Autoclaved bone for craniofacial reconstruction: effects of supplementation with bone marrow or recombinant human...

Replantation of resected bone after autoclaving is employed by many units in both craniofacial and orthopedic tumor reconstructive surgery. The procedure is attractive because it maintains the original anatomy, is reliable, and provides a good immediate clinical result. However, doubts have been raised about the ability of the autoclaved bone to revitalize. The present study aimed to explore, in an animal model, the revitalization of autoclaved bone and to determine whether it would be possible to enhance graft revitalization using either autogeneic bone marrow or recombinant human fibroblast growth factor-2, a peptide with stimulatory effects on both endothelial and osteogenic cells. Twenty-eight adult rats were subjected to bilateral parietal cranioplasties (4 x 6 mm), and 75 percent of the grafts were subjected to autoclaving (121 degrees C; 20 minutes) and subsequently treated randomly according to one of the following strategies: no further treatment, or supplementation with bone marrow or recombinant human fibroblast growth factor-2. The remaining grafts were replanted as fresh autografts. The results were evaluated after 4 and 12 weeks by radiologic, histologic, and histomorphometric analyses. After 4 weeks, no major differences were observed between treatments. At 12 weeks, however, no distinction in graft revitalization between autografts and autoclaved grafts supplemented with recombinant human fibroblast growth factor-2 was observed, whereas autoclaved grafts with or without bone marrow displayed significantly less revitalization compared with autografts. The results indicate that autoclaved bone will revitalize by remodeling, and that the efficacy of this process can be increased significantly by simultaneous supplementation with recombinant human fibroblast growth factor-2.