Most commercially available calcium phosphate-based bone substitutes are composed of either hydroxyapatite (HA), β-tricalcium phosphate (β-TCP), or a mixture of both, termed biphasic calcium phosphate (BCP). Among them, synthetic calcium phosphate biomaterials that resemble the inorganic phase of bone have proven to be biocompatible and osteoconductive. However, these alternatives have inherent disadvantages including morbidity, surgical procedures, costs and safety concerns 5, 6, 7, 8, 9, 10.įor several decades, researchers and clinicians have attempted to develop a safe and effective alternative to autologous bone grafting for the regeneration of large bone defects. Other procedures for large bone regeneration are the Masquelet’s induced membrane, the Illizarov’s distraction or advanced therapies with bone morphogenetic proteins or culture expanded bone marrow mesenchymal stem cells. Transplantation of vascularized bone also requires complex microsurgery to adapt to both the local vasculature and skeleton 3, 4. Therefore, this surgical procedure is often associated with complications such as infection, hematoma, postoperative pain, and muscular and neural damage. Nevertheless, the amount of bone is limited and the procedure adds morbidity at the harvesting site. Bone can be taken from several areas e.g., iliac crest or fibula, depending on the severity and amount needed for reconstruction of the defect. This procedure necessitates harvesting the patient’s own bone and subsequently transplanting it to the defect site. Autologous bone grafting is still considered the gold standard treatment due to its osteoconductive, osteoinductive and osteogenic properties. Notably, the successful repair of large bone defects caused by trauma, tumor resection or disease remains a clinical challenge for orthopedic and plastic surgeons and often requires additional treatments. However, there are some conditions in which bone regeneration is delayed, compromised or beyond the physiological healing potential 1, 2. Taken together, this pilot study demonstrated the feasibility of precised pre-surgical planning and reconstruction of large bone defects with 3D-printed personalized scaffolds.īone is a dynamic tissue that possesses the intrinsic capacity to heal within 6–8 weeks after immobilization of a fracture. Histology confirmed bone growth inside the porous 3D scaffolds with or without vascular pedicle inclusion. The presence of the vascular pedicle further enhanced bone formation. After 3 months, the untreated defect remained non-bridged while the 3D scaffold guided bone regeneration. Bone regeneration was evaluated 1, 2 and 3 months post-implantation. Critical-sized segmental defects created in the mid-diaphyseal region of the metatarsus were either left empty or treated with the 3D scaffold alone or in combination with an axial vascular pedicle. Pre-operative computed tomography scans were performed to visualize the metatarsus and vasculature and to fabricate customized scaffolds and surgical guides by 3D printing. This pilot study aimed to investigate the feasibility of regenerating large bone defects in sheep using 3D-printed customized calcium phosphate scaffolds with or without surgical vascularization. Successful bone repair also depends on sufficient vascularization and to address this challenge, novel strategies focus on the development of vascularized biomaterial scaffolds. Although autografts are considered to be the gold standard treatment for reconstruction of large bone defects resulting from trauma or diseases, donor site morbidity and limited availability restrict their use.
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