Reconstruction of complex cranial wounds with demineralized bone matrix and bilayer artificial skin.
Complex wounds involving loss of both cranium and scalp are difficult to reconstruct. Current solutions include both autogenous and alloplastic materials. Tissue engineering provides interesting alternatives for reconstruction of missing bone and soft tissue. Demineralized bone matrix and Integra, artificial bilayer skin substitute, have been used successfully to reconstruct bone and skin as isolated defects, but never in combination. This study investigates the possibility of using demineralized bone matrix in a gel carrier and Integra for combined cranial and scalp defects. The study was divided into two parts. In the first, demineralized bone matrix in the forms of Grafton Flex (n = 12) and Grafton putty (n = 12) was used to reconstruct 15-mm critical size cranial defects in female adult New Zealand White rabbits. In the control group (n = 6), the defect was left empty. The second part of the study investigated the use of Integra and Grafton Flex to reconstruct a 15-mm cranial defect with an overlying full-thickness scalp defect (n = 6). The first study revealed bony healing of the critical-size cranial defect with demineralized bone matrix. The second study demonstrated successful reconstitution of scalp and cranium with both demineralized bone matrix and Integra. We conclude that complex cranial defects involving bone and soft tissue may be successfully reconstructed with their tissue-engineered substrates, demineralized bone matrix (Grafton) and Integra artificial skin.
Shermak
M A
MA
Division of Plastic and Reconstructive Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, No. A640, Baltimore, Maryland 21224, USA.
Wong
L
L
Inoue
N
N
Nicol
T
T
D015502:Absorptiometry, Photon; D000704:Analysis of Variance; D000818:Animals; D015519:Bone Density; D001853:Bone Marrow / Q000473:pathology; D001857:Bone Matrix / Q000637:transplantation*; D001861:Bone Regeneration; D018786:Bone Substitutes / Q000627:therapeutic use*; D003648:Decalcification Technique; D004337:Drug Carriers; D005260:Female; D005500:Follow-Up Studies; D005549:Foreign-Body Reaction / Q000473:pathology; D005782:Gels; D006018:Glycols; D008852:Microradiography; D011817:Rabbits; D019651:Plastic Surgery Procedures; D012535:Scalp / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D016038:Skin Transplantation; D017768:Skin, Artificial; D012886:Skull / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D013223:Statistics as Topic; D014021:Tissue Preservation; D014945:Wound Healing
D018786:Bone Substitutes; D004337:Drug Carriers; D005782:Gels; D006018:Glycols