Prefabrication of vascularized bioartificial bone grafts in vivo for segmental mandibular reconstruction: experimental pilot study in sheep and first clinical application

Prefabrication of scaffolds for group 1: intraoperative loading of the predrilled β-TCP-cylinders with osteogenic material from the iliac crest (A), preparation of a muscle pouch in the latissimus dorsi muscle (B), implantation of the loaded cylinders directly into the muscle pouch (C and D).

Prefabrication of scaffolds for group 2: preparation of perforating vessels from the thoraco-dorsal trunk (A), intraoperative loading of the predrilled β-TCP-cylinders with osteogenic material from the iliac crest (B), surgical supply with a central vascular bundle for axial perfusion (C and D).

Immunhistochemical determination of the vascular density with Factor VIII rabbit polyclonal^® on decalcified paraffin slices of 1μm thickness in central (A), intermediate (B) and outer (C) regions of interest (ROI) in the β-TCP-cylinders (M, matrix; P, pore; arrow indicates vessels).

Results after prefabrication: conventional CT of group 1 (A) and group 2 (B), macroscopic view of group 1 (C) and group 2 (D), microscopic view of group 1 (E) and group 2 (F) after surface staining of undecalcified methylmethacrylate (MMA) embedded slices of 30μm thickness with alizarine-methylene blue.

Residual ceramic area (A), bone formation (B) and vascular density in scaffolds of group 1 and group 2.

Clinical application: angio-CT of the latissimus dorsi muscle after 6 months of prefabrication (A), arterial bleeding from the central vascular bundle of the bioartificial bone grafts during explantation (B), piezo-surgical shaping of the cylinders according to a virtual template (C), adaption of a titanium mesh to a commercialized mandible (D). Filling of the titanium mesh with the individually shaped bioartificial bone grafts (E), transplantation for mandibular reconstruction (F).

3D view of conventional CT (colored segmentation): before mandibular reconstruction (A), bioartificial bone grafts after 6 months of prefabrication before transplantation (B), and after mandibular reconstruction (C and D).