What has plastic surgery research ever done for us?
The abiding principle of plastic surgery is the restoration of form and function. Historically, plastic surgeons have been instrumental in developing new surgical techniques to achieve this, often during times of conflict.
During the First World War plastic surgeons including Sir Harold Gillies made great advances in facial reconstruction and in the Second World War Sir Archibald McIndoe revolutionised the management of burns.
The revolutionary era of transplantation developed following the ideas of Sir Peter Medawar (Nobel Laureate) to understand the immune tolerance that sufferers of massive burns seemed to generate and be able to accept skin allografts until they recovered.
In the post-war era, Joseph Murray, an American plastic surgeon and Nobel laureate, performed the first renal transplant and plastic surgeons have been instrumental in developing microsurgery.
The 21st century has seen rapid advancement of laboratory science. Tissue engineering and scar free wound healing are two of the many fields that plastic surgeons are helping to translate into clinical applications.
What types of research are undertaken by plastic surgeons?
Plastic surgery research encompasses laboratory science through to clinical trials of new drugs and techniques. The specialty is highly collaborative with the result that projects frequently cross multiple disciplines. Some of the research topics are outlined below; further information about research units in the UK can be found here
Microsurgery has transformed the ability for plastic surgeons to reconstruct areas of the body that are absent either at birth, due to disease or as a result of injury. Microsurgery allows free tissue transfer (‘free flaps') where tissue is removed from one area of the body and re-plumbed into another by reconnecting very small blood vessels.
Microsurgery is used on a daily basis by plastic surgeons. Technical advances in microsurgical equipment continue but a greater focus is on maximising patient safety and enhancing the reconstructive outcome. Advances in flap reconstruction include perforator flaps and new super-thin flaps.
Scar-free would healing would result in a surgical revolution. At the present time wound healing with scar formation is unavoidable. However, scientists have shown that during development in the womb various body structures grow together without leaving a scar. Our understanding of this process has lead to the development of new drugs that aim to achieve scar-free healing.
Injury or disease can result in the loss of tissue, such as skin, muscle, cartilage and bone. If this is severe, there may not be enough tissue left for reconstruction. In the future tissue engineering may allow the artificial growth of new tissues that can then be transplanted into the patient to overcome this problem.
One group set to benefit from this technology is patients with extensive burns with insufficient skin for harvesting skin grafts. The skin is a complex organ with many components such as sweat glands and hair follicles that are crucial for it to function properly. Tissue engineering has enabled plastic surgeons to reconstruct and replace skin components. However, current techniques are limited and further work is needed before this becomes a practical solution for wound repair.
Composite tissue allotranplantation
One groundbreaking and sensitive area of reconstructive surgery is that of human facial transplantation. Although the anatomical and microsurgical knowledge is available and full and partial facial transplants have now taken place outside the UK, there are still many issues concerning the psychological impact on the recipient and their family as well as the long-term risks of immunosuppression. Alongside this more widely publicised research, there is considerable work being undertaken to manipulate tolerance in donor specific ways, so that many other structures (limbs and major body parts) could also be successfully transplanted.
Where is plastic surgery research taking place?
Most of the plastic surgery units in the UK are engaged in some form of research. A list is available here. The work is published in national and international scientific journals and disseminated at conferences and through the development of clinical guidelines. The Journal of Plastic, Reconstructive and Aesthetic Surgery is the international publication associated with BAPRAS.
How can I help?
In addition to the major research funding bodies, there are a number of charitable organisations that support plastic surgery research including the Scar Free Foundation. This major charity was set up by BAPRAS in 1999, and is a highly effective and well managed organisation which remains the only specific research funding body supporting the areas of concern surrounding reconstructive surgery.