Current Use of Biological Scaffolds in Plastic Surgery

Background: Properly designed biodegradable scaffolds facilitate repair or regeneration of stromal tissues. Over the past 50 years, a variety of synthetic, semisynthetic, and decellularized scaffolds have been developed that provide surgeons with tools to reconstruct a wide array of structural defects. Methods: The authors review the literature of biological degradable scaffolds in current clinical use in the United States and highlight their design principles and products in common use. Results: Host tissues populate scaffolds with inflammatory cells, fibroblasts, blood vessels, nerves, and lymphatics. Cells lay down extracellular matrix macromolecules, whereas enzymes degrade the scaffold. Over time, the scaffold can be totally replaced by host tissues. Conclusions: The greatest use of scaffolds in plastic surgery is in skin replacement, breast reconstruction, abdominal wall reconstruction, and peripheral nerve repair. Other areas of importance are cartilage and bone replacement and support for lining replacements such as bowel, bladder, mucosa, and dura. The wide range of research being performed in this field is likely to provide surgeons with more choices and improved materials to repair and regenerate stromal structures.