Enhancing dermal and bone regeneration in calvarial defect surgery
Introduction: To optimize the functional and esthetic result of cranioplasty, it is necessary to choose appropriate materials and take steps to preserve and support tissue vitality. As far as materials are concerned, custom-made porous hydroxyapatite implants are biomimetic, and therefore, provide g...
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| Format: | Article |
| Language: | English |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2014-09-01
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| Series: | Indian Journal of Plastic Surgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.4103/0970-0358.146581 |
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| author | Bruno Zanotti Nicola Zingaretti Daria Almesberger Angela Verlicchi Roberto Stefini Mauro Ragonese Gianni Franco Guarneri Pier Camillo Parodi |
| author_facet | Bruno Zanotti Nicola Zingaretti Daria Almesberger Angela Verlicchi Roberto Stefini Mauro Ragonese Gianni Franco Guarneri Pier Camillo Parodi |
| author_sort | Bruno Zanotti |
| collection | DOAJ |
| description | Introduction: To optimize the functional and esthetic result of cranioplasty, it is necessary to choose appropriate materials and take steps to preserve and support tissue vitality. As far as materials are concerned, custom-made porous hydroxyapatite implants are biomimetic, and therefore, provide good biological interaction and biointegration. However, before it is fully integrated, this material has relatively low mechanical resistance. Therefore, to reduce the risk of postoperative implant fracture, it would be desirable to accelerate regeneration of the tissues around and within the graft. Objectives: The objective was to determine whether integrating growth-factor-rich platelet gel or supportive dermal matrix into hydroxyapatite implant cranioplasty can accelerate bone remodeling and promote soft tissue regeneration, respectively. Materials and Methods: The investigation was performed on cranioplasty patients fitted with hydroxyapatite cranial implants between 2004 and 2010. In 7 patients, platelet gel was applied to the bone/prosthesis interface during surgery, and in a further 5 patients, characterized by thin, hypotrophic skin coverage of the cranial lacuna, a sheet of dermal matrix was applied between the prosthesis and the overlying soft tissue. In several of the former groups, platelet gel mixed with hydroxyapatite granules was used to fill small gaps between the skull and the implant. To confirm osteointegration, cranial computed tomography (CT) scans were taken at 3-6 month intervals for 1-year, and magnetic resonance imaging (MRI) was used to confirm dermal integrity. Results: Clinical examination performed a few weeks after surgery revealed good dermal regeneration, with thicker, healthier skin, apparently with a better blood supply, which was confirmed by MRI at 3-6 months. Furthermore, at 3-6 months, CT showed good biomimetism of the porous hydroxyapatite scaffold. Locations at which platelet gel and hydroxyapatite granules were used to fill gaps between the implant and skull appeared to show more rapid integration of the implant than untreated areas. Results were stable at 1-year and remain so to date in cases where follow-up is still ongoing. Conclusions: Bone remodeling time could be reduced by platelet gel application during cranioplasty with porous hydroxyapatite implants. Likewise, layering dermal matrix over such implants appears to promote dermal tissue regeneration and the oshtemo mimetic process. Both of these strategies may, therefore, reduce the likelihood of postsurgical fracture by promoting mechanical resistance. |
| format | Article |
| id | doaj-art-a52725b6a1bf42098c2c78b53d78a5e6 |
| institution | Kabale University |
| issn | 0970-0358 1998-376X |
| language | English |
| publishDate | 2014-09-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Plastic Surgery |
| spelling | doaj-art-a52725b6a1bf42098c2c78b53d78a5e62025-08-20T03:38:12ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Plastic Surgery0970-03581998-376X2014-09-01470332533210.4103/0970-0358.146581Enhancing dermal and bone regeneration in calvarial defect surgeryBruno Zanotti0Nicola Zingaretti1Daria Almesberger2Angela Verlicchi3Roberto Stefini4Mauro Ragonese5Gianni Franco Guarneri6Pier Camillo Parodi7Neurosurgery Clinic, University of Udine, Reggio Emilia, ItalyDepartment of Plastic and Reconstructive Surgery, University of Udine, Reggio Emilia, ItalyDepartment of Plastic and Reconstructive Surgery, University of Udine, Reggio Emilia, ItalyNeurology Unit, Free University of Neuroscience “Anemos”, Reggio Emilia, ItalyNeurosurgery Clinic, A.O. Spedali Civili, Brescia, ItalyUrologic Clinic, Catholic University Medical School of Rome, ItalyDepartment of Plastic and Reconstructive Surgery, University of Udine, Reggio Emilia, ItalyDepartment of Plastic and Reconstructive Surgery, University of Udine, Reggio Emilia, ItalyIntroduction: To optimize the functional and esthetic result of cranioplasty, it is necessary to choose appropriate materials and take steps to preserve and support tissue vitality. As far as materials are concerned, custom-made porous hydroxyapatite implants are biomimetic, and therefore, provide good biological interaction and biointegration. However, before it is fully integrated, this material has relatively low mechanical resistance. Therefore, to reduce the risk of postoperative implant fracture, it would be desirable to accelerate regeneration of the tissues around and within the graft. Objectives: The objective was to determine whether integrating growth-factor-rich platelet gel or supportive dermal matrix into hydroxyapatite implant cranioplasty can accelerate bone remodeling and promote soft tissue regeneration, respectively. Materials and Methods: The investigation was performed on cranioplasty patients fitted with hydroxyapatite cranial implants between 2004 and 2010. In 7 patients, platelet gel was applied to the bone/prosthesis interface during surgery, and in a further 5 patients, characterized by thin, hypotrophic skin coverage of the cranial lacuna, a sheet of dermal matrix was applied between the prosthesis and the overlying soft tissue. In several of the former groups, platelet gel mixed with hydroxyapatite granules was used to fill small gaps between the skull and the implant. To confirm osteointegration, cranial computed tomography (CT) scans were taken at 3-6 month intervals for 1-year, and magnetic resonance imaging (MRI) was used to confirm dermal integrity. Results: Clinical examination performed a few weeks after surgery revealed good dermal regeneration, with thicker, healthier skin, apparently with a better blood supply, which was confirmed by MRI at 3-6 months. Furthermore, at 3-6 months, CT showed good biomimetism of the porous hydroxyapatite scaffold. Locations at which platelet gel and hydroxyapatite granules were used to fill gaps between the implant and skull appeared to show more rapid integration of the implant than untreated areas. Results were stable at 1-year and remain so to date in cases where follow-up is still ongoing. Conclusions: Bone remodeling time could be reduced by platelet gel application during cranioplasty with porous hydroxyapatite implants. Likewise, layering dermal matrix over such implants appears to promote dermal tissue regeneration and the oshtemo mimetic process. Both of these strategies may, therefore, reduce the likelihood of postsurgical fracture by promoting mechanical resistance.http://www.thieme-connect.de/DOI/DOI?10.4103/0970-0358.146581biomaterials integrationbone regenerationcranioplastydermal matrixplatelet gel |
| spellingShingle | Bruno Zanotti Nicola Zingaretti Daria Almesberger Angela Verlicchi Roberto Stefini Mauro Ragonese Gianni Franco Guarneri Pier Camillo Parodi Enhancing dermal and bone regeneration in calvarial defect surgery Indian Journal of Plastic Surgery biomaterials integration bone regeneration cranioplasty dermal matrix platelet gel |
| title | Enhancing dermal and bone regeneration in calvarial defect surgery |
| title_full | Enhancing dermal and bone regeneration in calvarial defect surgery |
| title_fullStr | Enhancing dermal and bone regeneration in calvarial defect surgery |
| title_full_unstemmed | Enhancing dermal and bone regeneration in calvarial defect surgery |
| title_short | Enhancing dermal and bone regeneration in calvarial defect surgery |
| title_sort | enhancing dermal and bone regeneration in calvarial defect surgery |
| topic | biomaterials integration bone regeneration cranioplasty dermal matrix platelet gel |
| url | http://www.thieme-connect.de/DOI/DOI?10.4103/0970-0358.146581 |
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