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Reconstruction of the Calvarium with rhBMP-2: Repair of Wound Complicated by Durectomy and Infection
Zoe M. MacIsaac, Sameer Shakir, Sanjay Naran, James J. Cray, Darren M. Smith, MD1, Christopher R. Kinsella, Jr., MD1, Mark P. Mooney, Gregory M. Cooper, Joseph E. Losee
University of Pittsburgh
2013-02-28
Presenter: Zoe M MacIsaac
Affidavit:
All of the work in this abstract presents the efforts of the presenting author, in conjunction with the coauthors.
Director Name: Joseph E Losee
Author Category: Other Specialty Resident
Presentation Category: Basic Science Research
Abstract Category: Craniomaxillofacial
BACKGROUND:
The purpose of this study was to compare the efficacy of rhBMP-2 mediated bone regeneration with autologous bone graft for repair of calvarial defects complicated by 1) previous infection and 2) durectomy with dural repair.
METHODS:
Eighteen adult New Zealand White rabbits underwent subtotal calvariectomy and durectomy, followed by dural repair. Following six weeks, bone flaps inoculated with S. aureus and replaced. After 6 days, bone flaps were removed and wounds debrided, followed by 10 days of antibiotics. Following 6 additional weeks of recovery, defects were debrided and definitive reconstruction performed: empty control (n=3), vehicle control (buffer solution on an absorbable collagen sponge (ACS), n=2), autograft (cryopreserved calvarial graft, n=3), or rhBMP-2 (rhBMP-2/ACS, n=10). Animals underwent CT through 6 weeks, and defects were examined histologically.
RESULTS:
At 6 weeks, rhBMP-2/ACS and autologous bone groups were statistically equivalent (80% and 96% healing, respectively). Empty and vehicle control groups (14% and 18% healing) were inferior to the rhBMP-2/ACS and autograft groups at each timepoint (p<0.001). Histologically, the autograft group was less trabecular and cellular than bone formed in the rhBMP-2/ACS group. rhBMP-2 performed equivalently in this defect to immediate repair of a favorable wound (p=0.972).
CONCLUSIONS:
rhBMP-2 therapy is as effective in reconstructing calvarial defects in the calvarial wound after durectomy, dural repair and infection, as in the acute favorable calvarial wound. Compared to cryopreserved autograft, rhBMP-2 bone resulted in equal defect coverage and similar thickness. Further studies are necessary to demonstrate the long-term viability and remodeling of this treatment modality.
