Prefabricated Vascularized Bone Graft Using Autologous Tissue, Biomaterials, and Growth Factors: A New Technique for Bone Reconstruction

Although clinically, grafting of vascularized autologous bone has been preferably performed, there are some disadvantages for this grafting therapy, such as the limited availability of donor site and the clinical difficulty to harvest the bone graft of desired shape and size. As one trial, we have designed a prefabricated vascularized bone graft by combining autologous vessels, particulate cancellous bone and marrow (PCBM), and β-tricalcium phosphate (β-TCP) with a biodegradable membrane. However, the volume of vascularized bone tissue newly formed was small and the density was low. In this study, the controlled system of basic fibroblast growth factor (bFGF) was combined with the conventional preparation method to improve the nature of vascularized bone graft. The femur vessels of rabbits were rolled with a membrane of L-lactide-ε-caploractone copolymer. Hydrogel microspheres of gelatin were prepared as the release carrier of bFGF. Autologous PCBM harvested from the beforehand tibia of rabbits was mixed with β-TCP granules with or without the microspheres incorporating bFGF and packed into the rolled membrane. When bone formation was assessed at different time intervals, additional mixing of bFGF significantly increased the volume of vascularized bone tissue compared to that without bFGF. It is concluded that combination of bFGF release system was a promising method to prefabricate the bone graft of large size with good blood circulation.

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Prefabricated Vascularized Bone Graft Using Autologous Tissue, Biomaterials, and Growth Factors: A New Technique for Bone Reconstruction

Advanced Biomaterials VI - Key Engineering Materials ◽

10.4028/0-87849-967-9.51 ◽

2005 ◽

pp. 51-54

Author(s):

A. Hokugo ◽

K. Mushimoto ◽

S. Morita ◽

Yasuhiko Tabata

Keyword(s):

Growth Factors ◽

Bone Graft ◽

New Technique ◽

Bone Reconstruction ◽

Vascularized Bone Graft ◽

Autologous Tissue ◽

A New Technique ◽

Vascularized Bone

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Scaphoid Nonunion With Poor Prognostic Factors

Hand ◽

10.1177/1558944716661994 ◽

2016 ◽

Vol 12 (2) ◽

pp. 135-139 ◽

Cited By ~ 10

Author(s):

Tahseen Chaudhry ◽

Lauren Uppal ◽

Dominic Power ◽

Michael Craigen ◽

Simon Tan

Keyword(s):

Prognostic Factors ◽

Bone Graft ◽

Femoral Condyle ◽

Donor Site ◽

Donor Site Morbidity ◽

Vascularized Bone Graft ◽

Union Rate ◽

Poor Prognostic Factor ◽

Low Incidence ◽

Vascularized Bone

Background: To report on the results of free medial femoral condyle (MFC) vascularized bone graft for scaphoid nonunions with 1 or more poor prognostic factors. Methods: We have used the free MFC vascularized bone graft for scaphoid nonunions that have 1 or more factors associated with a poor prognosis. These were, a delay in presentation of over 5 years, a proximal pole nonunion, the presence of avascular necrosis (AVN), or previous nonunion surgery. We used this technique on 20 patients over a 4.5-year period. Results: Our overall union rate was 88.5% (17 of 19 patients), with 1 patient failing to attend for follow-up. Our mean union time was 7 months (2-18). All patients had at least 1 poor prognostic factor and over half had 2 or more. Of those with AVN with or without other factors, the union rate was 85% (11 of 13). There were 2 donor site complications that required a further procedure and 2 patients with residual wrist pain that required a scapho-trapezio-trapezoid joint fusion and a radial styloidectomy, respectively. Both nonunions were offered further surgery, and 1 elected to undergo successful revision surgery. Conclusions: Overall, this technique showed good results, in a subgroup of patients that typically have poorer outcomes, with a low incidence of donor site morbidity. Our union rate compares favorably with other techniques for this difficult subset of patients with 1 or more poor prognostic factors, although results are clearly not as good as those of studies using the MFC graft for all scaphoid nonunions. We continue to reserve this technique for nonunions with 1 or more poor prognostic factors, and we believe that this technique should at least be considered in these patients.

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Myoarchitectonic advancement of the C2 spinous process for C1-C2 posterior fusion: A novel technique

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.153237 ◽

2015 ◽

Vol 6 (02) ◽

pp. 267-271 ◽

Cited By ~ 1

Author(s):

Ajit Kumar Sinha ◽

Sumit Goyal

Keyword(s):

Bone Graft ◽

Perioperative Complications ◽

Spinous Process ◽

Donor Site ◽

Donor Site Morbidity ◽

Posterior Fusion ◽

Vascularized Bone Graft ◽

Novel Technique ◽

Posterior Arthrodesis ◽

Vascularized Bone

ABSTRACT Study Design: Retrospective descriptive study of an innovative surgical technique. Objective: To assess the feasibility of using a large C2 spinous process as a vascularized bone graft donor with muscles attached to it in C1-C2 posterior fusion with evaluation of post operative fusion and pain in these cases. Summary of Background Data: C1-C2 posterior fusion essentially requires a bone graft and for this a separate incision is needed at the donor site with its associated morbidity. The procedure also entails detachment of muscles attached to the C2 spinous process. Due to the detachment of these muscles with important functions, postoperative nuchal pain is common in these patients. We developed a novel technique of harvesting the vascularized C2 spinous process as a bone graft to minimize the above-mentioned complications. Materials and Methods: Five patients with atlanto-axial dislocation due to various pathologies underwent C1-C2 posterior arthrodesis with the present technique. They were followed up for 6 to 18 months and were evaluated for feasibility of procedure, post operative fusion and post operative complications, especially pain. Results: The procedure was accomplished successfully in all patients without any perioperative complications. All patients were pain free 3 months after surgery—mean Visual Analogue Scale (VAS) was 0.4. Fusion (confirmed by plain radiography in three and by CT scan in two patients) was achieved in all five patients (100%). Conclusion: Myoarchitectonic advancement of C2 spinous process is a novel technique of C1-C2 posterior fusion in which a local vascularized bone graft is used avoiding donor site morbidity and at the same time preservation of dynamic function of muscles attached reduces the post operative pain.

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Reverse Segmental Pedicled Ulna Transfer as a Salvage Procedure in Wrist Fusion

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2001.0611 ◽

2001 ◽

Vol 26 (6) ◽

pp. 589-592 ◽

Cited By ~ 4

Author(s):

G. GERMANN ◽

M. SAUERBIER ◽

H. U. STEINAU ◽

M. B. WOOD

Keyword(s):

Bone Graft ◽

Ulnar Artery ◽

New Technique ◽

Tumour Resection ◽

Salvage Procedure ◽

Vascularized Bone Graft ◽

Wrist Fusion ◽

A New Technique ◽

Distally Based ◽

Vascularized Bone

A new technique for wrist fusion using vascularized bone graft is described. A distally based, pedicled segment of the distal ulna, nourished by the ulnar artery or the distally based palmar-ulnar branch of the anterior interosseus artery was used in three patients to restore carpal height after infection ( n = 2) or tumour resection ( n = 1). The forearm is converted to a situation similar to a wide ulnar resection. All three wrist fusions healed uneventfully. This new technique is suitable in cases where a vascularized bone graft is required, but microsurgical techniques are not appropriate or are rejected by the patient.

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