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Hany Angelis Abadia Borges De ,oliveira - One of the best experts on this subject based on the ideXlab platform.
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Periósteo como opção de tratamento das perfurações da membrana sinusal em procedimentos de levantamento do soalho do seio maxilar
Universidade Federal de Uberlândia, 2013Co-Authors: Hany Angelis Abadia Borges De ,oliveiraAbstract:A elevação do seio maxilar é uma técnica cirúrgica que visa aumentar o volume ósseo em maxila atrófica, com osso autógeno e/ou biomateriais, com a finalidade de inserir implantes dentais. Esse procedimento pode levar a algumas complicações, como sangramento, infecção do seio maxilar, deiscência da ferida, sinusite crônica e perda do enxerto. A maioria destas complicações podem estar relacionadas com a perfuração da membrana sinusal, com ocorrência de 10 a 35%, o que compromete a utilização de enxertos particulados. Diferentes técnicas são propostas para obliterar a perfuração sinusal, tal como dobrar ou suturar a membrana, utilização de um adesivo de cianoacrilato, cola de fibrina, plasma rico em fatores de crescimento, membrana de colágeno e enxerto de conjuntivo. As membranas de colágeno reabsorvíveis têm sido o método mais utilizado para o tratamento de perfuração da membrana sinusal. Este biomaterial funciona como uma barreira mecânica que evita a invasão do tecido conjuntivo e epitelial para o interior da cavidade óssea. Considerando que o periósteo é uma membrana de colágeno, ele poderia ser utilizado para o tratamento de perfurações da membrana do seio maxilar. O presente estudo propõe avaliar a efetividade clínica do enxerto autógeno de periósteo, utilizado para obliteração de perfuração da membrana sinusal ocorrida em procedimentos de levantamento de seio maxilar. De janeiro de 2009 a novembro de 2012 foram selecionados 81 procedimentos de levantamento de seio maxilar, em indivíduos saudáveis com 25 a 60 anos de idade. Nestes, em 16 procedimentos ocorreram perfurações de membrana sinusal. O grupo de estudo foi dividido em dois subgrupos: subgrupo I - pacientes cuja membrana sinusal foi perfurada e obliterada com enxerto de periósteo e subgrupo II - pacientes cuja membrana não foi perfurada. Aqueles que tiveram a membrana sinusal perfurada, foram tratados com enxerto de periósteo removido da região doadora do enxerto ósseo, na área retromolar. Os pacientes foram seguidos diariamente durante os primeiros 10 dias, até a remoção das suturas e monitorados a cada duas semanas por um período de dois meses. Todos os pacientes toleraram o procedimento usando o periósteo como tratamento da perfuração da membrana sinusal e o pós-cirúrgico foi sem intercorrências. O acompanhamento clínico e radiográfico dos pacientes, no pós cirúrgico, demonstrou que a técnica proposta foi clinicamente eficaz e que o periósteo pode ser utilizado em perfurações de tamanhos variáveis, desde que a membrana não esteja totalmente dilacerada. Considerando a viabilidade do procedimento e os resultados clínicos, é possível concluir que o periósteo é eficaz no tratamento das perfurações da membrana do seio maxilar.Maxillary sinus lifting is a technique to increase bone volume in atrophic maxilla, with autogenous bone and/or biomaterials, in order to place implant. This procedure may lead to some complications such as bleeding, maxillary sinus infection, wound dehiscence, sinus fistulae, chronic sinusitis, and loss of the Graft. Most of these complications can be related to perforation of the sinus membrane, that occurring in 10 to 35%, which undertakes the use of particulate Grafts. Different techniques are proposed to obliterate the sinusal perforation, such as folding or suturing membrane, use of a cyanoacrylate adhesive, fibrin glue, plasma rich in growth factors, collagen membrane, conjunctive Graft. The resorbable collagen membranes have been the most common option to treat a sinus membrane perforation. This biomaterial operates as a mechanical barrier that prevents the invasion of connective and epithelial tissues inside the bone cavity. Whereas the Periosteum is a membrane collagen, it could be used for treating sinus membrane perforation. The present study proposes to evaluate the clinical effectiveness of the autogenous Periosteum, used for obliteration of sinus membrane perforation occurred in procedures maxillary sinus lifting. From January 2009 to November 2012 were selected 81 procedures maxillary sinuses lifting in healthy subjects ranging from 25 to 60 years of age. In these, there were 16 procedures with sinus membrane perforations. The study group was divided into 2 subgroups: subgroup I - patients whose sinus membrane was perforated and obliterated with Periosteum Graft and subgroup II- patients whose membrane was not perforated. Those who had the sinus membrane perforation were treated with autologous Periosteum removed from the bone Graft donor region, retromolar area. Patients were followed daily for the first 10 days until the sutures were removed and monitored every two weeks two month. All patients tolerated the procedure using the Periosteum as a treatment for a sinus membrane perforation during sinus lifting and their post-surgical results were uneventful. During the post-operation period was observed only a slight swelling at the Graft donor site. The clinical and radiographic follow-ups of patients after surgery demonstrated that the proposed technique is clinical effective, and the Periosteum can be used in the various sizes of perforations, since that the membrane is not completely dilacerated. Whereas with the viability of the procedure and the clinical results, it is possible to conclude that Periosteum is effective in treatment of sinus membrane perforation
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Periósteo como opção de tratamento das perfurações da membrana sinusal em procedimentos de levantamento do soalho do seio maxilar
'EDUFU - Editora da Universidade Federal de Uberlandia', 2013Co-Authors: Hany Angelis Abadia Borges De ,oliveiraAbstract:Maxillary sinus lifting is a technique to increase bone volume in atrophic maxilla, with autogenous bone and/or biomaterials, in order to place implant. This procedure may lead to some complications such as bleeding, maxillary sinus infection, wound dehiscence, sinus fistulae, chronic sinusitis, and loss of the Graft. Most of these complications can be related to perforation of the sinus membrane, that occurring in 10 to 35%, which undertakes the use of particulate Grafts. Different techniques are proposed to obliterate the sinusal perforation, such as folding or suturing membrane, use of a cyanoacrylate adhesive, fibrin glue, plasma rich in growth factors, collagen membrane, conjunctive Graft. The resorbable collagen membranes have been the most common option to treat a sinus membrane perforation. This biomaterial operates as a mechanical barrier that prevents the invasion of connective and epithelial tissues inside the bone cavity. Whereas the Periosteum is a membrane collagen, it could be used for treating sinus membrane perforation. The present study proposes to evaluate the clinical effectiveness of the autogenous Periosteum, used for obliteration of sinus membrane perforation occurred in procedures maxillary sinus lifting. From January 2009 to November 2012 were selected 81 procedures maxillary sinuses lifting in healthy subjects ranging from 25 to 60 years of age. In these, there were 16 procedures with sinus membrane perforations. The study group was divided into 2 subgroups: subgroup I - patients whose sinus membrane was perforated and obliterated with Periosteum Graft and subgroup II- patients whose membrane was not perforated. Those who had the sinus membrane perforation were treated with autologous Periosteum removed from the bone Graft donor region, retromolar area. Patients were followed daily for the first 10 days until the sutures were removed and monitored every two weeks two month. All patients tolerated the procedure using the Periosteum as a treatment for a sinus membrane perforation during sinus lifting and their post-surgical results were uneventful. During the post-operation period was observed only a slight swelling at the Graft donor site. The clinical and radiographic follow-ups of patients after surgery demonstrated that the proposed technique is clinical effective, and the Periosteum can be used in the various sizes of perforations, since that the membrane is not completely dilacerated. Whereas with the viability of the procedure and the clinical results, it is possible to conclude that Periosteum is effective in treatment of sinus membrane perforation.Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorMestre em OdontologiaA elevação do seio maxilar é uma técnica cirúrgica que visa aumentar o volume ósseo em maxila atrófica, com osso autógeno e/ou biomateriais, com a finalidade de inserir implantes dentais. Esse procedimento pode levar a algumas complicações, como sangramento, infecção do seio maxilar, deiscência da ferida, sinusite crônica e perda do enxerto. A maioria destas complicações podem estar relacionadas com a perfuração da membrana sinusal, com ocorrência de 10 a 35%, o que compromete a utilização de enxertos particulados. Diferentes técnicas são propostas para obliterar a perfuração sinusal, tal como dobrar ou suturar a membrana, utilização de um adesivo de cianoacrilato, cola de fibrina, plasma rico em fatores de crescimento, membrana de colágeno e enxerto de conjuntivo. As membranas de colágeno reabsorvíveis têm sido o método mais utilizado para o tratamento de perfuração da membrana sinusal. Este biomaterial funciona como uma barreira mecânica que evita a invasão do tecido conjuntivo e epitelial para o interior da cavidade óssea. Considerando que o periósteo é uma membrana de colágeno, ele poderia ser utilizado para o tratamento de perfurações da membrana do seio maxilar. O presente estudo propõe avaliar a efetividade clínica do enxerto autógeno de periósteo, utilizado para obliteração de perfuração da membrana sinusal ocorrida em procedimentos de levantamento de seio maxilar. De janeiro de 2009 a novembro de 2012 foram selecionados 81 procedimentos de levantamento de seio maxilar, em indivíduos saudáveis com 25 a 60 anos de idade. Nestes, em 16 procedimentos ocorreram perfurações de membrana sinusal. O grupo de estudo foi dividido em dois subgrupos: subgrupo I - pacientes cuja membrana sinusal foi perfurada e obliterada com enxerto de periósteo e subgrupo II - pacientes cuja membrana não foi perfurada. Aqueles que tiveram a membrana sinusal perfurada, foram tratados com enxerto de periósteo removido da região doadora do enxerto ósseo, na área retromolar. Os pacientes foram seguidos diariamente durante os primeiros 10 dias, até a remoção das suturas e monitorados a cada duas semanas por um período de dois meses. Todos os pacientes toleraram o procedimento usando o periósteo como tratamento da perfuração da membrana sinusal e o pós-cirúrgico foi sem intercorrências. O acompanhamento clínico e radiográfico dos pacientes, no pós cirúrgico, demonstrou que a técnica proposta foi clinicamente eficaz e que o periósteo pode ser utilizado em perfurações de tamanhos variáveis, desde que a membrana não esteja totalmente dilacerada. Considerando a viabilidade do procedimento e os resultados clínicos, é possível concluir que o periósteo é eficaz no tratamento das perfurações da membrana do seio maxilar
Barastegui Fernández David - One of the best experts on this subject based on the ideXlab platform.
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Análisis de la revascularización de injertos estructurales masivos de hueso criopreservado mediante periostio vascularizado en modelo de conejo
'Universitat Autonoma de Barcelona', 2017Co-Authors: Barastegui Fernández DavidAbstract:La reconstrucción de defectos óseos segmentarios tras las cirugías de resección ósea son un de los mayores problemas con los que se encuentra el cirujano ortopédico en la actualidad. Dentro de las técnicas de reconstrucción disponibles en la actualidad, la reconstrucción con aloinjertos estructurales es una de las opciones más utilizadas, aún teniendo unas tasas de complicaciones y secuelas importantes. Actualmente con el auge del campo de la microcirugía, las técnicas combinadas reconstructivas con aloinjertos estructurales y aportes biológicos mediante injertos vascularizados puede ser una de las claves para disminuir esas tasas de complicación y mejorar la supervivencia de los constructos. En este trabajo se ha valorado la combinación de injerto estructural óseo criopreservado combinado con injerto vascularizado de periostio libre en defecto masivo en un modelo animal de conejo infiriendo como hipótesis que la asociación de dicho constructo potencia la consolidación y la revascularización de dicho aloinjerto estructural. Se ha realizado el estudio en 39 conejos sanos, repartidos en dos grupos, realizándose un defecto masivo en el radio de la extremidad superior del animal para posteriormente realizar una reconstrucción con aloinjerto estructural criopreservado aislado en un grupo (grupo control) y asociado a un injerto vascularizado libre de periostio en el grupo experimental (grupo periostio). Se han realizado controles evolutivos de los conejos en ambos en diferentes seguimientos, a las 5, 10 y 20 semanas respectivamente y se ha realizado estudio radiológico, histológico macroscópico y microscópico tanto óptico como electrónico para valorar la consolidación de los injertos y su potencial revascularización. Como resultados del estudio, se ha observado un aumento de la organización del callo óseo neoformado a expensas de una osificación endocondral, así como una mejor maduración del mismo desde el primer subgrupo a las 5 semanas a nivel macro y microscópico. En cuanto a la revascularización del mismo se ha observado un aumento del numero de osteocitos viables en los grupos experimentales, así como un proceso de revitalización de osteocitos en proceso de apoptosis no definitiva y neovasos estructurados en la interfase hueso huésped-aloinjerto en el grupo experimental (asociando periostio vascularizado) sin observarse dicho fenómeno tan claro a nivel de la parte central del injerto. Este proceso de revascularización se combina con un proceso de resorción-neo formación de hueso nativo a través del injerto estructural. En conclusión, en el presente estudio se ha observado que la asociación de periostio vascularizado libre a un aloinjerto estructural criopreservado acelera la consolidación de la interfase mostrando una mejor estructuración y maduración del callo óseo mediante osteoformación endocondral (similar a la especia humana) y promoviendo la revascularización ósea en la zona de interfase hueso huésped-aloinjerto combinada con fenómenos de resorción y neoformación ósea. Ante estos resultados se debe considerar en la práctica clínica la reconstrucción de grandes defectos óseos con técnicas combinadas de injerto criopreservado estructural asociando injertos vascularizados de periostio para una mejor tasa de supervivencia y de complicaciones de dichos constructos.Reconstruction of segmental bone defects after bone resection surgeries are one of the biggest problems orthopedic surgeons currently face. Among the reconstruction techniques available, structural reconstruction with alloGraft is one of the most used options, even with the high complication rates and sequelae. With the current rise in microsurgery field, combined reconstructive techniques using structural alloGrafts and biological contributions such as vascularized autoGrafts can be key elements in the reduction of complication rates and improve survival of the constructs. The current study has evaluated the combination of cryopreserved structural bone Grafts and free vascularized Periosteum Grafts in large defects in a rabbit model with the hypothesis that the association of said construct enhances the consolidation and revascularization of the structural alloGraft. The study was performed in 39 healthy rabbits divided into two groups, performing a large defect in the radius of the animal’s superior extremity to subsequently perform a reconstruction with an isolated cryopreserved structural alloGraft in one group (control group) and a free vascularized Periosteum Graft in the experimental group (Periosteum group). Controls were performed in both groups at 5, 10 and 20 weeks respectively and radiological, histological macroscopic and microscopic exams to assess the consolidation of the Grafts and their potential revascularization. Results showed an increase in the organization of newly formed bone callus at the expense of endochondral ossification, as well as better maturation from the first subgroup at 5 weeks at macro and micro level. The same was observed for revascularization with an increased number of viable osteocytes in the experimental group and an osteocyte revitalization process in non definitive apoptosis and structured neovascularization at the alloGraft-host junction in the experimental group (associating vascularized Periosteum) this phenomenon not being observed so clearly in the central part of the Graft. This revascularization process was combined with a native bone resorption through the structural Graft. In conclusion, the present study showed that the association of free vascularized Periosteum with cryopreserved structural alloGraft accelerates consolidation at the junction showing better structuring and maturation of bone callus by endochondral bone formation (similar to the human species) and promoting bone revascularization in the alloGraft-host bone junction combined with phenomena of resorption and bone formation. Given these results, the reconstruction of large bone defects with combined techniques of cryopreserved structural bone Grafts and free vascularized Periosteum Grafts should be considered in clinical practice due to the improved survival and complication rates of these constructs
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Análisis de la revascularización de injertos estructurales masivos de hueso criopreservado mediante periostio vascularizado en modelo de conejo /
2017Co-Authors: Barastegui Fernández David, Universitat Autònoma De Barcelona. Departament De CirurgiaAbstract:La reconstrucción de defectos óseos segmentarios tras las cirugías de resección ósea son un de los mayores problemas con los que se encuentra el cirujano ortopédico en la actualidad. Dentro de las técnicas de reconstrucción disponibles en la actualidad, la reconstrucción con aloinjertos estructurales es una de las opciones más utilizadas, aún teniendo unas tasas de complicaciones y secuelas importantes. Actualmente con el auge del campo de la microcirugía, las técnicas combinadas reconstructivas con aloinjertos estructurales y aportes biológicos mediante injertos vascularizados puede ser una de las claves para disminuir esas tasas de complicación y mejorar la supervivencia de los constructos. En este trabajo se ha valorado la combinación de injerto estructural óseo criopreservado combinado con injerto vascularizado de periostio libre en defecto masivo en un modelo animal de conejo infiriendo como hipótesis que la asociación de dicho constructo potencia la consolidación y la revascularización de dicho aloinjerto estructural. Se ha realizado el estudio en 39 conejos sanos, repartidos en dos grupos, realizándose un defecto masivo en el radio de la extremidad superior del animal para posteriormente realizar una reconstrucción con aloinjerto estructural criopreservado aislado en un grupo (grupo control) y asociado a un injerto vascularizado libre de periostio en el grupo experimental (grupo periostio). Se han realizado controles evolutivos de los conejos en ambos en diferentes seguimientos, a las 5, 10 y 20 semanas respectivamente y se ha realizado estudio radiológico, histológico macroscópico y microscópico tanto óptico como electrónico para valorar la consolidación de los injertos y su potencial revascularización. Como resultados del estudio, se ha observado un aumento de la organización del callo óseo neoformado a expensas de una osificación endocondral, así como una mejor maduración del mismo desde el primer subgrupo a las 5 semanas a nivel macro y microscópico. En cuanto a la revascularización del mismo se ha observado un aumento del numero de osteocitos viables en los grupos experimentales, así como un proceso de revitalización de osteocitos en proceso de apoptosis no definitiva y neovasos estructurados en la interfase hueso huésped-aloinjerto en el grupo experimental (asociando periostio vascularizado) sin observarse dicho fenómeno tan claro a nivel de la parte central del injerto. Este proceso de revascularización se combina con un proceso de resorción-neo formación de hueso nativo a través del injerto estructural. En conclusión, en el presente estudio se ha observado que la asociación de periostio vascularizado libre a un aloinjerto estructural criopreservado acelera la consolidación de la interfase mostrando una mejor estructuración y maduración del callo óseo mediante osteoformación endocondral (similar a la especia humana) y promoviendo la revascularización ósea en la zona de interfase hueso huésped-aloinjerto combinada con fenómenos de resorción y neoformación ósea. Ante estos resultados se debe considerar en la práctica clínica la reconstrucción de grandes defectos óseos con técnicas combinadas de injerto criopreservado estructural asociando injertos vascularizados de periostio para una mejor tasa de supervivencia y de complicaciones de dichos constructos.Reconstruction of segmental bone defects after bone resection surgeries are one of the biggest problems orthopedic surgeons currently face. Among the reconstruction techniques available, structural reconstruction with alloGraft is one of the most used options, even with the high complication rates and sequelae. With the current rise in microsurgery field, combined reconstructive techniques using structural alloGrafts and biological contributions such as vascularized autoGrafts can be key elements in the reduction of complication rates and improve survival of the constructs. The current study has evaluated the combination of cryopreserved structural bone Grafts and free vascularized Periosteum Grafts in large defects in a rabbit model with the hypothesis that the association of said construct enhances the consolidation and revascularization of the structural alloGraft. The study was performed in 39 healthy rabbits divided into two groups, performing a large defect in the radius of the animal's superior extremity to subsequently perform a reconstruction with an isolated cryopreserved structural alloGraft in one group (control group) and a free vascularized Periosteum Graft in the experimental group (Periosteum group). Controls were performed in both groups at 5, 10 and 20 weeks respectively and radiological, histological macroscopic and microscopic exams to assess the consolidation of the Grafts and their potential revascularization. Results showed an increase in the organization of newly formed bone callus at the expense of endochondral ossification, as well as better maturation from the first subgroup at 5 weeks at macro and micro level. The same was observed for revascularization with an increased number of viable osteocytes in the experimental group and an osteocyte revitalization process in non definitive apoptosis and structured neovascularization at the alloGraft-host junction in the experimental group (associating vascularized Periosteum) this phenomenon not being observed so clearly in the central part of the Graft. This revascularization process was combined with a native bone resorption through the structural Graft. In conclusion, the present study showed that the association of free vascularized Periosteum with cryopreserved structural alloGraft accelerates consolidation at the junction showing better structuring and maturation of bone callus by endochondral bone formation (similar to the human species) and promoting bone revascularization in the alloGraft-host bone junction combined with phenomena of resorption and bone formation. Given these results, the reconstruction of large bone defects with combined techniques of cryopreserved structural bone Grafts and free vascularized Periosteum Grafts should be considered in clinical practice due to the improved survival and complication rates of these constructs
Jung-ju Huang - One of the best experts on this subject based on the ideXlab platform.
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The effect of bone inhibitors on Periosteum-guided cartilage regeneration.
Scientific Reports, 2020Co-Authors: Hui-yi Hsiao, Chao-min Cheng, Shu-wei Kao, Jia-wei Liu, Chun-shin Chang, Leila Harhaus, Jung-ju HuangAbstract:The regeneration capacity of knee cartilage can be enhanced by applying periosteal Grafts, but this effect varies depending on the different sources of the periosteal Grafts applied for cartilage formation. Tibia Periosteum can be used to enhance cartilage repair. However, long-term analysis has not been conducted. The endochondral ossification capacity of tibia Periosteum during cartilage repair also needs to be investigated. In this study, both vascularized and non-vascularized tibia Periosteum Grafts were studied to understand the relationship between tissue perfusion of the Periosteum Graft and the effects on cartilage regeneration and bone formation. Furthermore, anti-ossification reagents were added to evaluate the efficacy of the prevention of bone formation along with cartilage regeneration. A critical-size cartilage defect (4 × 4 mm) was created and was covered with an autologous tibia vascularized periosteal flap or with a non-vascularized tibia Periosteum patch on the knee in the rabbit model. A portion of the vascularized Periosteum group was also treated with the anti-osteogenic reagents Fulvestrant and IL1β to inhibit unwanted bone formation. Our results indicated that the vascularized Periosteum significantly enhanced cartilage regeneration in the cartilage defect region in long-term treatment compared to the non-vascularized group. Furthermore, the addition of anti-osteogenic reagents to the vascularized Periosteum group suppressed bone formation but also reduced the cartilage regeneration rate. Our study using vascularized autologous tissue to repair cartilage defects of the knee may lead to the modification of current treatment in regard to osteoarthritis knee repair.
Universitat Autònoma De Barcelona. Departament De Cirurgia - One of the best experts on this subject based on the ideXlab platform.
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Análisis de la revascularización de injertos estructurales masivos de hueso criopreservado mediante periostio vascularizado en modelo de conejo /
2017Co-Authors: Barastegui Fernández David, Universitat Autònoma De Barcelona. Departament De CirurgiaAbstract:La reconstrucción de defectos óseos segmentarios tras las cirugías de resección ósea son un de los mayores problemas con los que se encuentra el cirujano ortopédico en la actualidad. Dentro de las técnicas de reconstrucción disponibles en la actualidad, la reconstrucción con aloinjertos estructurales es una de las opciones más utilizadas, aún teniendo unas tasas de complicaciones y secuelas importantes. Actualmente con el auge del campo de la microcirugía, las técnicas combinadas reconstructivas con aloinjertos estructurales y aportes biológicos mediante injertos vascularizados puede ser una de las claves para disminuir esas tasas de complicación y mejorar la supervivencia de los constructos. En este trabajo se ha valorado la combinación de injerto estructural óseo criopreservado combinado con injerto vascularizado de periostio libre en defecto masivo en un modelo animal de conejo infiriendo como hipótesis que la asociación de dicho constructo potencia la consolidación y la revascularización de dicho aloinjerto estructural. Se ha realizado el estudio en 39 conejos sanos, repartidos en dos grupos, realizándose un defecto masivo en el radio de la extremidad superior del animal para posteriormente realizar una reconstrucción con aloinjerto estructural criopreservado aislado en un grupo (grupo control) y asociado a un injerto vascularizado libre de periostio en el grupo experimental (grupo periostio). Se han realizado controles evolutivos de los conejos en ambos en diferentes seguimientos, a las 5, 10 y 20 semanas respectivamente y se ha realizado estudio radiológico, histológico macroscópico y microscópico tanto óptico como electrónico para valorar la consolidación de los injertos y su potencial revascularización. Como resultados del estudio, se ha observado un aumento de la organización del callo óseo neoformado a expensas de una osificación endocondral, así como una mejor maduración del mismo desde el primer subgrupo a las 5 semanas a nivel macro y microscópico. En cuanto a la revascularización del mismo se ha observado un aumento del numero de osteocitos viables en los grupos experimentales, así como un proceso de revitalización de osteocitos en proceso de apoptosis no definitiva y neovasos estructurados en la interfase hueso huésped-aloinjerto en el grupo experimental (asociando periostio vascularizado) sin observarse dicho fenómeno tan claro a nivel de la parte central del injerto. Este proceso de revascularización se combina con un proceso de resorción-neo formación de hueso nativo a través del injerto estructural. En conclusión, en el presente estudio se ha observado que la asociación de periostio vascularizado libre a un aloinjerto estructural criopreservado acelera la consolidación de la interfase mostrando una mejor estructuración y maduración del callo óseo mediante osteoformación endocondral (similar a la especia humana) y promoviendo la revascularización ósea en la zona de interfase hueso huésped-aloinjerto combinada con fenómenos de resorción y neoformación ósea. Ante estos resultados se debe considerar en la práctica clínica la reconstrucción de grandes defectos óseos con técnicas combinadas de injerto criopreservado estructural asociando injertos vascularizados de periostio para una mejor tasa de supervivencia y de complicaciones de dichos constructos.Reconstruction of segmental bone defects after bone resection surgeries are one of the biggest problems orthopedic surgeons currently face. Among the reconstruction techniques available, structural reconstruction with alloGraft is one of the most used options, even with the high complication rates and sequelae. With the current rise in microsurgery field, combined reconstructive techniques using structural alloGrafts and biological contributions such as vascularized autoGrafts can be key elements in the reduction of complication rates and improve survival of the constructs. The current study has evaluated the combination of cryopreserved structural bone Grafts and free vascularized Periosteum Grafts in large defects in a rabbit model with the hypothesis that the association of said construct enhances the consolidation and revascularization of the structural alloGraft. The study was performed in 39 healthy rabbits divided into two groups, performing a large defect in the radius of the animal's superior extremity to subsequently perform a reconstruction with an isolated cryopreserved structural alloGraft in one group (control group) and a free vascularized Periosteum Graft in the experimental group (Periosteum group). Controls were performed in both groups at 5, 10 and 20 weeks respectively and radiological, histological macroscopic and microscopic exams to assess the consolidation of the Grafts and their potential revascularization. Results showed an increase in the organization of newly formed bone callus at the expense of endochondral ossification, as well as better maturation from the first subgroup at 5 weeks at macro and micro level. The same was observed for revascularization with an increased number of viable osteocytes in the experimental group and an osteocyte revitalization process in non definitive apoptosis and structured neovascularization at the alloGraft-host junction in the experimental group (associating vascularized Periosteum) this phenomenon not being observed so clearly in the central part of the Graft. This revascularization process was combined with a native bone resorption through the structural Graft. In conclusion, the present study showed that the association of free vascularized Periosteum with cryopreserved structural alloGraft accelerates consolidation at the junction showing better structuring and maturation of bone callus by endochondral bone formation (similar to the human species) and promoting bone revascularization in the alloGraft-host bone junction combined with phenomena of resorption and bone formation. Given these results, the reconstruction of large bone defects with combined techniques of cryopreserved structural bone Grafts and free vascularized Periosteum Grafts should be considered in clinical practice due to the improved survival and complication rates of these constructs
Hui-yi Hsiao - One of the best experts on this subject based on the ideXlab platform.
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The effect of bone inhibitors on Periosteum-guided cartilage regeneration.
Scientific Reports, 2020Co-Authors: Hui-yi Hsiao, Chao-min Cheng, Shu-wei Kao, Jia-wei Liu, Chun-shin Chang, Leila Harhaus, Jung-ju HuangAbstract:The regeneration capacity of knee cartilage can be enhanced by applying periosteal Grafts, but this effect varies depending on the different sources of the periosteal Grafts applied for cartilage formation. Tibia Periosteum can be used to enhance cartilage repair. However, long-term analysis has not been conducted. The endochondral ossification capacity of tibia Periosteum during cartilage repair also needs to be investigated. In this study, both vascularized and non-vascularized tibia Periosteum Grafts were studied to understand the relationship between tissue perfusion of the Periosteum Graft and the effects on cartilage regeneration and bone formation. Furthermore, anti-ossification reagents were added to evaluate the efficacy of the prevention of bone formation along with cartilage regeneration. A critical-size cartilage defect (4 × 4 mm) was created and was covered with an autologous tibia vascularized periosteal flap or with a non-vascularized tibia Periosteum patch on the knee in the rabbit model. A portion of the vascularized Periosteum group was also treated with the anti-osteogenic reagents Fulvestrant and IL1β to inhibit unwanted bone formation. Our results indicated that the vascularized Periosteum significantly enhanced cartilage regeneration in the cartilage defect region in long-term treatment compared to the non-vascularized group. Furthermore, the addition of anti-osteogenic reagents to the vascularized Periosteum group suppressed bone formation but also reduced the cartilage regeneration rate. Our study using vascularized autologous tissue to repair cartilage defects of the knee may lead to the modification of current treatment in regard to osteoarthritis knee repair.