Comparing calvarial transport distraction with and without radiation and fat grafting

• Published in: Journal of cranio-maxillo-facial surgery Vol. 42; no. 7; pp. 1412 - 1422
• Main Authors: Yuhasz, Mikell M, Koch, Felix P, Kwiatkowski, Anna, Young, Calvin, Clune, James, Travieso, Rob, Wong, Kenneth, Van Houten, Joshua, Steinbacher, Derek M
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.10.2014
• Subjects: 3D distraction; Adipose Tissue - transplantation; Animals; Bone Density - physiology; Bone Density - radiation effects; Bone Diseases - radiotherapy; Bone Diseases - surgery; Bone distraction; Bone Regeneration - physiology; Bone Regeneration - radiation effects; Bone Remodeling - physiology; Bone Remodeling - radiation effects; Calvaria; Dentistry; Dura Mater - pathology; Dura Mater - radiation effects; Fluorescent Dyes; Male; Osteogenesis - physiology; Osteogenesis - radiation effects; Osteogenesis, Distraction - methods; Periosteum - pathology; Periosteum - radiation effects; Rabbits; Radiotherapy Dosage; Random Allocation; Reconstructive Surgical Procedures - methods; Scalp - pathology; Scalp - radiation effects; Skull - radiation effects; Skull - surgery; Skull reconstruction; Surgery; Surgical Flaps - surgery; Wound Healing - physiology; Wound Healing - radiation effects; X-Ray Microtomography - methods; 3D distraction; Calvaria; Bone distraction; Skull reconstruction
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2014.04.003

Abstract The purpose of this study is to: a) assess transport distraction to reconstruct cranial defects in radiated and non-radiated fields b) examine adipose grafting's effect on the bony regenerate and overlying wound, and c) elucidate sources of bone formation during transport distraction osteogenesis. Twenty-three male New Zealand white rabbits (3 months; 3.5 kg) were used, 10 non-irradiated and 13 irradiated (17 treatment, 6 control) with a one-time fraction of 35 Gy. A 16 × 16 mm defect was abutted by a 10 × 16 mm transport disc 5 weeks after irradiation, and 11 animals were fat grafted at the distraction site. Latency (1 day), distraction (1.5 mm/day), and consolidation (4 weeks) followed. Fluorochromes were injected subcutaneously and microCT, fluorescence, and histology assessed. In distracted animals without fat grafting, bone density measured 701.87 mgHA/ccm and 2271.95 mgHA/ccm in irradiated and non-irradiated animals. In distracted animals with fat grafting, bone density measured 703.23 mgHA/ccm and 2254.27 mgHA/ccm in irradiated and non-irradiated animals. Fluorescence revealed ossification emanating from the dura, periosteum, and transport segment with decreased formation in irradiated animals. Transport distraction is possible for cranial reconstruction in irradiated fields but short-term osseous fill is significantly diminished. Adipose grafting enhances wound healing in previously irradiated fields but does not enhance ossification.