Endocultivation: Computer-Aided Tissue Engineering of Customized, Vascularized Bone Grafts for Mandibular Reconstruction



Endocultivation: Computer-Aided Tissue Engineering of Customized, Vascularized Bone Grafts for Mandibular Reconstruction


P. H. WARNKE





Currently, major bone discontinuity defects of more than 6 cm are repaired with an autologous vascularized fibula, scapula, iliac crest, or rib transplant. Recent advances in the emerging field of regenerative medicine, that is, repairing damaged tissue through growing it anew by means of tissue engineering, may offer new solutions for reconstructive surgeons. “Regeneration” means that one repairs the damaged tissue by growing it anew with methods of tissue engineering, thus circumventing the issue of immunologic rejection, as the patient’s own cells are used to cultivate the required tissue. I describe a technique of endocultivation, which involves the growing of customized, computer-designed, vascularized replacements for subsequent transfer, to reconstruct previously resected bone. It should be emphasized that endocultivation techniques are still at a basic stage of development and are currently more suited to homogenous tissue like bone. However, they may offer the potential to grow more complex organ replacements in the future.




ANATOMY

The latissimus dorsi is a flat, fanlike muscle that arises directly from the spinal processes of the lower six thoracic vertebrae, the lumbar and sacral vertebrae, and the dorsal iliac crest via the thoracolumbar fascia. The muscle inserts between the teres and pectoralis muscles at the humerus, and together with the teres major, it forms the posterior axillary fold (7). The main nutrient vessel is the thoracodorsal artery, which regularly gives off a strong branch to the serratus anterior muscle. The length of the extramuscular part of the vessel course varies from 6 to 16 cm and is about 9 cm, on average (8). The extramuscular part gives off several minor branches (7). At the point of origin from the subscapularis vessels, the thoracodorsal vessels have diameters of 1.5 to 4 mm (artery) and 3 to 5 mm (vein after unification of the two concomitant veins) (7, 8). Whereas the thoracodorsal artery provides blood mainly to the proximal and lateral two-thirds of the muscle, the distal parts of the muscle are reached by perforating branches of the intercostal arteries (7, 8).

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Jun 26, 2016 | Posted by in General Surgery | Comments Off on Endocultivation: Computer-Aided Tissue Engineering of Customized, Vascularized Bone Grafts for Mandibular Reconstruction
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