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Ng S, Lok E, Oe T. Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopaedic Setting. Adv Wound Care (New Rochelle) 2024. [PMID: 39001834 DOI: 10.1089/wound.2023.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024] Open
Abstract
SIGNIFICANCE Lower extremity traumatic wounds are associated with numerous perioperative challenges. Their aetiologies determine the characteristics and extent of the injury. The timing of subsequent surgical intervention and wound healing optimization post lower extremity trauma are integral to successful perioperative lower extremity wound management. RECENT ADVANCES Managing trauma to the lower extremities employs a multidisciplinary surgical approach. The objective of this review is to summarise lower limb trauma assessment, advancements in lower extremity trauma management, and the clinical applications of advanced wound care in lower limb traumatic wounds. The advent of lower limb reconstruction and the development of advance wound care modalities have helped to improve the management of these complex injuries. CRITICAL ISSUES The extensive involvement of bone, soft tissues, nerves, and blood vessels of severe lower extremity trauma wounds present a challenge for clinicians in both the acute care setting and during patient rehabilitation. If not properly managed, these injuries, may be subject to a decline in limb function and may possibly result in limb loss. To reveal developing limb-threatening conditions, serial examinations should be performed. FUTURE DIRECTIONS The majority of lower limb traumatic wound will benefit from the perioperative administration of an appropriate negative pressure wound therapy (NPWT) based system, which can help to promote granulation tissue and remove wound exudate prior to definitive closure and/ or reconstruction. NPWT should be included as an important adjunct in the surgical management of lower limb traumatic wounds.
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Affiliation(s)
- Sally Ng
- Austin Health, Plastic and Reconstructive Surgery, 145 Studley Rd, Heidelberg, Victoria, Australia, 3084;
| | - Evania Lok
- Austin Health, Department of Plastic and Reconstructive Surgery, Heidelberg, Victoria, Australia;
| | - Timothy Oe
- Austin Health, Department of Plastic and Reconstructive Surgery, Heidelberg, Victoria, Australia;
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Honda S, Fujibayashi S, Shimizu T, Yamaguchi S, Okuzu Y, Takaoka Y, Masuda S, Takemoto M, Kawai T, Otsuki B, Goto K, Matsuda S. Strontium-loaded 3D intramedullary nail titanium implant for critical-sized femoral defect in rabbits. J Biomed Mater Res B Appl Biomater 2024; 112:e35393. [PMID: 38385959 DOI: 10.1002/jbm.b.35393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
The treatment of critical-sized bone defects has long been a major problem for surgeons. In this study, an intramedullary nail shaped three-dimensional (3D)-printed porous titanium implant that is capable of releasing strontium ions was developed through a simple and cost-effective surface modification technique. The feasibility of this implant as a stand-alone solution was evaluated using a rabbit's segmental diaphyseal as a defect model. The strontium-loaded implant exhibited a favorable environment for cell adhesion, and mechanical properties that were commensurate with those of a rabbit's cortical bone. Radiographic, biomechanical, and histological analyses revealed a significantly higher amount of bone ingrowth and superior bone-bonding strength in the strontium-loaded implant when compared to an untreated porous titanium implant. Furthermore, one-year histological observations revealed that the strontium-loaded implant preserved the native-like diaphyseal bone structure without failure. These findings suggest that strontium-releasing 3D-printed titanium implants have the clinical potential to induce the early and efficient repair of critical-sized, load-bearing bone defects.
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Affiliation(s)
- Shintaro Honda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Seiji Yamaguchi
- Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Takaoka
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Soichiro Masuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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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: 20] [Impact Index Per Article: 20.0] [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, 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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Buckberry J, Crane-Kramer G. The dark satanic mills: Evaluating patterns of health in England during the industrial revolution. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 39:93-108. [PMID: 36335796 DOI: 10.1016/j.ijpp.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/18/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE this research seeks to investigate the impact the industrial revolution had on the population of England. MATERIALS Pre-existing skeletal data from 1154 pre-Industrial (1066-1700 CE) and 4157 industrial (1700-1905) skeletons from 21 cemeteries (N = 5411). METHODS Context number, sex, age-at-death, stature and presence/absence of selected pathological conditions were collated. The data were compared using chi square, Kolmogorov-Smirnov, t-tests and logistic regression (α = 0.01). RESULTS There was a statistically significant increase in cribra orbitalia, periosteal reactions, rib lesions, fractures, rickets, osteoporosis, osteoarthritis, enamel hypoplasia, dental caries and periapical lesions in the industrial period. Osteomyelitis decreased from the pre-industrial to industrial period. CONCLUSION Our results confirm the industrial revolution had a significant negative impact on human health, however the prevalence of TB, treponemal disease, maxillary sinusitis, osteomalacia, scurvy, gout and DISH did not change, suggesting these diseases were not impacted by the change in environmental conditions. SIGNIFICANCE This is the largest study of health in the industrial revolution that includes non-adults and adults and considers age-at-death alongside disease status to date. This data supports the hypothesis that the rise of industry was associated with a significant decline in general health, but not an increase in all pathological conditions.
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Gonzalez Matheus I, Hutmacher DW, Olson S, Redmond M, Sutherland A, Wagels M. A Medical-Grade Polycaprolactone and Tricalcium Phosphate Scaffold System With Corticoperiosteal Tissue Transfer for the Reconstruction of Acquired Calvarial Defects in Adults: Protocol for a Single-Arm Feasibility Trial. JMIR Res Protoc 2022; 11:e36111. [PMID: 36227628 PMCID: PMC9614622 DOI: 10.2196/36111] [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: 01/14/2022] [Revised: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background Large skull defects present a reconstructive challenge. Conventional cranioplasty options include autologous bone grafts, vascularized bone, metals, synthetic ceramics, and polymers. Autologous options are affected by resorption and residual contour deformities. Synthetic materials may be customized via digital planning and 3D printing, but they all carry a risk of implant exposure, failure, and infection, which increases when the defect is large. These complications can be a threat to life. Without reconstruction, patients with cranial defects may experience headaches and stigmatization. The protection of the brain necessitates lifelong helmet use, which is also stigmatizing. Objective Our clinical trial will formally study a hybridized technique's capacity to reconstruct large calvarial defects. Methods A hybridized technique that draws on the benefits of autologous and synthetic materials has been developed by the research team. This involves wrapping a biodegradable, ultrastructured, 3D-printed scaffold made of medical-grade polycaprolactone and tricalcium phosphate in a vascularized, autotransplanted periosteum to exploit the capacity of vascularized periostea to regenerate bone. In vitro, the scaffold system supports cell attachment, migration, and proliferation with slow but sustained degradation to permit host tissue regeneration and the replacement of the scaffold. The in vivo compatibility of this scaffold system is robust—the base material has been used clinically as a resorbable suture material for decades. The importance of scaffold vascularization, which is inextricably linked to bone regeneration, is underappreciated. A variety of methods have been described to address this, including scaffold prelamination and axial vascularization via arteriovenous loops and autotransplanted flaps. However, none of these directly promote bone regeneration. Results We expect to have results before the end of 2023. As of December 2020, we have enrolled 3 participants for the study. Conclusions The regenerative matching axial vascularization technique may be an alternative method of reconstruction for large calvarial defects. It involves performing a vascularized free tissue transfer and using a bioresorbable, 3D-printed scaffold to promote and support bone regeneration (termed the regenerative matching axial vascularization technique). This technique may be used to reconstruct skull bone defects that were previously thought to be unreconstructable, reduce the risk of implant-related complications, and achieve consistent outcomes in cranioplasty. This must now be tested in prospective clinical trials. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620001171909; https://tinyurl.com/4rakccb3 International Registered Report Identifier (IRRID) DERR1-10.2196/36111
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Affiliation(s)
- Isabel Gonzalez Matheus
- Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Queenland, Australia.,Herston Biofabrication Institute, Herston, Australia.,The Australian Centre for Complex Integrated Surgical Solutions, Translational Research Institute, Woolloongabba, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Dietmar W Hutmacher
- Regenerative Medicine Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | - Sarah Olson
- Department of Neurosurgery, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Michael Redmond
- Herston Biofabrication Institute, Herston, Australia.,Department of Neurosurgery, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Allison Sutherland
- The Australian Centre for Complex Integrated Surgical Solutions, Translational Research Institute, Woolloongabba, Australia
| | - Michael Wagels
- Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Queenland, Australia.,Herston Biofabrication Institute, Herston, Australia.,The Australian Centre for Complex Integrated Surgical Solutions, Translational Research Institute, Woolloongabba, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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Rigal S. Stratégie de prise en charge des fracas des membres inférieurs en chirurgie de guerre. Réparé ou amputé : le soldat debout. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2022. [DOI: 10.1016/j.banm.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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8
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Wagner T, Hummelink S, Ulrich D. Past, present and future in plastic flap surgery: From surgeon to bioengineer driven progress. A personal view. J Tissue Viability 2022; 31:800-803. [DOI: 10.1016/j.jtv.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
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Castrisos G, Gonzalez Matheus I, Sparks D, Lowe M, Ward N, Sehu M, Wille ML, Phua Y, Medeiros Savi F, Hutmacher D, Wagels M. Regenerative matching axial vascularisation of absorbable 3D-printed scaffold for large bone defects: A first in human series. J Plast Reconstr Aesthet Surg 2022; 75:2108-2118. [PMID: 35370116 DOI: 10.1016/j.bjps.2022.02.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/10/2021] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND We describe the first clinical series of a novel bone replacement technique based on regenerative matching axial vascularisation (RMAV). This was used in four cases: a tibial defect after treatment of osteomyelitis; a calvarial defect after trauma and failed titanium cranioplasty; a paediatric tibial defect after neoadjuvant chemotherapy and resection of Ewing sarcoma; and a paediatric mandibular deficiency resulting from congenital hemifacial microsomia. METHOD All patients underwent reconstruction with three-dimensional (3D)-printed medical-grade polycaprolactone and tricalcium phosphate (mPCL-TCP) scaffolds wrapped in vascularised free corticoperiosteal flaps. OUTCOME Functional volumes of load-sharing regenerate bone have formed in all cases after a moderate duration of follow-up. At 36 cm, case 1 remains the longest segment of load bearing bone ever successfully reconstructed. This technique offers an alternative to existing methods of large volume bone defect reconstruction that may be safe, reliable, and give predictable outcomes in challenging situations. It achieves this by using a bioresorbable scaffold to support and direct the growth of regenerate bone, driven by RMAV. CONCLUSION This technique may facilitate the reconstruction of bone defects previously thought unreconstructable, reduce the risk of long-term implant-related complications and achieve these outcomes in a hostile environment. These potential benefits must now be formally tested in prospective clinical trials.
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Affiliation(s)
- George Castrisos
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Isabel Gonzalez Matheus
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; The Herston Biofabrication Institute, Herston; The University of Queensland, Australia; Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Australia; The Australian Centre for Complex Integrated Surgical Solutions, Woolloongabba , Australia.
| | - David Sparks
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Faculty of Engineering, Queensland University of Technology, Kelvin Grove, Australia; Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Australia
| | - Martin Lowe
- Department of Orthopaedic Surgery, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - Nicola Ward
- Department of Orthopaedic Surgery, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - Marjoree Sehu
- Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Australia; Infection Management Services, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - Marie-Luise Wille
- Queensland University of Technology Node ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, QLD, Australia; Queensland University of Technology, Institute of Health Biomedical Innovation, Australia
| | - Yun Phua
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Flavia Medeiros Savi
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia; Queensland University of Technology, Institute of Health Biomedical Innovation, Australia
| | - Dietmar Hutmacher
- Queensland University of Technology Node ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, QLD, Australia; Queensland University of Technology, Institute of Health Biomedical Innovation, Australia
| | - Michael Wagels
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; The Herston Biofabrication Institute, Herston; The University of Queensland, Australia; Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Australia; Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia; The Australian Centre for Complex Integrated Surgical Solutions, Woolloongabba , Australia
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10
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New Technique for the Proximal Leg Reconstruction: Medial Sural Artery-Based Cross-leg Flap. Indian J Orthop 2021; 55:481-485. [PMID: 34306564 PMCID: PMC8275715 DOI: 10.1007/s43465-021-00411-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/24/2021] [Indexed: 02/04/2023]
Abstract
Reconstruction of the lower extremity, especially the proximal lower leg, is known to be a challenge for reconstructive surgeons. When there is extensive vascular damage, the use of local flaps and microsurgical methods will be limited, so there are few reconstructive options available. We want to define the use of medial sural artery-based cross-leg flap for the reconstruction of the proximal lower leg. A 51-year-old male had a soft tissue defect on the proximal leg region because of a gun-shot injury. We observed that there was no chance of a local flap as a result of CT angiography. We considered free flap to be risky because of extensive vascular damage and medial sural artery-based cross-leg flap was planned. 12*20-cm-sized medial sural artery-based cross-leg flap was elevated from the contralateral leg and adapted to the defect without tension. Medial sural artery-based flap is mostly used as a vascular island for the reconstruction of knee defects. However, its use as a cross-leg flap has not been found in the literature. We believe that it is a safe option to consider in challenging cases such as after flap failure or patients not suitable for a free flap.
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Sparks DS, Saifzadeh S, Savi FM, Dlaska CE, Berner A, Henkel J, Reichert JC, Wullschleger M, Ren J, Cipitria A, McGovern JA, Steck R, Wagels M, Woodruff MA, Schuetz MA, Hutmacher DW. A preclinical large-animal model for the assessment of critical-size load-bearing bone defect reconstruction. Nat Protoc 2020; 15:877-924. [PMID: 32060491 DOI: 10.1038/s41596-019-0271-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 11/11/2019] [Indexed: 12/31/2022]
Abstract
Critical-size bone defects, which require large-volume tissue reconstruction, remain a clinical challenge. Bone engineering has the potential to provide new treatment concepts, yet clinical translation requires anatomically and physiologically relevant preclinical models. The ovine critical-size long-bone defect model has been validated in numerous studies as a preclinical tool for evaluating both conventional and novel bone-engineering concepts. With sufficient training and experience in large-animal studies, it is a technically feasible procedure with a high level of reproducibility when appropriate preoperative and postoperative management protocols are followed. The model can be established by following a procedure that includes the following stages: (i) preoperative planning and preparation, (ii) the surgical approach, (iii) postoperative management, and (iv) postmortem analysis. Using this model, full results for peer-reviewed publication can be attained within 2 years. In this protocol, we comprehensively describe how to establish proficiency using the preclinical model for the evaluation of a range of bone defect reconstruction options.
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Affiliation(s)
- David S Sparks
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Department of Plastic & Reconswrapping a sterile Coban wrap around the limb distallytructive Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Queensland, Australia
| | - Siamak Saifzadeh
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Medical Engineering Research Facility, Queensland UCoban wrap only comes non-sterile. Sterilize Coban wrap before use.niversity of Technology, Chermside, Queensland, Australia
| | - Flavia Medeiros Savi
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,ARC Centre for Additive Biomanufactthe mounting resin base cement. Use it only in a laboratory fume cabinet and withuring, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Constantin E Dlaska
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Jamieson Trauma Institute, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - Arne Berner
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Department of Trauma Surgery, University Hospital of Regensburg, Regensburg, Germany
| | - Jan Henkel
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Johannes C Reichert
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, König-Ludwig-Haus, Julius-Maximilians-University, Würzburg, Germany.,Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
| | - Martin Wullschleger
- Jamieson Trauma Institute, Royal Brisbane Hospital, Herston, Queensland, Australia.,Griffith University, School of Medicine, Southport, Queensland, Australia
| | - Jiongyu Ren
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Amaia Cipitria
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - Jacqui A McGovern
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Roland Steck
- Medical Engineering Research Facility, Queensland UCoban wrap only comes non-sterile. Sterilize Coban wrap before use.niversity of Technology, Chermside, Queensland, Australia
| | - Michael Wagels
- Department of Plastic & Reconswrapping a sterile Coban wrap around the limb distallytructive Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, Queensland, Australia.,Australian Centre for Complex Integrated Surgical Solutions (ACCISS), Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Maria Ann Woodruff
- ARC Centre for Additive Biomanufactthe mounting resin base cement. Use it only in a laboratory fume cabinet and withuring, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Biofabrication and Tissue Morphology Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Michael A Schuetz
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Jamieson Trauma Institute, Royal Brisbane Hospital, Herston, Queensland, Australia
| | - Dietmar W Hutmacher
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia. .,ARC Centre for Additive Biomanufactthe mounting resin base cement. Use it only in a laboratory fume cabinet and withuring, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
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12
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Sparks DS, Savi FM, Saifzadeh S, Schuetz MA, Wagels M, Hutmacher DW. Convergence of Scaffold-Guided Bone Reconstruction and Surgical Vascularization Strategies-A Quest for Regenerative Matching Axial Vascularization. Front Bioeng Biotechnol 2020; 7:448. [PMID: 31998712 PMCID: PMC6967032 DOI: 10.3389/fbioe.2019.00448] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/13/2019] [Indexed: 02/06/2023] Open
Abstract
The prevalent challenge facing tissue engineering today is the lack of adequate vascularization to support the growth, function, and viability of tissue engineered constructs (TECs) that require blood vessel supply. The research and clinical community rely on the increasing knowledge of angiogenic and vasculogenic processes to stimulate a clinically-relevant vascular network formation within TECs. The regenerative matching axial vascularization approach presented in this manuscript incorporates the advantages of flap-based techniques for neo-vascularization yet also harnesses the in vivo bioreactor principle in a more directed "like for like" approach to further assist regeneration of the specific tissue type that is lost, such as a corticoperiosteal flap in critical sized bone defect reconstruction.
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Affiliation(s)
- David S Sparks
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Southside Clinical Division, School of Medicine, University of Queensland, Woolloongabba, QLD, Australia
| | - Flavia Medeiros Savi
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Siamak Saifzadeh
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Medical Engineering Research Facility, Queensland University of Technology, Chermside, QLD, Australia
| | - Michael A Schuetz
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, QLD, Australia.,Jamieson Trauma Institute, Royal Brisbane Hospital, Herston, QLD, Australia
| | - Michael Wagels
- Department of Plastic & 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, Woolloongabba, QLD, Australia
| | - Dietmar W Hutmacher
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.,ARC Centre for Additive Bio-Manufacturing, Queensland University of Technology, Kelvin Grove, QLD, Australia
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13
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Long-term, patient-centered outcomes of lower-extremity vascular trauma. J Trauma Acute Care Surg 2018; 85:S104-S111. [DOI: 10.1097/ta.0000000000001956] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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14
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Sparks DS, Wagels M, Taylor GI. Bone reconstruction: A history of vascularized bone transfer. Microsurgery 2017; 38:7-13. [PMID: 29134687 DOI: 10.1002/micr.30260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/06/2017] [Accepted: 10/03/2017] [Indexed: 11/09/2022]
Affiliation(s)
- David S Sparks
- Centre for Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia.,The Taylor Lab, Department of Anatomy and Neuroscience, University of Melbourne, Victoria, Australia.,Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Woollongabba, Queensland, Australia.,Southside Clinical Division, School of Medicine, University of Queensland, Woollongabba, Queensland, Australia
| | - Michael Wagels
- Department of Plastic & Reconstructive Surgery, Princess Alexandra Hospital, Woollongabba, Queensland, Australia.,Southside Clinical Division, School of Medicine, University of Queensland, Woollongabba, Queensland, Australia
| | - G Ian Taylor
- The Taylor Lab, Department of Anatomy and Neuroscience, University of Melbourne, Victoria, Australia
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15
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Sparks DS, Saleh DB, Rozen WM, Hutmacher DW, Schuetz MA, Wagels M. Vascularised bone transfer: History, blood supply and contemporary problems. J Plast Reconstr Aesthet Surg 2017; 70:1-11. [DOI: 10.1016/j.bjps.2016.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/12/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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16
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Soft tissue reconstruction after compound tibial fracture: 235 cases over 12 years. J Plast Reconstr Aesthet Surg 2015; 68:1276-85. [DOI: 10.1016/j.bjps.2015.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/03/2015] [Accepted: 05/18/2015] [Indexed: 11/16/2022]
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17
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Wagels M, Rowe D, Senewiratne S, Theile DR. Response to re: history of lower limb reconstruction after trauma. ANZ J Surg 2014; 84:99. [PMID: 24450794 DOI: 10.1111/ans.12467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Wagels
- Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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18
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Affiliation(s)
- Shahriar Raj Zaman
- Department of Plastic and Reconstructive Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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