Bone transplantation

Abstract

According to one principle of surgery, the transplantation of vital tissue is the best method of reconstructing a defect. Because of absent immunologic reactions, high osteogenic potency, and preserved stability, transplantation of autogenous bone shows the best results. Necrosis of transplanted bone, leading inevitably to absorption and remodeling of the graft, can be avoided if microsurgically vascularized autogenous bone segments are transferred. Disadvantages are the low availability and the necessity of additional operations. As an alternative, deep-frozen allogeneic bone is used. However, this kind of bone shows delayed incorporation based on cellular and humoral immune reactions, and it is also installed into the host bed after overcoming the immune barrier. The risk of microbiological contamination or transmission of unrecognized germs such as HIV is a cause of great expense in bone banking techniques. If one succeeds in reducing (a) the immunologic defense reaction and (b) the risk of infection by sterilization or disinfection without damaging the osteoinductive proteins of bone matrix, the rate of complications can be lowered. Demineralized bone matrix can be used if biomechanical stability is not required. Its ability to induce osteogenesis without a major immune reaction or the risk of transmitting diseases justifies its clinical application. Further intensive research in these areas is unavoidable.

Quality Control in Hospital Bone Banking

“…In 1668 Job van Meekeren, a Dutch surgeon was the first to perform bone transplantation (Schweiberer et al 1990). He repaired a skull defect in a soldier with part of a skull from a dog.…”

Effect of intramedullary polymethylmethacrylate and autogenous cancellous bone on healing of frozen segmental allografts

“…In all cases, allografts were from immunologically mismatched donors. Mismatching was determined with use of mixed lymphocyte reaction cultures and a stimulation indcx of 10 or grcatcr (22). The allograft was stabilized with an interlocking nail tcchnique.…”

In vitro and In vivo study on the effect of autogenous cancellous bone and intramedullary polymethylmethacrylate on allograft construct strength

“…Anesthesia was induced with an injcctablc technique (thiopental) and maintained with halothane in oxygen. In all cases, allografts were from immunologically mismatched donors, as documented with use of dogs with a mixed lymphocyte cullure reaclion o f I0 or greater (19). The allograft was stabilized with an interlocking nail technique.…”