Download PDF
J Reconstr Microsurg 2015; 31(04): 291-299
DOI: 10.1055/s-0034-1396770
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of Bone Prefabrication with Vascularized Periosteal Flaps, Hydroxyapatite, and Bioactive Glass in Rats

Burak Ersoy
1   Department of Plastic, Reconstructive and Aesthetic Surgery, Maltepe University School of Medicine, Istanbul, Turkey
,
Mehmet Bayramiçli
2   Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University School of Medicine, Istanbul, Turkey
,
Feriha Ercan
3   Department of Histology and Embryology, Marmara University School of Medicine, Istanbul, Turkey
,
Hakan Şirinoğlu
4   Department of Plastic, Reconstructive and Aesthetic Surgery, Kartal Dr. Lütfi Kırdar Research and Training Hospital, Istanbul, Turkey
,
Pınar Turan
3   Department of Histology and Embryology, Marmara University School of Medicine, Istanbul, Turkey
,
Ayhan Numanoğlu
2   Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University School of Medicine, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

01 August 2014

11 October 2014

Publication Date:
18 March 2015 (online)

    Permissions and Reprints

Abstract

Background Periosteal flaps possess osteoprogenitor cells and an osteoinductive potential that can be further augmented by combination with a biodegradable scaffold; therefore, various osteoconductive and osteostimulative biomaterials are frequently combined with periosteal flaps in studies of bone prefabrication. An experimental study was designed to determine and compare the contribution of bioactive glass and hydroxyapatite to osteoneogenesis in rats when combined with a periosteal flap.

Materials and Methods In 60 Sprague Dawley rats, saphenous artery periosto-fasciocutaneous island flaps were transposed to abdomen. In group 1, the flap was left alone, in group 2, an empty artificial pocket made of Gore-Tex (W. L. Gore & Associates, Inc.; Flagstaff, AZ) was sutured onto the periosteal layer, and in groups 3 and 4, the pocket was filled with bioactive glass and hydroxyapatite, respectively. Following sampling for histological analysis, a 4-point scoring system was used to grade inflammatory cell infiltration, osteogenesis, angiogenesis, and cell migration into the bioactive material.

Results The combination of the periosteal flap with any of the bioactive materials resulted in significantly higher percentages of animals exhibiting osteogenesis (80% in hydroxyapatite group and 93.3% in the bioactive glass group; p = 0.0000528) and angiogenesis. Comparison of the bioactive material groups revealed that a significantly higher proportion of animals in the bioactive glass group exhibited moderate or severe inflammation (80 vs. 20%; p = 0.002814).

Conclusion Periosteal flaps prefabricated with hydroxyapatite or bioactive glass in rats exhibit osteogenic capacities that are not dependent on direct bone contact or proximity to vascular bony tissue. The innate capacity of the periosteal flap when utilized alone for osteoneogenesis was found to be rather insufficient.

Keywords

hydroxyapatite - bioactive glass - periosteum - rats - osteogenesis
 

  • References

  • 1 Bayramiçli M, Ersoy B, Sirinoğlu H. A new experimental flap design: the saphenous artery periosto-fasciocutaneous flap of the rat. J Reconstr Microsurg 2012; 28 (3) 175-179
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Reddi AH. Regulation of cartilage and bone differentiation by bone morphogenetic proteins. Curr Opin Cell Biol 1992; 4 (5) 850-855
    CrossrefPubMedGoogle Scholar
  • 3 Wozney JM. The bone morphogenetic protein family and osteogenesis. Mol Reprod Dev 1992; 32 (2) 160-167
    CrossrefPubMedGoogle Scholar
  • 4 Rosen V, Thies RS. The BMP proteins in bone formation and repair. Trends Genet 1992; 8 (3) 97-102
    CrossrefPubMedGoogle Scholar
  • 5 Wang EA. Bone morphogenetic proteins (BMPs): therapeutic potential in healing bony defects. Trends Biotechnol 1993; 11 (9) 379-383
    CrossrefPubMedGoogle Scholar
  • 6 Yajima H, Tamai S, Ishida H, Kisanuki O. Prefabricated vascularized periosteal grafts using fascial flap transfers. J Reconstr Microsurg 1995; 11 (3) 201-205
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Finley JM, Acland RD, Wood MB. Revascularized periosteal grafts—a new method to produce functional new bone without bone grafting. Plast Reconstr Surg 1978; 61 (1) 1-6
    CrossrefPubMedGoogle Scholar
  • 8 Puckett CL, Hurvitz JS, Metzler MH, Silver D. Bone formation by revascularized periosteal and bone grafts, compared with traditional bone grafts. Plast Reconstr Surg 1979; 64 (3) 361-365
    CrossrefPubMedGoogle Scholar
  • 9 Romana MC, Masquelet AC. Vascularized periosteum associated with cancellous bone graft: an experimental study. Plast Reconstr Surg 1990; 85 (4) 587-592
    CrossrefPubMedGoogle Scholar
  • 10 Kostopoulos L, Karring T. Role of periosteum in the formation of jaw bone. An experiment in the rat. J Clin Periodontol 1995; 22 (3) 247-254
    PubMedGoogle Scholar
  • 11 Skoog T. The use of periosteum and Surgicel for bone restoration in congenital clefts of the maxilla. A clinical report and experimental investigation. Scand J Plast Reconstr Surg 1967; 1 (2) 113-130
    CrossrefPubMedGoogle Scholar
  • 12 Ishida H, Tamai S, Yajima H, Inoue K, Ohgushi H, Dohi Y. Histologic and biochemical analysis of osteogenic capacity of vascularized periosteum. Plast Reconstr Surg 1996; 97 (3) 512-518
    CrossrefPubMedGoogle Scholar
  • 13 Payement G, Therin M, Dansard C, Delay E. Etude de la capacité ostéogénique d'un lambeau périosté vascularisé et tubulisé autour d'un implant madréporaire. Etude expérimentale chez le mouton. Ann Chir Plast Esthet 1996; 41 (6) 651-659
    PubMedGoogle Scholar
  • 14 Ono I, Gunji H, Suda K , et al. Bone induction of hydroxyapatite combined with bone morphogenetic protein and covered with periosteum. Plast Reconstr Surg 1995; 95 (7) 1265-1272
    CrossrefPubMedGoogle Scholar
  • 15 Breitbart AS, Grande DA, Kessler R, Ryaby JT, Fitzsimmons RJ, Grant RT. Tissue engineered bone repair of calvarial defects using cultured periosteal cells. Plast Reconstr Surg 1998; 101 (3) 567-574 , discussion 575–576
    CrossrefPubMedGoogle Scholar
  • 16 Vögelin M D E, Jones NF, Lieberman JR, Baker JM, Tsingotjidou AS, Brekke JH. Prefabrication of bone by use of a vascularized periosteal flap and bone morphogenetic protein. Plast Reconstr Surg 2002; 109 (1) 190-198
    CrossrefPubMedGoogle Scholar
  • 17 Cornell CN. Osteoconductive materials and their role as substitutes for autogenous bone grafts. Orthop Clin North Am 1999; 30 (4) 591-598
    CrossrefPubMedGoogle Scholar
  • 18 Hench LL, Wilson J. Surface-active biomaterials. Science 1984; 226 (4675) 630-636
    CrossrefPubMedGoogle Scholar
  • 19 Oonishi H, Iwaki Y, Kin N , et al. Hydroxyapatite in revision of total hip replacements with massive acetabular defects: 4- to 10-year clinical results. J Bone Joint Surg Br 1997; 79 (1) 87-92
    CrossrefPubMedGoogle Scholar
  • 20 McGrath JC, Drummond GB, McLachlan EM, Kilkenny C, Wainwright CL. Guidelines for reporting experiments involving animals: the ARRIVE guidelines. Br J Pharmacol 2010; 160 (7) 1573-1576
    CrossrefPubMedGoogle Scholar
  • 21 Ersoy B, Sirinoğlu H, Bayramiçli M. A new role for hygienic pad in the laboratory settings. Microsurgery 2010; 30 (5) 422
    PubMedGoogle Scholar
  • 22 Bayramiçli M, Yilmaz B, Numanoğlu A. Modified protective rat vest. Plast Reconstr Surg 1998; 101 (3) 859-860
    PubMedGoogle Scholar
  • 23 Fisher RA. On the interpretation of chi square fromcontingency tables and the calculation of P. JR Stat Soc 1922; 85: 87-94
    PubMedGoogle Scholar
  • 24 Dailiana ZH, Shiamishis G, Niokou D, Ioachim E, Malizos KN. Heterotopic neo-osteogenesis from vascularized periosteum and bone grafts. J Trauma 2002; 53 (5) 934-938
    CrossrefPubMedGoogle Scholar
  • 25 Takato T, Harii K, Nakatsuka T, Ueda K, Ootake T. Vascularized periosteal grafts: an experimental study using two different forms of tibial periosteum in rabbits. Plast Reconstr Surg 1986; 78 (4) 489-497
    CrossrefPubMedGoogle Scholar
  • 26 van den Wildenberg FA, Goris RJ, Tutein Nolthenius-Puylaert MB. Free revascularised periosteum transplantation: an experimental study. Br J Plast Surg 1984; 37 (2) 226-235
    CrossrefPubMedGoogle Scholar
  • 27 Canalis RF, Burstein FD. Osteogenesis in vascularized periosteum. Interactions with underlying bone. Arch Otolaryngol 1985; 111 (8) 511-516
    CrossrefPubMedGoogle Scholar
  • 28 Burstein FD, Canalis RF. Studies on the osteogenic potential of vascularized periosteum: behavior of periosteal flaps transferred onto soft tissues. Otolaryngol Head Neck Surg 1985; 93 (6) 731-735
    PubMedGoogle Scholar
  • 29 Peltola MJ, Aitasalo KMJ, Suonpää JTK, Yli-Urpo A, Laippala PJ, Forsback AP. Frontal sinus and skull bone defect obliteration with three synthetic bioactive materials. A comparative study. J Biomed Mater Res B Appl Biomater 2003; 66 (1) 364-372
    PubMedGoogle Scholar
  • 30 Cancian DC, Hochuli-Vieira E, Marcantonio RA, Garcia Júnior IR. Utilization of autogenous bone, bioactive glasses, and calcium phosphate cement in surgical mandibular bone defects in Cebus apella monkeys. Int J Oral Maxillofac Implants 2004; 19 (1) 73-79
    PubMedGoogle Scholar
  • 31 Nakamura O, Kaji Y, Imaizumi Y, Yamagami Y, Yamamoto T. Prefabrication of vascularized bone allograft in a recipient rat using a flow-through vascular pedicle, bone morphogenetic protein, and bisphosphonate. J Reconstr Microsurg 2013; 29 (4) 241-248
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Ritsilä V, Alhopuro S, Rintala A. Bone formation with free periosteum. An experimental study. Scand J Plast Reconstr Surg 1972; 6 (1) 51-56
    CrossrefPubMedGoogle Scholar
  • 33 Konofaos P, Ver Halen JP. Nerve repair by means of tubulization: past, present, future. J Reconstr Microsurg 2013; 29 (3) 149-164
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Moreira-Gonzalez A, Jackson IT, Miyawaki T, Barakat K, DiNick V. Clinical outcome in cranioplasty: critical review in long-term follow-up. J Craniofac Surg 2003; 14 (2) 144-153
    CrossrefPubMedGoogle Scholar
  • 35 Verret DJ, Ducic Y, Oxford L, Smith J. Hydroxyapatite cement in craniofacial reconstruction. Otolaryngol Head Neck Surg 2005; 133 (6) 897-899
    CrossrefPubMedGoogle Scholar