title: Repair of a Complicated Calvarial Defect: Reconstruction of an Infected Wound With rhBMP-2.
abstract: BACKGROUND
  Management of the previously infected craniofacial defect remains a significant clinical challenge, posing obstacles such as wound healing complications, lack of donor site availability, and predisposition to failure of the repair. Optimal therapy would reconstruct like with like, without donor site morbidity. The purpose of this study was to compare the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2)-mediated bone regeneration with the current standard of autologous bone graft for repair of previously infected calvarial defects.
  
  
  METHODS
  Nineteen adult New Zealand white rabbits underwent subtotal calvariectomy. Bone flaps were inoculated with Staphylococcus aureus and replanted. After 1 week of infection, bone flaps were removed, and wounds were debrided, followed by 10 days of antibiotic treatment. After 6 weeks, animals underwent scar debridement followed by definitive reconstruction in 1 of 4 groups: empty control (n = 3), vehicle control (buffer solution on absorbable collagen sponge [ACS], n = 3), autologous bone graft (n = 3), or rhBMP-2 repair (rhBMP-2/ACS, n = 10). Animals underwent computed tomography imaging at 0, 2, 4, and 6 weeks postoperatively, followed by euthanization and histological analysis. Percent healing was determined by 3-dimensional analysis. A (time × group) 2-way analysis of variance was performed on healing versus treatment group and postoperative time.
  
  
  RESULTS
  At 6 weeks postoperatively, rhBMP-2/ACS and autologous bone graft resulted in 93% and 68% healing, respectively, whereas the empty and vehicle control treatment resulted in 27% and 26% healing (P < 0.001). Histologically, compared to autologous bone graft, bone in the rhBMP-2/ACS group was more cellular and more consistently continuous with wound margins.
  
  
  CONCLUSIONS
  The rhBMP-2 therapy is effective in achieving radiographic coverage of previously infected calvarial defects.
authors.affiliation: From the *Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA; †Georgia Health Sciences University, Augusta, GA; ‡Division of Plastic Surgery, University of Wisconsin, Madison, WI; §Department of General Surgery, St Louis University, St Louis, MO; ∥Department of Oral Biology, and ¶Departments of Anthropology and Orthodontics, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Zoe M
authors.initials: ZM
authors.lastname: MacIsaac
authors.forename: Sameer
authors.initials: S
authors.lastname: Shakir
authors.forename: Sanjay
authors.initials: S
authors.lastname: Naran
authors.forename: Darren M
authors.initials: DM
authors.lastname: Smith
authors.forename: James J
authors.initials: JJ
authors.lastname: Cray
authors.forename: Harry S
authors.initials: HS
authors.lastname: Nayar
authors.forename: Liliana
authors.initials: L
authors.lastname: Camison
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Kinsella
authors.forename: Mark P
authors.initials: MP
authors.lastname: Mooney
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Cooper
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D055396:Bone Morphogenetic Protein 2 / Q000494:pharmacology*; D004195:Disease Models, Animal; D011817:Rabbits; D011994:Recombinant Proteins / Q000494:pharmacology*; D019651:Plastic Surgery Procedures / Q000379:methods; D012886:Skull / Q000601:surgery* / Q000637:transplantation; D016212:Transforming Growth Factor beta / Q000494:pharmacology*; D014182:Transplantation, Autologous; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2