Cryostored autologous skull bone for cranioplasty? A study on cranial bone flaps’ viability and microbial contamination after deep-frozen storage at −80 °C

Chan, David; Mok, Yi Tan; Lam, P. M.; Tong, Cindy S.W.; Ng, S. Thomas; Sun, Taoping; Poon, Wai Sang

doi:10.1016/j.jocn.2017.04.016

Cited by 34 publications

(21 citation statements)

References 17 publications

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“…While freezing appears to preserve the morphological state of the mineralized bone tissue and the mineral content, the cellular components are affected more severely. Chan et al could not detect vital osteoblasts in any of the 18 cryopreserved human bone flaps examined, with a minimum storage time of 4 months in this study [7].…”

Section: Discussioncontrasting

confidence: 48%

Cranial bone flap resorption—pathological features and their implications for clinical treatment

Göttsche

Mende

Schram³

et al. 2020

Neurosurg Rev

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Cranioplasty following decompressive craniectomy (DC) has a primary complication when using the autologous bone: aseptic bone resorption (ABR). So far, risk factors such as age, number of fragments, and hydrocephalus have been identified but a thorough understanding of the underlying pathophysiology is still missing. The aim of this osteopathological investigation was to gain a better understanding of the underlying processes. Clinical data of patients who underwent surgical revision due to ABR was collected. Demographics, the time interval between craniectomy and cranioplasty, and endocrine serum parameters affecting bone metabolism were collected. Removed specimens underwent qualitative and quantitative histological examination. Two grafts without ABR were examined as controls. Compared to the controls, the typical layering of the cortical and cancellous bone was largely eliminated in the grafts. Histological investigations revealed the coexistence of osteolytic and osteoblastic activity within the necrosis. Bone appositions were distributed over the entire graft area. Remaining marrow spaces were predominantly fibrotic or necrotic. In areas with marrow cavity fibrosis, hardly any new bone tissue was found in the adjacent bone, while there were increased signs of osteoclastic resorption. Insufficient reintegration of the flap may be due to residual fatty bone marrow contained in the bone flap which seems to act as a barrier for osteogenesis. This may obstruct the reorganization of the bone structure, inducing aseptic bone necrosis. Following a path already taken in orthopedic surgery, thorough lavage of the implant to remove the bone marrow may be a possibility, but will need further investigation.

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Section: Discussioncontrasting

confidence: 48%

Cranial bone flap resorption—pathological features and their implications for clinical treatment

Göttsche

Mende

Schram³

et al. 2020

Neurosurg Rev

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“…However, Chan et al reported that among the 38 cases of cranial flaps preserved at -80°C, 18 were cultured with osteocytes and bacteria, and all osteocytes did not survive. In addition, five cases (27.8%) were cultured with bacteria [24]. It was concluded that osteocytes BioMed Research International…”

Section: Causes Of Infection and Reabsorption In Cranial Flapsmentioning

confidence: 99%

Establishment and Characteristic Analysis of a Dog Model for Autologous Homologous Cranioplasty

Zhu

Zhao

et al. 2020

BioMed Research International

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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.

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“…In our case series, most patients required scalp reconstruction because of chronic infected wounds after previous multiple surgical interventions, radiation therapy, and/or prior alloplastic cranioplasty. Besides the fact that cranioplasty is associated with a high complication rate, we believe that the above mentioned patient characteristics are strong contraindications for cranioplasty [ 25 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of composite defects of the scalp and neurocranium—a treatment algorithm from local flaps to combined AV loop free flap reconstruction

et al. 2018

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BackgroundReconstruction of cranial composite defects, including all layers of the scalp and the neurocranium, poses an interdisciplinary challenge. Especially after multiple previous operations and/or radiation therapy, sufficient reconstruction is often only possible using microsurgical free flap transplantation. The aim of this study was to analyze the therapy of interdisciplinary cases with composite defects including the scalp and neurocranium.MethodsFrom 2009 to 2017, 23 patients with 18 free flaps and 10 pedicled/local flaps were analyzed. First choices for free flaps were muscle flaps followed by fasciocutaneous flaps.ResultsExcept for four patients, a stable coverage could be reached in the first operation. Three of these patients received a local scalp rotation flap in the first operation and needed an additional free flap because the local flap was no longer sufficient for coverage after wound healing deficiency or tumor relapse. The superficial temporal artery or external carotid artery served as recipient vessels. In special cases, venous grafts or an arteriovenous loop (AV loop) were used as extensions for the recipient vessels.ConclusionsIn summary, an interdisciplinary approach with radical debridement of infected or necrotic tissue and the reconstruction of the dura mater are essential to reach a stable, long-lasting reconstructive result. Based on our experience, free flaps seem to be the first choice for patients after multiple previous operations and/or radiation therapy.

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Cryostored autologous skull bone for cranioplasty? A study on cranial bone flaps’ viability and microbial contamination after deep-frozen storage at −80 °C

Cited by 34 publications

References 17 publications

Cranial bone flap resorption—pathological features and their implications for clinical treatment

Cranial bone flap resorption—pathological features and their implications for clinical treatment

Establishment and Characteristic Analysis of a Dog Model for Autologous Homologous Cranioplasty

Reconstruction of composite defects of the scalp and neurocranium—a treatment algorithm from local flaps to combined AV loop free flap reconstruction

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