Man as a Living Bioreactor: Prefabrication of a Custom Vascularized Bone Graft in the Gastrocolic Omentum

Abstract

Reconstruction of critical-size jaw defects still remains challenging. The standard treatment today is transplantation of autologous bone grafts, which is associated with high donor-site morbidity and unsatisfactory outcomes. We aimed to reconstruct a mandibular discontinuity defect after ablative surgery using the gastrocolic omentum as a bioreactor for heterotopic ossification. Three-dimensional computed tomography data were used to produce an ideal virtual replacement for the mandibular defect. A titanium mesh cage was filled with bone mineral blocks, infiltrated with 12 mg of recombinant human bone morphogenetic protein 2, and enriched with bone marrow aspirate. The scaffold was implanted into the gastrocolic omentum, and 3 months later, a free flap was harvested to reconstruct the mandibular defect. In vivo single photon emission computed tomography/computed tomography revealed bone remodeling and mineralization inside the mandibular transplant during prefabrication and after transplantation. Reconstruction was possible without any further modifications of the graft. A histological evaluation revealed that large sections of the Bio-Oss material were covered with osteoid matrix 3 months after transplantation. The quality of life of the patient significantly increased with acquisition of the ability to masticate and the improvement in pronunciation and aesthetics. Heterotopic bone induction to form a mandibular replacement inside the gastrocolic omentum is possible in human subjects. Heterotopic prefabrication is associated with many advantages, like allowing a reduced operative burden compared with conventional techniques and good three-dimensional outcomes.

Tissue engineering applications in otolaryngology—The state of translation

“…Heatmap representing the proportion of publications by year that utilized specific translational research methodologies from construct characterization to human trial to investigate craniofacial tissue engineering 49‐72,74‐77,79,81‐84,145‐197 …”

“…The vascularization and precursor cells present in these bioreactors allow for larger bone constructs to be engineered 81 . The first human case of mandibular reconstruction using the greater omentum as a bioreactor was reported in 2016 82 . A follow‐up investigation after 10 months showed that the amount of vital mineralized bone tissue of the graft in the mandible had continued to increase 81 .…”

Implantable electrical stimulation bioreactor with liquid crystal polymer based electrodes for enhanced bone regeneration at mandibular large defects in rabbit

“…This in vivo bioreactor system with ES benefits from one-staged direct application compared to a two-staged procedure where first the bioreactor is transplanted to the well-vascularized heterotopic sites prefabricated, and then, the regenerated tissue is transplanted to the orthotopic site [17,57].…”

Mesenchymal Stem Cells for Optimizing Bone Volume at the Dental Implant Recipient Site

“…In a groundbreaking study, Wiltfang et al [52] have reconstructed a mandibular discontinuity defect after ablative surgery using the gastrocolic omentum as a bioreactor for heterotopic ossification via a titanium mesh cage filled with bone mineral blocks, infiltrated with 12 mg of recombinant human BMP2, and enriched with bone marrow aspirate. The scaffold was implanted into the gastrocolic omentum, and 3 months later, a free flap was harvested to reconstruct the mandibular defect.…”