title: Novel animal model of calvarial defect in an infected unfavorable wound: reconstruction with rhBMP-2.
abstract: BACKGROUND
  Recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on an absorbable collagen sponge has been shown to induce the healing of acute, primary, large-scale calvarial defects in rabbits. However, clinical circumstances often require the reconstruction of a previously infected and chronically scarred wound. This study was designed to evaluate the efficacy of rhBMP-2/absorbable collagen sponge to improve healing in the previously infected, unfavorable calvarial defect model.
  
  
  METHODS
  Subtotal defects were made in the calvariae of 15 adult New Zealand White rabbits. The bone flap was inoculated with Staphylococcus aureus and replaced in situ. After a 2-week infection period, animals underwent bone flap removal and a 10-day course of antibiotic therapy. On postoperative day 42, the defect was exposed and treated with (1) no intervention/control (group 1; n = 5), or (2) absorbable collagen sponge with 0.43 mg/ml of rhBMP-2 (group 2; n = 10). Bone growth was analyzed with serial computed tomographic imaging and postmortem histology. Percentage bone healing was compared between groups using the t test.
  
  
  RESULTS
  The treatment group (group 2) demonstrated statistically more healing (55.6 percent) compared with the control group (group 1) (29 percent; p < 0.01). However, rhBMP-2-induced bone was not histologically or radiographically similar to native bone, lacking both continuity and a well-defined diploic space.
  
  
  CONCLUSIONS
  These data suggest that rhBMP-2-treated collagen sponges may be useful for the repair of calvarial defects following infection. However, the osseous healing observed in this study was significantly less than previous reports in acute, noninfected models and was dissimilar to native bone. Further work is needed to optimize treatment of the previously infected calvarial wound with rhBMP-2.
authors.affiliation: Pittsburgh, Pa. From the Division of Plastic Surgery and the Departments of Oral Biology, Bioengineering, Anthropology, and Orthodontics, University of Pittsburgh.
authors.forename: Gary E
authors.initials: GE
authors.lastname: DeCesare
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Cooper
authors.forename: Darren M
authors.initials: DM
authors.lastname: Smith
authors.forename: James J
authors.initials: JJ
authors.lastname: Cray
authors.forename: Emily L
authors.initials: EL
authors.lastname: Durham
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Kinsella
authors.forename: Mark P
authors.initials: MP
authors.lastname: Mooney
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
mesh_terms: D000818:Animals; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D001861:Bone Regeneration / Q000187:drug effects / Q000502:physiology; D004195:Disease Models, Animal; D009336:Necrosis; D010027:Osteotomy; D011817:Rabbits; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D012886:Skull / Q000000981:diagnostic imaging / Q000293:injuries* / Q000382:microbiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016212:Transforming Growth Factor beta / Q000008:administration & dosage / Q000627:therapeutic use*; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology*
chemical_list: D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2