3D bioprinting in plastic and reconstructive surgery: current concepts, progress, and clinical application

BackgroundBioprinting is one of the most rapidly developing fields in medicine. Plastic and reconstructive surgery will be affected enormously by bioprinting, due to its original purpose of restoring injured or lost tissue. This article in particular has the purpose to analyze the current state of bioprinted tissues as well as research engagement for its application in plastic and reconstructive surgery.Material and methodsA systematic search for the time span between 2000 and 2022 was performed on EMBASE, PubMed, Scopus, and Web of Science databases according to the PRISMA Guidelines. Criteria for the selection of publications were in vitro, animal in vivo, and human in vivo studies where three-dimensional bioprinting of tissue was performed. We extracted data such as (a) author's country of origin, (b) in vitro study, (c) animal in vivo study, and (d) human in vivo study and categorized the publications by topics such as (1) neural tissue, (2) vascularization, (3) skin, (4) cartilage, (5) bone, and (6) muscle. Additionally, recent discoveries of in vivo animal trials were summarized.ResultsOut of a pool of 1.629 articles, only 29 publications met our criteria. Of these publications, 97% were published by university institutions. Publications from China (28%, n=8), the USA (28%, n=8), and Germany (10%, n=3) led the publication list on 3D bioprinting. Concerning the publications, 45% (n=13) were in vitro studies, 52% (n=15) in vivo studies on animal models, and 3% (n=1) pilot clinical studies on humans as reported by Zhou et al. (EBioMedicine 28: 287-302, 2018). Regarding the classification of topics, our study revealed that publications were mainly in the field of 3D printing of cartilage (n=13, 39%), skin (n=7, 21%), bone (n=6, 18%), and vascularization (n=5, 15%).ConclusionsTo this date, it has not been yet possible to bioprint whole tissue systems. However, the progress in three-dimensional bioprinting is rapid. There are still some challenges, which need to be overcome regarding cell survival before and during the printing process, continuation of architecture of bioprinted multilinear cells, and long-term stabilization and survival of complex tissues.