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März V, Vogt PM, Schlottmann F. [Reconstruction options for infection-related defects : Plastic surgery armamentarium]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:567-572. [PMID: 38748218 DOI: 10.1007/s00113-024-01439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The occurrence of infections has always been feared in all surgical disciplines. Plastic reconstructive surgery faces the challenge of treating infection-related defects on a patient-specific basis, which requires a multidisciplinary treatment concept. Satisfactory treatment success can only be achieved through radical debridement for infection cleansing, optimization of the perfusion situation paired with targeted anti-infective treatment and, if necessary, with soft tissue reconstruction by plastic surgery. OBJECTIVE This article presents the current possibilities of plastic and reconstructive surgery with respect to the reconstruction of infection-related defects. MATERIAL AND METHODS Proven and reliable strategies are presented and supplemented by promising experimental approaches. RESULTS Due to the often multilayered defect situation caused by infections, from the epidermis to cancellous bone, the entire armamentarium of plastic and reconstructive surgery is used for reconstruction. CONCLUSION The early involvement of plastic surgery in the treatment of infections and the interdisciplinary and multimodal treatment approach have proven their worth in the treatment of complex infection situations.
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Affiliation(s)
- Vincent März
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Peter M Vogt
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Frederik Schlottmann
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Thunich S, Krezdorn N. [Secondary defect coverage and functional reconstruction]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:573-581. [PMID: 38981982 DOI: 10.1007/s00113-024-01451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 07/11/2024]
Abstract
Secondary reconstruction in trauma surgery is crucial for restoring both functional and esthetic results in patients with complex defects. Established reconstructive techniques in plastic surgery offer a wide range of options for an effective treatment. This applies not only to covering large defects with free flaps but especially also for the functional reconstruction of bony, neural and musculotendinous impairments. Advances in the fields of microsurgery and 3D printing show innovative approaches to further improve the therapeutic options. A multidisciplinary approach, requiring close collaboration between trauma and plastic surgeons, is necessary to optimize treatment plans and outcomes. The effective management of complications and qualified postoperative care are essential for the success of reconstructive measures.
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Affiliation(s)
- Stephan Thunich
- Abteilung für Plastische- und Brustchirurgie, Seeland Universitätsklinik, Sygehusvej 10, 4000, Roskilde, Dänemark
| | - Nicco Krezdorn
- Abteilung für Plastische- und Brustchirurgie, Seeland Universitätsklinik, Sygehusvej 10, 4000, Roskilde, Dänemark.
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland.
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Manescu (Paltanea) V, Antoniac I, Antoniac A, Laptoiu D, Paltanea G, Ciocoiu R, Nemoianu IV, Gruionu LG, Dura H. Bone Regeneration Induced by Patient-Adapted Mg Alloy-Based Scaffolds for Bone Defects: Present and Future Perspectives. Biomimetics (Basel) 2023; 8:618. [PMID: 38132557 PMCID: PMC10742271 DOI: 10.3390/biomimetics8080618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Treatment of bone defects resulting after tumor surgeries, accidents, or non-unions is an actual problem linked to morbidity and the necessity of a second surgery and often requires a critical healthcare cost. Although the surgical technique has changed in a modern way, the treatment outcome is still influenced by patient age, localization of the bone defect, associated comorbidities, the surgeon approach, and systemic disorders. Three-dimensional magnesium-based scaffolds are considered an important step because they can have precise bone defect geometry, high porosity grade, anatomical pore shape, and mechanical properties close to the human bone. In addition, magnesium has been proven in in vitro and in vivo studies to influence bone regeneration and new blood vessel formation positively. In this review paper, we describe the magnesium alloy's effect on bone regenerative processes, starting with a short description of magnesium's role in the bone healing process, host immune response modulation, and finishing with the primary biological mechanism of magnesium ions in angiogenesis and osteogenesis by presenting a detailed analysis based on a literature review. A strategy that must be followed when a patient-adapted scaffold dedicated to bone tissue engineering is proposed and the main fabrication technologies are combined, in some cases with artificial intelligence for Mg alloy scaffolds, are presented with examples. We emphasized the microstructure, mechanical properties, corrosion behavior, and biocompatibility of each study and made a basis for the researchers who want to start to apply the regenerative potential of magnesium-based scaffolds in clinical practice. Challenges, future directions, and special potential clinical applications such as osteosarcoma and persistent infection treatment are present at the end of our review paper.
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Affiliation(s)
- Veronica Manescu (Paltanea)
- Faculty of Material Science and Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania; (V.M.); (A.A.); (R.C.)
- Faculty of Electrical Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania; (G.P.); (I.V.N.)
| | - Iulian Antoniac
- Faculty of Material Science and Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania; (V.M.); (A.A.); (R.C.)
- Academy of Romanian Scientists, 54 Splaiul Independentei, RO-050094 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania; (V.M.); (A.A.); (R.C.)
| | - Dan Laptoiu
- Department of Orthopedics and Trauma I, Colentina Clinical Hospital, 19-21 Soseaua Stefan cel Mare, RO-020125 Bucharest, Romania;
| | - Gheorghe Paltanea
- Faculty of Electrical Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania; (G.P.); (I.V.N.)
| | - Robert Ciocoiu
- Faculty of Material Science and Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania; (V.M.); (A.A.); (R.C.)
| | - Iosif Vasile Nemoianu
- Faculty of Electrical Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania; (G.P.); (I.V.N.)
| | - Lucian Gheorghe Gruionu
- Faculty of Mechanics, University of Craiova, 13 Alexandru Ioan Cuza, RO-200585 Craiova, Romania;
| | - Horatiu Dura
- Faculty of Medicine, Lucian Blaga University of Sibiu, RO-550169 Sibiu, Romania;
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Laubach M, Hildebrand F, Suresh S, Wagels M, Kobbe P, Gilbert F, Kneser U, Holzapfel BM, Hutmacher DW. The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective. J Funct Biomater 2023; 14:341. [PMID: 37504836 PMCID: PMC10381286 DOI: 10.3390/jfb14070341] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
The treatment of bone defects remains a challenging clinical problem with high reintervention rates, morbidity, and resulting significant healthcare costs. Surgical techniques are constantly evolving, but outcomes can be influenced by several parameters, including the patient's age, comorbidities, systemic disorders, the anatomical location of the defect, and the surgeon's preference and experience. The most used therapeutic modalities for the regeneration of long bone defects include distraction osteogenesis (bone transport), free vascularized fibular grafts, the Masquelet technique, allograft, and (arthroplasty with) mega-prostheses. Over the past 25 years, three-dimensional (3D) printing, a breakthrough layer-by-layer manufacturing technology that produces final parts directly from 3D model data, has taken off and transformed the treatment of bone defects by enabling personalized therapies with highly porous 3D-printed implants tailored to the patient. Therefore, to reduce the morbidities and complications associated with current treatment regimens, efforts have been made in translational research toward 3D-printed scaffolds to facilitate bone regeneration. Three-dimensional printed scaffolds should not only provide osteoconductive surfaces for cell attachment and subsequent bone formation but also provide physical support and containment of bone graft material during the regeneration process, enhancing bone ingrowth, while simultaneously, orthopaedic implants supply mechanical strength with rigid, stable external and/or internal fixation. In this perspective review, we focus on elaborating on the history of bone defect treatment methods and assessing current treatment approaches as well as recent developments, including existing evidence on the advantages and disadvantages of 3D-printed scaffolds for bone defect regeneration. Furthermore, it is evident that the regulatory framework and organization and financing of evidence-based clinical trials remains very complex, and new challenges for non-biodegradable and biodegradable 3D-printed scaffolds for bone regeneration are emerging that have not yet been sufficiently addressed, such as guideline development for specific surgical indications, clinically feasible design concepts for needed multicentre international preclinical and clinical trials, the current medico-legal status, and reimbursement. These challenges underscore the need for intensive exchange and open and honest debate among leaders in the field. This goal can be addressed in a well-planned and focused stakeholder workshop on the topic of patient-specific 3D-printed scaffolds for long bone defect regeneration, as proposed in this perspective review.
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Affiliation(s)
- Markus Laubach
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Sinduja Suresh
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Michael Wagels
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia;
- The Herston Biofabrication Institute, The University of Queensland, Herston, QLD 4006, Australia
- Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, QLD 4102, Australia
- Department of Plastic and Reconstructive Surgery, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia
- The Australian Centre for Complex Integrated Surgical Solutions, Woolloongabba, QLD 4102, Australia
| | - Philipp Kobbe
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Boris M. Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Dietmar W. Hutmacher
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Max Planck Queensland Centre (MPQC) for the Materials Science of Extracellular Matrices, Queensland University of Technology, Brisbane, QLD 4000, Australia
- ARC Training Centre for Cell and Tissue Engineering Technologies (CTET), Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
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