Abstract
Objective The aim of this study is to establish a large animal (dog) model that can be referred clinically for autologous homologous cranioplasty. Methods Our large skull defect dog model was established by emulating the decompressive craniectomy with 22 adult beagle dogs. The autologous bones were taken out from the dogs and divided into two groups, the freeze-drying (FD) group and the single freezing (SF) group. They were then stored in the bone bank at -20°C after being irradiated with 25 KGy. Three months later, the bones were reimplanted. After operation, we closely watch the experimental objects for four more months examining the infection and survival of the bone graft. Results Through macroscopic observation, it was found that, among 44 cranial flaps (bilateral) from the rest of the 22 dogs, grade A cranial flaps accounted for 86.4% (19/22) in the SF group and only 31.8% (7/22) in the FD group. Although osteogenic osteoclast, Harvard tube, neovascularization, and angiogenic factors were found through the pathological results, including an electron microscope and calmodulin tracer, it could be verified by using X-CT and micro-CT that early bone resorption could be still found even in grade A bone flap. Conclusion By using the common clinical method to preserve the cranial flaps, we established an experimental dog model of autologous cranioplasty for a large area of cranial defect. It was proved that this model could reproduce the infections and bone resorption which typically happened in clinical autologous homologous cranioplasty. As a conclusion, the established model can be used as an effective experimental tool for further research to improve the success rate of autologous homologous cranioplasty.
Highlights
Decompressive craniectomy is often performed to alleviate intracranial pressure caused by craniocerebral injury, cerebral hemorrhage, etc
Grade C meant that the defect area was >30%, the thickness of the bone flap could be felt significantly uneven by palpation, or bones were replaced by soft connective tissues instead (Figure 1(b)) and could not even be felt
The results showed that the quality of cranial flaps in the single freezing (SF) group was better than that in the FD group
Summary
Decompressive craniectomy is often performed to alleviate intracranial pressure caused by craniocerebral injury, cerebral hemorrhage, etc. The resulted cranial defects need a secondary operation, i.e., cranioplasty [1]. Three-dimensional titanium mesh, which is constructed through CT graphic analysis, has become more and more popular. Due to subcutaneous fluid infection, scar contraction, and slow healing, titanium mesh may get exposed. The patient may face the risk of removing it. Titanium’s attributes of heat conduction, hardness, and anti-impact are obviously worse than those of autologous cranial flaps [2, 3]. Autogenous cranioplasty was performed very early in clinical practice. Because of its excellent biocompatibility, relatively strong anti-infective ability, no risk of disease transmission, and low cost, autogenous cranioplasty should have been the first choice [4,5,6].
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