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Reconstruction of Calvarial Wounds Complicated by Infection: Effect of Varying Doses of Bone Morphogenetic Protein 2
Lucas A. Dvoracek, Kyle Parks, F. Paul Marji, Saigopalakrishna Yerneni, Phil G. Campbell, Gregory M. Cooper, James R. Gilbert, Joseph E. Losee
University of Pittsburgh
2020-02-11
Presenter: Lucas Dvoracek
Affidavit:
The presenting author is responsible for all of the work on this project and all of the work is his original work.
Director Name: Vu T. Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: Craniomaxillofacial
Introduction: Calvarial defects complicated by infection and scarring are a reconstructive challenge. BMP-2 bioprinted on acellular dermal matrix (ADM) has shown promise in stimulating osseous regeneration in these calvarial defects in rabbits. The optimal dose has yet to be determined.
Methods: Thirty New Zealand white rabbits underwent subtotal calvariectomy wherein a 15mm x 15mm flap of bone was excised and incubated in a planktonic solution of S. aureus before reimplantation. After subsequent infection the flap was removed and the surgical wound debrided, followed by antibiotic treatment. On postoperative week 6, the scarred calvarial defects were treated with acellular dermal matrix bioprinted with 11ug, 55ug, or 110ug of BMP-2. Bone regeneration was analyzed with serial CT at days 1 and 21 and 2, 4, and 6 months.
Results: All groups demonstrated progressive healing of the defects during the follow-up period. One-way ANOVA showed no difference among groups at any time points. The 110ug group trended toward more healing than other doses, with 82% (±5.8% S.E.) bone regeneration, compared to 60% (±9.1%) and 67% (±15.4%) healing in the 11ug and 55ug groups. No formation of heterotopic bone was noted in animals treated with higher doses.
Conclusion: Higher doses of BMP-2 biopatterned ADM led to greater amounts of healing, while still requiring orders of magnitude less than the doses administered in commercially available clinical products. An off-the-shelf implantable product based on this technique may be an alternative to existing methods for stimulating bony regeneration in scarred calvarial defects.
