Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; The Herston Biofabrication Institute, Herston; The University of Queensland, Australia; Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Australia; The Australian Centre for Complex Integrated Surgical Solutions, Woolloongabba , Australia.
J Plast Reconstr Aesthet Surg. 2022 Jul;75(7):2108-2118. doi: 10.1016/j.bjps.2022.02.057. Epub 2022 Mar 9.
We describe the first clinical series of a novel bone replacement technique based on regenerative matching axial vascularisation (RMAV). This was used in four cases: a tibial defect after treatment of osteomyelitis; a calvarial defect after trauma and failed titanium cranioplasty; a paediatric tibial defect after neoadjuvant chemotherapy and resection of Ewing sarcoma; and a paediatric mandibular deficiency resulting from congenital hemifacial microsomia.
All patients underwent reconstruction with three-dimensional (3D)-printed medical-grade polycaprolactone and tricalcium phosphate (mPCL-TCP) scaffolds wrapped in vascularised free corticoperiosteal flaps.
Functional volumes of load-sharing regenerate bone have formed in all cases after a moderate duration of follow-up. At 36 cm, case 1 remains the longest segment of load bearing bone ever successfully reconstructed. This technique offers an alternative to existing methods of large volume bone defect reconstruction that may be safe, reliable, and give predictable outcomes in challenging situations. It achieves this by using a bioresorbable scaffold to support and direct the growth of regenerate bone, driven by RMAV.
This technique may facilitate the reconstruction of bone defects previously thought unreconstructable, reduce the risk of long-term implant-related complications and achieve these outcomes in a hostile environment. These potential benefits must now be formally tested in prospective clinical trials.
我们描述了一种基于再生匹配轴向血管化（RMAV）的新型骨替代技术的首个临床系列。该技术在四个病例中得到了应用：骨髓炎治疗后的胫骨缺损；创伤和钛颅骨修补失败后的颅骨缺损；新辅助化疗和尤文肉瘤切除后的小儿胫骨缺损；以及由先天性单侧颜面发育不全引起的小儿下颌骨缺损。
所有患者均采用三维（3D）打印的医用级聚己内酯和磷酸三钙（mPCL-TCP）支架和血管化游离皮质骨皮瓣进行重建。
在适度的随访时间后，所有病例均形成了具有一定承重功能的再生骨。在 36 厘米处，病例 1 仍然是迄今为止成功重建的最长承重骨段。与现有的大体积骨缺损重建方法相比，该技术提供了一种替代方案，它可能是安全、可靠的，并在具有挑战性的情况下提供可预测的结果。它通过使用生物可吸收支架来支撑和引导再生骨的生长，这是由 RMAV 驱动的。
该技术可能有助于重建以前认为无法重建的骨缺损，降低长期植入物相关并发症的风险，并在恶劣的环境中实现这些结果。这些潜在的益处现在必须通过前瞻性临床试验来正式测试。
