title: Tissue engineering:  revolution and challenge in auricular cartilage reconstruction.
abstract: External ear reconstruction for congenital deformity such as microtia or following trauma remains one of the greatest challenges for reconstructive plastic surgeons. The problems faced in reconstructing the intricate ear framework are highly complex. A durable, inert material that is resistant to scar contracture is required. To date, no material, autologous or prosthetic, is available that perfectly mimics the shapely elastic cartilage found in the ear. Current procedure involves autologous costal cartilage that is sculpted to create a framework for the overlying soft tissues. However, this is associated with donor-site morbidity, and few surgeons worldwide are skilled in the techniques required to obtain excellent results. Various alloplastic materials have therefore been used as a framework. However, a degree of immunogenicity and infection and extrusion are inevitable, and results are often disappointing. Tissue-engineered cartilage is an alternative approach but, despite significant progress in this area, many problems remain. These need to be addressed before routine clinical application will become possible. The current tissue-engineered options are fragile and inflexible. The next generation of auricular cartilage engineering is promising, with smart materials to enhance cell growth and integration, and the application of stem cells in a clinical setting. More recently, the authors' team designed the world's first entirely synthetic trachea composed of a novel nanocomposite material seeded with the patient's own stem cells. This was successfully transplanted in a patient at the Karolinska Hospital in Sweden and may translate into a tissue-engineered auricle in the future.
authors.affiliation: London, United Kingdom From the Center for Nanotechnology & Regenerative Medicine, UCL Division of Surgery & Interventional Science, the ENT Institute, and the Center for Stem Cells and Regenerative Medicine, University College London, and the Department of Plastic and Reconstructive Surgery, Royal Free Hampstead NHS Trust Hospital.
authors.forename: Leila
authors.initials: L
authors.lastname: Nayyer
authors.forename: Kavi H
authors.initials: KH
authors.lastname: Patel
authors.forename: Ali
authors.initials: A
authors.lastname: Esmaeili
authors.forename: Radoslaw A
authors.initials: RA
authors.lastname: Rippel
authors.forename: Martin
authors.initials: M
authors.lastname: Birchall
authors.forename: Gregory
authors.initials: G
authors.lastname: O'Toole
authors.forename: Peter E
authors.initials: PE
authors.lastname: Butler
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Seifalian
mesh_terms: D001672:Biocompatible Materials; D002356:Cartilage / Q000601:surgery; D019902:Chondrocytes / Q000502:physiology; D004425:Ear Cartilage / Q000503:physiopathology / Q000601:surgery; D004431:Ear, External / Q000002:abnormalities / Q000293:injuries / Q000601:surgery*; D006801:Humans; D012272:Ribs / Q000601:surgery; D013234:Stem Cells / Q000502:physiology; D023822:Tissue Engineering / Q000379:methods*; D054457:Tissue Scaffolds
chemical_list: D001672:Biocompatible Materials