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  • Title: [Healing of free vascularized bone allotransplants: optimizing by short-term immunosuppression and host-derived neovascularization].
    Author: Giessler GA, Friedrich PF, Shin RH, Bishop AT.
    Journal: Unfallchirurg; 2009 May; 112(5):479-86. PubMed ID: 19280168.
    Abstract:
    BACKGROUND: Living bone allotransplants (ATs) currently require long-term immunosuppression (IS), but this is impractical for extremity-preserving procedures. An alternative method to maintain viability of the transplant uses host-derived neoangiogeneic vessels combined with short-term IS. MATERIALS AND METHODS: Diaphyseal femoral defects in Dutch-Belted rabbits were reconstructed with a free microvascular AT from New Zealand White rabbits. Additionally, a host-derived intramedullary pedicled fascial flap was placed and short-term IS administered to two of four groups. Neovascularization and bone healing were quantified by microangiography and a custom radiographic score. RESULTS: Bone ATs with perfused fascial flaps achieved bone healing equivalent to autotransplant controls, even when they received IS only until host-derived neoangiogenesis replaced the original perfusion. Vascularized ATs without this combination achieved significantly inferior results. SUMMARY: This rabbit model demonstrated that increased bone turnover allows good healing but may temporarily weaken the allotransplant. However, by the more intense replacement of the graft with host-derived cells, this process may, in the long-term, ultimately result in a better transplant than an avascular graft.
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