scholarly journals Immediate Mandibular Reconstruction Using a Cellular Bone Allograft Following Tumor Resection in a Pediatric Patient

FACE ◽  
2021 ◽  
pp. 273250162110572
Author(s):  
David M. Alfi ◽  
Abdullahi Hassan ◽  
Sebastian M. East ◽  
Elena C. Gianulis
Keyword(s):  
Pediatric Patient ◽  
Donor Site ◽  
Tumor Resection ◽  
Bone Allograft ◽  
Mandibular Reconstruction ◽  
Autogenous Bone ◽  
Segmental Defect ◽  
Intraoral Approach ◽  
Cellular Bone ◽  
Cellular Bone Allograft

Reconstruction of large segmental mandibular defects presents a challenge for oral and maxillofacial surgeons, particularly in the skeletally immature pediatric patient. Autogenous bone graft is historically preferred; however, harvest of autograft requires a second surgical site, risking donor-site complications as well as the potential for long-term complications in the growing child. Here, we present the first known report of a pediatric patient who underwent immediate mandibular reconstruction of a 6.5-cm long segmental defect using a cellular bone allograft (VF-CBA) combined with custom-fabricated guides and plates following tumor resection. The use of VF-CBA, along with the custom guides and plates, eliminated the need for autograft harvest in a child, enabled an entirely intraoral approach, avoiding the creation of a cutaneous scar, and reduced the total operative time, resulting in a fast recovery and improved patient satisfaction. By 7 months postoperative, the patient’s mandible was fully healed with solid osseous consolidation. These results support VF-CBA combined with custom intraoral guides and plates as an effective treatment option for reconstruction of large segmental mandibular defects in a pediatric patient.

Enhancement of Bone Implants by Substituting Nitinol for Titanium (Ti-6Al-4V): A Modeling Comparison

2014 ◽  
Author(s):  
Narges Shayesteh Moghaddam ◽  
Mohammad Elahinia ◽  
Michael Miller ◽  
David Dean
Keyword(s):  
Tumor Resection ◽  
Stress Shielding ◽  
High Strength ◽  
Standard Of Care ◽  
Mandibular Reconstruction ◽  
Bone Plate ◽  
Segmental Defect ◽  
Stress Strain ◽  
Element Analysis ◽  
Grade 5

Mandibular segmental defect reconstruction is most often necessitated by tumor resection, trauma, infection, or osteoradionecrosis. The standard of care treatment for mandibular segmental defect repair involves using metallic plates to immobilize fibula grafts, which replace the resected portion of mandible. Surgical grade 5 titanium (Ti-6Al-4V) is commonly used to fabricate the fixture plate due to its low density, high strength, and high biocompatibility. One of the potential problems with mandibular reconstruction is stress shielding caused by a stiffness mismatch between the Titanium fixation plate and the remaining mandible bone and the bone grafts. A highly stiff fixture carries a large portion of the load (e.g., muscle loading and bite force), therefore the surrounding mandible would undergo reduced stress. As a result the area receiving less strain would remodel and may undergo significant resorption. This process may continue until the implant fails. To avoid stress shielding it is ideal to use fixtures with stiffness similar to that of the surrounding bone. Although Ti-6Al-4V has a lower stiffness (110 GPa) than other common materials (e.g., stainless steel, tantalum), it is still much stiffer than the cancellous (1.5–4.5 GPa) and cortical portions of the mandible (17.6–31.2 GPa). As a solution, we offer a nitinol in order to reduce stiffness of the fixation hardware to the level of mandible. To this end, we performed a finite element analysis to look at strain distribution in a human mandible in three different cases: I) healthy mandible, II) resected mandible treated with a Ti-6Al-4V bone plate, III) resected mandible treated with a nitinol bone plate. In order to predict the implant’s success, it is useful to simulate the stress-strain trajectories through the treated mandible. This work covers a modeling approach to confirm superiority of nitinol for mandibular reconstruction. Our results show that the stress-strain trajectories of the mandibular reconstruction using nitinol fixation is closer to normal than if grade 5 surgical titanium fixation is used.

Long-term results of mandibular reconstruction with autogenous bone grafts and oral implants after tumor resection

2008 ◽  
Vol 19 (10) ◽  
pp. 1074-1080 ◽  
Author(s):  
Matteo Chiapasco ◽  
Giacomo Colletti ◽  
Eugenio Romeo ◽  
Marco Zaniboni ◽  
Roberto Brusati
Keyword(s):  
Tumor Resection ◽  
Bone Grafts ◽  
Mandibular Reconstruction ◽  
Long Term Results ◽  
Autogenous Bone ◽  
Oral Implants ◽  
Autogenous Bone Grafts

scholarly journals Repair of a Comminuted Talar Neck Fracture using a Cellular Bone Allograft combined with a Textured Allograft Wedge

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Alaa Mansour ◽  
Timothy D. Howard ◽  
Elena Gianulis ◽  
Danielle Scheunemann
Keyword(s):  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Compressive Force ◽  
Bone Allograft ◽  
Unique Challenge ◽  
Subtalar Dislocation ◽  
Neck Fracture ◽  
Cellular Bone ◽  
Cellular Bone Allograft ◽  
Talar Neck Fractures

Category: Trauma; Ankle Introduction/Purpose: Talar neck fractures are uncommon and are characterized by displacement, comminution, and soft tissue injury. Treatment of talar neck fractures while avoiding complications, such as osteonecrosis and long-term morbidity, presents a unique challenge to surgeons. One option for treating talar neck fractures is cellular bone allograft containing viable lineage- committed bone cells (V-CBA), which provides the osteoconductive, osteoinductive, and osteogenic properties needed for bone formation. Additionally, a structural textured allograft (STA) wedge designed to resist migration and sustain compressive force can also be used in repairing talar neck fractures. This case study describes the successful repair of a comminuted talar neck fracture using V-CBA combined with an STA wedge. Methods: A 46-year-old male patient sustained a talar neck fracture following a fall from a 12-foot ladder. Radiographic and computed tomography (CT) imaging revealed significant comminution, consequent varus angulation, and a large bony void, as well as dislocation of the posterior subtalar joint. The patient was otherwise healthy with no comorbidities. Open reduction internal fixation was performed laterally to reduce the posterior subtalar dislocation. Medially, a 6.5mm STA wedge was used to correct the varus deformity and 1cc of V-CBA was used to fill the void. Results: At 6 months, the talar neck fracture had healed with solid osseous consolidation evident on radiographic images. Conclusion: These results demonstrate that an STA wedge, with a textured design that resists migration, used in combination with a V-CBA successfully repaired a comminuted talar neck fracture.

scholarly journals A large database study of hospitalization charges and follow-up re-admissions in US lumbar fusion surgeries using a cellular bone allograft (CBA) versus recombinant human bone morphogenetic protein-2 (rhBMP-2)

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Bradley Wetzell ◽  
Julie B. McLean ◽  
Mark A. Moore ◽  
Venkateswarlu Kondragunta ◽  
Kimberly Dorsch
Keyword(s):  
Lumbar Fusion ◽  
Bone Allograft ◽  
Bone Morphogenetic Protein 2 ◽  
Morphogenetic Protein ◽  
Human Bone Morphogenetic Protein ◽  
Initial Procedure ◽  
Cellular Bone ◽  
Recombinant Human Bone ◽  
Cellular Bone Allograft

Abstract Background The objective of this study was to retrospectively compare initial procedure and 12-month follow-up hospitalization charges and resource utilization (lengths of stay; LOS) for lumbar fusion surgeries using either recombinant human bone morphogenetic protein-2 (rhBMP-2) or a cellular bone allograft comprised of viable lineage-committed bone cells (V-CBA) via a large US healthcare system database. Potentially relevant re-admissions during the follow-up period were also assessed. Methods A total of 16,172 patients underwent lumbar fusion surgery using V-CBA or rhBMP-2, of whom 3503 (21.66%) patients had follow-up re-admission data. Initial patient, procedure, and hospital characteristics were assessed to determine confounding factors. Multivariate regression modeling compared differences in hospitalization charges (in 2018 US dollars) and LOS (in days) between the groups, as well as incidences of potentially relevant re-admissions during the 12-month follow-up period. Results The adjusted mean initial procedure and 12-month follow-up hospital charges were significantly lower in the V-CBA group versus the rhBMP-2 group ($109,061 and $108,315 versus $160,191 and $130,406, respectively; P < 0.0001 for both comparisons). This disparity remained in an ad hoc comparison of charges for initial single-level treatments only (V-CBA = $103,064, rhBMP-2 = $149,620; P < 0.0001). The adjusted mean initial LOS were significantly lower in the V-CBA group (3.77 days) versus the rhBMP-2 group (3.88 days; P < 0.0001), but significantly higher for the cumulative follow-up hospitalizations in the 12-month follow-up period (7.87 versus 7.46 days, respectively; P < 0.0001). Differences in rates of follow-up re-admissions aligned with comorbidities at the initial procedure. Subsequent lumbar fusion rates were comparable, but significantly lower for V-CBA patients who had undergone single-level treatments only, in spite of V-CBA patients having significantly higher rates of initial comorbidities that could negatively impact clinical outcomes. Conclusions The results of this study indicate that use of V-CBA for lumbar fusion surgeries performed in the US may result in substantially lower overall hospitalization charges versus rhBMP-2, with both exhibiting similar rates of 12-month re-admissions and subsequent lumbar fusion procedures.

scholarly journals A Large Database Study of Hospitalization Charges and Follow-up Re-admissions in US Lumbar Fusion Surgeries Using a Cellular Bone Allograft (CBA) versus Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2)

2020 ◽  
Author(s):  
Bradley Wetzell ◽  
Julie B McLean ◽  
Mark A Moore ◽  
Venkateswarlu Kondragunta ◽  
Kimberly Dorsch
Keyword(s):  
Lumbar Fusion ◽  
Bone Allograft ◽  
Bone Morphogenetic Protein 2 ◽  
Morphogenetic Protein ◽  
Human Bone Morphogenetic Protein ◽  
Initial Procedure ◽  
Cellular Bone ◽  
Recombinant Human Bone ◽  
Cellular Bone Allograft

Abstract BackgroundThe objective of this study was to retrospectively compare initial procedure and 12-month follow-up hospitalization charges and resource utilization (lengths of stay; LOS) for lumbar fusion surgeries using either recombinant human bone morphogenetic protein-2 (rhBMP-2) or a cellular bone allograft comprised of viable lineage-committed bone cells (V-CBA) via a large US healthcare system database. Potentially-relevant re-admissions during the follow-up period were also assessed.MethodsA total of 16,172 patients underwent lumbar fusion surgery using V-CBA or rhBMP-2, of whom 3,503 (21.66%) patients had follow-up re‑admission data. Initial patient, procedure, and hospital characteristics were assessed to determine confounding factors. Multivariate regression modeling compared differences in hospitalization charges (in 2018 US dollars) and LOS (in days) between the groups, as well as incidences of potentially-relevant readmissions during the 12‑month follow-up‑ period.ResultsThe adjusted mean initial procedure and 12-month follow-up‑ hospital charges were significantly lower in the V-CBA group versus the rhBMP-2 group ($109,061 and $108,315 versus $160,191 and $130,406, respectively; P<0.0001 for both comparisons). This disparity remained in an ad hoc comparison of charges for initial single-level treatments only (V-CBA = $103,064, rhBMP-2 = $149,620; P<0.0001).The adjusted mean initial LOS were significantly lower in the V-CBA group (3.77 days) versus the rhBMP-2 group (3.88 days; P<0.0001), but significantly higher for the cumulative follow-up hospitalizations in the 12‑month follow-up period (7.87 versus 7.46 days, respectively; P<0.0001). Differences in rates of follow-up re‑admissions aligned with comorbidities at the initial procedure. Subsequent lumbar fusion rates were comparable, but significantly lower for V-CBA patients who had undergone single-level treatments only, in spite of V-CBA‑ patients having significantly higher rates of initial comorbidities that could negatively impact clinical outcomes.ConclusionsThe results of this study indicate that use of V-CBA for lumbar fusion surgeries performed in the US may result in substantially lower overall hospitalization charges versus rhBMP-2, with both exhibiting similar rates of 12-month re-admissions and subsequent lumbar fusion procedures.

scholarly journals A Large Database Study of Hospitalization Charges and Follow-up Re-admissions in Us Lumbar Fusion Surgeries Using a Cellular Bone Allograft (CBA) Versus Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2)

2020 ◽  
Author(s):  
Bradley Wetzell ◽  
Julie B McLean ◽  
Mark A Moore ◽  
Venkateswarlu Kondragunta ◽  
Kimberly Dorsch
Keyword(s):  
Lumbar Fusion ◽  
Bone Allograft ◽  
Bone Morphogenetic Protein 2 ◽  
Morphogenetic Protein ◽  
Human Bone Morphogenetic Protein ◽  
Initial Procedure ◽  
Cellular Bone ◽  
Recombinant Human Bone ◽  
Cellular Bone Allograft

Abstract BackgroundThis retrospective study of a large US healthcare system database compared initial procedure and 12-month follow-up hospitalization charges and resource utilization (lengths of stay; LOS) for lumbar fusion surgeries using either recombinant human bone morphogenetic protein-2 (rhBMP‑2) or a cellular bone allograft comprised of viable lineage-committed bone cells (V‑CBA). Potentially-relevant re-admissions during the follow-up period were also assessed.MethodsA total of 16,172 patients underwent lumbar fusion surgery using V-CBA or rhBMP-2, of whom 3,503 (21.66%) patients had follow-up re‑admission data. Initial patient, procedure, and hospital characteristics were assessed to determine confounding factors. Multivariate regression modeling compared differences in hospitalization charges (in 2018 US dollars) and LOS (in days) between the groups, as well as incidences of potentially-relevant re‑admissions during the 12‑month follow‑up period.ResultsThe adjusted mean initial procedure and 12-month follow‑up hospital charges were significantly lower in the V-CBA group versus the rhBMP‑2 group ($109,061 and $108,315 versus $160,191 and $130,406, respectively; P<0.0001 for both comparisons). This disparity remained in an ad hoc comparison of charges for initial single-level treatments only (V‑CBA = $103,064, rhBMP-2 = $149,620; P<0.0001).The adjusted mean initial LOS were significantly lower in the V‑CBA group (3.77 days) versus the rhBMP-2 group (3.88 days; P<0.0001), but significantly higher for the cumulative follow-up hospitalizations in the 12‑month follow-up period (7.87 versus 7.46 days, respectively; P<0.0001). Differences in rates of follow-up re‑admissions aligned with comorbidities at the initial procedure. Subsequent lumbar fusion rates were comparable, but significantly lower for V-CBA patients who had undergone single-level treatments only, in spite of V‑CBA patients having significantly higher rates of initial comorbidities that could negatively impact clinical outcomes.ConclusionsThe results of this study indicate that use of V-CBA for lumbar fusion surgeries performed in the US may result in substantially lower overall hospitalization charges versus rhBMP-2, with both exhibiting similar rates of 12-month re-admissions and subsequent lumbar fusion procedures.

scholarly journals Bone Allograft Segment Covered with a Vascularized Fibular Periosteal Flap: A New Technique for Pediatric Mandibular Reconstruction

2018 ◽  
Vol 11 (1) ◽  
pp. 065-070 ◽  
Author(s):  
Nicolas E. Sierra ◽  
Paula Diaz-Gallardo ◽  
Jorge Knörr ◽  
Vasco Mascarenhas ◽  
Eloy García-Diez ◽  
...  
Keyword(s):  
Donor Site ◽  
Bone Allograft ◽  
Mandibular Reconstruction ◽  
Fibular Graft ◽  
Periosteal Flap ◽  
Facial Contour ◽  
Vascularized Fibula ◽  
Proven Efficacy ◽  
A New Technique ◽  
The Right

The free vascularized fibular graft is nowadays the preferred technique for pediatric mandibular reconstruction. Despite the versatility and proven efficacy for restoring the facial appearance and maxillomandibular function, those mandibular reconstructions with free vascularized fibula associate difficulties for a simultaneous restoration of the alveolar height and facial contour, which are derived from the height discrepancy between the fibula and the native mandible. In addition, the donor-site growth and morbidity are of special concern in the pediatric patient. We report a novel technique for pediatric mandibular reconstruction, in an 11-year-old girl, using a combination of a bone allograft segment with a vascularized fibular periosteal flap (VFPF), after resection of an Ewing sarcoma located at the right body of the mandible. The patient has showed optimal cosmetic, functional, and radiological outcomes, which have been maintained for 2.5 years, without detecting donor-site complications. Through this original technique, and based on the powerful osteogenic and vasculogenic properties of the pediatric VFPFs, we could effectively reconstruct a large mandibular defect providing a functional and aesthetic reconstruction, while avoiding the potential morbidity associated with the fibula resection.

Efficacy of a Cellular Bone Allograft for Foot and Ankle Arthrodesis and Revision Nonunion Procedures

2016 ◽  
Vol 38 (3) ◽  
pp. 277-282 ◽  
Author(s):  
Travis J. Dekker ◽  
Peter White ◽  
Samuel B. Adams
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Bone Allograft ◽  
Ankle Arthrodesis ◽  
Foot And Ankle ◽  
Union Rate ◽  
Joint Preparation ◽  
History Of ◽  
Cellular Bone ◽  
Cellular Bone Allograft

Background: Bone graft substitutes are often required in patients at risk for nonunion, and therefore, an allograft that most closely mimics an autograft is highly sought after. This study explored the utility and efficacy of a cellular bone allograft used for foot and ankle arthrodesis and revision nonunion procedures in a patient population at risk for nonunion. Methods: An institutional review board–approved retrospective review of consecutive patients who underwent arthrodesis and revision nonunion procedures with a cellular bone allograft was performed at a single academic institution. No external sources of funding were provided for this study. Inclusion criteria included patients who were more than 1 year after surgery or less than 1 year after surgery if they had undergone a second operative procedure for nonunion or if they had computed tomography–documented union. Forty operative procedures in 36 patients with a mean follow-up of 13 months (range, 6-25 months) were included for data analysis. All patients had at least one of the following risk factors associated with nonunion: current smoker, diabetes, avascular necrosis (AVN) of the involved bone, active same-site operative infection, history of nonunion, previous same-site surgery, or gap of 5 mm or greater after joint preparation. The primary outcome was radiographic union. Results: The union rate in this high-risk population was 83% (33/40). Univariate analysis demonstrated that the use of a cellular bone allograft helped mitigate the presence of risk factors known to cause nonunion. There was no significant difference in fusion rates among groups with current smoking, AVN of the involved bone, active same-site operative infections, history of nonunion, rheumatoid arthritis on medication, previous same-site operative procedures or infections, or a gap of 5 mm or greater after joint preparation. However, in this population, diabetic and female patients remained at a high risk of recurrent nonunion ( P = .0015), despite the use of a cellular bone allograft. Chi-square analysis of patients with increasing numbers of risk factors directly correlated with an increased risk of nonunion ( P = .025). Four wound complications were reported in this cohort that required irrigation and debridement (10%). Conclusion: These data demonstrated a union rate of 83% in patients with risk factors known to cause nonunion. The benefits of the use of a cellular bone allograft allowed for the avoidance of morbidity associated with autograft harvesting while still improving the local biology to facilitate fusion in a difficult patient population to attain a successful fusion mass. Level of Evidence: Level IV, retrospective case series.

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