Reconstruction of Large Skeletal Defects: Current Clinical Therapeutic Strategies and Future Directions Using 3D Printing

Frontiers in Bioengineering and Biotechnology

Alain Hoornaert¹  Carina Kampleitner²  Meadhbh Á. Brennan³  Pierre Layrolle⁴  Luciano Vidal⁴ 

[1] CHU Nantes, Department of Implantology, Faculty of Dental Surgery, University of Nantes, Nantes, France;Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria;Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, United States;INSERM, UMR 1238, PHY-OS, Bone Sarcomas and Remodeling of Calcified Tissues, Faculty of Medicine, University of Nantes, Nantes, France;

关键词: large bone defects;    bone regeneration;    tissue engineering;    vascularization;    three-dimensional printing;   

DOI  :  10.3389/fbioe.2020.00061

来源: DOAJ

【 摘 要 】

The healing of bone fractures is a well-orchestrated physiological process involving multiple cell types and signaling molecules interacting at the fracture site to replace and repair bone tissue without scar formation. However, when the lesion is too large, normal healing is compromised. These so-called non-union bone fractures, mostly arising due to trauma, tumor resection or disease, represent a major therapeutic challenge for orthopedic and reconstructive surgeons. In this review, we firstly present the current commonly employed surgical strategies comprising auto-, allo-, and xenograft transplantations, as well as synthetic biomaterials. Further to this, we discuss the multiple factors influencing the effectiveness of the reconstructive therapy. One essential parameter is adequate vascularization that ensures the vitality of the bone grafts thereby supporting the regeneration process, however deficient vascularization presents a frequently encountered problem in current management strategies. To address this challenge, vascularized bone grafts, including free or pedicled fibula flaps, or in situ approaches using the Masquelet induced membrane, or the patient’s body as a bioreactor, comprise feasible alternatives. Finally, we highlight future directions and novel strategies such as 3D printing and bioprinting which could overcome some of the current challenges in the field of bone defect reconstruction, with the benefit of fabricating personalized and vascularized scaffolds.

【 授权许可】

Unknown