Tissue engineering has become a hot topic in modern medicine. Its application in a surgical setting, such as for the treatment of skeletal defects, still has to tackle some problems that might look simple at first sight, but need a well-structured handling combining surgery and science, with in a central position the patient, who is both cell donor and receptor of the tissue engineered end product. To achieve this goal in a clinical setting, a five steps pathway is described and designated as the Pentaconcept, integrating all ingredients for successful reconstructive procedures.