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Firdaus Hussin MS, Abdullah HZ, Idris MI, Abdul Wahap MA. Extraction of natural hydroxyapatite for biomedical applications—A review. Heliyon 2022; 8:e10356. [PMID: 36082327 PMCID: PMC9445296 DOI: 10.1016/j.heliyon.2022.e10356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/18/2022] [Accepted: 08/15/2022] [Indexed: 01/04/2023] Open
Abstract
Hydroxyapatite has recently played a crucial role in the sustainable development of biomedical applications. Publications related to hydroxyapatite as filler for biopolymers have exhibited an increasing trend due to the expanding research output. Based on the latest publications, the authors reviewed the research trends regarding hydroxyapatite use in biomedical applications. Analysis of the Scopus database using the keywords ‘hydroxyapatite” and “biomedical applications” determined that 1,714 papers were produced between 2012 and 2021. The number of publications related to these keywords more than doubled between 2012 (99) and 2021 (247). The hydrothermal method, solid-state reactions, the sol-gel process, emulsion, micro-emulsion, and mostly chemical precipitation were used to produce synthetic hydroxyapatite. Meanwhile, calcination, alkaline hydrolysis, precipitation, hydrothermal, and a combination of these techniques were used in producing natural hydroxyapatite. Studies in the current literature reveal that shell-based animal sources have been frequently used as hydroxyapatite resources during investigations concerning biomedical applications, while calcination was the extraction method most often applied. Essential trace elements of fish bone, oyster shell, and eggshell were also found in hydroxyapatite powder. Abalone mussel shell and eggshell showed Ca/P ratios closer to the stoichiometric ratio due to the use of effective extraction methods such as manipulating aging time or stirring process parameters. This review should greatly assist by offering scientific insights to support all the recommended future research works, not only that associated with biomedical applications.
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Shirosaki Y, Furuse M, Asano T, Kinoshita Y, Kuroiwa T. Skull Bone Regeneration Using Chitosan⁻Siloxane Porous Hybrids-Long-Term Implantation. Pharmaceutics 2018; 10:pharmaceutics10020070. [PMID: 29890682 PMCID: PMC6027072 DOI: 10.3390/pharmaceutics10020070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 11/16/2022] Open
Abstract
Burr holes in craniotomy are not self-repairing bone defects. To regenerate new bone at the sites of these defects, a good scaffold is required. Biodegradable hybrids including silica or siloxane networks have been investigated as bone tissue scaffolds. This study examined skull bone regeneration using chitosan-siloxane hybrids after long-term implantation (two and three years). After implantation of the hybrids, the surrounding cells migrated and formed fibrous tissues and blood vessels. Then, bone formation occurred from the surrounding blood vessels. Addition of calcium ions and coating with hydroxyapatite improved bone regeneration. Finally, the regenerated tissue area became smaller than the initial hole, and some areas changed to completed bone tissues.
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Affiliation(s)
- Yuki Shirosaki
- Faculty of Engineering, Kyushu Institute of Technology, 1-1 Sensui-cho, Tobata-ku, Kitakyushu 804-8550, Japan.
| | - Motomasa Furuse
- Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
| | - Takuji Asano
- Nikkiso Co., Ltd., Ebisu, Shibuya-ku, Tokyo 150-6022, Japan.
| | | | - Toshihiko Kuroiwa
- Department of Neurosurgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
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Matsukawa H, Miyama M, Miyazaki T, Uemori G, Kinoshita Y, Sakakibara F, Saito N, Tsuboi T, Noda K, Ota N, Tokuda S, Kamiyama H, Tanikawa R. Impacts of pressure bonding fixation on a bone flap depression and resorption in patients with craniotomy. J Clin Neurosci 2017; 41:162-167. [PMID: 28262399 DOI: 10.1016/j.jocn.2017.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/10/2017] [Indexed: 12/01/2022]
Abstract
Fixation of bone flaps after craniotomy is a routine part of every neurosurgical procedure. Common problems encountered are bone flap depression and resorption. Authors performed the pressure-bonding bone flap fixation (PBFF) using absorbable craniofix (AC) and hydroxyapatite wedge (HW). The aim of the present study is to evaluate the efficacy of PBFF to prevent a bone flap depression and resorption in patients treated with craniotomy. Four-hundred fifty-four patients underwent craniotomies. Authors collected the following data: age, sex, type of craniotomy, what kind of surgery, whether bypass surgery was performed, whether surgery was the initial, whether AC and the HW were used, bone flap depression and resorption at 6-month after the craniotomy. PBFF was defined as a bone flap fixation using both AC and HW to impress a bone flap to forehead. The mean age was 62±13years and 404 (89%) patients were women. PBFF was performed in 71 patients (16%), either AC or HW was used in 141 (31%), only AC was used in 116 (25%), and only HW was used in 25 (5.5%). At 6-month after the surgery, a bone flap depression was seen in 38 patients (8.4%), and a bone flap resorption was seen in 66 (15%). Multivariate analysis showed that only a PBBF showed a negative correlation with bone flap depression (p=0.044) and resorption (p=0.011). The results of the present study showed that PBFF reduced a bone flap depression and resorption and provided excellent postoperative cosmetic results.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
| | - Masataka Miyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Genki Uemori
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Yu Kinoshita
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Fumihiro Sakakibara
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Norihiro Saito
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
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Poly(trimethylene carbonate)-based composite materials for reconstruction of critical-sized cranial bone defects in sheep. J Craniomaxillofac Surg 2017; 45:338-346. [DOI: 10.1016/j.jcms.2016.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/03/2016] [Accepted: 12/07/2016] [Indexed: 12/25/2022] Open
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Ono H, Sase T, Tanaka Y, Takasuna H. Histological assessment of porous custom-made hydroxyapatite implants 6 months and 2.5 years after cranioplasty. Surg Neurol Int 2017; 8:8. [PMID: 28217387 PMCID: PMC5288982 DOI: 10.4103/2152-7806.198735] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/03/2016] [Indexed: 11/26/2022] Open
Abstract
Background: In cranial reconstruction, the features of artificial bone differ. Custom-made porous hydroxyapatite (HAp) implants for cranioplasty have been used all over the world because of their good cosmetic, biocompatibility, and osteoconductive properties. Surgical techniques were analyzed, and histological assessment of new bone formation in the hydroxyapatite was performed. Methods: Over a 6-year time period, 41 patients underwent cranioplasty using a custom-made three-dimensional hybrid pore structured hydroxyapatite (3DHPoHAp) implant. The surgical techniques and histological evaluations of 3DHPoHAp in 2 cases, removed 6 months and 2.5 years after cranioplasty, are described. Results: Using 3DHPoHAp, cranioplasty was successfully performed for all patients. The implant fit the bone defect exactly, and surgical manoeuvres were simple and easy. All implants were firmly fixed using a titanium plate, and postoperative infection occurred in 1 patient (2.4%). New bone formation was seen in 2 cases 6 months and 2.5 years after cranioplasty. Osteoblasts were progressing to the stoma at various depths, and bone tissue had ripened. Furthermore, lamellar structure was observed in the case at 2.5 years. Conclusions: In this study, there was a low infection rate, and new bone formation was seen in vivo after cranioplasty. This study also demonstrated that the 3DHPoHAp implant is a good candidate for cranial bone implants because its good osteoconductivity and biocompatibility.
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Affiliation(s)
- Hajime Ono
- Department of Neurosurgery, St. Marianna University School of Medicine, Toyoko Hospital, Kawasaki City, Japan
| | - Taigen Sase
- Department of Neurosurgery, St. Marianna University School of Medicine, Toyoko Hospital, Kawasaki City, Japan
| | - Yuichiro Tanaka
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
| | - Hiroshi Takasuna
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki-shi, Kanagawa, Japan
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Khader BA, Towler MR. Materials and techniques used in cranioplasty fixation: A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 66:315-322. [PMID: 27207068 DOI: 10.1016/j.msec.2016.04.101] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/17/2016] [Accepted: 04/29/2016] [Indexed: 11/29/2022]
Abstract
Cranioplasty is the surgical repair of a deficiency or deformity of the skull. The purpose of cranioplasty is to provide protection for the brain following cranial surgery, and to offer relief to psychological disadvantages while increasing social performance. There are several materials that had been used for cranioplasty but an ideal product has yet to be developed, hence the ongoing research into biologic and non-biologic alternatives to the existing materials. This article critiques the products currently used for cranioplasty in order to facilitate the development of new materials, which can improve patient outcomes.
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Affiliation(s)
- Basel A Khader
- Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, M5B 2K3, ON, Canada
| | - Mark R Towler
- Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, M5B 2K3, ON, Canada.
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Shirosaki Y, Okamoto K, Hayakawa S, Osaka A, Asano T. Preparation of Porous Chitosan-Siloxane Hybrids Coated with Hydroxyapatite Particles. BIOMED RESEARCH INTERNATIONAL 2015; 2015:392940. [PMID: 26078948 PMCID: PMC4452833 DOI: 10.1155/2015/392940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/13/2014] [Indexed: 11/17/2022]
Abstract
This paper describes the apatite deposition of chitosan-silicate porous hybrids derived from chitosan and γ-glycidoxypropyltrimethoxysilane (GPTMS) in alkaline phosphate solution. The preparation of porous hybrids with needle-like apatite on their surfaces is described. Following apatite deposition the porous hybrids maintained high porosity. The enzymatic degradation rate was low even after 6 months and the porous hybrids were very flexible and cut easily using surgical scissors.
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Affiliation(s)
- Yuki Shirosaki
- Frontier Research Academy for Young Researchers, Kyushu Institute of Technology, 2-4 Hibikino, Wakamatsu-ku, Kitakyushu 808-0196, Japan
| | - Kohei Okamoto
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan
| | - Satoshi Hayakawa
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan
| | - Akiyoshi Osaka
- Graduate School of Natural Science and Technology, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama 700-8530, Japan
| | - Takuji Asano
- Nikkiso Co., Ltd., Ebisu, Shibuya-ku, Tokyo 150-6022, Japan
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Feroze AH, Walmsley GG, Choudhri O, Lorenz HP, Grant GA, Edwards MSB. Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends. J Neurosurg 2015; 123:1098-107. [PMID: 25699411 DOI: 10.3171/2014.11.jns14622] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cranial bone repair is one of the oldest neurosurgical practices. Reconstructing the natural contours of the skull has challenged the ingenuity of surgeons from antiquity to the present day. Given the continuous improvement of neurosurgical and emergency care over the past century, more patients survive such head injuries, thus necessitating more than ever before a simple, safe, and durable means of correcting skull defects. In response, numerous techniques and materials have been devised as the art of cranioplasty has progressed. Although the goals of cranioplasty remain the same, the evolution of techniques and diversity of materials used serves as testimony to the complexity of this task. This paper highlights the evolution of these materials and techniques, with a particular focus on the implications for managing pediatric calvarial repair and emerging trends within the field.
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Affiliation(s)
- Abdullah H Feroze
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine
| | - Graham G Walmsley
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine
| | - Omar Choudhri
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucille Packard Children's Hospital; and
| | - H Peter Lorenz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
| | - Gerald A Grant
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucille Packard Children's Hospital; and
| | - Michael S B Edwards
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucille Packard Children's Hospital; and
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Mardas N, Dereka X, Donos N, Dard M. Experimental Model for Bone Regeneration in Oral and Cranio-Maxillo-Facial Surgery. J INVEST SURG 2013; 27:32-49. [DOI: 10.3109/08941939.2013.817628] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aesthetic refinement of secondary cranioplasty using methyl methacrylate bone cements. Aesthetic Plast Surg 2013; 37:592-600. [PMID: 23584430 DOI: 10.1007/s00266-013-0110-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 03/06/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cranioplasty using alternate alloplastic bone substitutes instead of autologous bone grafting is inevitable in the clinical field. The authors present their experiences with cranial reshaping using methyl methacrylate (MMA) and describe technical tips that are keys to a successful procedure. METHODS A retrospective chart review of patients who underwent cranioplasty with MMA between April 2007 and July 2010 was performed. For 20 patients, MMA was used for cranioplasty after craniofacial trauma (n = 16), tumor resection (n = 2), and a vascular procedure (n = 2). The patients were divided into two groups. In group 1, MMA was used in full-thickness inlay fashion (n = 3), and in group 2, MMA was applied in partial-thickness onlay fashion (n = 17). The locations of reconstruction included the frontotemporal region (n = 5), the frontoparietotemporal region (n = 5), the frontal region (n = 9), and the vertex region (n = 1). The size of cranioplasty varied from 30 to 144 cm(2). RESULTS The amount of MMA used ranged from 20 to 70 g. This biomaterial was applied without difficulty, and no intraoperative complications were linked to the applied material. The patients were followed for 6 months to 4 years (mean, 2 years) after MMA implantation. None of the patients showed any evidence of implant infection, exposure, or extrusion. Moreover, the construct appeared to be structurally stable over time in all the patients. CONCLUSIONS Methyl methacrylate is a useful adjunct for treating deficiencies of the cranial skeleton. It provides rapid and reliable correction of bony defects and contour deformities. Although MMA is alloplastic, appropriate surgical procedures can avoid problems such as infection and extrusion. An acceptable overlying soft tissue envelope should be maintained together with minimal contamination of the operative site. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Brie J, Chartier T, Chaput C, Delage C, Pradeau B, Caire F, Boncoeur MP, Moreau JJ. A new custom made bioceramic implant for the repair of large and complex craniofacial bone defects. J Craniomaxillofac Surg 2012; 41:403-7. [PMID: 23218977 DOI: 10.1016/j.jcms.2012.11.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Neurosurgery and Maxillofacial Surgery Departments of Limoges University Hospital Centre have developed a new concept of a custom made ceramic implant in hydroxyapatite (HA) for the reconstruction of large and complex craniofacial bone defects (more than 25 cm(2)). MATERIALS AND METHODS The manufacturing process of the implants used a stereolithography technique that produces implants with three-dimensional shapes derived directly from the scan file of the patient's skull without moulding or machining. Eight patients received 8 implants between 2005 and 2008. RESULTS The surgical procedure is simple and fast. The post-operative follow-up was 12 months. No major complications (infection or fracture of the implant) were observed. The cosmetic result was considered satisfactory by both patients and surgeons. CONCLUSIONS These new implants are well suited for reconstruction of large craniofacial bone defects (greater than 25 cm(2)) in adults and children over 8 years.
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Affiliation(s)
- Joël Brie
- Service de Chirurgie Maxillo-Faciale, CHU de Limoges, 2, avenue Martin Luther King, 87042 Limoges, cedex, France.
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How “Successful” Is Calvarial Reconstruction Using Frozen Autologous Bone? Plast Reconstr Surg 2012; 130:1110-1117. [DOI: 10.1097/prs.0b013e318267d4de] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Goodrich JT, Sandler AL, Tepper O. A review of reconstructive materials for use in craniofacial surgery bone fixation materials, bone substitutes, and distractors. Childs Nerv Syst 2012; 28:1577-88. [PMID: 22872276 DOI: 10.1007/s00381-012-1776-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 04/13/2012] [Indexed: 11/29/2022]
Abstract
Over the last 40 years, craniofacial surgery, in general, and surgery for craniosynostosis, in particular, has witnessed the introduction of a number of new materials for use in operations involving the cranial vault. Some of these materials have proven quite useful over time, while others have failed to meet their stated objectives. In this review, the more popular implant materials are analyzed, and their relative merits and drawbacks are discussed. Craniofacial surgery in the pediatric population has its own unique limitations, quite different from the adult population and those issues are reviewed as well.
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Affiliation(s)
- James Tait Goodrich
- Division of Pediatric Neurosurgery, Leo Davidoff Department of Neurological Surgery, Children's Hospital at Montefiore, Bronx, New York, USA.
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Hardy H, Tollard E, Derrey S, Delcampe P, Péron JM, Fréger P, Proust F. Tolérance clinique et degré d’ossification des cranioplasties en hydroxyapatite de larges défects osseux. Neurochirurgie 2012; 58:25-9. [DOI: 10.1016/j.neuchi.2011.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 09/13/2011] [Indexed: 10/16/2022]
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Hoenig JF. Frontal bone remodeling for gender reassignment of the male forehead: a gender-reassignment surgery. Aesthetic Plast Surg 2011; 35:1043-9. [PMID: 21573830 PMCID: PMC3236290 DOI: 10.1007/s00266-011-9731-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 03/28/2011] [Indexed: 11/29/2022]
Abstract
Gender-reassignment therapy, especially for reshaping of the forehead, can be an effective treatment to improve self-esteem. Contouring of the cranial vault, especially of the forehead, still is a rarely performed surgical procedure for gender reassignment. In addition to surgical bone remodeling, several materials have been used for remodeling and refinement of the frontal bone. But due to shortcomings of autogenous bone material and the disadvantages of polyethylene or methylmethacrylate, hydroxyapatite cement (HAC) composed of tetracalcium phosphate and dicalcium phosphate seems to be an alternative. This study aimed to analyze the clinical outcome after frontal bone remodeling with HAC for gender male-to-female reassignment. The 21 patients in the study were treated for gender reassignment of the male frontal bone using HAC. The average age of these patients was 33.4 years (range, 21–42 years). The average volume of HAC used per patient was 3.83 g. The authors’ clinical series demonstrated a satisfactory result. The surgery was easy to perform, and HAC was easy to apply and shape to suit individual needs. Overall satisfaction was very high. Therefore, HAC is a welcome alternative to the traditional use of autogenous bone graft for correction of cranial vault irregularities.
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Affiliation(s)
- Johannes Franz Hoenig
- Department of Plastic and Aesthetic Surgery, University Hospital and Medical School of Goettingen, Robert-Koch-Street 40, 37075, Goettingen, Germany.
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Wang H, Sun K, Li A, Wang W, Chui P. Size-controlled synthesis and characterization of fluorapatite nanocrystals in the presence of gelatin. POWDER TECHNOL 2011. [DOI: 10.1016/j.powtec.2011.01.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Van der Stok J, Van Lieshout EM, El-Massoudi Y, Van Kralingen GH, Patka P. Bone substitutes in the Netherlands - a systematic literature review. Acta Biomater 2011; 7:739-50. [PMID: 20688196 DOI: 10.1016/j.actbio.2010.07.035] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/26/2010] [Accepted: 07/28/2010] [Indexed: 01/28/2023]
Abstract
Autologous bone grafting is currently considered as the gold standard to restore bone defects. However, clinical benefit is not guaranteed and there is an associated 8-39% complication rate. This has resulted in the development of alternative (synthetic) bone substitutes. The aim of this systematic literature review was to provide a comprehensive overview of literature data of bone substitutes registered in the Netherlands for use in trauma and orthopedic surgery. Brand names of selected products were used as search terms in three available databases: Embase, PubMed and Cochrane. Manuscripts written in English, German or Dutch that reported on structural, biological or biomechanical properties of the pure product or on its use in trauma and orthopedic surgery were included. The primary search resulted in 475 manuscripts from PubMed, 653 from Embase and 10 from Cochrane. Of these, 218 met the final inclusion criteria. Of each product, structural, biological and biomechanical characteristics as well as their clinical indications in trauma and orthopedic surgery are provided. All included products possess osteoconductive properties but differ in resorption time and biomechanical properties. They have been used for a wide range of clinical applications; however, the overall level of clinical evidence is low. The requirements of an optimal bone substitute are related to the size and location of the defect. Calcium phosphate grafts have been used for most trauma and orthopedic surgery procedures. Calcium sulphates were mainly used to restore bone defects after tumour resection surgery but offer minimal structural support. Bioactive glass remains a potential alternative; however, its use has only been studied to a limited extent.
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Schneider G, Blechschmidt K, Linde D, Litschko P, Körbs T, Beleites E. Bone regeneration with glass ceramic implants and calcium phosphate cements in a rabbit cranial defect model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2010; 21:2853-2859. [PMID: 20859655 DOI: 10.1007/s10856-010-4143-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 08/03/2010] [Indexed: 05/29/2023]
Abstract
Hydroxyapatite cement (BoneSource®) and brushite calcium phosphate cement (chronOS™ Inject) were tested for fixation of glass ceramic implants (Bioverit®) in experimentally created cranial defects in 24 adult New Zealand White rabbits. Aim of the in vivo study was to assess and compare the biocompatibility and osseointegration of the implanted materials. Macroscopic and histological evaluations were performed 1 month, 3 months, and 6 months postoperatively. All implanted materials were well tolerated by the surrounding tissue. Both bone cements exhibited osteoconductive properties. Differences could be detected regarding to the rates of cement resorption and new bone formation. The brushite cement was resorbed faster than the hydroxyapatite cement. The chronOS™ Inject samples exhibited a higher rate of connective tissue formation and an insufficient osseointegration. BoneSource® was replaced by bone with minimal invasion of connective tissue. New bone formation occurred faster compared to the chronOS™ Inject group. Bioverit® implants fixed with BoneSource® were successfully osseointegrated.
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Affiliation(s)
- Gerlind Schneider
- Department of Otorhinolaryngology, Faculty of Medicine, Friedrich Schiller University, Jena, Germany.
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Ji C, Ahn JG. Clinical experience of the brushite calcium phosphate cement for the repair and augmentation of surgically induced cranial defects following the pterional craniotomy. J Korean Neurosurg Soc 2010; 47:180-4. [PMID: 20379469 DOI: 10.3340/jkns.2010.47.3.180] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 01/04/2010] [Accepted: 01/31/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To prevent temporal depression after the pterional craniotomy, this study was designed to examine the safety and aesthetic efficacy of the brushite calcium phosphate cement (CPC) in the repair and augmentation of bone defects following the pterional craniotomy. METHODS The brushite CPC was used for the repair of surgically induced cranial defects, with or without augmentation, in 17 cases of pterional approach between March, 2005 and December, 2006. The average follow-up month was 20 with range of 12-36 months. In the first 5 cases, bone defects were repaired with only brushite CPC following the contour of the original bone. In the next 12 cases, bone defects were augmented with the brushite CPC rather than original bone contour. For a stability monitoring of the implanted brushite CPC, post-implantation evaluations including serial X-ray, repeated physical examination for aesthetic efficacy, and three-dimensional computed tomography (3D-CT) were taken 1 year after the implantation. RESULTS The brushite CPC paste provided precise and easy contouring in restoration of the bony defect site. No adverse effects such as infection or inflammation were noticed during the follow-up periods from all patients. 3D-CT was taken 1 year subsequent to implantation showed good preservation of the brushite CPC restoration material. In the cases of the augmentation group, aesthetic outcomes were superior compared to the simple repair group. CONCLUSION The results of this clinical study indicate that the brushite CPC is a biocompatible alloplastic material, which is useful for prevention of temporal depression after pterional craniotomy. Additional study is required to determine the long-term stability and effectiveness of the brushite calcium phosphate cement for the replacement of bone.
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Affiliation(s)
- Cheol Ji
- Department of Neurosurgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Image-guided cranial osteoma resection and bioceramic porous hydroxyapatite custom-made reconstruction in a one-step surgical procedure. Technical notes and illustrative case. Acta Neurochir (Wien) 2010; 152:155-9. [PMID: 19430722 DOI: 10.1007/s00701-009-0374-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Removal of a large cranial tumour and reconstruction of the consequent bone defect in the same surgical setting is an ordinary procedure. A custom-made hydroxyapatite ceramic reconstruction of a cranial bone defect is a modern option that currently needs a preoperative stage of studying the bone defect and designing the implant. Consequently, if a reconstructive hydroxyapatite-based procedure after a cranial tumour resection is the aim, a two-stage surgery is necessary. The authors investigated the possibility of performing this procedure in a one-step surgery by the use of a neuronavigation system. METHODS Preoperatively, an epoxy-resin model is built by stereolithography on three-dimensional (3D) cranial computed tomographic (CT) scan data of the patient affected by the cranial tumour. Afterwards, the implant is designed on the base of the planned bone flap that the surgeon simulates on the model for the tumour resection. The CT scan of the patient is fused in the neuronavigational system with a 3D cranial CT scan performed on the model without the planned bone flap. Intra-operatively, the surgeon is guided by the neuronavigational system to remove the cranial tumour through the craniotomy preoperatively planned on the model and, for this reason, perfectly matching the prosthesis for shape and size. RESULTS In an illustrative case, a 26-year-old woman presented to the authors' attention for a large growing fronto-temporal osteoma. Because of the site of the tumour and the consequent challenging reconstruction of the bone defect, it was decided to attempt the cranioplasty with a custom-made hydroxyapatite ceramic implant. The removal of the osteoma and reconstruction with a hydroxyapatite ceramic implant was done in a one-step surgery. Seriate postoperative cranial CT scans showed a satisfying 3D result. CONCLUSIONS Surgical removal of a cranial bone tumour and optimal reconstruction with a custom-made hydroxyapatite ceramic implant is an appealing procedure that can be carried out in a one-step surgery by means of an intraoperative image-guidance system.
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Cieślik M, Mertas A, Morawska-Chochólł A, Sabat D, Orlicki R, Owczarek A, Król W, Cieślik T. The evaluation of the possibilities of using PLGA co-polymer and its composites with carbon fibers or hydroxyapatite in the bone tissue regeneration process - in vitro and in vivo examinations. Int J Mol Sci 2009; 10:3224-3234. [PMID: 19742134 PMCID: PMC2738921 DOI: 10.3390/ijms10073224] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 07/14/2009] [Accepted: 07/15/2009] [Indexed: 12/17/2022] Open
Abstract
Synthetic polymers belonging to the aliphatic polyester group have become highly promising biomaterials for reconstructive medicine. The purpose of the present work is a biological evaluation of lactide-glycolide co-polymer (PLGA) and its composites with carbon fibers (PLGA+CF) or hydroxyapatite (PLGA+HA). The cytotoxicity of the evaluated materials towards hFOB 1.19 human osteoblast-like cells was assessed. Moreover, during the one-year contact of the assessed materials with living osseous tissue, the progress of bone formation was analyzed and the accompanying process of the materials’ degradation was evaluated. The materials under evaluation proved to be biocompatible.
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Affiliation(s)
- Magdalena Cieślik
- Chair and Department of Stomatological Material Science, Pl. Akademicki 17, 41 907 Bytom, Medical University of Silesia, Katowice, Poland; E-Mail:
(R.O.)
- Author to whom correspondence should be addressed; E-Mail:
(M.C.); Tel. +48 032 2827942; Fax: +48 032 2827942
| | - Anna Mertas
- Chair and Department of Microbiology and Immunology, Jordana 19, 41 808 Zabrze, Medical University of Silesia, Katowice, Poland; E-Mails:
(A.M.);
(W.K.)
| | - Anna Morawska-Chochólł
- Department of Biomaterials, Faculty of Materials Science and Ceramics, Al. Mickiewicza 30, 30 059 Cracow, AGH University of Science and Technology, Cracow, Poland; E-Mail:
(A.M.-C.)
| | - Daniel Sabat
- Department and Institute of Pathomorphology, 3maja 13-15, 41 800 Zabrze, Medical University of Silesia, Poland; E-Mail:
(D.S.)
| | - Rajmund Orlicki
- Chair and Department of Stomatological Material Science, Pl. Akademicki 17, 41 907 Bytom, Medical University of Silesia, Katowice, Poland; E-Mail:
(R.O.)
| | - Aleksander Owczarek
- Division of Statistics, Ostrogórska 30, 95 010 Sosnowiec, Medical University of Silesia, Katowice, Poland; E-Mail:
(A.O.)
| | - Wojciech Król
- Chair and Department of Microbiology and Immunology, Jordana 19, 41 808 Zabrze, Medical University of Silesia, Katowice, Poland; E-Mails:
(A.M.);
(W.K.)
| | - Tadeusz Cieślik
- Department and Clinic of Maxillofacial Surgery, Francuska 20/24, 40 027 Katowice, Medical University of Silesia, Katowice, Poland; E-Mail:
(T.C.)
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Cabraja M, Klein M, Lehmann TN. Long-term results following titanium cranioplasty of large skull defects. Neurosurg Focus 2009; 26:E10. [DOI: 10.3171/2009.3.focus091] [Citation(s) in RCA: 206] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Decompressive craniectomy is an established procedure to lower intracranial pressure. Therefore, cranioplasty remains a necessity in neurosurgery as well. If the patient's own bone flap is not available, the surgeon can choose between various alloplast grafts. A review of the literature proves that 4–13.8% of polymethylmethacrylate plates and 2.6–10% of hydroxyapatite-based implants require replacement. In this retrospective study of large skull defects, the authors compared computer-assisted design/computer-assisted modeled (CAD/CAM) titanium implants for cranioplasty with other frequently used materials described in literature.
Methods
Twenty-six patients underwent cranioplasty with CAD/CAM titanium implants (mean diameter 112 mm). With the aid of visual analog scales, the patients' pain and cosmesis were evaluated 6–12 years (mean 8.1 years) after insertion of the implants.
Results
None of the implants had to be removed. Of all patients, 68% declared their outcomes as excellent, 24% as good, 0.8% as fair, and 0% as poor. There was no resulting pain in 84% of the patients, and 88% were satisfied with the cosmetic result, noting > 75 mm on the visual analog scale of cosmesis. All patients would have chosen cranioplasty again, stating an improvement in their quality of life by the calvarial reconstruction. Nevertheless, follow-up images obtained in 4 patients undergoing removal of meningiomas was only suboptimal.
Conclusions
With the aid of CAD technology, all currently used alloplastic materials are suited even for large skull defect cranioplasty. Analysis of the authors' data and the literature shows that cranioplasty with CAD/CAM titanium implants provides the lowest rate of complications, reasonable costs, and acceptable postoperative imaging. Polymethylmethacrylate is suited for primary cranioplasty or for long-term follow-up imaging of tumors. Titanium implants seem to be the material of choice for secondary cranioplasty of large skull defects resulting from decompressive craniectomy after trauma or infarction. Expensive HA-based ceramics show no obvious advantage over titanium or PMMA.
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Affiliation(s)
| | - Martin Klein
- 2Maxillofacial Surgery, Clinical Navigation and Robotics, Charité-Universitätsmedizin Berlin, Germany
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Kakigi A, Taguchi D, Takeda T. Mastoid obliteration using calcium phosphate bone paste with an artificial dermis soaked with basic fibroblast growth factor: Preliminary clinical report. Auris Nasus Larynx 2009; 36:15-9. [DOI: 10.1016/j.anl.2008.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 01/09/2008] [Accepted: 01/24/2008] [Indexed: 11/26/2022]
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Uygur F, Ulkür E, Pehlivan O, Celiköz B. Soft tissue necrosis following using calcium phosphate cement in calcaneal bone cyst: case report. Arch Orthop Trauma Surg 2008; 128:1397-401. [PMID: 18058113 DOI: 10.1007/s00402-007-0534-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2007] [Indexed: 11/29/2022]
Abstract
Calcium phosphate cements have received widespread attention for their possible role as bone-grafting material and bone fillers in skeletal defects. They were evaluated as a biomaterial in many aspects. No serious harmful effects such as foreign body reaction and tissue necrosis against to calcium phosphate cements have been reported yet. They were accepted as highly biocompatible materials. In this paper, we represent a patient who had soft tissue necrosis around lateral malleolar region, following using percutaneous calcium phosphate cement as a filler bone substitute in calcaneus bone cyst. The possible mechanisms were discussed.
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Affiliation(s)
- Fatih Uygur
- Department of Plastic and Reconstructive Surgery and Burn Unit, Gülhane Military Medical Academy and Medical Faculty, Haydarpasha Training Hospital, Selimiye Mahallesi Tibbiye Caddesi 34 668, Usküdar, Istanbul, Turkey.
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Greene AK, Warren SM, McCarthy JG. Onlay frontal cranioplasty using wire reinforced methyl methacrylate. J Craniomaxillofac Surg 2008; 36:138-142. [DOI: 10.1016/j.jcms.2007.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 05/21/2007] [Indexed: 11/24/2022] Open
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Vahtsevanos K, Triaridis S, Patrikidou A, Uttley D, Moore AJ, Bell A, Stapleton S, Archer DJ. The Atkinson Morley's Hospital joint neurosurgical – maxillofacial procedures: Cranioplasty case series 1985–2003. J Craniomaxillofac Surg 2007; 35:336-42. [DOI: 10.1016/j.jcms.2007.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 06/05/2007] [Indexed: 11/28/2022] Open
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Kitano M, Taneda M. Icing and multilayering technique of injectable hydroxyapatite cement paste for cranial base reconstruction after transsphenoidal surgery: technical note. Neurosurgery 2007; 61:E53-4; discussion E54. [PMID: 17876222 DOI: 10.1227/01.neu.0000289713.80178.ce] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Injectable hydroxyapatite cement (HAC, Biopex; Mitsubishi Pharma Corp., Osaka, Japan) can reconstruct the accurate contour of bone defects intraoperatively, and it is slowly replaced with bone by a process of resorption and osteoconduction, making it a useful substrate for the repair of cranial defects. In the operative site with continuous oozing of the cerebrospinal fluid, however, the implanted HAC may be dissolved and washed out as a result of its water solubility during the setting time. For successful reconstruction of cranial defects in such wet situations, we describe a new technique to reinforce the implanted HAC with a multilayered application. METHODS As a preliminary experiment, we observed that the setting process of the HAC was severely restricted by the environmental temperature. At a temperature of 5 degrees C, the initial setting time of the HAC could be extended to 10 hours after the beginning of the mixing of the HAC. Bone defects of the sellar floor after transsphenoidal surgery for pituitary adenomas, craniopharyngiomas, meningiomas, or suprasellar arachnoid cysts were reconstructed using the HAC in 55 patients during a 5-year period. The results and complications were obtained through retrospective review. RESULTS Ninety-eight percent of bone defects were successfully repaired using the HAC, and the reconstruction remained stable over the course of this study. There was one case of postoperative cerebrospinal fluid leakage. Wound infection occurred in one patient, which required reoperation and removal of the biomaterial. CONCLUSION The icing and multilayering method for proper use of this biomaterial resulted in restoration of the integrity of the cranial base bone and a decrease of cerebrospinal fluid leakage as a postoperative complication of transsphenoidal surgery. HAC is a biomaterial that is recommended to be used as the primary method for reconstructing cranial base bone defects.
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Affiliation(s)
- Masahiko Kitano
- Department of Neurosurgery, Kinki University School of Medicine, Osaka, Japan.
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Itthichaisri C, Wiedmann-Al-Ahmad M, Huebner U, Al-Ahmad A, Schoen R, Schmelzeisen R, Gellrich NC. Comparativein vitro study of the proliferation and growth of human osteoblast-like cells on various biomaterials. J Biomed Mater Res A 2007; 82:777-87. [PMID: 17326141 DOI: 10.1002/jbm.a.31191] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In vitro studies about the growth behavior of osteoblasts onto biomaterials is a basic knowledge and a screening method for the development and application of scaffolds in vivo. In this in vitro study human osteoblast-like (HOB) cells were cultured on seven different biomaterials used in dental and craniomaxillofacial surgery, respectively. The tested biomaterials were synthetic biodegradable (MacroPore, Ethisorb, PDS, Beriplast P) and nonbiodegradable polymers (Palacos) as well as calcium phosphate cement (BoneSource) and titanium. The cell proliferation and cell colonization were analyzed by scanning electron microscopy and EZ4U-test. Statistical analysis were performed. HOB-like cells cultivated on Ethisorb showed the highest proliferation rate. The proliferation rate was statistically significant compared with Palacos, MacroPore, and BoneSource. Whereas, Beriplast, PDS, and titanium yielded lower proliferation rates. However, there was no statistically significant difference compared with Palacos, MacroPore, and BoneSource. SEM analysis showed no significant difference in individual cell features and cell colonization. But an infiltration and a growth of HOB-like cells throughout the porous structure of Ethisorb, which is formed by crossing fibers, is a striking different feature (macrotopography). This feature can explain the highest proliferation rate of Ethisorb. The results showed that HOB-like cells appear to be sensitive to substrate composition and topography. Moreover, the basis for further studies with such biomaterial/osteoblast constructs in vivo are provided. Further focusing points are developing techniques to fabricate three-dimensional porous biomaterial/cell constructs, studying the tissue reaction and the bone regeneration of such constructs compared with the use of autologous bone.
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Affiliation(s)
- C Itthichaisri
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Universität Freiburg, Hugstetterstrasse 55, D-79106 Freiburg, Germany
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Staffa G, Nataloni A, Compagnone C, Servadei F. Custom made cranioplasty prostheses in porous hydroxy-apatite using 3D design techniques: 7 years experience in 25 patients. Acta Neurochir (Wien) 2007; 149:161-70; discussion 170. [PMID: 17242849 DOI: 10.1007/s00701-006-1078-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Accepted: 10/31/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND None of the materials currently used to reconstruct skull defects is fully satisfactory. Their biological and physical properties are very different to those of natural bone. Solid state, high porosity hydroxy-apatite (HA) seems to be a good support for bone regeneration within the prostheses, enabling integration of the heterologous material with low post-implant infective risk. MATERIALS AND METHODS A model of the cranium of each patient was made in epoxy resin by stereolithography. The prosthesis was built on this model using a ceramic sintering process. In each case, an exact copy of the missing bone flap was obtained (curvature, dimensions, margins, irregularities and thickness). The porosity obtained is the same as that of the spongy bone of the skull with interconnected macropores (>150 microm) to promote osteoblast migration into the prosthetic core. In The Neurosurgery Division of Cesena, 26 cranioplasty prostheses have been implanted with this technique in 7 years (from 1998 to 2004). No particular criteria were pre-established, but the main indications for use of ceramic prostheses were complex and/or extended (surface >25 cm(2)) post-surgery craniolacuna and/or previous unsuccessful procedures due to rejection, infection or bone flap reabsorption. RESULTS Twenty-five patients were included in this study. A clinical check-up and 3D CT (mean follow-up 30 months, range 12-79) always showed an excellent aesthetic result. No cases of infection, rejection or spontaneous prosthesis fragmentation were found. The surgical procedure was simpler and shorter than for other described procedures. CONCLUSIONS Bioceramic porous hydroxy-apatite prosthesis have been demonstrated as a valid alternative to traditional cranioplasty techniques both aesthetically and in terms of absence of infections/rejections. Principal limitations for the use of HA prostheses are the need for stereolithography process, the poor malleability of the material and the high cost.
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Affiliation(s)
- G Staffa
- Division of Neurotraumatology, Presidio Ospedaliero Bufalini, Cesena, Italy.
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Gómez G, Korkiakoski S, González MM, Länsman S, Ellä V, Salo T, Kellomäki M, Ashammakhi N, Arnaud E. Effect of FGF and Polylactide Scaffolds on Calvarial Bone Healing With Growth Factor on Biodegradable Polymer Scaffolds. J Craniofac Surg 2006; 17:935-42. [PMID: 17003623 DOI: 10.1097/01.scs.0000231624.87640.55] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Repair of bone defects remains a major concern in reconstructive surgery. Synthetic biodegradable polymers have been used as scaffolds for guided bone regeneration. Fibroblast growth factors (FGFs) promote cell growth, differentiation, and tissue maintenance factors. They can stimulate the proliferation of osteogenic cells and chondrocytes, and also promote angiogenesis. Acidic and basic fibroblast growth factors (FGF-1 and FGF-2, respectively) are the best known members of this protein family. To evaluate the healing of experimental bone defects using poly-L/D-lactide (PLDLA) 96/4 scaffolds and FGF-1, 18 adult rats were operated on. A 6-mm diameter critical size defect (CSD) was made in the calvarial bone of each rat. The animals were divided into three treatment groups: 1) Neither scaffold nor FGF was used (control group); 2) scaffold only; and 3) scaffold with FGF-1. Follow-up time was eight weeks. Samples were embedded in methylmethacrylate and 5-microm thick sections from the middle of each specimen were stained with modified Masson-Goldner method. The shape and size of defects were evaluated radiologically. New bone formation was measured histologically and histomorphometrically. Radiologically, in the control group the shape of the defects changed from round to oval and edges were blunt. In the other groups the defects were round with sharp edges. Histomorphometrically, mean surface area of bone trabeculae was 1.05 mm (SD +/- 0.25) in group 1 (no implant), 1.35 mm (SD +/- 0.52) in group 2 (implant) and 0.79 mm (SD +/- 0.34) in group 3 (implant and FGF-1). Histological examinations revealed no or little osteoid in the groups 1 and 2, whereas in the group 3 samples had little or moderate new bone formation. Accordingly, no clear benefit of using knitted PLDLA scaffolds combined with FGF-1 on the healing of calvarial critical size defects in rats could be demonstrated.
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Affiliation(s)
- García Gómez
- Department of Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain
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Sheikh BY. Simple and safe method of cranial reconstruction after posterior fossa craniectomy. ACTA ACUST UNITED AC 2006; 65:63-6. [PMID: 16378862 DOI: 10.1016/j.surneu.2005.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 03/14/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Reconstructing the posterior fossa after surgical intervention in this region is important both for prevention of postoperative complication such as headache and for cosmetic purposes. Several methods have been reported that use either synthetic or natural graft, the latter being either autograft or allograft. The previously described methods require either surgical intervention on a second setting or an additional procedure that prolongs the time of the surgery and may contribute to morbidity. The present report describes a simple modified method of reconstructing the postcraniectomy defect by using the patients' own bone dust, tissue glue, and gel foam sheets. METHODS The method of reconstruction requires collection of as much as possible of the produced bone dust at the time of craniectomy, adding tissue glue, placing in between 2 sheets of gel foam, and shaping it to match the surgical defect. RESULTS Ten cases of various posterior fossa pathologies managed at King Faisal hospital of the university between January 2000 and September 2004 had reconstruction of the posterior fossa after craniectomy during the same operative setting using the described method of cranial reconstruction. No complication was noted. Patients did not have any delayed postcraniectomy pain at reconstruction site. Postoperative plane x-ray of the skull and computed tomography showed good healing and shaping of the suboccipital bone at the surgical defect. CONCLUSIONS Reconstructive cranioplasty is an important part of any posterior fossa exposure. The present report describes a safe and simple method that gives acceptable results both clinically and radiologically.
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Affiliation(s)
- Bassem Y Sheikh
- Department of Neurosurgery, King Faisal University, Dammam 40040, Saudi Arabia; Department of Neurosurgery, King Fahd Hospital, Jeddah, 21382, Saudi Arabia.
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Abstract
Reconstruction of craniofacial bony deficiencies, whether acquired through trauma or as a result of treatment for disease, is a chronic problem. Although numerous approaches utilizing a wide array of materials ranging from alloplastic materials to autogenous bone grafts have been employed to achieve bony replacement, no ideal clinical approach exists. In this brief review, we will provide an overview of current approaches to treating craniofacial bony defects. We will then discuss advances being made in the design of scaffolding materials and potential candidate cell types with which to design tissue-engineered constructs for craniofacial skeletal repair.
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Affiliation(s)
- R P Nacamuli
- Children's Surgical Research Program, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, CA 94305, USA
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Abstract
The gold standard for closing small cranial defects is autogenous bone: iliac crest, rib, or split calvarial grafts. Autogenous grafts result in donor site morbidity, increased operative time, blood loss, and additional cost, and they are limited in quantity. Hydroxyapatite cements are alternative bone substitutes that eliminate these restrictions. Although the use of hydroxyapatite is well accepted in completely developed crania, its use in the growing pediatric skull is limited. The purpose of the current study was to address the safety and long-term efficacy of this bone substitute for the repair of craniofacial bone defects in the growing pediatric skull. Safety is measured dually by resistance of bone substitute to infection and its tolerability by lack of a foreign body reaction. Efficacy is evaluated as structural skull integrity, volume stability with time, aesthetic quality, and most importantly, the ability to integrate adequately into a growing cranium without subsequent deformity or complications. This is a retrospective review of all pediatric patients at the authors' institution who underwent reconstruction of cranial defects using hydroxyapatite cement between May 1997 and March 2001. Eight patients who underwent 11 operations between the ages of 25 and 100 months (mean, 55 months) were followed up between 23 and 72 months (mean, 38 months). No mortalities or significant morbidities were encountered in the study population. It has been the authors' experience that hydroxyapatite cement is both biocompatible and resistant to infection when used in sites not contiguous with sinus mucosa; and that it is a good alternative to autogenous bone in pediatric craniofacial reconstruction.
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Affiliation(s)
- Lisa David
- Department of Plastic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC 27157-1075, USA.
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Gómez E, Martín M, Arias J, Carceller F. Clinical applications of Norian SRS (calcium phosphate cement) in craniofacial reconstruction in children: our experience at Hospital La Paz since 2001. J Oral Maxillofac Surg 2005; 63:8-14. [PMID: 15635550 DOI: 10.1016/j.joms.2004.09.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The reconstructive surgeon has been searching for an ideal material to use in the reconstruction of craniofacial deformities. Although bone graft presents most of the ideal properties, its limited availability and donor-site morbidity makes its use compromised in some patients, especially in pediatric patients. In the search of this ideal material, calcium phosphate cements have shown promising results in patients with craniofacial deformities, because of its unlimited availability, avoidance of donor-site morbidity, and long-term maintenance. MATERIALS AND METHODS We report our experience at the Pediatric Division of Maxillofacial Surgery Department, Hospital La Paz, Madrid, since 2001, in the use of Norian SRS (calcium phosphate cement; Norian, Cupertino, CA) for the treatment of secondary craniofacial deformities. Clinical charts are retrospectively reviewed, paying attention to gender, age, pathologic conditions, previous surgeries, and the clinical applications of this kind of calcium phosphate cement. Complications are also reviewed. RESULTS Five patients have been treated for different craniofacial malformations, using Norian SRS as a part of the surgical procedure. The main indication was frontal and cranial irregularities. Temporal hollowing was also reconstructed with the calcium phosphate cement. All patients, except for 1, recuperated successfully. One patient suffered a wound dehiscence with subsequent infection of the material. CONCLUSION Norian SRS offers craniofacial surgeons an option in the treatment of pediatric patients with diverse craniofacial malformations, although special attention must be paid to the risk of infections in selected patients.
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Wurm G, Tomancok B, Holl K, Trenkler J. Prospective study on cranioplasty with individual carbon fiber reinforced polymer (CFRP) implants produced by means of stereolithography. ACTA ACUST UNITED AC 2004; 62:510-21. [PMID: 15576119 DOI: 10.1016/j.surneu.2004.01.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2003] [Accepted: 01/22/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the value of carbon fiber reinforced polymer (CFRP) cranial implants produced by means of 3-dimensional (3D) stereolithography (SL) and template modeling for reconstructions of complex or extensive cranial defects. PATIENTS A series of 41 cranioplasties with individual CFRP implants was performed in 37 patients between April 1996 and November 2002. Only patients with complex and/or large cranial defects were included, most of them having extended scarring or dural calcification and poor quality of the overlying soft-tissue cover after infection or multiple preceding operations. Involvement of frontal sinus, a known risk factor for complications after cranioplasty, was the case in 21 patients (51.2%). METHODS A computer-based 3D model of the skull with the bony defect was generated by means of stereolithography after acquisition, evaluation and transfer of the patient's helical computed tomography (CT) data. A wax template of the defect that was used to design the individual prosthesis-shape was invested in dental stone. Then, the cranial implant was fabricated out of CFRP by loosen mold. RESULTS Reconstruction of defects measuring up to 17 x 9 cm was performed. The intra-operative fit of the implants was excellent in 36 (87.8%), good in 1 (2.4%), and fair in 4 (9.8%) of the cases. Problems of implant fit occurred because of extended scarring and poor quality of soft-tissue cover. Adverse reactions were observed in 5 patients (1 subdural, 1 subcutaneous hematoma, 2 infections, 1 allergic reaction). Excellent contours and a solid stable reconstruction have been maintained in 30 out of 35 remaining plates (mean follow-up 3.6 years). No adverse effects concerning postoperative imaging, the accuracy of electroencephalograms and radiation therapy have been observed. CONCLUSIONS The authors believe that this relatively new technique represents an advance in the management of complex and large cranial defects, but seems less suitable for simple defects because of cost-intensive techniques. Because of the high mechanical strength, biocompatibility, innovative design, and especially radiolucency, CFRP implants should, however, be considered in smaller defects if further imaging investigations or irradiation therapies are necessary.
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Affiliation(s)
- Gabriele Wurm
- Department of Neurosurgery, Landesnervenklinik Wagner Jauregg, Linz, Austria
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Vougioukas VI, Hubbe U, van Velthoven V, Freiman TM, Schramm A, Spetzger U. Neuronavigation-assisted cranial reconstruction. Neurosurgery 2004; 55:162-7; discussion 167. [PMID: 15214985 DOI: 10.1227/01.neu.0000126940.20441.e7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2002] [Accepted: 02/10/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cranial defects resulting from congenital deformities, ablative resection of osseous tumors, traumatic injury, and destructive infectious lesions are often severe enough to warrant surgical reconstruction. In particular cases, satisfactory cosmetic results may be difficult to achieve because of the extent and location of the lesion. METHODS We evaluated the role of neuronavigation for reconstruction of large cranial defects with prefabricated titanium and intraoperatively constructed neuronavigation-assisted polymethylmethacrylate implants. RESULTS Neuronavigation-assisted cranial reconstruction was performed in 14 patients. Surgical procedure, illustrative cases, postoperative results, and apparent benefits of the technique are presented and discussed. In all patients, excellent cosmetic results were achieved. CONCLUSION In cranial reconstruction, neuronavigation is of value not only for intraoperative determination of resection margins but also for preoperative assessment and planning. The combination of navigation techniques with prefabricated or intraoperatively constructed implants enables achievement of excellent cosmetic results.
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Affiliation(s)
- Vassilios I Vougioukas
- Department of Neurosurgery, Albert-Ludwigs University of Freiburg, Freiburg im Breisgau, Germany.
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Apelt D, Theiss F, El-Warrak AO, Zlinszky K, Bettschart-Wolfisberger R, Bohner M, Matter S, Auer JA, von Rechenberg B. In vivo behavior of three different injectable hydraulic calcium phosphate cements. Biomaterials 2004; 25:1439-51. [PMID: 14643619 DOI: 10.1016/j.biomaterials.2003.08.073] [Citation(s) in RCA: 216] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Two dicalcium phosphate dihydrate (DCPD) hydraulic cements and one apatite hydraulic cement were implanted in epiphyseal and metaphyseal, cylindrical bone defects of sheep. The in vivo study was performed to assess the biocompatibility of the DCPD cements, using the apatite cement as control. After time periods of 2, 4 and 6 months the cement samples were clinically and histologically evaluated. Histomorphometrically the amount of new bone formation, fibrous tissue and the area of remaining cement were measured over time. In all specimens, no signs of inflammation were detectable either macroscopically or microscopically. All cements were replaced by different amounts of new bone. The two DCPD-cements showed the highest new bone formation and least cement remnants at 6 months, whereas the apatite was almost unchanged over all time periods.
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Affiliation(s)
- D Apelt
- MSRU, Equine Department, Faculty of Veterinary Medicine, University of Zurich, Winterthurerstr. 260, CH-8057 Zurich, Switzerland
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Abstract
This report describes a simple technique for augmentation rhinoplasty using calcium phosphate cement paste for postoperative and posttraumatic nasal deformities. This biomaterial was used to correct traumatic nasal bone deformity in one patient and for augmentation rhinoplasty after removal of the nasal implant in two patients. These patients were followed for a minimum 6 months and a maximum of 26 months. The esthetic results were satisfactory with no complication. Calcium phosphate cement consisting of alpha-tricalcium phosphate, dicalcium phosphate dibasic, and tetracalcium phosphate monoxide has been used for bone replacement and augmentation because of its good biocompatibility and osteoconductivity. This technique is easy and safe. It seems to be a suitable material for augmentation rhinoplasty in the Orient. Its long-term safety and reliability require proof with longer follow-up periods, however.
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Affiliation(s)
- Emi Okada
- Department of Plastic and Reconstructive Surgery, Toho University School of Medicine, Tokyo, Japan.
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Schliephake H, Gruber R, Dard M, Wenz R, Scholz S. Repair of calvarial defects in rats by prefabricated hydroxyapatite cement implants. ACTA ACUST UNITED AC 2004; 69:382-90. [PMID: 15127384 DOI: 10.1002/jbm.a.20121] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of the present study was to test the hypothesis that calvarial defects can be repaired by using preformed implants of calcium phosphate bone cement (CPBC) in rats. Sixty adult female Sprague-Dawley rats received full-thickness calvarial nonhealing defects with a diameter of 8 mm. Three different CPBCs were used: group 1: tetracalcium phosphate-based powder; group 2: a blend of amorphous and crystalline calcium phosphate precursors; and group 3: an alpha-tricalcium phosphate (alpha-TCP)-based powder. Implants were left to cure for 25-40 min at room temperature in a silicon mold of 7.9 mm and inserted press fit into the defects. Fifteen animals served as unfilled controls. After 13, 26, and 52 weeks, the material was analyzed qualitatively by using surface-stained undecalcified thick-section specimens and quantitatively by using semiautomated histometry. Kruskal-Wallis tests were applied to compare mean values of periimplant bone formation at a significance level of p < 0.05. Three implants of group 1 fractured during insertion. Resorption of CPBC without complementary bone formation was noticed in these implants. Unfractured implants were resorbed with simultaneous apposition of bone on the implant surface. After 52 weeks, the resorption rate varied between 23.1 and 39.3%. Periimplant bone formation increased continuously on average around all implant types, but it reached statistical significance only in group 2. The results showed that repair of calvarial defects can be achieved by preformed CPBC implants. The rate of resorption of preformed implants is, however, much lower than that reported for in vivo cured CPBC.
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Affiliation(s)
- H Schliephake
- Department of Oral and Maxillofacial Surgery, George-Augusta-University, Goettingen, Germany.
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Cebrián-Carretero JL, Pérez-López C, Alvarez F, Sarmiento MA, del Castillo JL, Muñoz-Caro JM. Reconstrucción craneal mediante malla de titanio y cemento de apatita carbonatada. Neurocirugia (Astur) 2004; 15:571-5; discussion 575-7. [PMID: 15632993 DOI: 10.1016/s1130-1473(04)70446-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the case of a 45 year old patient who was affected by an infectious disease of the temporal bone, after the surgical treatment of a meningioma in the greater sphenoid wing. This infection healed after the resection of the craniotomy flap. The remaining bone defect was reconstructed using a titanium mesh covered by hydroxyapatite cement (Norian). The result was excellent due to the strength of the titanium mesh and the volume and contour offered by the hydroxyapatite cement.
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Durham SR, McComb JG, Levy ML. Correction of large (>25 cm(2)) cranial defects with "reinforced" hydroxyapatite cement: technique and complications. Neurosurgery 2003; 52:842-5; discussion 845. [PMID: 12657179 DOI: 10.1227/01.neu.0000054220.01290.8e] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Accepted: 12/04/2002] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hydroxyapatite cement is both biocompatible and osteoconductive, and it lacks significant toxic or immunogenic properties, making it an ideal substrate for the repair of cranial defects. However, with its putty-like composition, the repair of large cranial defects can be difficult because significant settling occurs as the cement hardens. We describe a technique in which we use hydroxyapatite cement, reinforced with tantalum mesh and titanium miniplates, for the repair of large (>25 cm(2)) cranial defects. METHODS After the margins of the cranioplasty are delineated, tantalum mesh is placed under the edges of the defect. Titanium miniplate single-hole bars are used to criss-cross the defect and are then secured to the surrounding bone with screws. The mesh is secured to the bars with 28-gauge stainless steel wire. Hydroxyapatite cement is applied in the defect and contoured appropriately. RESULTS We performed nine cranioplasties in eight patients ranging in age from 1.5 to 35 years (mean, 12.2 +/- 10.1 yr). The reasons for cranioplasty included cranial defect from prior trauma (n = 4), fibrous dysplasia (n = 2), infected bone flaps (n = 2), and tumor (n = 1). The cranioplasties ranged in size from 40 to 196 cm(2) (mean, 128.3 +/- 56.9 cm(2)). Follow-up ranged from 2 to 33 months (mean, 11.4 +/- 12.8 mo). Two cranioplasty constructs were removed at 1 and 3 months postoperatively owing to infection. CONCLUSION The use of hydroxyapatite cement with mesh and miniplates provides internal structural support and increased stability of the construct. Although this technique provides an excellent cosmetic result and no evidence to date of bony resorption, the rate of infection is alarmingly high in these large constructs.
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Affiliation(s)
- Susan R Durham
- Department of Neurosurgery, Oregon Health and Science University, Portland 97201-3098, USA
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Eppley BL. Hydroxyapatite cranioplasty: I. Experimental results from a new quick-setting material. J Craniofac Surg 2003; 14:85-8. [PMID: 12544227 DOI: 10.1097/00001665-200301000-00015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The biophysical characteristics of a new formulation of hydroxyapatite (HA) for craniofacial applications having a rapid set time was evaluated in animals. Using a mature rabbit model, the material was applied in both cranial defects and as a geometrically shaped cranial onlay. Visual and histological assessment was done after 1 year of implantation. The material remained morphologically stable after 1 year, with complete preservation of its onlay shape and stable fill of the cranial defects. A significant osteoconductive response was seen with bone growth across the inner and outer surfaces of the inlays and along the sides of the onlays. No fibrovascular ingrowth or bony replacement of the material itself was evident as a result of the age of the study animals or the compact density of the material. This rapid-setting HA formulation offers similar favorable tissue responses as those of other longer setting HA materials.
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Affiliation(s)
- Barry L Eppley
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis 46202, USA.
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Kubo S, Takimoto H, Kato A, Yoshimine T. Endoscopic Cranioplasty with Calcium Phosphate Cement for Pterional Bone Defect after Frontotemporal Craniotomy: Technical Note. Neurosurgery 2002. [DOI: 10.1227/00006123-200210000-00046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kubo S, Takimoto H, Kato A, Yoshimine T. Endoscopic cranioplasty with calcium phosphate cement for pterional bone defect after frontotemporal craniotomy: technical note. Neurosurgery 2002; 51:1094-6; discussion 1096. [PMID: 12234424 DOI: 10.1097/00006123-200210000-00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2002] [Accepted: 05/21/2002] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Postoperative pterional depression is a minor but unpleasant sequela of frontotemporal craniotomy. We developed a simple method for repair of this condition with the use of an endoscope and calcium phosphate cement. METHODS The cranial defect was approached by means of endoscopic visualization through a small incision within the hairline. The defect was repaired with an injectable calcium phosphate cement. RESULTS The bone defect was easily accessed and readily repaired in all five patients. No adverse reactions to the implant were observed. Satisfactory cosmetic results were obtained in all patients treated with the use of this method. CONCLUSION This minimally invasive cranioplasty technique proved to be effective for the repair of the postoperative pterional defect.
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Affiliation(s)
- Shigeki Kubo
- Department of Neurosurgery, Osaka Neurological Institute, Japan.
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