Effects of Surgical Angiogenesis on Segmental Bone Reconstruction With Cryopreserved Massive-Structural Allografts in a Porcine Tibia Model

The effect of surgical revascularization on the mechanical properties of cryopreserved bone allograft in a porcine tibia model

Cryopreserved bone allografts(CBA) are susceptible to infection, nonunion, and late stress fracture. Although surgical revascularization by intramedullary implantation of an arteriovenous bundle (AV bundle) generates a neoangiogenic blood supply, there is potential for vascular ingrowth-mediated bone resorption to weaken the graft. For this reason, we have evaluated changes in CBA mechanical properties of structural tibial allografts with and without surgically induced angiogenesis. Cryopreserved tibia bone allografts were transplanted to reconstruct a 3.5 cm segmental tibial defect in 16 Yucatan mini pigs. Surgical revascularization was performed in half by implantation of a cranial tibial AV bundle, (revascularization group). A control group of identical size had a ligated AV bundle implanted, (ligated group). At 20 weeks micro-computed tomography (CT) measured bone mineral density (BMD) as well as bone union. Reference point indentation (RPI) compared cortex material properties, and axial compression determined the allotransplant compressive modulus. Seven of eight tibiae in the angiogenesis group were healed at both junction points at 20 weeks. Only four of eight tibiae healed in the ligated control group. There was no significant difference between the revascularization and ligated control groups in BMD and axial compression test. Similarly, RPI parameters were statistically equal. In paired comparisons with contralateral tibias, however, some RPI values were significantly worse in the ligated control group tibiae. This study demonstrates no adverse effect of surgical angiogenesis on cryopreserved structural bone allograft biomechanical properties in a large animal orthotopic segmental tibial defect model. These data suggest the potential value of surgical angiogenesis in clinical limb-sparing reconstructive surgery.

Aspirin effect on bone remodeling and skeletal regeneration: Review article

Bone tissues are one of the most complex tissues in the body that regenerate and repair themselves spontaneously under the right physiological conditions. Within the limitations of treating bone defects, mimicking tissue engineering through the recruitment of scaffolds, cell sources and growth factors, is strongly recommended. Aspirin is one of the non-steroidal anti-inflammatory drugs (NSAIDs) and has been used in clinical studies for many years due to its anti-coagulant effect. On the other hand, aspirin and other NSAIDs activate cytokines and some mediators in osteoclasts, osteoblasts and their progenitor cells in a defect area, thereby promoting bone regeneration. It also stimulates angiogenesis by increasing migration of endothelial cells and the newly developed vessels are of emergency in bone fracture repair. This review covers the role of aspirin in bone tissue engineering and also, highlights its chemical reactions, mechanisms, dosages, anti-microbial and angiogenesis activities.

Proximal Perineural Femoral Nerve Injection in Pigs Using an Ultrasound-Guided Lateral Subiliac Approach-A Cadaveric Study

Simple Summary

Desensitizing the femoral nerve improves pain control in several species undergoing pelvic limb surgeries. Despite possible advantages, this method has not yet been described in pigs, although they make an accepted surgical animal model. We developed an approach for femoral nerve blockade using ultrasound guidance in pigs which could be useful for pain control in pigs undergoing pelvic limb surgery.

Abstract

Desensitizing the femoral nerve (FN) improves pain control in several species undergoing pelvic limb surgeries. Despite its advantages, this method has not yet been described in pigs, although they make an accepted surgical animal model. Based on anatomical dissections, first performed in two pig cadavers, an ultrasound-guided access for localization and perineural infiltration of the FN trunk at the iliopsoas compartment level was specified. The FN was found running between the psoas major and medial portion of iliac muscle. Ultrasonographically, the FN appeared as a hypoechogenic round–oval structure surrounded by a hyperechogenic rim. Technical feasibility and accuracy were assessed in six additional pig cadavers by injecting 0.15 mL kg⁻¹ methylene blue dye bilaterally in direct proximity to the nerve. The needle was inserted caudoventral to the coxal tuber, traversing the ultrasound plane as it progressed towards the FN in dorsomedial direction. Staining of the nerve was evaluated by dissection. The injection was considered effective if the nerve was stained in its entire circumference over a length of 2 cm. FNs of all investigated individuals could be successfully stained. This ultrasound-guided subiliac approach allows feasible and accurate access to the FN and may be useful in producing a successful blockade in vivo.

Matrix metalloproteinase (MMP)-degradable tissue engineered periosteum coordinates allograft healing via early stage recruitment and support of host neurovasculature

Despite serving as the clinical "gold standard" treatment for critical size bone defects, decellularized allografts suffer from long-term failure rates of ~60% due to the absence of the periosteum. Stem and osteoprogenitor cells within the periosteum orchestrate autograft healing through host cell recruitment, which initiates the regenerative process. To emulate periosteum-mediated healing, tissue engineering approaches have been utilized with mixed outcomes. While vascularization has been widely established as critical for bone regeneration, innervation was recently identified to be spatiotemporally regulated together with vascularization and similarly indispensable to bone healing. Notwithstanding, there are no known approaches that have focused on periosteal matrix cues to coordinate host vessel and/or axon recruitment. Here, we investigated the influence of hydrogel degradation mechanism, i.e. hydrolytic or enzymatic (cell-dictated), on tissue engineered periosteum (TEP)-modified allograft healing, especially host vessel/nerve recruitment and integration. Matrix metalloproteinase (MMP)-degradable hydrogels supported endothelial cell migration from encapsulated spheroids whereas no migration was observed in hydrolytically degradable hydrogels in vitro, which correlated with increased neurovascularization in vivo. Specifically, ~2.45 and 1.84-fold, and ~3.48 and 2.58-fold greater vessel and nerve densities with high levels of vessel and nerve co-localization was observed using MMP degradable TEP (MMP-TEP) -modified allografts versus unmodified and hydrolytically degradable TEP (Hydro-TEP)-modified allografts, respectively, at 3 weeks post-surgery. MMP-TEP-modified allografts exhibited greater longitudinal graft-localized vascularization and endochondral ossification, along with 4-fold and 2-fold greater maximum torques versus unmodified and Hydro-TEP-modified allografts after 9 weeks, respectively, which was comparable to that of autografts. In summary, our results demonstrated that the MMP-TEP coordinated allograft healing via early stage recruitment and support of host neurovasculature.

Recent Advances of Chitosan-Based Injectable Hydrogels for Bone and Dental Tissue Regeneration

Traditional strategies of bone repair include autografts, allografts and surgical reconstructions, but they may bring about potential hazard of donor site morbidity, rejection, risk of disease transmission and repetitive surgery. Bone tissue engineering (BTE) is a multidisciplinary field that offers promising substitutes in biopharmaceutical applications, and chitosan (CS)-based bone reconstructions can be a potential candidate in regenerative tissue fields owing to its low immunogenicity, biodegradability, bioresorbable features, low-cost and economic nature. Formulations of CS-based injectable hydrogels with thermo/pH-response are advantageous in terms of their high-water imbibing capability, minimal invasiveness, porous networks, and ability to mold perfectly into an irregular defect. Additionally, CS combined with other naturally-derived or synthetic polymers and bioactive agents has proven to be an effective alternative to autologous bone and dental grafts. In this review, we will highlight the current progress in the development of preparation methods, physicochemical properties and applications of CS-based injectable hydrogels and their perspectives in bone and dental regeneration. We believe this review is intended as starting point and inspiration for future research effort to develop the next generation of tissue-engineering scaffold materials.

Ultrasound-guided sciatic nerve block at the midthigh level in a porcine model: A descriptive study

BACKGROUND AND OBJECTIVE

There are a growing number of porcine models being used for orthopaedic experiments for human beings. Therefore, pain management of those research pigs using ultrasound (US)-guided nerve block can be usefully performed. The aim of this study is to determine optimal US approaches for accessing and localizing the sciatic nerve at the midthigh level, a relevant block site for hindlimb surgery in female Yorkshire pigs.

METHODS

As a first step, we dissected the intubated, blood-washed out pigs (n = 3) and confirmed the anatomical position of the sciatic nerve at midthigh level. After dissection, we found the sciatic nerve, connected with nerve stimulator, and checked the dorsiflexion or plantar flexion of the hindlimb. We matched the sciatic nerve location with the US image. After the pigs were euthanized, the neural structures of the sciatic nerve were confirmed by histological examination with H&E staining. In second step, a main US-guided sciatic nerve block study was done in the intubated, live pigs (n = 8) based on the above study.

RESULTS

In lateral position, the effective US-guided nerve block site was about 6 cm from the patella crease level; immediately proximal to the bifurcation of the sciatic nerve into the tibial nerve and common peroneal nerve. The distal femur was selected as the landmark. There were no vessels or other nerves surrounding the sciatic nerve. The needle-tip was positioned less than 1 cm lateral from the distal femur and about 2 cm deep to skin. 'Donut sign' in US images was confirmed in all 16 nerves.

CONCLUSIONS

Midthigh level sciatic nerve is located superficially, which enables nerve block to be easily performed using US. This is the first study to describe midthigh sciatic nerve block in the lateral position under US guidance in a porcine model from a clinical perspective.