Use of a composite pedicled muscle flap and rhBMP-7 for mandibular reconstruction.

The aim of this study was to investigate the feasibility of reconstructing critical size continuity osteoperiosteal defects of the mandible using a composite of recombinant BMP-7 contained in a bovine type-1 collagen carrier wrapped in a pedicled sterno-occipitalis muscle flap. At 3 months following surgery, bridging of the surgical defect was noted in three subjects (60%). Histologically, the induced bone regenerate showed maturation from woven to lamellar bone. Islands of cartilage were distributed throughout the defect. Replacement ossification of the degenerated muscle was a common feature in all specimens. Microradiography showed a gradual increase in the calcification of mineralized tissue from the margin to the centre of the newly generated bone. This research represents a proof of the concept that bone can be satisfactorily formed within a muscular scaffolding at the site of the created defect in a one-stage procedure.

[1]  E. Wang,et al.  Healing segmental femoral defects in sheep using recombinant human bone morphogenetic protein. , 1993, Clinical orthopaedics and related research.

[2]  V. Rosen,et al.  Effects of BMP-2, BMP-4, and BMP-6 on osteoblastic differentiation of bone marrow-derived stromal cell lines, ST2 and MC3T3-G2/PA6. , 1996, Biochemical and biophysical research communications.

[3]  G. Boering,et al.  Morbidity from iliac crest bone harvesting. , 1996, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[4]  T. Gerhart,et al.  Healing Bone Using Recombinant Human Bone Morphogenetic Protein 2 and Copolymer , 1998, Clinical orthopaedics and related research.

[5]  J. Hollinger,et al.  Tissue Engineering of Bone in the Craniofacial Complex , 1999, Annals of the New York Academy of Sciences.

[6]  A. Ayoub,et al.  Histological assessment of bioengineered new bone in repairing osteoperiosteal mandibular defects in sheep using recombinant human bone morphogenetic protein-7. , 2004, The British journal of oral & maxillofacial surgery.

[7]  A. Ayoub,et al.  Contour and volume assessment of repairing mandibular osteoperiosteal continuity defects in sheep using recombinant human osteogenic protein 1. , 2006, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[8]  A. Reddi,et al.  Complete regeneration of bone in the baboon by recombinant human osteogenic protein-1 (hOP-1, bone morphogenetic protein-7). , 1996, Growth factors.

[9]  J. Wozney,et al.  Mandibular Reconstruction Using Bone Morphogenetic ProteinLong‐Term Follow‐up in a Canine Model , 1999, The Laryngoscope.

[10]  C. Gregory.  The Current Status of Bone and Joint Transplants , 1972, Clinical orthopaedics and related research.

[11]  M. Urist,et al.  Recombinant Human Bone Morphogenetic Protein (rhBMP) Induced Heterotopic Bone Development In Vivo and In Vitro , 1996, Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine.

[12]  A. Ayoub,et al.  The role of ultrasound in monitoring reconstruction of mandibular continuity defects using osteogenic protein-1 (rhOP-1). , 2003, International journal of oral and maxillofacial surgery.

[13]  M A Pogrel,et al.  A comparison of vascularized and nonvascularized bone grafts for reconstruction of mandibular continuity defects. , 1997, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[14]  E. Wang,et al.  Mandibular reconstruction with a recombinant bone-inducing factor. Functional, histologic, and biomechanical evaluation. , 1991, Archives of otolaryngology--head & neck surgery.

[15]  V. Rosen,et al.  The healing of segmental bone defects, induced by recombinant human bone morphogenetic protein (rhBMP-2). A radiographic, histological, and biomechanical study in rats. , 1992, The Journal of bone and joint surgery. American volume.

[16]  B ANGMAR,et al.  Studies on the ultrastructure of dental enamel. IV. The mineralization of normal human enamel. , 1963, Journal of ultrastructure research.

[17]  S. Cook,et al.  Use of an osteoinductive biomaterial (rhOP-1) in healing large segmental bone defects. , 1998, Journal of orthopaedic trauma.

[18]  R. Khouri.  Avoiding free flap failure. , 1992, Clinics in plastic surgery.

[19]  S D Cook,et al.  Effect of recombinant human osteogenic protein-1 on healing of segmental defects in non-human primates. , 1995, The Journal of bone and joint surgery. American volume.

[20]  S Jepsen,et al.  Mandibular reconstruction with a prefabricated vascularized bone graft using recombinant human osteogenic protein-1: an experimental study in miniature pigs. Part I: Prefabrication. , 2001, International journal of oral and maxillofacial surgery.

[21]  P. Boyne,et al.  Application of Bone Morphogenetic Proteins in the Treatment of Clinical Oral and Maxillofacial Osseous Defects , 2001, The Journal of bone and joint surgery. American volume.

[22]  H Terheyden,et al.  Prefabrication of vascularized bone grafts using recombinant human osteogenic protein-1--part 3: dosage of rhOP-1, the use of external and internal scaffolds. , 2004, International journal of oral and maxillofacial surgery.