Repair of a Complicated Calvarial Defect
| Autor: | Harry S. Nayar, Zoe M. MacIsaac, Joseph E. Losee, James J. Cray, Liliana Camison, Sameer Shakir, Gregory M. Cooper, Sanjay Naran, Christopher R. Kinsella, Mark P. Mooney, Darren M. Smith |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Radiography medicine.medical_treatment Bone Morphogenetic Protein 2 030230 surgery Transplantation Autologous 03 medical and health sciences 0302 clinical medicine Transforming Growth Factor beta Animals Medicine Craniofacial Bone regeneration Analysis of Variance Wound Healing Calvarial defect Debridement business.industry Skull Plastic Surgery Procedures Recombinant Proteins Infected wound Surgery Transplantation Disease Models Animal Rabbits business Wound healing 030217 neurology & neurosurgery |
| Zdroj: | Annals of Plastic Surgery. 76:205-210 |
| ISSN: | 0148-7043 |
| DOI: | 10.1097/sap.0000000000000515 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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