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Reconstruction of Calvarial Defects with rhBMP-2: Repair of a Calvarial Defect Complicated by Infection and Scar
Zoe M. MacIsaac, Sameer Shakir, Sanjay Naran, James J. Cray, Harry S. Nayar, Darren M. Smith, Christopher R. Kinsella, Jr., Mark P. Mooney, Gregory M. Cooper, Joseph E. Losee
All work in this presentation was performed by Zoe MacIsaac, with assistance from co-authors
2013-02-28
Presenter: Zoe M MacIsaac
Affidavit:
All work in this presentation was performed by Zoe MacIsaac, with assistance from co-authors
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 effectiveness of recombinant human bone morphogenetic protein-2 (rhBMP-2) mediated bone regeneration with autograft for repair of previously infected calvarial defects.
METHODS:
Nineteen adult New Zealand White rabbits underwent subtotal calvariectomy. Bone flaps were inoculated with S. aureus and replaced. Following 6 days of infection, bone flaps were removed and wounds debrided, followed by 10 days of antibiotic treatment. After six weeks of recovery, animals underwent scar debridement followed by definitive reconstruction in one of four groups: empty control (n=3), vehicle control (buffer solution on absorbable collagen sponge (ACS), n=3), autologous bone graft (n=3), or rhBMP-2 repair (rhBMP-2/ACS, n=10). Animals underwent CT at 0, 2, 4 and 6 weeks postoperatively, followed by euthanization and histological analysis. Percent healing was determined by 3-dimensional analysis. A (time x group) 2-way ANOVA was performed on healing versus treatment group and postoperative time.
RESULTS:
At six weeks postoperatively, rhBMP-2/ACS and autologous graft resulted in 93% and 68% healing, respectively, while the empty and vehicle control groups resulted in 27% and 26% healing (p<0.001). Histologically, compared to autologous bone graft reconstruction, bone in the rhBMP-2/ACS group was more cellular and more consistently continuous with wound margins. Compared to immediate favorable reconstruction (96.8% healing), rhBMP-2 in this setting was similarly effective (p>0.05).
CONCLUSIONS:
rhBMP-2 therapy is effective in achieving radiographic coverage of calvarial defects complicated by previous infection. Future studies may employ manipulations such as additional growth factors/cell therapy to further improve results in this difficult scenario.
