Swiss Health Magazine

Flesh of the flesh

Articular cartilage and bone cultivated from an individual’s own tissue, an ideal chest without artificial implants, paralyzed patients who recover … this is nowhere near everything that regenerative medicine can do. At University Hospital Basel, scientific research in this area has been proceeding in parallel with intensive practices for many years. Professor Dirk Schaefer, Head of the Plastic, Reconstructive, Aesthetic and Hand Surgery Department, tells us how regenerative medicine is pushing the boundaries.

Professor Schaefer, your team researches body tissue cultivation. How do new technologies, which you’ve called Tissue Engineering, help people nowadays and what can we expect in the future?

— Work on the Tissue Engineering project has been going on for more than 2 decades.  About 15 years ago, our team of 4 or 5 clinical professors plus a full professor working in the experimental surgery laboratory began growing cartilaginous and bone tissue from our patients’ materials. Later we started to grow nerve tissue from these so-called autogenous materials. To get cartilaginous tissue, we make a nasal septum biopsy, and to create a 5cm diameter sample, we need only 6 millimeters of a patient’s own tissue, without noticeable scars! We are already using this method for nose recovery after tumor removal and for knee joint defects.

Bone tissue is grown from autogenous cells of fat tissue. During the operation, we take adipose cells and put them into a special piece of equipment, and in two hours we get enough cells to create bone tissue, which is very convenient for the treatment of fractures. All of this can be realized over the course of one operation. The distinctive advantage of this method is that there is no need to take bone tissue from, for example, hip bones, as this can cause serious pain after the procedure.

We have found a way to grow large amounts of bone in order to use this method in restoring the defects of big and/or long bones in the areas of the hand, extremities, head, skull and chin.

Our clinic also conducts research in the area of nerve tissue creation, which can later be grafted onto a patient. It is important that the new tissue should not be defective in order to avoid problems with sensitivity and nervous system complications. Cultivated nerve tissue can be used after traumas of a strangulated nature, when some part of the nerve is missing.

— Why exactly is adipose tissue the source material?

— Adipose tissue is a perfect and almost unlimited source for autogenous stem cells. We take the necessary amount of adipose cells via a minimally invasive method and use them to regenerate bones and nerves. Earlier, when it was necessary to reconstruct bone tissue, surgeons used artificial materials, but those materials could not be fully integrated into the human body, so problems appeared in later years. There are no serious consequences with the transplantation of autogenous human material implants, as these tissues are fully integrated into the human body and they take over functions of the damaged tissue.

This is to say that from any autogenous material, whether bone or adipose tissue, you can almost create a new person, can’t you?

— In the early 1990s, there were some publications which stated that soon we would be able to create… maybe not a full human, but some of their parts, such as a hand or a leg. But the predictions proved to be too visionary, as the human body is a really complex and highly developed structure. We have learned to purposefully replace certain tissues of the human body, such as cartilaginous, bone and nerve tissues. But in the case of complete organs, artificial prosthesis and donor organs for transplantation are still used.

— How actively is the method you are talking about used in practical medicine?

— Cultivated cartilaginous tissue is used in the treatment of articular cartilage defects, which occur as a result of injuries and accidents among sportsmen, for example. We can reconstruct cartilaginous nasal tissue after the removal of a tumor. We also use this method when treating thumb joint arthrosis, which is found in around one third of all women. In some severe cases, we have to remove this joint in order to reduce pain and here we work on its reconstruction. There are some plans afoot to use this technique in ear reconstruction. Bone tissue can be applied to any part of the human skeleton.

— You mentioned nervous tissue regeneration. Does this give hope to paralyzed patients?

— Yes. We work closely, for example, with the Swiss Paraplegic Centre. Today, it is possible for paralyzed patients to recover certain functions after skiing or motorbike accidents. For example, by changing the nerves’ location, it is possible to restore prehensile function to the hand. This is a wonderful outcome! If a person who was unable to move his arm can raise a spoon to his mouth after the operation, it means he can partly serve himself and become independent.

— How does your method help people with severe facial injuries following a car accident, for example? You work in this area, don’t you?

— Each case, of course, is individual. Today we are able to correct big scars on a patient’s face after thermal and chemical burns. A small number of centers can transplant faces or facial components, but this always involves immunosuppressive measures and is still considered to be experimental. There is a risk of infectious contamination or rejection of the grafted tissue. This is the reason we follow the methods of autogenous tissue grafting. By expanding the skin and using fat stem cells and microsurgical techniques, we can fully restore the surface of an individual’s face. Of course, this is all based upon the condition that the patient’s eyes function and the face muscles and bones have not been damaged.

— Is the aim to restore the beauty of a patient’s face?

— The aesthetic part of this work is also important. There is a direct link between appearance, good health and social status. That is why we try hard to maintain an attractive face after an operation.

— Do you often have to deal with the consequences of unsuccessful plastic surgery?

— Yes. It’s pretty common. Among patients from other countries, we have had some cases of complications after inappropriate use of medicines for the face, the misuse of breast implants, and problems as a result of liposuction. Some situations have been extremely serious, right up to sensory loss and functional impairment. The new method helps in cases where tissue regeneration is necessary.

— What is the treatment plan in the case of severe skin damage?

— The treatment program consists of several stages. First of all, it is necessary to seal the wounds. After that we examine the skin, its structure, texture, and tone, in order to take the opportunity to cover defects by mobilizing the skin and transplanting it into the defect. If there are scars, we arrange them in such a way that they are less noticeable. I always recommend replacing one big part of the skin instead of many small ones. If you arrange the skin correctly and have previously examined its form and structure, the scars become less noticeable. In each individual case, we prepare a personalized treatment plan.

— Is it possible for the autogenous tissue to replace artificial breast implants?

— In certain cases it is possible. Sometimes after childbirth, the feeling of a foreign body appears in the breast and a woman decides to get rid of her implants. As a result of their removal, a disparity in the skin and breast volume appears, so the next stage is lifting, which can be accompanied by the implantation of autogenous tissue from the hip or other parts of the body. It is a minimally invasive method of treatment which takes 3–4 days, including a consultation with a physician and preparation for surgery.

— If patients want to correct their appearance and look for a good surgeon, can they consult you? Or do you send them to cosmetic surgeons so as not to lose focus on the projects you are working on?

It is important to distinguish between such words as aesthetic and cosmetic. The term «cosmetic surgery» is freely used in media and society, but it is not a medical term. Anyone can call themselves a cosmetic surgeon. Our specialization is plastic, reconstructive and aesthetic surgery.

We are acting on a changing state (the aging process, the consequences of an accident, a developmental defect), meaning that we can bring somebody from an altered situation to an — in general — accepted normal or natural state For example, a woman with a big crooked nose doesn’t correspond to the normal ideal of beauty, so we can help her with aesthetic surgery. Another issue is when ordinary or even quite beautiful people, for whatever reason, want to change their body and sometimes exaggerate some of its parts, make them abnormal or supranatural — this is called “cosmetic” surgery.

In that regard, we at University Hospital Basel have a great responsibility. We educate and develop the competency of our colleagues and young specialists and pass on our knowledge and ethics to them. To prevent this uncontrollable passion for surgical operations without consideration of the consequences, it is important to educate the younger generation upon which ideals of beauty are imposed by the mass media. This year, we plan to open the first educational division of aesthetic and plastic surgery in a University Department anywhere in the world.

— What helps an individual to stay healthy and look younger for longer?

— As you get older, some changes are going on in your tissues. The skin loses its elasticity and the amount of subcutaneous tissue decreases. If this is accompanied by a long-term unhealthy lifestyle, such as smoking, alcohol abuse, or sunbathing, then the skin doesn’t change for the better. In such cases, we tell the patients: «Our options are limited.» This must be taken into account during an operation. I think a good diet, vitamin balance, normal sleep, lack of bad habits, skin care and fluid balance control, as well as physical exercise, are very important things.

— You are a graphic designer, according to your first degree. Do you have the opportunity, from time to time, to take a break from all this work and visit an exhibition?

Of course I do! We live in Basel, which is the Capital of Culture and the location of the famous ART Basel. Here we have a lot of museums of fine art, where you have the chance to see something new. While traveling, I take the opportunity to visit museums in other cities. It is a real pleasure for me, as I have a great fondness for art! While viewing pictures you can understand a lot about yourself, about the world. Looking at them, I often think that we should take things as we find them.

Dirk Schaefer

Professor, Head of the Plastic, Reconstructive, Aesthetic and Hand Surgery Clinic of University Hospital Basel, Doctor of Medicine, Doctor of Philosophy.

He was born in Bonn and is 54 years old. From 1984 to 1986, Dr. Schaefer studied graphic design at the Bodensee School of Art in Constantsa (Germany). Since 1986, he has devoted himself to medicine, graduating with a Bachelor Degree from the University of Illinois, the Virginia Medical College and the Albert Ludwig University of Freiburg, where he defended his dissertation in 1992.

From 1992 to 2000, Dr. Schaefer worked at the University Medical Center of Freiburg, at first in the general surgical unit and then in the Plastic and Hand Surgery Clinic. Since 2002, he has worked at University Hospital Basel. In 2010 he became Head of the Plastic, Reconstructive, Aesthetic and Hand Surgery Deparment of University Hospital Basel.

He is a member of the Swiss Medical Association, a Council Member of the Swiss Society of Plastic, Reconstructive and Aesthetic Surgery (SGPRÄC), a Member of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC), a National Delegate in the International Confederation for Plastic, Reconstructive, and Aesthetic Surgery (ICOPLAST), and a Council Member of the German-speaking Association of Peripheral Nerves and Vessels Microsurgery.