Growth and transplantation of a custom vascularised bone graft in a man.
BACKGROUND
A major goal of research in bone transplantation is the ability to avoid creation of secondary bone defects. We aimed to repair an extended mandibular discontinuity defect by growth of a custom bone transplant inside the latissimus dorsi muscle of an adult male patient.


METHODS
Three-dimensional computed tomography (CT) scanning and computer-aided design techniques were used to produce an ideal virtual replacement for the mandibular defect. These data were used to create a titanium mesh cage that was filled with bone mineral blocks and infiltrated with 7 mg recombinant human bone morphogenetic protein 7 and 20 mL of the patient's bone marrow. Thus prepared, the transplant was implanted into the latissimus dorsi muscle and 7 weeks later transplanted as a free bone-muscle flap to repair the mandibular defect.


RESULTS
In-vivo skeletal scintigraphy showed bone remodelling and mineralisation inside the mandibular transplant both before and after transplantation. CT provided radiological evidence of new bone formation. Postoperatively, the patient had an improved degree of mastication and was satisfied with the aesthetic outcome of the procedure.


CONCLUSIONS
Heterotopic bone induction to form a mandibular replacement inside the latissimus dorsi muscle in a human being is possible. This technique allows for a lower operative burden compared with conventional techniques by avoiding creation of a secondary bone defect. It also provides a good three-dimensional outcome.
Warnke
P H
PH
Department of Oral and Maxillofacial Surgery, University of Kiel, Arnold-Heller-Str 16, 24105 Kiel, Germany. warnke@mkg.uni-kiel.de
Springer
I N G
IN
Wiltfang
J
J
Acil
Y
Y
Eufinger
H
H
Wehmöller
M
M
Russo
P A J
PA
Bolte
H
H
Sherry
E
E
Behrens
E
E
Terheyden
H
H
D030201:Activin Receptors, Type I; D001854:Bone Marrow Cells / Q000166:cytology / Q000187:drug effects; D002454:Cell Differentiation / Q000187:drug effects; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000601:surgery; D008875:Middle Aged; D010012:Osteogenesis; D011183:Postoperative Complications; D011506:Proteins / Q000494:pharmacology; D011859:Radiography; D011877:Radionuclide Imaging; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D023822:Tissue Engineering / Q000379:methods*
D011506:Proteins; C425423:ACVR1 protein, human; D030201:Activin Receptors, Type I