title: Axially vascularised mandibular constructs: Is it time for a clinical trial?
abstract: Applying regenerative therapies in the field of cranio-maxillofacial reconstruction has now become a daily practice. However, regeneration of challenging or irradiated bone defects following head and neck cancer is still far beyond clinical application. As the key factor for sound regeneration is the development of an adequate vascular supply for the construct, the current modalities using extrinsic vascularization are incapable of regenerating such complex defects. Our group has recently introduced the intrinsic axial vascularization technique to regenerate mandibular defects using the arteriovenous loop (AVL). The technique has shown promising results in terms of efficient vascularization and bone regeneration at the preclinical level. In this article, we have conducted a narrative literature review about using the AVL to vascularize tissue-engineering constructs at the preclinical level. We have also conducted a systematic literature review about applying the technique of axial vascularization in the field of craniofacial regeneration. The versatility of the technique and the possible challenges are discussed, and a suggested protocol for the first clinical trial applying the AVL technique for mandibular reconstruction is also presented.
authors.affiliation: Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Egypt; Tissue Engineering Laboratories, Faculty of Dentistry, University of Alexandria, Alexandria, Egypt. Electronic address: ahmad.eweida@alexmed.edu.eg.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Eweida
authors.affiliation: Plastic, Reconstructive and Hand Surgery Department, Hospital Erlangen, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
authors.affiliation: Tissue Engineering Laboratories, Faculty of Dentistry, University of Alexandria, Alexandria, Egypt.
authors.forename: Mona K
authors.initials: MK
authors.lastname: Marei
authors.affiliation: Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Egypt.
authors.forename: Habashi A
authors.initials: HA
authors.lastname: Elhammady
authors.affiliation: Department of Radiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
authors.forename: Ashraf N
authors.initials: AN
authors.lastname: Etaby
authors.affiliation: Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Egypt.
authors.forename: Ayman S
authors.initials: AS
authors.lastname: Nabawi
authors.affiliation: Head and Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Egypt.
authors.forename: Mahmoud F
authors.initials: MF
authors.lastname: Sakr
mesh_terms: D000818:Animals; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001861:Bone Regeneration / Q000502:physiology*; D016025:Bone Transplantation / Q000379:methods; D006801:Humans; D063175:Mandibular Reconstruction / Q000379:methods*; D018919:Neovascularization, Physiologic / Q000502:physiology; D013524:Surgical Flaps / Q000098:blood supply; D023822:Tissue Engineering / Q000379:methods*
keywords: Arterio-venous loop; Axial vascularization; Clinical trials; Mandibular reconstruction; Regenerative medicine; Tissue engineering