Bioengineered surgical repair of a chronic oronasal fistula in a cat using autologous platelet-rich fibrin and bone marrow with a tailored 3D printed implant

Abstract

Clinical summary: A tissue engineering approach was used to aid the surgical repair of a chronic oronasal fistula (ONF) in a 13-year-old cat. A three-dimensional (3D) printed mesh, tailored to the size and shape of the ONF, was created to support a soft tissue flap used to close the defect; and also to provide a matrix for mesenchymal stromal cells present in bone marrow aspirate and bioactive cytokines and growth factors present in platelet-rich fibrin harvested from the patient. A CT scan at day 75 after surgery revealed the formation of new tissue in the defect and the healing process was complete at follow-up 6 months after surgery. Relevance and novel information: Complications are frequently reported following surgical repair of ONFs and include dehiscence of the palatal suture line, flap necrosis due to damage to the greater palatine artery and maxillary osteomyelitis, mainly due to chronic infection and bone lysis. The case described here demonstrates how input from a multidisciplinary team and the use of a biomaterial, processed by sophisticated technologies, can create a precision regenerative medicine strategy adapted to the patient's clinical needs; this provided a novel therapeutic solution for an otherwise hard to treat clinical problem.

The Application of Polycaprolactone in Three-Dimensional Printing Scaffolds for Bone Tissue Engineering

“…For animal surgery, Carla [ 133 ] conducted a surgical therapy of a chronic oronasal fistula in a cat using autologous platelet-rich fibrin and bone marrow loaded printed PCL scaffold. A CT scan revealed complete healing after a six-month follow-up.…”

Preparation and characterization of leukocyte‐ and platelet‐rich fibrin membrane derived from cats' blood

“…Several authors have used a centrifugation process at 3000 rpm to produce PRF from human patients (Hartshorne & Gluckman, 2016b; Sam, Vadakkekuttical, & Amol, 2015; Zumarán et al, 2018). The same centrifugation was also employed to produce PFR in a feline case report (Soares et al, 2018). Based on g‐force and centrifugation duration, the platelet‐rich fibrin constructed may differ in consistency, from gel‐like substance to a dense fibrin membrane (Arnoczky & Sheibani‐Rad, 2013).…”

“…Cats present several surgical conditions, involving skin, soft tissue and orthopedics and traumatology (Langley‐Hobbs, Demetriou, & Ladlow, 2014; Montavon, Voss, & Langley‐Hobbs, 2009), which justify the use of this biomaterial. However, there are a few reports of the PRF application in cats (Soares et al, 2018).…”

Canine-Origin Platelet-Rich Fibrin as an Effective Biomaterial for Wound Healing in Domestic Cats: A Preliminary Study

“…These animals were tested negative for Leishmania infantum and Dirofilaria immitis , had a regularly updated vaccine and deworming schedule, and lived mostly indoors and without a traveling record. Each PRF clot was produced as described in previous works [ 16 , 18 ]. Briefly, after local trichotomy of the area and skin cleansing, 5 mL of whole blood was collected to sterilized conical base polypropylene tubes (57 × 15.3 mm), without clot activator.…”

“…The success of PRF in the human clinical context has been supported by both in vitro and in vivo scientific research [ 2 , 12 , 13 , 14 , 15 ]. The increasing interest in platelet-based therapies has contributed to the development of novel veterinary treatments [ 16 , 17 ]. A recent in vitro study conducted by the authors of the present work also demonstrated the burst of PDGF-BB, TGF-ß1, VEGF-A, and interleukin-8 concentration released from both canine and feline intact PRFs over 10 days [ 18 ].…”