Vascularized Periosteal Flaps Accelerate Osteointegration and Revascularization of Allografts in Rats

Abstract

Background Surgical reconstruction of large bone defects with structural bone allografts can restore bone stock but is associated with complications such as nonunion, fracture, and infection. Vascularized reconstructive techniques may provide an alternative in the repair of critical bone defects; however, no studies specifically addressing the role of vascularized periosteal flaps in stimulating bone allograft revascularization and osseointegration have been reported.Questions/purposes (1) Does a vascularized periosteal flap increase the likelihood of union at the allograft-host junction in a critical-size defect femoral model in rats?(2) Does a vascularized periosteal flap promote revascularization of a critical-size defect structural bone allograft in a rat model? (3) What type of ossification occurs in connection with a vascularized periosteal flap?One of the authors certifies that he (MA) has received payments or benefits, during the study period, an amount of USD 10,000 to 100,000 from Societat Catalana de Cirurgia Ortopedica i Traumatologia (Barcelona, Spain). Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Effect of vascularized periosteum on revitalization of massive bone isografts: An experimental study in a rabbit model

“…Non vascularized techniques do not offer osteogenic capacity to the complex osseous reconstructions, so microsurgical skills are necessary to achieve bone healing in most of those cases. The osteogenic properties of periosteal flaps have been widely demonstrated in preclinical studies and clinical series (Capanna, Bufalini, & Campanacci, 1993; Chang & Weber, 2004; Gallardo‐Calero et al, 2019; Nau et al, 2016; Soldado, Fontecha, et al, 2012). Bone neoformation can be increased by 50% when a periosteal flap is used with a biodegradable scaffold (Nau et al, 2016; Vögelin, Jones, Huang, Brekke, & Lieberman, 2005).…”

“…This process appears not only in the ends but also in the amid graft, in contrast to control groups. Previous studies have named MBA revitalization to the creeping substitution process (Gallardo‐Calero et al, 2019; Nau et al, 2016). When associating a periosteum flap, their qualitative descriptive analysis showed newly formed bone tissue containing osteocytes and osteoblasts within the margin of the trabeculae, whereas osteoclast lacunae with osteoclasts were observed at the allograft border with the nonmineralized tissue.…”

Motivating role of type H vessels in bone regeneration

“…Many studies have shown that osteoblasts, osteoclasts and vascular ECs are linked by signalling molecules that promote another 13‐15 . As a consequence, the intimate spatial and temporal link between osteogenesis and angiogenesis has been termed “angiogenic‐osteogenic coupling.” 16 Two subtypes of vascular ECs with completely different morphological, molecular and functional characteristics have been identified in developing bone tissues, namely type H vascular ECs with high expression of CD31 and EMCN, and type L vascular ECs with low expression of CD31 and EMCN.…”

Bone nonunion management in children with a vascularized tibial periosteal graft

“…The angiogenic and osteogenic properties of periosteal in pediatric‐age patients, attributed to the presence of abundant stem cells in the cambium layer, make this tissue ideal as a flap to treat extremely complex biological scenarios (Camilli & Penteado, 1994; Finley, Acland, & Wood, 1978; Gallardo‐Calero et al, 2019; Soldado et al, 2012). Vascularized periosteal grafts have been recently reported for musculoskeletal reconstruction in children for two purposes: preventing bone nonunion of massive bone allografts and treating recurrent bone nonunion (Soldado, Fontecha, Barber, et al, 2012) with excellent results.…”