The effects of nonvascularized versus vascularized bone grafting on calvarial defect healing

It remains unknown whether bone graft vascularity influences calvarial healing. The purposes of this study were (1) to develop a model to study nonvascularized and vascularized calvarial grafts as well as (2) to compare effects of bone graft vascularity on calvarial healing. Bilateral calvarial defects were created in 26 Wistar rats. The defects were left empty within 1 parietal region. On the contralateral side, the defects were partially closed with native parietal bone (control group, n = 6), nonvascularized (N-V, n = 10), or vascularized bone grafts (VAS, n = 10). The vascularized grafts were supplied by perforating dural arterioles. Bone mineralization and healing patterns from serial microcomputed tomographic scans were compared within and across the groups using parametric and nonparametric tests. Differences in bone mineral content across sides were significant between the groups at weeks 6 (P = 0.016) and 12 (P = 0.025). Bone formation was greater within both the control and VAS groups versus the N-V group at weeks 6 and 12 (P < 0.05). Healing patterns differed between the groups (P < 0.05), progressing through islands of new bone formation within the control and VAS groups while limited to defect margins on the N-V graft side. In conclusion, a bilateral calvarial defect model was established to study bone graft vascularity. Bone quantity and healing patterns differed in the presence of the nonvascularized versus vascularized grafts. Although the calvarial defect model is often applied within the plastic surgery literature to study bone substitutes, greater understanding of basic mechanisms influencing calvarial healing is first needed to avoid confounding results.