Enhancing mandibular bone regeneration and perfusion via axial vascularization of scaffolds

Objective: Reconstruction of large and complex bone segments is a challenging problem facing maxillofacial surgery. The majority of current regenerative approaches rely on extrinsic vascularization, which is deficient after cancer ablation and irradiation. The aim of the study was to investigate the efficacy of intrinsic axial vascularization of synthetic bone scaffolds in the management of critical-size mandibular defects. Materials and methods: Scaffold-guided mandibular regeneration in two groups of adult male goats was compared. Only the scaffolds of the second group were axially vascularized via in situ embedding of an arteriovenous loop through microsurgical anastomosis of facial vessels. After 6 months of follow up, both groups were compared through radiological, biomechanical, histological and histomorphometric analysis. Results: The axially vascularized constructs have showed significantly more central vascularization (p = 0.021) and markedly enhanced central bone formation (p = 0.08). The biomechanical characteristics were enhanced, but the difference between both groups was not statistically significant (p = 0.98). Conclusions: Axially vascularized synthetic mandibular grafts show better vascularization at their central regions, permitting more efficient bone regeneration. Clinical relevance: The encouraging results of the proposed technique could be of benefit in optimizing the reconstruction of large critical-size bone defects. © 2013 Springer-Verlag Berlin Heidelberg.