title: Impact of radiation therapy on healing and stability of vascularized bone grafts in a dog model.
abstract: The purpose of the study was to observe the impact of radiation therapy on healing and biomechanical properties of vascularized bone grafts, and thus to establish an appropriate large animal model. Ten male beagles were divided into two experimental groups: radiation (R) and control (C). The left 5th to 7th ribs of the animals of group R were irradiated 3 and 2 weeks preoperatively, using a dose of 8 Gy each time. Each animal of both groups underwent the following operative procedures. The 5th and 7th ribs were removed, and the 5th rib was replaced by a vascularized pedicle transfer of the 4th rib. The 7th rib was reconstructed using a pedicle transplant of the 8th rib. The 5th and 7th ribs were used as nonvascularized bone grafts to replace the donor sites of the 4th and 8th ribs, respectively. Group R received two further irradiation cycles 2 and 3 weeks postoperatively. The vascularized rib grafts of group R demonstrated a higher number of delayed unions in plain x-rays and avascular bone segments in microangiography than the control group. The presence of vital osteocytes in histology was not significantly different between groups. Biomechanical tests focusing on the durability of vascularized ribs against bending and torsion forces demonstrated a reduction of average maximum bending moments by 56.6% after radiation compared to controls (P < 0.05). Twisting moments were reduced by 47.6% (P < 0.05). The data demonstrate a significant worsening in bone healing and stability after pre- and postoperative radiation therapy to the wound bed and bone grafts. Thus, a large animal model is established for further determination of different strategies of radiotherapy in combination with vascularized bone transfers.
authors.affiliation: Department of Hand, Replantation, and Microsurgery, Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Eisenschenk
authors.forename: Christiane
authors.initials: C
authors.lastname: Witzel
authors.forename: Martin
authors.initials: M
authors.lastname: Lautenbach
authors.forename: Axel
authors.initials: A
authors.lastname: Ekkernkamp
authors.forename: Ulrich
authors.initials: U
authors.lastname: Weber
authors.forename: Markus V
authors.initials: MV
authors.lastname: Küntscher
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D016025:Bone Transplantation / Q000379:methods*; D004285:Dogs; D017102:Fracture Healing / Q000528:radiation effects*; D008297:Male; D023421:Models, Animal; D012272:Ribs / Q000098:blood supply / Q000473:pathology / Q000502:physiology / Q000528:radiation effects*; D014945:Wound Healing / Q000528:radiation effects