Brey Eric M, Cheng Ming-Huei, Allori Alexander, Satterfield William, Chang David W, Patrick Charles W, Miller Michael J
Chicago, Hines, and Maywood, Ill.; Taipei, Taiwan; and Houston, Texas From the Department of Biomedical Engineering, Illinois Institute of Technology; Department of Research, Hines Veterans Affairs Hospital; Department of Surgery, Loyola University Medical Center; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Laboratory of Reparative Biology and Bioengineering, Department of Plastic Surgery and Center for Biomedical Engineering, and Department of Veterinary Sciences, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2007 Apr 1;119(4):1216-1222. doi: 10.1097/01.prs.0000254361.74614.bb.
Muscle fascia and periosteum have been used clinically to guide prefabrication of vascularized bone flaps for reconstruction of complex three-dimensional tissues. Although it seems that both locations have the capacity to generate vascularized bone, there have been no studies that directly compare different implantation sites. The authors performed a rigorous, quantitative, histomorphometric comparison of bone prefabrication in a large-animal model comparing graft implanted against muscle fascia and periosteum.
Twenty skeletally mature domestic sheep were implanted with rectangular chambers containing equal weights of morcellized bone graft. Two chambers were implanted into each sheep, one with the open face apposed to the cambium layer of the rib periosteum and the other with the open face apposed to the fascia of the latissimus dorsi muscle. Animals were euthanized at 3, 6, 9, 12, and 24 weeks and the chambers were harvested. Tissue inside the chambers was analyzed for shape conformation to chamber geometry, gross tissue volume, and bone histomorphology.
There were no differences in volume or shape of tissue formed in the chambers. However, chambers in contact with fascia consisted almost entirely of fibrovascular tissue, with progressive resorption of the morcellized bone graft and little evidence of new bone. Chambers in contact with periosteum showed active endochondral, direct, and appositional bone formation over time, with increasing calcified tissue area and new bone formation.
Both periosteum and muscle fascia were able to vascularize bone grafts, but bone formation was higher in the periosteum. The periosteum appears to be a more suitable foundation from which to promote flap prefabrication.
肌肉筋膜和骨膜已在临床上用于指导带血管蒂骨瓣的预制，以重建复杂的三维组织。尽管这两个部位似乎都有生成带血管蒂骨的能力，但尚无直接比较不同植入部位的研究。作者在大型动物模型中对植入肌肉筋膜和骨膜的骨预制进行了严格、定量的组织形态计量学比较。
对20只骨骼成熟的家养绵羊植入装有等量碎骨移植块的矩形腔室。每只绵羊植入两个腔室，一个腔室的开口面与肋骨骨膜的生发层相对，另一个腔室的开口面与背阔肌筋膜相对。在3、6、9、12和24周时对动物实施安乐死并取出腔室。分析腔室内组织的形状与腔室几何形状的契合度、大体组织体积和骨组织形态。
腔室内形成的组织在体积或形状上没有差异。然而，与筋膜接触的腔室几乎完全由纤维血管组织组成，碎骨移植块逐渐吸收，几乎没有新骨形成的迹象。与骨膜接触的腔室随着时间推移显示出活跃的软骨内成骨、直接成骨和附加成骨，钙化组织面积增加且有新骨形成。
骨膜和肌肉筋膜都能够使骨移植块血管化，但骨膜中的骨形成更多。骨膜似乎是促进皮瓣预制的更合适基础。
