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Journal of Korean Cleft Palate-Craniofacial Association 2004;5(1):37-42.
Effect of Bone Marrow Exposure in Rabbit Skull Osteogenesis.
Sang Gue Kang, Jin Il Kim, Jang Hyun Lee, Yong Bae Kim
Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea. sgkang@hosp.sch. ac.kr
The volumetric maintenance and integration of autogenous bone graft remain an essential problem and challenge to the surgeon. Several factors have been considered, such as the embryonic origin of the donor bone, the handling of the graft and its anatomic structure. The role of recipient bed is not yet completely clear, and the specific influence of bone marrow seems only partially known. This study aimed to evaluate the effects on incorporation of onlay bone graft after exposure of the bone marrow. Bone graft was positioned subperiosteally in frontal region of 30 rabbits skull. In 30 rabbits, they were teated in 3 different ways; Group A: the donor cortical bone were grafted onto recipient cortical bone. Group B: the cortical layer from full thickness bone of donor site were removed and donor cancellous bone were grafted onto recipient cortical bone. Group C: the recipient bed was ground to remove the external cortical layer and exposure the underlying marrow. Also the cortical layer from donor bone were removed and donor cancellous bone were grafted onto recipient cancellous bone. The outcome was assessed after four and six weeks by routine histology and immunochemical labelling for endothelial cell and TGF-beta. Marrow exposure resulted in an explosive bone formation, prompt graft incorporation, earlier onset of bone remodelling, but also localized resorption at the host bed due to increased vulnerability to pressure. This finding emphasize the essential role of the bone marrow constituents to bone graft incorporation. In conclusion, an exposure of the underlying bone marrow with maximal maintenance of pressure-resistant cortical outer bone seems indicated. This could be accomplished by multiple small cortical perforations, which is presently under analysis.
Keywords: Bone graft; Bone marrow
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