Man as a Living Bioreactor: Prefabrication of a Custom Vascularized Bone Graft in the Gastrocolic Omentum
| Autor: | Hendrik Naujokat, Yahja Acil, Joerg Wiltfang, Michael Rohnen, Ulf Lützen, Jan-Hendrik Egberts, Henning Wieker |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Biomedical Engineering Medicine (miscellaneous) Bioengineering Free flap Bone morphogenetic protein Surgical Flaps Bone remodeling 03 medical and health sciences 0302 clinical medicine Bioreactors stomatognathic system Osteogenesis medicine Humans 030223 otorhinolaryngology Bone mineral Bone Transplantation Tissue Engineering business.industry 030206 dentistry Middle Aged Plastic Surgery Procedures medicine.disease Surgery Transplantation Mandibular Neoplasms Heterotopic ossification business Gastrocolic reflex Omentum |
| Zdroj: | Tissue engineering. Part C, Methods. 22(8) |
| ISSN: | 1937-3392 |
| Popis: | Reconstruction of critical-size jaw defects still remains challenging. The standard treatment today is transplantation of autologous bone grafts, which is associated with high donor-site morbidity and unsatisfactory outcomes. We aimed to reconstruct a mandibular discontinuity defect after ablative surgery using the gastrocolic omentum as a bioreactor for heterotopic ossification. Three-dimensional computed tomography data were used to produce an ideal virtual replacement for the mandibular defect. A titanium mesh cage was filled with bone mineral blocks, infiltrated with 12 mg of recombinant human bone morphogenetic protein 2, and enriched with bone marrow aspirate. The scaffold was implanted into the gastrocolic omentum, and 3 months later, a free flap was harvested to reconstruct the mandibular defect. In vivo single photon emission computed tomography/computed tomography revealed bone remodeling and mineralization inside the mandibular transplant during prefabrication and after transplantation. Reconstruction was possible without any further modifications of the graft. A histological evaluation revealed that large sections of the Bio-Oss material were covered with osteoid matrix 3 months after transplantation. The quality of life of the patient significantly increased with acquisition of the ability to masticate and the improvement in pronunciation and aesthetics. Heterotopic bone induction to form a mandibular replacement inside the gastrocolic omentum is possible in human subjects. Heterotopic prefabrication is associated with many advantages, like allowing a reduced operative burden compared with conventional techniques and good three-dimensional outcomes. |
| Databáze: | OpenAIRE |
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