple. We believe that this innovative 3D-printed P4HB nipple reconstruction scaffold will be readily translatable to the clinic. STATEMENT OF SIGNIFICANCE: Nearly all autologous tissue techniques and engineered tissue substitutes utilized for nipple reconstruction are hindered by scar contracture and substantial loss of projection of the reconstructed nipple, leading to significant patient dissatisfaction. Using 3D-printed P4HB scaffolds filled with either processed costal cartilage or 3D P4HB lattices, we have engineered neo-nipples that resist the forces induced by scar contracture, resulting in maintenance of neo-nipple projection over time and biomechanically approximating human nipples after 6 months in vivo implantation. This novel 3D-printed bioabsorbable P4HB scaffold will be readily translatable to the clinic to reconstruct nipples with patient-specific dimensions and long-lasting projection.
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Affiliation(s)
- Xue Dong
- Laboratory of Bioregenerative Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College, 525 East 68th Street, Payson 709-A, New York, NY 10065, United States
| | - Ishani D Premaratne
- Laboratory of Bioregenerative Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College, 525 East 68th Street, Payson 709-A, New York, NY 10065, United States
| | | | | | - Jeffrey Scott
- Tepha, Inc., Lexington, MA, United States; Department of Medical Science, Brown University, Providence, RI, United States
| | - Mariam Gadjiko
- Laboratory of Bioregenerative Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College, 525 East 68th Street, Payson 709-A, New York, NY 10065, United States
| | - Nabih Berri
- Laboratory of Bioregenerative Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College, 525 East 68th Street, Payson 709-A, New York, NY 10065, United States
| | - Paula Ginter
- Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, United States
| | - Jason A Spector
- Laboratory of Bioregenerative Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Weill Cornell Medical College, 525 East 68th Street, Payson 709-A, New York, NY 10065, United States; Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States.
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10
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Goldenberg D, McLaughlin C, Koduru SV, Ravnic DJ. Regenerative Engineering: Current Applications and Future Perspectives. Front Surg 2021; 8:731031. [PMID: 34805257 PMCID: PMC8595140 DOI: 10.3389/fsurg.2021.731031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022] Open
Abstract
Many pathologies, congenital defects, and traumatic injuries are untreatable by conventional pharmacologic or surgical interventions. Regenerative engineering represents an ever-growing interdisciplinary field aimed at creating biological replacements for injured tissues and dysfunctional organs. The need for bioengineered replacement parts is ubiquitous among all surgical disciplines. However, to date, clinical translation has been limited to thin, small, and/or acellular structures. Development of thicker tissues continues to be limited by vascularization and other impediments. Nevertheless, currently available materials, methods, and technologies serve as robust platforms for more complex tissue fabrication in the future. This review article highlights the current methodologies, clinical achievements, tenacious barriers, and future perspectives of regenerative engineering.
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Affiliation(s)
- Dana Goldenberg
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, United States
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Caroline McLaughlin
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, United States
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Srinivas V. Koduru
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, United States
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Dino J. Ravnic
- Irvin S. Zubar Plastic Surgery Research Laboratory, Penn State College of Medicine, Hershey, PA, United States
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
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11
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Liu H, Jain S, Ahlinder A, Fuoco T, Gasser TC, Finne-Wistrand A. Pliable, Scalable, and Degradable Scaffolds with Varying Spatial Stiffness and Tunable Compressive Modulus Produced by Adopting a Modular Design Strategy at the Macrolevel. ACS POLYMERS AU 2021; 1:107-122. [PMID: 36855428 PMCID: PMC9954393 DOI: 10.1021/acspolymersau.1c00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Clinical results obtained when degradable polymer-based medical devices are used in breast reconstruction following mastectomy are promising. However, it remains challenging to develop a large scaffold structure capable of providing both sufficient external mechanical support and an internal cell-like environment to support breast tissue regeneration. We propose an internal-bra-like prototype to solve both challenges. The design combines a 3D-printed scaffold with knitted meshes and electrospun nanofibers and has properties suitable for both breast tissue regeneration and support of a silicone implant. Finite element analysis (FEA) was used to predict the macroscopic and microscopic stiffnesses of the proposed structure. The simulations show that introduction of the mesh leads to a macroscopic scaffold stiffness similar to the stiffness of breast tissue, and mechanical testing confirms that the introduction of more layers of mesh in the modular design results in a lower elastic modulus. The compressive modulus of the scaffold can be tailored within a range from hundreds of kPa to tens of kPa. Biaxial tensile testing reveals stiffening with increasing strain and indicates that rapid strain-induced softening occurs only within the first loading cycle. In addition, the microscopic local stiffness obtained from FEA simulations indicates that cells experience significant heterogeneous mechanical stimuli at different places in the scaffold and that the local mechanical stimulus generated by the strand surface is controlled by the elastic modulus of the polymer, rather than by the scaffold architecture. From in vitro experiments, it was observed that the addition of knitted mesh and an electrospun nanofiber layer to the scaffold significantly increased cell seeding efficiency, cell attachment, and proliferation compared to the 3D-printed scaffold alone. In summary, our results suggest that the proposed design strategy is promising for soft tissue engineering of scaffolds to assist breast reconstruction and regeneration.
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Affiliation(s)
- Hailong Liu
- Department
of Fibre and Polymer Technology, KTH Royal
Institute of Technology, 100 44, Stockholm, Sweden,Department
of Engineering Mechanics, KTH Royal Institute
of Technology, 100 44, Stockholm, Sweden
| | - Shubham Jain
- Department
of Fibre and Polymer Technology, KTH Royal
Institute of Technology, 100 44, Stockholm, Sweden
| | - Astrid Ahlinder
- Department
of Fibre and Polymer Technology, KTH Royal
Institute of Technology, 100 44, Stockholm, Sweden
| | - Tiziana Fuoco
- Department
of Fibre and Polymer Technology, KTH Royal
Institute of Technology, 100 44, Stockholm, Sweden
| | - T. Christian Gasser
- Solid
Mechanics, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44, Stockholm, Sweden,Faculty
of Health Sciences, University of Southern
Denmark, 5230, Odense, Denmark,
| | - Anna Finne-Wistrand
- Department
of Fibre and Polymer Technology, KTH Royal
Institute of Technology, 100 44, Stockholm, Sweden,
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