Plastic and Regenerative Surgery

For people who've lost tissue due to cancer, burns or other trauma, reconstructive options can be limited to moving tissue from one part of the body to another or trying to stimulate new tissue growth within the injured area. But for major injuries, such as limb amputation and severe facial trauma, very few effective treatment options exist.

Focus areas

In the Center for Regenerative Biotherapeutics, Mayo Clinic plastic surgeons and researchers are developing regenerative medicine-based treatments for people with congenital anomalies of the hands and face, such as microtia, cleft lip and cleft palate; burns; limb and muscle loss; facial aging; facial nerve injuries; injuries to major nerves in the arms and legs; breast cancer; and other reconstructive needs.

• Hand transplantation. In 2010, Mayo Clinic started the Hand Transplant Program, which is the first-of-its-kind clinical program in the U.S. During a hand transplant, a person who's had one or both hands amputated receives hands and a portion of the forearms from a donor.
• Face transplantation. In 2016, Mayo Clinic performed its first face transplant for a patient who had experienced severe facial trauma. The Face Transplant Research Program has been in existence since 2013 and builds on Mayo's existing expertise in head, neck and face reconstruction.
• Facial reanimation. Mayo Clinic's facial reanimation program treats patients who've lost movement in part of their faces. These include children and adults with facial nerve injuries; children born without a facial nerve, meaning they can't smile; and adults who've had tumors or experienced trauma. To restore lost function, Mayo surgeons may use nerve grafts and muscle transfers.
• Lymphedema. The Department of Plastic and Reconstructive Surgery treats patients with lymphedema. Lymphedema can occur secondary to many forms of cancer surgery, including breast cancer. Surgeons using special microsurgical techniques can bypass damaged lymph channels or move lymph nodes to areas requiring regeneration of new lymphatic tissue.

Plastic and regenerative surgery projects include:

• Preclinical modeling. Researchers are developing an animal model to study stem cell repopulation of a decellularized limb — a limb in which all the cells have been removed. After using this preclinical model to better understand limb re-cellularization, Mayo investigators can begin trials using human tissue. Researchers believe this will lead to an ability to effectively reconstruct some facial anomalies, such as those of the nose and ear, and perhaps defects within the extremities.
• Immunosuppression. For hand and face transplants to be successful, the recipient's nerves must regrow into the transplanted region. As immunosuppression is required for patients receiving such transplants, research is underway to study the effects of immunosuppression on nerve regeneration.

• Psychological assessment. Hand and face transplants are life changing for patients, but require years of monitoring and rehabilitation. This means patients must have strong social support systems in place before and after their procedures.

  With this project, researchers are developing a standardized preoperative psychological assessment for patients wishing to undergo vascularized composite allotransplantation, which includes hand and face transplants.

In 2017, a generous gift from a Mayo Clinic benefactor provided funding for clinical trials of a new product capable of increasing blood flow and stem cells within areas of tissue loss and injury. This new technology is aimed at speeding the healing of complex wounds, helping healing in cases of diabetic and radiated wounds, and improving healing of tendons and bones.

Other areas of regenerative plastic reconstructive surgery research and clinical practice include:

• Nerve reconstruction
• Fat stromal cell injection
• Artificial skin
• Targeted muscle re-innervation for patients with amputations
• Functional muscle transfers