Periosteum-guided prefabrication of vascularized bone of clinical shape and volume.
BACKGROUND
Large craniofacial skeletal defects require complex reconstruction. Vascularized tissue transfer is the current standard in treatment, but these operations are technically difficult and associated with donor-site morbidity. Guided flap prefabrication offers a technique for endogenously engineering vascularized composite tissues with complex three-dimensional structure. This study evaluates the relationship between implantation time and tissue structure for generating tissues of clinically relevant volume and structure.


METHODS
Twenty skeletally mature domestic sheep were implanted with poly(methyl methacrylate) chambers designed to mimic the size and shape of the mental protuberance of the mandible. Each chamber was filled with morcellized bone graft and implanted with the open face apposed to the cambium layer of the rib periosteum. Chambers were harvested at 3, 6, 9, 12, and 24 weeks, and the tissue inside the chambers was analyzed for shape conformation to chamber geometry, gross tissue volume, and bone histomorphometric parameters.


RESULTS
Histologically, active endochondral, direct, and appositional bone formation was observed. Calcified tissue area and new bone formation increased for each time point up to 12 weeks of implantation. The tissues formed maintained volumetric and geometrical structure consistent with the chamber up to 9 weeks after implantation. Significant decreases in total volume and agreement with chamber geometry were observed at 12 and 24 weeks.


CONCLUSIONS
Periosteum-guided tissue prefabrication was found to be an effective means of engineering three-dimensional vascularized bone of clinical size and shape. The optimal duration of incubation before significant volume loss occurs is 9 weeks in this large-animal model.
Cheng
Ming-Huei
MH
Taipei, Taiwan; Chicago, Hines, and Maywood, Ill.; Houston, Texas; New York, N.Y.; and Columbus, Ohio From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University; the Department of Biomedical Engineering, Illinois Institute of Technology; the Research Service, Hines Veterans Affairs Hospital; the Department of Plastic Surgery and Center for Biomedical Engineering, University of Texas M. D. Anderson Cancer Center; the Institute of Reconstructive Plastic Surgery Laboratories, New York University Medical Center; the Department of Surgery, Loyola University Medical Center; and the Division of Plastic Surgery, The Ohio State University Medical Center.
Brey
Eric M
EM
Allori
Alexander C
AC
Gassman
Andrew
A
Chang
David W
DW
Patrick
Charles W
CW
Miller
Michael J
MJ
D000818:Animals; D001672:Biocompatible Materials; D016025:Bone Transplantation; D001842:Bone and Bones / Q000098:blood supply*; D015194:Diffusion Chambers, Culture; D048091:Guided Tissue Regeneration; D020007:Implants, Experimental; D010012:Osteogenesis; D010521:Periosteum / Q000502:physiology*; D012756:Sheep
D001672:Biocompatible Materials