The clinical relevance of perichondrium was recognized more than a century ago. In children and adolescents, perichondrium is essential for the formation and growth of the cartilaginous part of craniofacial features and must be considered during reconstructive surgery in the head and neck area. Also in adults, perichondrium must be preserved during surgical intervention for adequate postoperative healing and cartilage maintenance. Furthermore, the regenerative function of perichondrium in the ribs enables the harvesting of the rib cartilage tissue for reconstruction of craniofacial features. With the advancement of tissue engineering, renewed attention has been focused on the perichondrium, because without this crucial tissue, the function of cartilage engineered for craniofacial reconstruction is incomplete and may not be suitable for long-term reconstructive goals. Furthermore, interest in the perichondrium was revived owing to its possible role as a microenvironment containing stem and progenitor cells. Here we will revisit seminal studies on the perichondrium and review the current literature to provide a holistic perspective on the importance of this tissue in the context of regenerative medicine. We will also highlight the functional significance of perichondrium for cartilage tissue engineering. Impact statement All adult cartilage tissues, with the exception of articular and fibrocartilage, are lined by a stratified tissue called the perichondrium. The perichondrium contributes to growth, structural stability, and regeneration and maintenance of the organ, but the cellular mechanisms underlying these processes are not well understood. This review provides a comprehensive summary of past and recent studies on perichondrium from the vantage point of tissue engineering and regenerative medicine. Of particular relevance is the evidence that perichondrium might contain chondrogenic progenitor cells. Cartilage tissue engineering holds great promise for novel treatments of craniofacial defects, and a better understanding of the function and structure of the perichondrium could contribute to improved therapies for head and neck reconstructive surgery and beyond.
Keywords: auricular reconstruction; cartilage; chondrogenic progenitor cells; perichondrium; tissue engineering.