Tissue engineering in thoracic surgery

Adequate reconstruction after extensive resection of the trachea, the chest wall, or the diaphragm represents a considerable challenge for the confronted thoracic surgeon. Therefore, different materials and surgical techniques have been tested; the results were not always satisfying. Increasing evidence exists that tissue engineering can be used to replace damaged tissues and organs such as the trachea, the lungs, the chest wall, and the diaphragm. This review focuses on the current progress in tissue engineering in general thoracic surgery, illustrating the existing options in particular for tracheal reconstruction. Furthermore, a detailed overview concerning the different options of tissue engineering in the replacement of the lung, the chest cavity, the diaphragm, and the chest wall is given. Considerable progress could be yielded in the development of a tissue-engineered tracheal graft, where the step from the animal model into the clinical application in the human patient was feasible. Regarding tissue engineering of the chest wall, the diaphragm, and the chest cavity encouraging preliminary results were obtained in the preclinical testing. However, the step into the clinical application could not be reached up till now. Tissue engineering seems to represent an appropriate future option for reconstruction after extensive resection of the trachea, the chest wall, or the diaphragm. Although tissue engineering is still not reality and therefore far away from daily clinical routine, further studies are definitely warranted enabling continuous improvements as soon as possible, particularly in thoracic surgery.