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Case Report: Reconstruction of a Large Maxillary Defect With an Engineered, Vascularized, Prefabricated Bone Graft
Tarek Ismail1,2, Alexander Haumer1,2, Alexander Lunger1
1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
Frontiers in Oncology
|December 23, 2021
Summary
This study presents a novel vascularized, engineered composite graft for complex maxillary defects, improving oral function and aesthetics. The technique shows promise for reduced donor site morbidity compared to traditional methods.
Area of Science:
- Regenerative Medicine
- Oral and Maxillofacial Surgery
- Tissue Engineering
Background:
- Complex midface defects pose significant anatomical, functional, and aesthetic challenges.
- Current treatments often involve autologous tissue transfer with associated donor site morbidity.
Observation:
- A two-step surgical approach utilized an engineered composite graft for a hemimaxillary defect.
- The graft was created using autologous stromal vascular fraction (SVF) cells on an allogenic bone matrix, enhanced with bone morphogenic protein-2 (BMP-2), and vascularized with an arteriovenous (AV) bundle.
Findings:
- Orthotopic transfer of the prefabricated graft restored orbital floor integrity, separated oral and nasal cavities, and improved midface symmetry.
- The patient regained normal diet, speech, and swallowing functions, with stable results over a 2-year follow-up.
- Despite some resorption, the engineered graft demonstrated safety and feasibility, offering improved oral rehabilitation and decreased donor site morbidity.
Implications:
- This engineered composite graft represents a viable alternative for complex maxillary reconstruction.
- Further research is needed to address graft resorption and optimize size and shape preservation.
- The technique holds potential for enhanced patient outcomes in reconstructive surgery.
