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.
Highlights
The management of critical size bone defects is still a challenge to the reconstructive surgeon in the twenty first century (Wagels et al, 2013)
Reviewing pre-clinical studies related to omental flaps in bone tissue regeneration, alongside an osseoconductive scaffold, there is a clear role for native mesenchymal stem cells growing into the scaffold in synergy with new blood vessel formation guided by the omentum
Biomechanical strength was not superior at 8 weeks when compared to the periosteal flap or periosteal flap with scaffold alone. This may indicate an initial advantage in bone regeneration during the early stages of scaffold axial vascularization with adjunctive cellular techniques, but perhaps may be eventually offset by the neo-osteogenic potential of the periosteum at a later time point
Summary
The management of critical size bone defects is still a challenge to the reconstructive surgeon in the twenty first century (Wagels et al, 2013). These defects may arise after trauma or oncological bone resection. The goal of limb salvage is restoration of bone stock to facilitate mechanical loading within a reasonable time period. This can be achieved by limb shortening, non-vascularized autograft, the Masquelet technique (autograft placed into an induced membrane), distraction osteogenesis and vascularized bone with or without allograft. The value of limb salvage to both the patient and the community in which they live seems self-evident, yet it has become increasingly clear that successful limb salvage can outperform amputation and prosthetic rehabilitation after prolonged follow up (Bosse et al, 2002; Chung et al, 2009; Higgins et al, 2010)
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