Massive autogenous bone grafts

Autogenous bone graft is the best biologic material available to repair a skeletal defect. These necrotic grafts are revascularized and repaired through creeping substitution to provide an almost identical structure for the one it replaced. There is a limited supply of autogenous bone, but it is the standard against which other methods should be measured.     

Cranioplasty using allogeneic perforated demineralized bone matrix with autogenous bone paste

The efficacy of allogeneic perforated demineralized bone matrix with autogenous bone paste in the treatment of full-thickness cranial defects was evaluated in 10 consecutive patients between June 1998 and December 1998. The skull defects resulted from trauma in 9 patients and removal of a cranial tumor in 1 patient. The size of the skull defects ranged from 8 x 6 cm to 11 x 12.5 cm. Follow-up averaged 33 months for all patients. Postimplantation evaluations included serial photographs, repeated physical examination, and three-dimensional computed tomography for all patients. Visual inspection of the implanted biomaterial 6 months later was possible in 1 patient. The contour of the reconstructed skull was acceptable aesthetically without any secondary depression noted during the follow-up period. Three-dimensional computed tomographic scans taken 2 years after implantation indicated that the allogeneic perforated demineralized bone matrix provided a matrix for new bone formation with remarkable osteoinductive potential for new bone formation. The autogenous bone paste was able to caulk the demineralized bone matrix and fill the contour irregularities and gaps of the reconstructed cranium. The results from this clinical study indicated that allogeneic perforated demineralized bone matrix with autogenous bone paste is a promising alternative to an autogenous bone graft and or alloplastic material for cranioplasty.     

The role of free periosteal grafts in improving the survival of autogenous onlay bone grafts to the facial bones in rabbits

Summary Comparison is made between the survival of two groups of autogenous onlay bone grafts with periosteum taken from the ilium and applied to the nasal bones, in rabbits. In one group the periosteum on the graft surface was left undisturbed, while in the other an overlay of free periosteum was applied to the de-periostealised bone graft at the recipient site.Using serial radiographic recording of the bone grafts for periods up to one year, together with terminal histological examination, it was found that the overlay group survived better at all stages. This is attributed to increased rapidity of vascularisation and osteogenic activity in the periosteal osteoblasts in those grafts having a superimposed free graft of periosteum, with increased production of periosteal new bone more rapidly replacing the underlying bone of the graft.It is suggested that clinical application of these findings might allow accurate contour sculpturing of onlay bone grafts, while in no way impairing graft survival.Presented to the Swiss Association of Plastic and Reconstructive Surgery, on 3rd October, 1975 at Murten, Switzerland     

Resection arthrodesis of the shoulder with autogenous fibular bone grafts

We report the results of wide local excision of stage II8 proximal humeral tumors followed by reconstruction with parallel nonvascularized fibular bone grafts in three patients. Mean follow-up was 5 years (range 3 years to 8 years, 6 months). The pathologic diagnosis was osteogenic sarcoma in two patients and Ewing's sarcoma in one. The rotator cuff and deltoid were excised to achieve a wide margin around these tumors. All patients remain free from disease. They were able to return to previous work and sport activities. Two had a fracture of the graft; one fell from a mountain bike and the other fell at work. The former fracture united; the latter fracture required fixation and bone grafting to achieve union. By Enneking's 30-point functional evaluation, all three patients were in the excellent category with scores of 25, 26, and 28. We conclude that for the treatment of malignant tumors of the shoulder region with muscle involvement, excision followed by arthrodesis with parallel autogenous fibular bone grafts provides a method of retaining satisfactory upper limb function and acceptable cosmesis.     

Cranioplasty utilizing a preserved autogenous bone flap coated with acrylic resin

Summary Cranioplasty utilizing a resin-coated preserved autogenous skull flap was devised and used in 36 cases, 14 of them being followed up radiologically. It has been confirmed that this method is advantageous in that it repairs the skull defect satisfactorily both from surgical and cosmetic points of view. Furthermore this method causes no anxiety to the patient because of the autogenous origin of the bone flap. We recommend this method for cranioplasty when an autogenous bone flap is preserved.     

Intraoperative extracorporeal autogenous irradiated bone grafts in tumor surgery

There are several procedures for reconstruction of bony defects after resection of malignant musculoskeletal tumors. The clinical results of intraoperative extracorporeal autogenous irradiated bone grafts in 20 patients with musculoskeletal tumors are discussed. The authors' method of treatment consists of: (1) wide en bloc resection of the tumor with involved bone; (2) curettage of the tumor from the resected bone; (3) extracorporeal irradiation with 50 Gy as a bolus single dose to the isolated bone; and (4) reimplantation of the irradiated bone into the host with fixation devices. Twelve bone sarcomas and eight soft tissue sarcomas with bone involvement were treated surgically with this reconstruction method after wide resection of the tumors. The irradiated bone was used as an intercalary graft in seven cases, as an osteoarticular graft in 11 cases, and as a hemicortical graft in two cases. The theoretical advantages of this method are certain sterilization of tumor cells with radiation, easy availability and good adaptation of size and shape, no risk of disease transmission, preservation of bone stock and ligamentous tissue, and no immunologic reaction. Radiologically, bony union occurred in 23 of 29 (79%) osteotomy sites. The overall radiographic evaluation rating was 74% and the functional rating was 73% according to the International Society of Limb Salvage rating system. Nonunion (20%) and infection (15%) were the two major complications. Preservation of the tendon insertions and ligamentous structures of the irradiated bone seemed to restore excellent joint function. No local recurrence was detected from the irradiated bones during the mean followup of 45 months. These results indicate intraoperative extracorporeal irradiated bone graft can be a widely applicable method for reconstruction in tumor surgery.     

The effects of cisplatin on the incorporation of fresh syngeneic and frozen allogeneic cortical bone grafts

Allograft transplantation with concomitant chemotherapy has proven successful in the treatment of malignant bone tumors. However, these chemotherapeutic agents may delay tissue healing, resulting in clinical complications. To clarify the effects of cisplatin on the healing of bone grafts, we studied the incorporation of stably fixed massive diaphyseal femoral syngeneic and allogeneic grafts in rats treated with cisplatin. These data were compared with those of historical controls from animals that did not receive cisplatin. Rats that were to receive a fresh syngeneic graft or frozen allogeneic graft were given cisplatin every 4 weeks starting 9 weeks preoperatively and continuing until the time of death. The total bone area of the graft in animals that received cisplatin was smaller than that of the graft in untreated control rats that did not receive cisplatin. The area of the frozen allograft did not increase between 2 and 4 months. Revascularization was incomplete in cisplatin-treated groups at 2 months, but by 4 months, vessel ingrowth in fresh syngeneic grafts approached control values. Frozen allografts remained poorly revascularized at 4 months. Host-graft union was poor at 2 months in cisplatin-treated rats compared with controls. In cisplatin-treated rats, the host-graft union of the frozen allograft remained inferior at 4 months while that of the syngeneic graft improved. Allogeneic cortical bone grafts are incorporated more slowly and incompletely than syngeneic grafts, and this handicap is exacerbated by the administration of cisplatin.     

Revascularisation of fresh compared with demineralised bone grafts in rats.

Revascularisation of bone grafts is influenced by both the anatomical origin and the pre-implantation processing of the graft. We investigated the revascularisation by entrapment of 141Ce (cerium)-labelled microspheres in large, fresh and demineralised syngeneic grafts of predominantly cancellous (iliac bone) or cortical (tibial diaphysis) bone three weeks after heterotopic implantation in rats. The mean (SD) 141Ce deposition index (counts per minute (cpm) of mg recovered implant/cpm of mg host iliac bone) was higher in fresh iliac bone grafts, 0.98 (0.46) compared to that of demineralised iliac bone, 0.32 (0.20), p < 0.001, and fresh tibial bone grafts, 0.51 (0.27), p = 0.007. We found no significant difference in the mean 141Ce deposition index between fresh tibial bone grafts and demineralised tibial bone grafts, 0.35 (0.42), p = 0.4, or between demineralised tibial grafts and demineralised iliac bone grafts, p = 0.8. The results suggest that whereas fresh cancellous grafts are revascularised more completely than fresh cortical grafts, there is no difference in the revascularisation of demineralised cancellous and cortical grafts. In addition, fresh cancellous bone is revascularised more completely than demineralised cancellous bone, whereas there is no difference between fresh and demineralised cortical bone.     

自体和异体滑膜内、外肌腱移植的实验研究

目的　比较自体和异体滑膜内肌腱 (intrasynovial tendon,IT )及滑膜外肌腱 (extrasynovialtendon,ET)作鞘管内移植后两者愈合过程和粘连的异同。方法　应用兔新鲜自体和深低温冻存的异体趾深屈肌腱 (IT)、腓骨长肌腱 (ET) ,分别移植于兔左后肢第二趾 (IT)、四趾 (ET)鞘管内修复趾深屈肌腱缺损。自体、异体组各 2 1只兔。术后 10天、3、6周取两组移植腱及对侧正常腱作组织学观察 ;术后 4、8周取材作生物力学测定。结果　两组 IT移植后粘连轻 ,而两组 ET移植后粘连明显 ,滑动功能差于 IT移植(F =14.10 ,P <0 .0 1)。术后 8周时异体移植腱的最大抗断裂载荷值低于自体移植腱 (F =10 .11,P <0 .0 1)。结论　鞘管内自体或异体肌腱移植后均有供腱的组织特异性 ,两者 IT移植后滑动功能均优于 ET组。异体肌腱 (IT、ET)移植后的愈合过程慢于自体移植组。     

自体颅骨移植在眶底重建中的应用

目的 评价自体颅骨移植在治疗面部外伤致眶底缺损中的作用。方法 对34例面部创伤眶底爆裂骨折（以下简称眶底骨折）有骨质缺损者,采用冠状切口取自休遭受,结膜切口加外眦切开入路进行骨移植修复缺损。结果 所有病例术后创口愈合良好,无感染。供骨区无并发症发生。1例术后3个月内有轻微下睑外翻,通过自行按摩半年后已不明显,8例术前有眶下区麻木者,术后1-6个月全部恢复,4例有复视者术后消失,通过半年至5年（平衡11个月）的随诊,移植骨成活良好,供受骨区切口瘢痕不明显,均取得了满意的临床疗效。结论 自体颅骨移植并发症少,对眶底的重建有许多优点。是眶底重建的理想移植材料。