The use of an induced muscle flap to reconstruct mandibular defects

Al-Fotawi, Randa (2014) The use of an induced muscle flap to reconstruct mandibular defects. PhD thesis, University of Glasgow.

Abstract

The treatment of challenging large osseous defects presents a formidable problem for orthopaedic and maxillofacial surgeons. Autogenous bone grafting is the present method of choice to replace the lost tissue, but supplies of autologous bone are limited and harvesting of the graft is associated with donor site morbidity. Artificial biomaterials hold much promise, but do not, by themselves, supply the osteoprogenitor cells needed for bone formation. Moreover, there are often issues with resorption of the scaffold used in the biomaterial, as well as limited vascularity. This study investigates the novel application of a composite bone mineral (Cerament TM Spine Support) as an injectable bone cement loaded with cytokines and seeded with induced mesenchymal stromal cells, for maxillofacial reconstruction in rabbits. This study aims to test the feasibility of converting a pedicled muscle flap into bone to reconstruct a critical-size defect in the mandible as the above three components would theoretically have the combined effect of osteoconduction, osteoinduction and osteogenesis. The study included a comprehensive assessment of bone regeneration using plain radiography, Cone Beam computerized Tomography (CBCT), Micro-Computerized Tomography (micro-CT) and histology.
Results at 3 months following surgery showed areas of bone formation and remnants of residual cement throughout the muscle and connective tissue in the surgical defect. Data analysis showed that complete bone integration or incorporation for the reconstruction of the surgical defect was not achieved. However, the regenerated bone displayed a high degree of remodeling with an intricate network of woven bone trabeculae within the cement. The bone was thicker in the bucco-lingual direction and exhibited more red and fatty marrow spaces compared to the contralateral (non-operated) side.
The study confirmed that bone formation within a muscle flap in the maxillofacial region is possible. However, a wide range of variation in the patterns of bone formation was seen among the samples. The findings demonstrated the remarkable potential for the use of autologous muscle flaps as bioreactors for injectable scaffoldings, BMP, rMSCs to facilitate the reconstruction of maxillofacial bony defects.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: Regenerative medicine, bone bioengineering, bone regeneration, reconstruction
• Subjects: R Medicine > R Medicine (General); R Medicine > RK Dentistry
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Supervisor's Name: Ayoub, Professor Ashraf
• Date of Award: 2014
• Depositing User: Ms RANDA ALFOTAWI
• Unique ID: glathesis:2014-5862
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 19 Dec 2014 15:02
• Last Modified: 21 Dec 2017 11:59
• URI: https://theses.gla.ac.uk/id/eprint/5862