Department of Craniofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
J Craniomaxillofac Surg. 2019 Aug;47(8):1274-1279. doi: 10.1016/j.jcms.2019.04.002. Epub 2019 Jun 3.
Restoration of the mandible after defects caused by ablative surgery remains challenging. Microvascular free flaps from the scapula, fibula or iliac crest remain the 'gold standard'. A drawback of these methods is donor-side morbidity, availability and the shape of the bone. Former cases have shown that prefabrication of a customized bone flap in the latissimus dorsi muscle may be successful; however, this method is still associated with high donor-side morbidity. Osteogenesis in the omentum majus of rabbits by wrapping the periosteum into it was confirmed recently and is particularly interesting for bone endocultivation. Twelve adult male New Zealand white rabbits were used. In each, two hydroxyapatite blocks were implanted in the greater omentum with autologous bone or autologous bone + rhBMP-2. Bone density measurements were performed by CT scans. Fluorochrome labelling was used for new bone formation detection. The animals were sacrificed at week 10, and the specimens were harvested for histological and histomorphometric analysis. In histological and fluorescence microscopic analysis, new bone formation could be found, as well as new blood vessels and connective tissue. No significant differences were found regarding the histological analysis and bone density measurements between the groups. It could be demonstrated that the omentum majus is a practical way to use one's own body as a bioreactor for prefabrication of tissue-engineered bony constructs. Regarding the influence and exact dose of rhBMP-2, further research is necessary. To establish and improve this method, further large-animal experimental studies are also necessary.
切除术后导致的下颌骨缺损的修复仍然具有挑战性。肩胛骨、腓骨或髂嵴的游离微血管皮瓣仍然是“金标准”。这些方法的缺点是供体部位的发病率、可用性和骨的形状。以前的病例表明，在背阔肌中预制定制骨瓣可能是成功的；然而，这种方法仍然与高供体部位发病率相关。最近证实，将骨膜包裹在大网膜中可以在大网膜中诱导骨生成，这对于骨内培养特别有趣。使用了 12 只成年雄性新西兰白兔。在每只兔子中，两个羟基磷灰石块分别用自体骨或自体骨+rhBMP-2 植入大网膜中。通过 CT 扫描进行骨密度测量。荧光标记用于检测新骨形成。在第 10 周，处死动物，并采集标本进行组织学和组织形态计量学分析。在组织学和荧光显微镜分析中，可以发现新骨形成，以及新的血管和结缔组织。各组之间的组织学分析和骨密度测量无显著差异。可以证明大网膜是一种实用的方法，可以将自身的身体用作组织工程骨构建体预制的生物反应器。关于 rhBMP-2 的影响和确切剂量，还需要进一步的研究。为了建立和改进这种方法，还需要进行进一步的大型动物实验研究。
