Soft-tissue augmentation and replacement in the head and neck. General considerations.

It is clear that many of the factors that affect wound healing when natural biomaterials are used also affect the long-term success of semisynthetic and synthetic alloplasts. The development of a new generation of biomaterials that combine synthetic components with bioactive proteins are just now beginning to move from the laboratory into clinical testing. Within the next decade, biologically active growth proteins, in combination with resorbable synthetic alloplasts, may allow missing tissues to be regenerated rather than just "filled in" by permanent implants. There will also be a steady drift away from materials that show any risk of being carcinogenic or immunoreactive over time. As promising as these new alloplasts appear to be, we should learn from past experience. Implants that initially seem biocompatible can fail in unpredictable ways when exposed to the hostile environment of the body. As surgeons, we well ultimately be held responsible for the biomaterials we implant. Our selection of biomaterials should be based on sound scientific and surgical knowledge, and not solely upon the recommendations of manufacturers. The authors hope that the information in this monograph will help to integrate reconstructive options so that autologous tissues are used whenever possible and synthetic materials are appropriately selected and applied when necessary.