Biomaterials in

Plastic Surgery
MAE 539 HOMEWORK 2
BY SWATHI UPADHAYAY AND ANIYA KOLHATKAR

Introduction
Plastic surgery deals with the repair, reconstruction, or replacement of physical
defects of form or function involving the skin, musculoskeletal system, cranio and
maxillofacial
structures,
hand,
extremities,
Commonly
Characteristics
usedofbiomaterials
biomaterials
ininplastic
plastic
surgery:
surgery:breast and trunk, and external genitalia.

Types:
PDMS(
Non
Poly
siloxane/silicone)
Firsttoxic
use
ofdimethyl
biomaterials
in plastic surgery was recorded many years ago by Sushruta
Titanium
Reconstructive
Surgery
Non
allergenic
Samhita
in a medical encyclopedia. Surgeons created a prosthetic nose, from skin
Acellular
Non
carcinogenic
dermal matrix (ADM)
Microsurgery
graft
taken
from patients cheek.
Hyaluronic
Resistant
to
Acid
mechanical
strain
Hand Surgery(HA)
InCosmetic
1923,
surgeon
Polyglycolic
Easy
to fabricate
Acid
inSmith-Peterson
required forms constructed first glass mould arthroplasty (surgery
Surgery
Polyglactic
ofCranofacial
a joint).
Resistant
toacid
resorption
Surgery
Polyglactin
Easy to sterilize
910(Vicryl)
without changing the material
Oral
and
Maxillofacial
Surgery
Polydioxanone(PDS)
Causing no inflammatory or foreign body reaction

Polyglecaprone
Non supportive 25
of growth of micro-organism
Nylon
Radio-transparent
Polyamide
Souce:
Source: http://www.arcplasticsurgeons.com/files/2015/04/plastic-surgeryPolyproylene
Easy to handle by surgeon
http://ee_ce_img.s3.amazonaws.com/cache/c
training-vs-cosmetic-surgery-training2-e1426016478225.jpg
e_img/media/remote/ce_img/https_ee_chann
Polyethelene
el_images.s3.amazonaws.com/articlePolybutester
figures/7839/article-g03_400_237.jpg
Polyvinylidene fluoride(PVDF)

Source: American College of Surgerons-https://www.facs.org/education/resources/residency-search/specialties/plastic

Silicone (PDMS)
Applications:
Advantages:

Disdvantages:

1. silastic sheets in orbital floor reconstruction

Stable and inert material

2. preformed implants in malar augmentation

gives
3. Hydrophobic,
custom implants inwhich
maxillary
and zygomatic
reconstruction
resistance

to enzyme actions

4.
implants in chin augmentation (shown in
prefabricated
Great
Flexibility
Figure 2)

Local Infection

Inflammatory Reactions

Capsular Contracture
Source:http://spao.com.au/fileadmin/_migrated/pics/
silicone-partial-hand-prosthesis.jpg

5. custom implants in ear reconstruction

6. preformed and block implants in nasal augmentation
7. preformed implants in breast augmentation or
reconstruction
8. silastic rods in first stage tendon reconstruction
9. prefabricated implants in cranioplasty and forehead
contouring
10. prefabricated expanders in tissue expansion
11. silastic sheets for scar revision
Source:Advanced polymeric biomaterials - an integrated solution for plastic, reconstructive and aesthetic
surgery. Jecan Cristian Radu, Filip Cristina Iulia, Rducu Laura, Hernic Daniel. s.l.: Key Engineering
Materials, 2015, Vol. Vol. 638. pp 197-204.

Source:http://www.lovethatface.com/files/2013/04/c
hin_surgery04.jpg

Hyaluronic Acid (HA)

Advantages
Applications:
Assured facial rejuvenation

Disadvantages

Immediate reaction-

Offer reduced risks compared to

invasive surgery

Pain

Erythema

Generally well tolerated

Swelling

Delayed sideeffects

Erythemactous Granulomas

Pigmentation or persistent
scarring

Source:http://irandermatology.com/wpcontent/uploads/2014/04/h-acid.jpg
Source:Advanced polymeric biomaterials - an integrated solution for plastic, reconstructive and aesthetic surgery. Jecan Cristian Radu, Filip Cristina Iulia,
Rducu Laura, Hernic Daniel. s.l.: Key Engineering Materials, 2015, Vol. Vol. 638. pp 197-204.

Acellular Dermal Matrix (ADM)

Acellular Dermal Matrix Types and Different Applications

Product Type

Advantages

AlloDerm

Faster Healing time

Better
aesthetic outcome
Strattice
(LifeCell)
DermaMatrix
West Chester,
Improved(Synthes,
skin elasticity
Pa.)

Derivation Applications
Burn wounds, abdominal, chest wall,
Disadvantages
and breast reconstructions,
High cost
Human
craniofacial repairs, hand
Lack reconstruction
of elasticity compared with

materials
Porcinesynthetic
Abdominal
and breast reconstructions
Abdominal
wall andconstant
breast
Inability
to withstand
Human
reconstruction, facial reconstruction
tension
Reduced scar contracture
Abdominal wall and breast
Low capacity
for full integration
FlexHD
(Ethicon,
Inc.,and
Somerville,
N.J.)
Human
reconstruction
Allows
mobility
function
of
Abdominal
into body
partswall reconstructions, burn
joints that require skin coverage
Permacol (Covidien, Mansfield, Mass.)
Porcine
wounds, hand reconstruction, eyelid
Improved resistance to infection
reconstruction

AlloMax (Bard, Warwick, R.I.)

Surgimend PRS (TEI Biosciences, Inc,
Boston, Mass.)

Human
Fetal
bovine

Surgisis (Cook Medical)

Porcine

Breast reconstruction, hernia repair

Hernia repair, muscle flap
reinforcement
Abdominal and chest wall
Source: unuim.com
reconstructions, lip augmentation

Source:Regenerative Biomaterials: A Review. Derek A. Banyard, Jenna Martin Bourgeois, Alan D. Widgerow, Gregory R. D. Evans. Irvine:
Regenerative Medicine, 2015.

Titanium: Nasal Reconstruction

Ti being considered for nasal reconstruction because of

biocompatibility and favorable mechanical properties.

Response of nasal epithelial cells depends on surface

characteristics of implant.

TiO2 nano-network on Ti surface using electrochemical

anodization treatment.

Surface roughness, protein adsorption was studied.

Source:Primary human nasal epithelial cell response to titanium surface with a nanonetwork structure in nasal implant applications. Wei-En Yang,
Ming-Ying Lan, Sheng-Wei Lee, Jeng-Kuei Chang, Her-Hsiung Huang. s.l.: Nanoscale Research Letters, 2015.

Biomaterials in Cranioplasty
Different materials used for cranioplasty
Biopolymers- PMMA, PEEK
PMMA

PEEK

Autologous bonean
grafts
Polymethylmethacrylate
ester of acrylic acid and
benzoyl peroxide liquid monomer is a paste which
Allografts
solidifies into a translucent material with strength
similar to that of native bone.
Xenografts
Advantages

inert,

minimum side reactions

adheres tightly to healthy bone,

MRI safe,

doesnt heat up when exposed to solar radiation

Poly-ether-ether-ketone (PEEK) is a colorless

polymeric material
Advantages

Disadvantages
http://www.dailymail.co.uk/news/article-2270648/Malala-Yousafzai

Taliban-shooting-victim-undergo-final-brain-operation.html
forms in an exergonic
chemical reaction which
means that during surgery the brain and

underlying tissues must be continuously washed

with cool serum

good thermoplastic resistance to cold, heat,

water and steam
Chemically inert
Structural strength almost identical to
native bone

Source: A medical insight on the of biomaterials for cranioplasty surgery. Dumitru Mohan1, V. Munteanu, H. Moisa and A.V. Ciurea. s.l.: Trans
Tech Publications, 2015, Vol. 638.

Biomaterials in Cranioplasty
The 4-year long study the authors
conducted show 3 cases in which PMMA
implants didnt have a successful
integration
PEEK-based implants were all perfectly
integrated and didnt generate cranial
deformity. There were no cases of
implant rejection and no surgical
complications occurred.
The main advantage of PEEK consists of
the mechanical properties which are
similar to that of human cortical bone
because the elastic modulus of PEEK is
approximately 8.3Gpa which is close to
that of human cortical bone (17.7Gpa)
when PMMA has an elastic modulus of
3.2
Gpa.
Before and after MRI images of a PEEK implant surgery of a child with
cranial deformity die to traffic accident
Source: A medical insight on the of biomaterials for cranioplasty surgery. Dumitru Mohan1, V. Munteanu, H. Moisa and A.V. Ciurea. s.l.:
Trans Tech Publications, 2015, Vol. 638.

Silk for fabrication of artificial skin

Nanofibers increasingly used because of porosity

Three variation of electrospinning compared to study the cell infiltration

Traditional
Electrospinning
(TE)
Electrospinning
used to
create nanofibers, synthetic or natural.
Salt leeching Electrospinning(SLE)
The fibre sheets can be used as scaffold for cell growth in tissue
Cold-plate
or cryogenic electrospinning(CPE)

engineering

The natural polymers have better results due to better

biocompatibility and no toxicity issues.

Electrospinning process
Source: 20. kdScientific. What is
elecrtrospinning? Inflowmation
Chronicles. Spring 2009.

Source:3D electrospun silk fibroin nanofibers for fabrication of artificial skin.

Faheem A. Sheikh, , Hyung Woo Ju, Jung Min Lee, Bo Mi Moon, Hyun Jung Park, Ok
Joo Lee, Jung-Ho Kim, Dong-Kyu Kim, Chan Hum Park. 2015, Nanomedicine:
Nanotechnology, Biology and Medicine, Vol. 11, pp. 681-691.

Surface morphology and crosssection image of the scaffolds by

TE, SLE and CPE

Surface morphology and crosssection image of the scaffolds by

CPE for humidity 30%,50% and 90%.

Treatment of surgical and burn wounds

Significant increase of skin

in both
PI-AuNP
andin drug delivery systems.
thickness
Nanoparticles
have
application
GI-AuNP group.

Gold nanoparticle shows the most potential because of

GI-AuNP
5 times
stability induced
in biological
mediaskin

than ordinary
drug
growth
The nanoparticles
are coated

with a stabilizer which

delivery
systems,
maintains
the integrity of the core nanoparticle and maintain
original
chemical effect
properties
and electrical charges.
Dose
dependent
of NP.
After
Usually
biohazardous
materials used so possible side effects
ccertan
concerntration,

skin growth
or saturated
less
Consider
using phytochemicals,

Gallic Acid, Protocatechuic

skin
because
increased
Acidgrowth
and isoflavone
are
used in this study.

Au act as
concentrations
Actively exhibit of
anticancer,
antioxidant,
catalysts
forproperties.
certain biochemical
antialergic
reactions.

anti inflammatory

AuNP delivery system

Source:icanhassceince.com

Oxidize easily

Poor solubility in aqueous conditions

A.

Regeneration
of skin for different
delivery
Source: Transdermal treatment of the surgical and burned wound skin
with phytochemical-capped
gold
nanoparticles. Jaewook
B.,
systems
Lee, JiEun Kim, Jun Go, Jong Ho Lee, Dong-Wook Han, DaeYoun Hwang, JAebeom Lee.
s.l.: Colloids and Surfaces B: Biointerfaces
2015, Vol. 135.

GI-AuNPs
PI-AuNps

Current research..

Orbital defects using Ti

implants

Shape Memory alloys to aid

in physiotherapy of partial
facial paralysis.

The process of virtual

reconstruction of the orbital
floor using the shape and
position of the opposite
maxillary sinus

Actuator mechanism in the robot

mask.

Source:. Robot Assisted Physiotherapy to Support Rehabilitation of Facial Paralysis. Dushyantha

Jayatilake, Takashi Isezaki, Yohei Teramoto, Kiyoshi Eguchi, and Kenji Suzuki. 2014, IEEE
TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING, Vol. 22.

Thank You.
Questions?