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Ghosh YA, Xin H, Al Maruf DSA, Cheng K, Wise I, Burrows C, Gupta R, Cheung VKY, Wykes J, Leinkram D, Froggatt C, Lewin W, Kruse HV, Tomaskovic-Crook E, McKenzie DR, Crook J, Clark JR. Novel Sheep Model to Assess Critical-Sized Bone Regeneration with Periosteum for In Vivo Bioreactors. Tissue Eng Part C Methods 2024; 30:159-169. [PMID: 38368556 DOI: 10.1089/ten.tec.2023.0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
Considerable research is being undertaken to develop novel biomaterials-based approaches for surgical reconstruction of bone defects. This extends to three-dimensional (3D) printed materials that provide stable, structural, and functional support in vivo. However, few preclinical models can simulate in vivo human biological conditions for clinically relevant testing. In this study we describe a novel ovine model that allows evaluation of in vivo osteogenesis via contact with bone and/or periosteum interfaced with printed polymer bioreactors loaded with biomaterial bone substitutes. The infraspinous scapular region of 14 Dorset cross sheep was exposed. Vascularized periosteum was elevated either attached to the infraspinatus muscle or separately. In both cases, the periosteum was supplied by the periosteal branch of the circumflex scapular vessels. In eight sheep, a 3D printed 4-chambered polyetheretherketone bioreactor was wrapped circumferentially in vascularized periosteum. In 6 sheep, 12 double-sided 3D printed 2-chambered polyetherketone bioreactors were secured to the underlying bone allowing direct contact with the bone on one side and periosteum on the other. Our model enabled simultaneous testing of up to 24 (12 double-sided) 10 × 10 × 5 mm bioreactors per scapula in the flat contact approach or a single 40 × 10 mm four-chambered bioreactor per scapula using the periosteal wrap. De novo bone growth was evaluated using histological and radiological analysis. Of importance, the experimental model was well tolerated by the animals and provides a versatile approach for comparing the osteogenic potential of cambium on the bone surface and elevated with periosteum. Furthermore, the periosteal flaps were sufficiently large for encasing bioreactors containing biomaterial bone substitutes for applications such as segmental mandibular reconstruction.
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Affiliation(s)
- Yohaann A Ghosh
- Department of Head & Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- School of Medicine & Dentistry, Griffith University, Gold Coast, Australia
| | - Hai Xin
- Department of Head & Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - D S Abdullah Al Maruf
- Department of Head & Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Kai Cheng
- Department of Head & Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Australia
| | - Innes Wise
- Laboratory Animal Services, The University of Sydney, Camperdown, Australia
| | - Chris Burrows
- Laboratory Animal Services, The University of Sydney, Camperdown, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Veronica Ka-Yan Cheung
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - James Wykes
- Department of Head & Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - David Leinkram
- Department of Head & Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Australia
| | - Catriona Froggatt
- Department of Head & Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Australia
| | - Will Lewin
- Arto Hardy Family Biomedical Innovation Hub, Chris O'Brien Lifehouse, Camperdown, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Camperdown, Australia
- Sarcoma and Surgical Research Centre, Chris O'Brien Lifehouse, Camperdown, Australia
| | - Hedi V Kruse
- Arto Hardy Family Biomedical Innovation Hub, Chris O'Brien Lifehouse, Camperdown, Australia
- Sarcoma and Surgical Research Centre, Chris O'Brien Lifehouse, Camperdown, Australia
- Faculty of Science, School of Physics, The University of Sydney, Camperdown, Australia
| | - Eva Tomaskovic-Crook
- Arto Hardy Family Biomedical Innovation Hub, Chris O'Brien Lifehouse, Camperdown, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Camperdown, Australia
- Faculty of Science, School of Physics, The University of Sydney, Camperdown, Australia
| | - David R McKenzie
- Arto Hardy Family Biomedical Innovation Hub, Chris O'Brien Lifehouse, Camperdown, Australia
- Sarcoma and Surgical Research Centre, Chris O'Brien Lifehouse, Camperdown, Australia
- Faculty of Science, School of Physics, The University of Sydney, Camperdown, Australia
| | - Jeremy Crook
- Arto Hardy Family Biomedical Innovation Hub, Chris O'Brien Lifehouse, Camperdown, Australia
- Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Camperdown, Australia
- Sarcoma and Surgical Research Centre, Chris O'Brien Lifehouse, Camperdown, Australia
- Faculty of Science, School of Physics, The University of Sydney, Camperdown, Australia
| | - Jonathan R Clark
- Department of Head & Neck Surgery, Chris O'Brien Lifehouse, Camperdown, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Australia
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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] [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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Finze R, Laubach M, Russo Serafini M, Kneser U, Medeiros Savi F. Histological and Immunohistochemical Characterization of Osteoimmunological Processes in Scaffold-Guided Bone Regeneration in an Ovine Large Segmental Defect Model. Biomedicines 2023; 11:2781. [PMID: 37893154 PMCID: PMC10604530 DOI: 10.3390/biomedicines11102781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Large-volume bone defect regeneration is complex and demands time to complete. Several regeneration phases with unique characteristics, including immune responses, follow, overlap, and interdepend on each other and, if successful, lead to the regeneration of the organ bone's form and function. However, during traumatic, infectious, or neoplastic clinical cases, the intrinsic bone regeneration capacity may exceed, and surgical intervention is indicated. Scaffold-guided bone regeneration (SGBR) has recently shown efficacy in preclinical and clinical studies. To investigate different SGBR strategies over periods of up to three years, we have established a well-characterized ovine large segmental tibial bone defect model, for which we have developed and optimized immunohistochemistry (IHC) protocols. We present an overview of the immunohistochemical characterization of different experimental groups, in which all ovine segmental defects were treated with a bone grafting technique combined with an additively manufactured medical-grade polycaprolactone/tricalcium phosphate (mPCL-TCP) scaffold. The qualitative dataset was based on osteoimmunological findings gained from IHC analyses of over 350 sheep surgeries over the past two decades. Our systematic and standardized IHC protocols enabled us to gain further insight into the complex and long-drawn-out bone regeneration processes, which ultimately proved to be a critical element for successful translational research.
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Affiliation(s)
- Ronja Finze
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (R.F.)
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany;
| | - Markus Laubach
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (R.F.)
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, 81377 Munich, Germany
| | - Mairim Russo Serafini
- Department of Pharmacy, Universidade Federal de Sergipe, Sao Cristovao 49100-000, Brazil;
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany;
| | - Flavia Medeiros Savi
- Centre for Biomedical Technologies, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (R.F.)
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Max Planck Queensland Center for the Materials Science of Extracellular Matrices, Queensland University of Technology, Brisbane, QLD 4059, Australia
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Kühl J, Gorb S, Kern M, Klüter T, Kühl S, Seekamp A, Fuchs S. Extrusion-based 3D printing of osteoinductive scaffolds with a spongiosa-inspired structure. Front Bioeng Biotechnol 2023; 11:1268049. [PMID: 37790253 PMCID: PMC10544914 DOI: 10.3389/fbioe.2023.1268049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Critical-sized bone defects resulting from trauma, inflammation, and tumor resections are individual in their size and shape. Implants for the treatment of such defects have to consider biomechanical and biomedical factors, as well as the individual conditions within the implantation site. In this context, 3D printing technologies offer new possibilities to design and produce patient-specific implants reflecting the outer shape and internal structure of the replaced bone tissue. The selection or modification of materials used in 3D printing enables the adaption of the implant, by enhancing the osteoinductive or biomechanical properties. In this study, scaffolds with bone spongiosa-inspired structure for extrusion-based 3D printing were generated. The computer aided design process resulted in an up scaled and simplified version of the bone spongiosa. To enhance the osteoinductive properties of the 3D printed construct, polycaprolactone (PCL) was combined with 20% (wt) calcium phosphate nano powder (CaP). The implants were designed in form of a ring structure and revealed an irregular and interconnected porous structure with a calculated porosity of 35.2% and a compression strength within the range of the natural cancellous bone. The implants were assessed in terms of biocompatibility and osteoinductivity using the osteosarcoma cell line MG63 and patient-derived mesenchymal stem cells in selected experiments. Cell growth and differentiation over 14 days were monitored using confocal laser scanning microscopy, scanning electron microscopy, deoxyribonucleic acid (DNA) quantification, gene expression analysis, and quantitative assessment of calcification. MG63 cells and human mesenchymal stem cells (hMSC) adhered to the printed implants and revealed a typical elongated morphology as indicated by microscopy. Using DNA quantification, no differences for PCL or PCL-CaP in the initial adhesion of MG63 cells were observed, while the PCL-based scaffolds favored cell proliferation in the early phases of culture up to 7 days. In contrast, on PCL-CaP, cell proliferation for MG63 cells was not evident, while data from PCR and the levels of calcification, or alkaline phosphatase activity, indicated osteogenic differentiation within the PCL-CaP constructs over time. For hMSC, the highest levels in the total calcium content were observed for the PCL-CaP constructs, thus underlining the osteoinductive properties.
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Affiliation(s)
- Julie Kühl
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
| | - Stanislav Gorb
- Department of Functional Morphology and Biomechanics, Kiel University, Kiel, Germany
| | - Matthias Kern
- Department of Prosthodontics, Propaedeutics and Dental Material, University Medical Center, Kiel, Germany
| | - Tim Klüter
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
| | - Sebastian Kühl
- Department of Electrical and Information Engineering, Kiel University, Kiel, Germany
| | - Andreas Seekamp
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
| | - Sabine Fuchs
- Experimental Trauma Surgery, Department of Orthopedics and Trauma Surgery, University Medical Center, Kiel, Germany
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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: 21] [Impact Index Per Article: 21.0] [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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Sparks DS, Savi FM, Dlaska CE, Saifzadeh S, Brierly G, Ren E, Cipitria A, Reichert JC, Wille ML, Schuetz MA, Ward N, Wagels M, Hutmacher DW. Convergence of scaffold-guided bone regeneration principles and microvascular tissue transfer surgery. SCIENCE ADVANCES 2023; 9:eadd6071. [PMID: 37146134 PMCID: PMC10162672 DOI: 10.1126/sciadv.add6071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
A preclinical evaluation using a regenerative medicine methodology comprising an additively manufactured medical-grade ε-polycaprolactone β-tricalcium phosphate (mPCL-TCP) scaffold with a corticoperiosteal flap was undertaken in eight sheep with a tibial critical-size segmental bone defect (9.5 cm3, M size) using the regenerative matching axial vascularization (RMAV) approach. Biomechanical, radiological, histological, and immunohistochemical analysis confirmed functional bone regeneration comparable to a clinical gold standard control (autologous bone graft) and was superior to a scaffold control group (mPCL-TCP only). Affirmative bone regeneration results from a pilot study using an XL size defect volume (19 cm3) subsequently supported clinical translation. A 27-year-old adult male underwent reconstruction of a 36-cm near-total intercalary tibial defect secondary to osteomyelitis using the RMAV approach. Robust bone regeneration led to complete independent weight bearing within 24 months. This article demonstrates the widely advocated and seldomly accomplished concept of "bench-to-bedside" research and has weighty implications for reconstructive surgery and regenerative medicine more generally.
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Affiliation(s)
- David S Sparks
- Centre for Biomedical Technologies, School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, QLD, Australia
| | - Flavia M Savi
- Centre for Biomedical Technologies, School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Constantin E Dlaska
- Centre for Biomedical Technologies, School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Siamak Saifzadeh
- Centre for Biomedical Technologies, School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, Australia
- Medical Engineering Research Facility, Queensland University of Technology, Chermside, QLD, Australia
| | - Gary Brierly
- Centre for Biomedical Technologies, School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Edward Ren
- Centre for Biomedical Technologies, School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Amaia Cipitria
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
- Biodonostia Health Research Institute, San Sebastian, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Johannes C Reichert
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, Germany
| | - Marie-Luise Wille
- Centre for Biomedical Technologies, School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Michael A Schuetz
- Centre for Biomedical Technologies, School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, Australia
- Jamieson Trauma Institute, Royal Brisbane Hospital, Herston, QLD, Australia
| | - Nicola Ward
- Department of Orthopaedics, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Michael Wagels
- Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, QLD, Australia
- Australian Centre for Complex Integrated Surgical Solutions (ACCISS), Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Dietmar W Hutmacher
- Centre for Biomedical Technologies, School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, Australia
- ARC Training Centre for Additive Biomanufacturing, Queensland University of Technology, Kelvin Grove, QLD, Australia
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Sparks DS, Wiper J, Lloyd T, Wille ML, Sehu M, Savi FM, Ward N, Hutmacher DW, Wagels M. Protocol for the BONE-RECON trial: a single-arm feasibility trial for critical sized lower limb BONE defect RECONstruction using the mPCL-TCP scaffold system with autologous vascularised corticoperiosteal tissue transfer. BMJ Open 2023; 13:e056440. [PMID: 37137563 PMCID: PMC10163528 DOI: 10.1136/bmjopen-2021-056440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Reconstruction of critical bone defects is challenging. In a substantial subgroup of patients, conventional reconstructive techniques are insufficient. Biodegradable scaffolds have emerged as a novel tissue engineering strategy for critical-sized bone defect reconstruction. A corticoperiosteal flap integrates the hosts' ability to regenerate bone and permits the creation of a vascular axis for scaffold neo-vascularisation (regenerative matching axial vascularisation-RMAV). This phase IIa study evaluates the application of the RMAV approach alongside a custom medical-grade polycaprolactone-tricalcium phosphate (mPCL-TCP) scaffold (Osteopore) to regenerate bone sufficient to heal critical size defects in lower limb defects. METHODS AND ANALYSIS This open-label, single-arm feasibility trial will be jointly coordinated by the Complex Lower Limb Clinic (CLLC) at the Princess Alexandra Hospital in Woolloongabba (Queensland, Australia), the Australian Centre for Complex Integrated Surgical Solutions (Queensland, Australia) and the Faculty of Engineering, Queensland University of Technology in Kelvin Grove (Queensland, Australia). Aiming for limb salvage, the study population (n=10) includes any patient referred to the CLLC with a critical-sized bone defect not amenable to conventional reconstructive approaches, after discussion by the interdisciplinary team. All patients will receive treatment using the RMAV approach using a custom mPCL-TCP implant. The primary study endpoint will be safety and tolerability of the reconstruction. Secondary end points include time to bone union and weight-bearing status on the treated limb. Results of this trial will help shape the role of scaffold-guided bone regenerative approaches in complex lower limb reconstruction where current options remain limited. ETHICS AND DISSEMINATION Approval was obtained from the Human Research Ethics Committee at the participating centre. Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12620001007921.
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Affiliation(s)
- David S Sparks
- Queensland University of Technology, Faculty of Engineering, Brisbane, Queensland, Australia
- The University of Queensland PA Southside Clinical School, Woolloongabba, Queensland, Australia
| | - Jay Wiper
- Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Thomas Lloyd
- Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Department of Radiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Marie-Luise Wille
- Queensland University of Technology, Faculty of Engineering, Brisbane, Queensland, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Mechanical, Medical, and Process Engineering | Faculty of Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Marjoree Sehu
- Department of Infectious Diseases, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Flavia M Savi
- Queensland University of Technology, Faculty of Engineering, Brisbane, Queensland, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Mechanical, Medical, and Process Engineering | Faculty of Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicola Ward
- Department of Orthopaedics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Dietmar W Hutmacher
- ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Mechanical, Medical, and Process Engineering | Faculty of Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health, School of Biomedical Siences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Wagels
- Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Australian Centre for Complex Integrated Surgical Solutions (ACCISS), Translational Research Institute Australia Ghrelin Research Group, South Brisbane, Queensland, Australia
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