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Mommsen P, März V, Krezdorn N, Aktas G, Sehmisch S, Vogt PM, Großner T, Omar Pacha T. Reconstruction of an Extensive Segmental Radial Shaft Bone Defect by Vascularized 3D-Printed Graft Cage. J Pers Med 2024; 14:178. [PMID: 38392611 PMCID: PMC10890561 DOI: 10.3390/jpm14020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
We report here a 46-year-old male patient with a 14 cm segmental bone defect of the radial shaft after third degree open infected fracture caused by a shrapnel injury. The patient underwent fixed-angle plate osteosynthesis and bone reconstruction of the radial shaft by a vascularized 3D-printed graft cage, including plastic coverage with a latissimus dorsi flap and an additional central vascular pedicle. Bony reconstruction of segmental defects still represents a major challenge in musculo-skeletal surgery. Thereby, 3D-printed scaffolds or graft cages display a new treatment option for bone restoration. As missing vascularization sets the limits for the treatment of large-volume bone defects by 3D-printed scaffolds, in the present case, we firstly describe the reconstruction of an extensive radial shaft bone defect by using a graft cage with additional vascularization.
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Affiliation(s)
- Philipp Mommsen
- Department of Trauma Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Vincent März
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625 Hannover, Germany
- Department of Plastic and Breast Surgery, Roskilde University Hospital, 4000 Roskilde, Denmark
| | - Gökmen Aktas
- Department of Trauma Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Stephan Sehmisch
- Department of Trauma Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Peter Maria Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Tobias Großner
- BellaSeno GmbH, 04103 Leipzig, Germany
- BellaSeno Pty Ltd., Brisbane, QLD 4220, Australia
| | - Tarek Omar Pacha
- Department of Trauma Surgery, Hannover Medical School, 30625 Hannover, Germany
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Evans C, Liu FJ, Glatt V, Hoyland J, Kirker-Head C, Walsh A, Betz O, Wells J, Betz V, Porter R, Saad F, Gerstenfeld L, Einhorn T, Harris M, Vrahas M. Use of genetically modified muscle and fat grafts to repair defects in bone and cartilage. Eur Cell Mater 2009; 18:96-111. [PMID: 20073015 PMCID: PMC4382019 DOI: 10.22203/ecm.v018a09] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We report a novel technology for the rapid healing of large osseous and chondral defects, based upon the genetic modification of autologous skeletal muscle and fat grafts. These tissues were selected because they not only possess mesenchymal progenitor cells and scaffolding properties, but also can be biopsied, genetically modified and returned to the patient in a single operative session. First generation adenovirus vector carrying cDNA encoding human bone morphogenetic protein-2 (Ad.BMP-2) was used for gene transfer to biopsies of muscle and fat. To assess bone healing, the genetically modified ("gene activated") tissues were implanted into 5mm-long critical size, mid-diaphyseal, stabilized defects in the femora of Fischer rats. Unlike control defects, those receiving gene-activated muscle underwent rapid healing, with evidence of radiologic bridging as early as 10 days after implantation and restoration of full mechanical strength by 8 weeks. Histologic analysis suggests that the grafts rapidly differentiated into cartilage, followed by efficient endochondral ossification. Fluorescence in situ hybridization detection of Y-chromosomes following the transfer of male donor muscle into female rats demonstrated that at least some of the osteoblasts of the healed bone were derived from donor muscle. Gene activated fat also healed critical sized defects, but less quickly than muscle and with more variability. Anti-adenovirus antibodies were not detected. Pilot studies in a rabbit osteochondral defect model demonstrated the promise of this technology for healing cartilage defects. Further development of these methods should provide ways to heal bone and cartilage more expeditiously, and at lower cost, than is presently possible.
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Affiliation(s)
- C.H. Evans
- Center for Molecular Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Collaborative Research Center, AO Foundation,Address for correspondence Chris Evans, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, 330, Brookline Avenue RN-115, Boston MA 02215, USA, Telephone Number: +1 617-667-4621, FAX Number: +1 617-667-7175,
| | - F.-J. Liu
- Center for Molecular Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - V. Glatt
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - J.A. Hoyland
- Tissue Injury and Repair Research Group, University of Manchester, Manchester, UK
| | - C. Kirker-Head
- Orthopaedic Research Laboratory, Tufts Cummings School of Veterinary Medicine, Grafton, MA, USA
| | - A. Walsh
- Orthopaedic Research Laboratory, Tufts Cummings School of Veterinary Medicine, Grafton, MA, USA
| | - O. Betz
- Center for Molecular Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - J.W. Wells
- Center for Molecular Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - V. Betz
- Center for Molecular Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - R.M. Porter
- Center for Molecular Orthopaedics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - F.A. Saad
- Department of Orthopaedic Surgery, Children’s Hospital, Boston, MA, USA
| | - L.C. Gerstenfeld
- Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA, USA
| | - T.A. Einhorn
- Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA, USA
| | - M.B. Harris
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - M.S. Vrahas
- Collaborative Research Center, AO Foundation,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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