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Scott D Boden - One of the best experts on this subject based on the ideXlab platform.
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evidence of osteoinduction by grafton Demineralized Bone Matrix in nonhuman primate spinal fusion
Spine, 2004Co-Authors: John Louisugbo, Hideki Murakami, Akihito Minamide, Hak Sun Kim, Scott D BodenAbstract:Study Design. A nonhuman primate posterolateral lumbar intertransverse process arthrodesis model was used to evaluate osteoinductive Bone graft materials. Objectives. To test two new formulations of Grafton Demineralized Bone Matrix (Flex and Matrix) for evidence of osteoinduction and their potential efficacy as an extender or enhancer for autogenous Bone in a previously validated nonhuman primate posterolateral lumbar fusion model. Summary of Background Data. Whereas several Demineralized Bone Matrix formulations have been shown to be variably osteoinductive in rodent ectopic Bone assays and rabbit spine applications, few have demonstrated efficacy in higher species and in more challenging applications such as posterolateral spine fusion. The authors are not aware of any published studies describing any Demineralized Bone Matrix that has been tested in a nonhuman primate posterolateral spine fusion model. Methods. After approval by the institutional animal care and use committee, eight skeletally mature rhesus macaques underwent single-level posterolateral arthrodesis. In four animals, autograft (4 g/side) was implanted with a piece of human Grafton Flex Demineralized Bone Matrix. In the other four animals, rhesus Grafton Matrix Demineralized Bone Matrix, a new and more porous formulation of Flex, was implanted with autograft (4 g) on one side of the spine, and Matrix with half the amount of autograft (2 g) was implanted on the opposite side. Radiographs were taken at intervals until the animals were killed at 24 weeks. Spinal fusion was evaluated by manual palpation (status was fused or not fused), and computed tomography was done to visualize the amount of Bone formation. Results. Fusion was ascertained by palpation in two of four monkeys receiving Flex with autograft and in three of four monkeys receiving Matrix with autograft. Evidence of osteoinduction was seen in all four monkeys on the Matrix with 4 g autograft side, which had larger fusion masses than in the other treatments. Histologic examination showed that the Bone formed was normal. Conclusions The rhesus Matrix formulation performed better than the human Flex. Evidence of osteoinduction was seen in all four monkeys that received Matrix, which improved the fusion success of autograft. This alone suggested that it might play a role as a graft enhancer, not merely as a graft extender. Human studies arewarranted.
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evidence of osteoinduction by grafton Demineralized Bone Matrix in nonhuman primate spinal fusion
Spine, 2004Co-Authors: John Louisugbo, Hideki Murakami, Akihito Minamide, Scott D BodenAbstract:Study Design. A nonhuman primate posterolateral lumbar intertransverse process arthrodesis model was used to evaluate osteoinductive Bone graft materials. Objectives. To test two new formulations of Grafton Demineralized Bone Matrix (Flex and Matrix) for evidence of osteoinduction and their potential efficacy as an extender or enhancer for autogenous Bone in a previously validated nonhuman primate posterolateral lumbar fusion model. Summary of Background Data. Whereas several Demineralized Bone Matrix formulations have been shown to be variably osteoinductive in rodent ectopic Bone assays and rabbit spine applications, few have demonstrated efficacy in higher species and in more challenging applications such as posterolateral spine fusion. The authors are not aware of any published studies describing any Demineralized Bone Matrix that has been tested in a nonhuman primate posterolateral spine fusion model. Methods. After approval by the institutional animal care and use committee, eight skeletally mature rhesus macaques underwent single-level posterolateral arthrodesis. In four animals, autograft (4 g/side) was implanted with a piece of human Grafton Flex Demineralized Bone Matrix. In the other four animals, rhesus Grafton Matrix Demineralized Bone Matrix, a new and more porous formulation of Flex, was implanted with autograft (4 g) on one side of the spine, and Matrix with half the amount of autograft (2 g) was implanted on the opposite side. Radiographs were taken at intervals until the animals were killed at 24 weeks. Spinal fusion was evaluated by manual palpation (status was fused or not fused), and computed tomography was done to visualize the amount of Bone formation. Results. Fusion was ascertained by palpation in two of four monkeys receiving Flex with autograft and in three of four monkeys receiving Matrix with autograft. Evidence of osteoinduction was seen in all four monkeys on the Matrix with 4 g autograft side, which had larger fusion masses than in the other treatments. Histologic examination showed that the Bone formed was normal. Conclusions The rhesus Matrix formulation performed better than the human Flex. Evidence of osteoinduction was seen in all four monkeys that received Matrix, which improved the fusion success of autograft. This alone suggested that it might play a role as a graft enhancer, not merely as a graft extender. Human studies arewarranted.
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new formulations of Demineralized Bone Matrix as a more effective graft alternative in experimental posterolateral lumbar spine arthrodesis
Spine, 1999Co-Authors: George J Martin, Scott D Boden, Louisa Titus, Nelson L ScarboroughAbstract:STUDY DESIGN A rabbit model of posterolateral intertransverse process spine arthrodesis was used. OBJECTIVE To determine the efficacy of two new formulations of Demineralized Bone Matrix. SUMMARY OF BACKGROUND DATA The flowable gel form of Grafton (Osteotech, Eatontown, NJ) Demineralized Bone Matrix has been shown to have osteoinductive properties in various models and currently is used clinically as Bone graft material in posterolateral lumbar spine arthrodesis. Two new formulations of Grafton, one made of flexible sheets (Flex) and the other made in a malleable consistency (Putty), have improved handling characteristics compared with the gel form. METHODS In this study, 108 New Zealand white rabbits underwent bilateral posterolateral intertransverse spine arthrodesis at L5-L6 using autogenous iliac crest Bone graft alone (control), one of the new forms of Demineralized Bone Matrix (DBM; made from rabbit Bone) alone or in combination with autogenous iliac crest Bone. Rabbits were killed 6 weeks after surgery. The lumbar spines were excised, and fusion success or failure was determined by manual palpation and radiography. Specimens also were processed for undecalcified histologic analysis. RESULTS Manual palpation of the harvested lumbar spines revealed that the fusion rates of the Flex-DBM/Auto group (9/9, 100%) and Putty-DBM/Auto group (10/10, 100%) were superior (P < 0.01) to those of the Auto/control group (3/9, 33%). As a stand-alone graft substitute, Flex-DBM performed superiorly with a fusion rate of 11/11 (100%) compared with that of Putty-DBM (10/12, 83%) and Gel-DBM (7/12, 58%). The devitalized version of Flex-DBM had a fusion rate of 4/11 (36%), which was comparable with the devitalized Putty-DBM rate of 4/12 (33%). Both were superior (P < 0.05) to the devitalized Gel-DBM rate of 0/12 (0%). More mature fusions with greater amounts of trabecular Bone were present radiographically and histologically in rabbits that received all forms of Demineralized Bone Matrix than in those in which autograft was used. CONCLUSIONS The new flexible sheet and malleable putty forms of Demineralized Bone Matrix were effective as graft extender and graft enhancer in a model of posterolateral lumbar spine fusion. These newer formulations of Grafton appear to have a greater capacity to form Bone than the gel form or autogenous Bone graft alone in this model.
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experimental posterolateral lumbar spinal fusion with a Demineralized Bone Matrix gel
Spine, 1998Co-Authors: Michael A Morone, Scott D BodenAbstract:Study design A controlled rabbit model of lumbar posterolateral intertransverse process arthrodesis was used to evaluate a Bone graft substitute. Objective To determine the efficacy of Demineralized Bone Matrix gel as an autograft extender, using different ratios of Demineralized Bone Matrix to autograft and to determine the efficacy of Demineralized Bone Matrix as an autogenous Bone graft enhancer by adding it to the usual quantity of autograft. Summary of background data Autogenous Bone is considered the most effective Bone graft material for posterolateral lumbar arthrodesis, yet nonunions occur in up to 30% of patients. In addition, donor site complications may occur in 25-30% of patients. This has prompted the search for and investigation of Bone graft extenders, enhancers, and substitutes. Commercially available Demineralized Bone Matrix gel is one possible graft extender and enhancer, which, unlike mineralized allografts, has osteoinductive properties. Although the gel is in common use, the efficacy of Demineralized Bone Matrix when used for posterolateral spine arthrodesis has not been examined in prospective clinical studies. Furthermore, no known animal studies have tested Demineralized Bone Matrix gel in a posterolateral arthrodesis model. Methods Forty-seven New Zealand white rabbits underwent bilateral posterolateral spine arthrodesis at L5-L6 using autogenous iliac crest Bone graft alone or in combination with Demineralized Bone Matrix. Four groups were formed on the basis of the ratio of autograft to Demineralized Bone Matrix: autograft alone (3 mL), 100:0 group; autograft (3 mL) and Demineralized Bone Matrix (1.5 mL), 100:50 group; autograft (1.5 mL) and Demineralized Bone Matrix (1.5 mL), 50:50 group; and autograft (0.75 mL) and Demineralized Bone Matrix (2.25 mL), 25:75 group. Rabbits were killed 6 weeks after surgery. Inspection, manual palpation, radiographic film, and histologic evaluation were used to assess fusion. Results All groups had similar fusion rates (66-73%) based on manual palpation. Rabbits implanted with Demineralized Bone Matrix had more mature fusion masses, evidenced by the greater trabecular Bone formation seen on radiographic film and histologic study. Conclusions Demineralized Bone Matrix was effective as a graft extender when used in up to a 3:1 ratio with autograft in a rabbit posterolateral spine fusion model. When less than the standard volume of autograft was used, the addition of Demineralized Bone Matrix gel lead to fusion success rates comparable to those of the standard amount of autograft alone. However, Demineralized Bone Matrix did not increase the frequency of successful fusion when added to the standard amount of autograft.
Jeffrey C Wang - One of the best experts on this subject based on the ideXlab platform.
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allograft versus Demineralized Bone Matrix in instrumented and noninstrumented lumbar fusion a systematic review
Global Spine Journal, 2018Co-Authors: Zorica Buser, Jeffrey C Wang, Darrel S Brodke, Jim A Youssef, Elke Rometsch, Jong Beom Park, Tim S Yoon, Hans Joerg MeiselAbstract:Study Design:Systematic review.Objectives:The aim was to determine the fusion efficacy of allograft and Demineralized Bone Matrix (DBM) in lumbar instrumented and noninstrumented fusion procedures ...
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outcomes of Demineralized Bone Matrix enriched with concentrated Bone marrow aspirate in lumbar fusion
The International Journal of Spine Surgery, 2016Co-Authors: Remi M Ajiboye, Mark A Eckardt, Jason T Hamamoto, Benjamin Plotkin, Michael D Daubs, Jeffrey C WangAbstract:Background Multiple studies have demonstrated that a significant amount of variability exists in various Demineralized Bone Matrix (DBM) formulations, which casts doubts on its reliability in consistently promoting fusion. Bone marrow aspirate (BMA) is a cellular based graft that contains mesenchymal stem cells (MSCs) and growth factors can confer osteogenic and osteoinductive potential to DBM. The goal of this study was to describe the outcome of DBM enriched with concentrated BMA in patients undergoing combined lumbar interbody and posterolateral fusion. Methods Eighty patients with a minimum of 12 months of follow-up were evaluated. Fusion and rates of complication were evaluated. Functional outcomes were assessed based on the modified Odom’s criteria. Multiple logistic regression analysis was used to examine the effects of independent variables on fusion outcome. Results The overall rate of solid fusion (i.e patients with both solid posterolateral and interbody fusion) was 81.3% (65/80). Specifically, the radiographic evidence of solid posterolateral and interbody fusions were 81.3% (65/80) and 92.5% (74/80), respectively. Seven (8.75%) patients developed hardware-related complications, 2 (2.5%) patients developed a postoperative infection and 2 (2.5%) patients developed clinical pseudarthrosis. Charlson comorbidity index (CCI) scores of 3 and 4 were associated with non-solid unions (CCI-3, p = 0.048; CCI-4, p = 0.03). Excellent or good outcomes were achieved in 58 (72.5%) patients. Conclusions Patients undergoing lumbar fusion using an enriched Bone graft containing concentrated BMA added to DBM can achieve successful fusion with relatively low complications and good functional outcomes. Despite these findings, more studies with higher level of evidence are needed to better understand the efficacy of this promising graft option.
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variability across ten production lots of a single Demineralized Bone Matrix product
Journal of Bone and Joint Surgery American Volume, 2010Co-Authors: Li Zhao, Jeffrey C Wang, Linda E A Kanim, Rick B DelamarterAbstract:Background: Demineralized Bone Matrix is an osteoinductive allograft derived from processed Bone that is commonly mixed with autogenous Bone in fusion procedures to treat diseases of the spine. An increasing number of Demineralized Bone Matrix-based products are commercially available for spinal fusion procedures, but osteoinductive variability has been found not only across different products but also among production lots from the same Demineralized Bone Matrix formulation. The purpose of this study was to assess the lot-to-lot variability across a single Demineralized Bone Matrix-based product in terms of both extracted Bone morphogenetic protein (BMP) concentrations (in vitro) and fusion performance in rats (in vivo). The goal was also to determine whether the in vitro measures could sufficiently and accurately predict the in vivo fusion performance of different Demineralized Bone Matrix-based product lots. Methods: BMP-2 and BMP-7 were extracted from ten production lots of InterGro DBM Putty and quantified with use of ELISA (enzyme-linked immunosorbent assay). A posterolateral lumbar spinal fusion was performed on forty athymic rats with implantation of a Demineralized Bone Matrix-based product. Fusion success was determined at eight weeks with use of radiographs and manual palpation of the segments. Logistic regression was used to determine the predictive abilities of BMPs. Results: Significant lot-to-lot variability was found in terms of both BMP concentrations (22 to 110 pg of BMP-2 per milligram of product and 44 to 125 pg of BMP-7 per milligram of product) and in vivo rates of fusion (0% to 75%; p < 0.04 for all). BMP-2 and BMP-7 concentrations correlated positively with each other across lots (r = 0.77, p < 0.0001). Most notably, extracted amounts of BMP-2 and BMP-7 each predicted in a dose-dependent manner the in vivo fusion performance in rats (R2 = 0.32, p < 0.01 for BMP-2, and R2 = 0.22, p < 0.009 for BMP-7). Conclusions: Assays for Demineralized Bone Matrix-extracted BMP-2 and BMP-7 levels may be feasible and sufficient for predicting spinal fusion performance of individual production lots from the same Demineralized Bone Matrix-based product. Clinical Relevance: In order to improve the consistency and efficacy of Demineralized Bone Matrix-mediated fusions in clinical settings, it may be valuable to perform simple terminal screenings for BMP-2 and BMP-7 on Demineralized Bone Matrix-based product lots prior to their commercial distribution.
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a comparison of commercially available Demineralized Bone Matrix for spinal fusion
European Spine Journal, 2007Co-Authors: Jeffrey C Wang, Linda E A Kanim, Ahmet Alanay, Davies Mark, Pat Campbell, Edgar G Dawson, Jay R LiebermanAbstract:In an effort to augment the available grafting material as well as to increase spinal fusion rates, the utilization of a Demineralized Bone Matrix (DBM) as a graft extender or replacement is common. There are several commercially available DBM substances available for use in spinal surgery, each with different amounts of DBM containing osteoinductive proteins. Each product may have different osteoinductivity potential due to different methods of preparation, storage, and donor specifications. The purpose of this study is to prospectively compare the osteoinductive potential of three different commercially available DBM substances in an athymic rodent spinal fusion model and to discuss the reasons of the variability in osteoinductivity. A posterolateral fusion was performed in 72 mature athymic nude female rats. Three groups of 18 rats were implanted with 1 of 3 DBMs (Osteofil, Grafton, and Dynagraft). A fourth group was implanted with rodent autogenous iliac crest Bone graft. The rats were sacrificed at 2, 4, 6, and 8 weeks. A dose of 0.3 cm3 per side (0.6 cm3per animal) was used for each substance. Radiographs were taken at 2 weeks intervals until sacrifice. Fusion was determined by radiographs, manual palpation, and histological analysis. The Osteofil substance had the highest overall fusion rate (14/18), and the highest early 4 weeks fusion rate of (4/5). Grafton produced slightly lower fusion rates of (11/17) overall, and lower early 4 weeks fusion rate of (2/5). There was no statistically significant difference between the rate of fusion after implantation of Osteofil and Grafton. None of the sites implanted with Dynagraft fused at any time point (0/17), and there was a significantly lower fusion rate between the Dynagraft and the other two substances at the six-week-time point and for final fusion rate (P = 0.0001, Fischer’s exact test). None of the autogenous iliac crest animals fused at any time point. Non-decalcified histology confirmed the presence of a pseudarthrosis or the presence of a solid fusion, and the results were highly correlated with the manual testing. Although all products claim to have significant osteoinductive capabilities, this study demonstrates that there are significant differences between some of the tested products.
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Demineralized Bone Matrix and spinal arthrodesis
The Spine Journal, 2005Co-Authors: Kenneth Lee, Jonathan G Roper, Jeffrey C WangAbstract:Spinal fusion is a gold-standard treatment for many disorders of the spine with autogenous Bone graft as the gold-standard source for augmenting fusion. However, the morbidity and limitations of autogenous Bone grafting has motivated the search for Bone graft alternatives. One such alternative is Demineralized Bone Matrix (DBM). The purpose of this paper is to describe and characterize the properties of DBM in addition to reviewing the results of its use in animal and human studies of spinal fusion. A thorough and critical review of the English-language literature was conducted. DBM is both osteoconductive and osteoinductive. Studies have produced variable results with respect to spinal fusion rates. Various studies have demonstrated inferior, equal, or enhanced fusion rates. Some of the differences in these studies include the animal models used, the manner in which DBM was prepared, and the carrier with which DBM was combined. These differences may account for the dissimilar results. DBM is able to function as a graft extender in the human species.
Jeffrey A Hammoudeh - One of the best experts on this subject based on the ideXlab platform.
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three dimensional cone beam computed tomography volumetric outcomes of rhbmp 2 Demineralized Bone Matrix versus iliac crest Bone graft for alveolar cleft reconstruction
Plastic and Reconstructive Surgery, 2017Co-Authors: Fan Liang, Stephen L K Yen, Thomas Imahiyerobo, Luke Sanborn, Leia Yen, Daniel Yen, Sheila Nazarian, Breanna Jedrzejewski, Mark M Urata, Jeffrey A HammoudehAbstract:Background:Recent studies indicate that recombinant human Bone morphogenetic protein-2 (rhBMP-2) in a Demineralized Bone Matrix scaffold is a comparable alternative to iliac Bone autograft in the setting of secondary alveolar cleft repair. Postreconstruction occlusal radiographs demonstrate improved
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a comparative analysis of recombinant human Bone morphogenetic protein 2 with a Demineralized Bone Matrix versus iliac crest Bone graft for secondary alveolar Bone grafts in patients with cleft lip and palate review of 501 cases
Plastic and Reconstructive Surgery, 2017Co-Authors: Jeffrey A Hammoudeh, Fan Liang, Stephen L K Yen, Thomas Imahiyerobo, Artur Fahradyan, Daniel J Gould, Leo Urbinelli, Joanna T Nguyen, William P Magee, Mark M UrataAbstract:Background Alveolar cleft reconstruction using iliac crest Bone graft is considered standard of care for children with complete cleft lip and palate at the time of mixed dentition. Harvesting Bone may result in donor-site morbidity and additional operating time and length of hospitalization. Recombinant human Bone morphogenetic protein (rhBMP)-2 with a Demineralized Bone Matrix is an alternative Bone source for alveolar cleft reconstruction. The authors investigated the outcomes of rhBMP-2/Demineralized Bone Matrix versus iliac crest Bone graft for alveolar cleft reconstruction by reviewing postoperative surgical complications and cleft closure. Methods A retrospective chart review was conducted for 258 rhBMP-2/Demineralized Bone Matrix procedures (mean follow-up, 2.9 years) and 243 iliac crest Bone graft procedures (mean follow-up, 4.1 years) on 414 patients over a 12-year period. The authors compared complications, canine eruption, and alveolar cleft closure between the two groups. Results In the rhBMP-2/Demineralized Bone Matrix group, one patient required prolonged intubation because of intraoperative airway swelling not thought to be caused by rhBMP-2, 36 reported facial swelling and one required outpatient steroids as treatment, and 12 had dehiscence; however, half of these complications resolved without intervention. Twenty-three of the 228 rhBMP-2/Demineralized Bone Matrix patients and 28 of the 242 iliac crest Bone graft patients required repeated surgery for alveolar cleft repair. Findings for canine tooth eruption into the cleft site through the graft were similar between the groups. Conclusions The rhBMP-2/Demineralized Bone Matrix appears to be an acceptable alternative for alveolar cleft repair. The authors found no increase in serious adverse events with the use of this material. Local complications, such as swelling and minor wound dehiscence, predominantly improved without intervention. Clinical question/level of evidence Therapeutic, III.
Mark M Urata - One of the best experts on this subject based on the ideXlab platform.
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three dimensional cone beam computed tomography volumetric outcomes of rhbmp 2 Demineralized Bone Matrix versus iliac crest Bone graft for alveolar cleft reconstruction
Plastic and Reconstructive Surgery, 2017Co-Authors: Fan Liang, Stephen L K Yen, Thomas Imahiyerobo, Luke Sanborn, Leia Yen, Daniel Yen, Sheila Nazarian, Breanna Jedrzejewski, Mark M Urata, Jeffrey A HammoudehAbstract:Background:Recent studies indicate that recombinant human Bone morphogenetic protein-2 (rhBMP-2) in a Demineralized Bone Matrix scaffold is a comparable alternative to iliac Bone autograft in the setting of secondary alveolar cleft repair. Postreconstruction occlusal radiographs demonstrate improved
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a comparative analysis of recombinant human Bone morphogenetic protein 2 with a Demineralized Bone Matrix versus iliac crest Bone graft for secondary alveolar Bone grafts in patients with cleft lip and palate review of 501 cases
Plastic and Reconstructive Surgery, 2017Co-Authors: Jeffrey A Hammoudeh, Fan Liang, Stephen L K Yen, Thomas Imahiyerobo, Artur Fahradyan, Daniel J Gould, Leo Urbinelli, Joanna T Nguyen, William P Magee, Mark M UrataAbstract:Background Alveolar cleft reconstruction using iliac crest Bone graft is considered standard of care for children with complete cleft lip and palate at the time of mixed dentition. Harvesting Bone may result in donor-site morbidity and additional operating time and length of hospitalization. Recombinant human Bone morphogenetic protein (rhBMP)-2 with a Demineralized Bone Matrix is an alternative Bone source for alveolar cleft reconstruction. The authors investigated the outcomes of rhBMP-2/Demineralized Bone Matrix versus iliac crest Bone graft for alveolar cleft reconstruction by reviewing postoperative surgical complications and cleft closure. Methods A retrospective chart review was conducted for 258 rhBMP-2/Demineralized Bone Matrix procedures (mean follow-up, 2.9 years) and 243 iliac crest Bone graft procedures (mean follow-up, 4.1 years) on 414 patients over a 12-year period. The authors compared complications, canine eruption, and alveolar cleft closure between the two groups. Results In the rhBMP-2/Demineralized Bone Matrix group, one patient required prolonged intubation because of intraoperative airway swelling not thought to be caused by rhBMP-2, 36 reported facial swelling and one required outpatient steroids as treatment, and 12 had dehiscence; however, half of these complications resolved without intervention. Twenty-three of the 228 rhBMP-2/Demineralized Bone Matrix patients and 28 of the 242 iliac crest Bone graft patients required repeated surgery for alveolar cleft repair. Findings for canine tooth eruption into the cleft site through the graft were similar between the groups. Conclusions The rhBMP-2/Demineralized Bone Matrix appears to be an acceptable alternative for alveolar cleft repair. The authors found no increase in serious adverse events with the use of this material. Local complications, such as swelling and minor wound dehiscence, predominantly improved without intervention. Clinical question/level of evidence Therapeutic, III.
Joseph E Losee - One of the best experts on this subject based on the ideXlab platform.
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reply Demineralized Bone Matrix and resorbable mesh bilaminate cranioplasty is ineffective for secondary reconstruction of large pediatric cranial defects
Plastic and Reconstructive Surgery, 2020Co-Authors: Lucas A Dvoracek, Joseph E Losee, Jonathan Y Lee, Ali Ayyash, Jesse A GoldsteinAbstract:Replacement of the autologous Bone flap after decompressive craniectomy can be complicated by significant osteolysis or infection with large defects over scarred dura. Demineralized Bone Matrix is an alternative to autologous reconstruction, effective when reconstructing large defects using a resorbable mesh bilaminate technique in primary cranioplasty, but this technique has not been studied for revision cranioplasty and the setting of scarred dura. Retrospective review was performed of patients receiving Demineralized Bone Matrix and resorbable mesh bilaminate cranioplasty for postdecompressive craniectomy defects. Seven patients (mean age, 4.2 years) were identified with a mean follow-up of 4.0 years. Computed tomography before the Demineralized Bone Matrix and resorbable mesh bilaminate cranioplasty and at least 1 year postoperatively were compared. Defects were characterized and need for revision was assessed. All patients had craniectomy with associated hemidural scarring. Five patients had autologous Bone flap cranioplasty associated with nearly total osteolysis, and two patients had deferral of Bone flap before Demineralized Bone Matrix and resorbable mesh bilaminate cranioplasty. Demineralized Bone Matrix and resorbable mesh bilaminate cranioplasty demonstrated unpredictable and poor ossification, with bony coverage unchanged at postoperative follow-up. All patients required major revision cranioplasty at a mean time of 2.5 years. Porous polyethylene was successfully used in six of the revisions, whereas exchange cranioplasty was used in the remaining patient, with a mean follow-up of 1.4 years. Although Demineralized Bone Matrix and resorbable mesh bilaminate is appropriate for primary cranioplasty, it should be avoided in the setting of scarred or infected dura in favor of synthetic materials or exchange cranioplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
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alveolar reconstruction in cleft patients decreased morbidity and improved outcomes with supplemental Demineralized Bone Matrix and cancellous allograft
Plastic and Reconstructive Surgery, 2012Co-Authors: Zoe M Macisaac, Joseph E Losee, Alex S Rottgers, Alexander J Davit, Matthew D Ford, Anand KumarAbstract:Background The safety and efficacy of supplemental allograft combined with iliac crest autograft as a treatment for cleft alveolus defects is poorly characterized. The authors report the safety and efficacy of supplemental Demineralized Bone Matrix and cancellous allograft with iliac crest Bone autograft in cleft alveolar Bone defects. Methods A retrospective review of one institution's experience with cleft alveolar Bone defects treated with traditional open iliac crest Bone graft alone (group 1) or minimal access iliac crest Bone graft plus Demineralized Bone Matrix and cancellous allograft (group 2) was performed. All patients (n = 36) were treated with alveolar fistula repair with primary closure. Results Twenty-two patients [17 unilateral and five bilateral clefts (n = 27)] were treated in group 1 and 14 [six unilateral clefts and eight bilateral clefts (n = 22)] in group 2. The average operative time per alveolus was 147 minutes in group 1 and 111 minutes in group 2. Average engraftment (Enemark Scale) was 1.96 in group 1 and 1.20 in group 2. In group 1, canine eruption was complete in 71.4 percent, partial in 21.4 percent, and unerupted in 3.5 percent; in group 2, canine eruption was complete in 22 percent, partial in 55 percent, and unerupted in 18 percent. Bone graft extrusion occurred in six patients in group 1. There were no wound infections or deaths. Conclusions The addition of supplemental Demineralized Bone Matrix and cancellous allograft in cleft alveolar defects is safe and effective. The authors' allograft supplemental surgical technique is associated with low morbidity, shorter operative times, and higher rates of Bone graft survival.
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Demineralized Bone Matrix and resorbable mesh bilaminate cranioplasty a novel method for reconstruction of large scale defects in the pediatric calvaria
Plastic and Reconstructive Surgery, 2009Co-Authors: Mimi T Chao, Shao Jiang, Darren M Smith, Gary E Decesare, Gregory M Cooper, Ian F Pollack, John A Girotto, Joseph E LoseeAbstract:Background: Pediatric patients with large-scale calvarial defects often lose the osteogenic potential of their dura before developing a diploic space sufficient to facilitate harvest of split-thickness calvarial grafts. The authors present their experience using Demineralized Bone Matrix and resorbable mesh bilaminate for the repair of large-scale cranial defects in pediatric patients. Methods: A retrospective review of the Cleft-Craniofacial Center database at Children’s Hospital of Pittsburgh was performed from 2003 through 2007. Patients who underwent cranioplasties using Demineralized Bone Matrix and resorbable mesh bilaminate were identified. Indications, defect size, quantity of Demineralized Bone Matrix used, complications, follow-up, and computed tomographic scans were reviewed. Results: Eleven patients underwent 13 skull reconstructions using Demineralized Bone Matrix and resorbable mesh bilaminate cranioplasty. Mean age was 3.6 years (range, 2.1 to 4.9 years); average defect size was 30.8 cm2 (range, 6.6 to 80.0 cm2). Mean clinical follow-up was 29.3 months (range, 13.4 to 41.8 months). All patients had follow-up computed tomographic scans. The average time of follow-up scan was 18.7 months postoperatively (range, 6.9 to 32.6 months). Seven patients had immediate postoperative scans in addition to long-term follow-up scans, facilitating the calculation of a 98 percent average defect healing (range, 95 to 100 percent). All patients had clinically stable cranial reconstructions at follow-up. Conclusions: When autogenous Bone is not available, Demineralized Bone Matrix and resorbable mesh bilaminate cranioplasty is an alternative method of calvarial reconstruction when used in a healthy site free of scarring or infection. This cranioplasty technique has provided consistent bony regeneration, with no donor-site morbidity.