Revascularisation during fracture healing with soft tissue injury

Melnyk, Mark; Henke, Thomas; Claes, Lutz; Augat, Peter

doi:10.1007/s00402-007-0543-0

Cited by 47 publications

(34 citation statements)

References 39 publications

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“…Similar time trends were reported by Melnyk et al [27], who also found increased perfusion shortly after fracture followed by a decline, in their study of perfusion in fracture healing with soft tissue damage, using a probe-based transcutaneous laser Doppler flowmeter measuring single points at the fracture site and one centimetre distally and proximally. Perfusion near the fracture site was only clearly greater than preoperatively at 3 and 7 days, and 14 days slightly greater.…”

Section: Discussionsupporting

confidence: 83%

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Characterising neovascularisation in fracture healing with laser Doppler and micro-CT scanning

Macdonald

Shefelbine

2013

Med Biol Eng Comput

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Vascularity of the soft tissues around a bone fracture is critical for successful healing, particularly when the vessels in the medullary canal are ruptured. The objective of this work was to use laser Doppler and micro-computer tomography (micro-CT) scanning to characterise neovascularisation of the soft tissues surrounding the fracture during healing. Thirty-two Sprague–Dawley rats underwent mid-shaft osteotomy of the left femur, stabilised with a custom-designed external fixator. Five animals were killed at each of 2, 4 days, 1, 2, 4 and 6 weeks post-operatively. Femoral blood perfusion in the fractured and intact contralateral limbs was measured using laser Doppler scanning pre- and post-operatively and throughout the healing period. At sacrifice, the common iliac artery was cannulated and infused with silicone contrast agent. Micro-CT scans of the femur and adjacent soft tissues revealed vessel characteristics and distribution in relation to the fracture zone. Blood perfusion dropped immediately after surgery and then recovered to greater than the pre-operative level by proliferation of small vessels around the fracture zone. Multi-modal imaging allowed both longitudinal functional and detailed structural analysis of the neovascularisation process.

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Section: Discussionsupporting

confidence: 83%

“…Our preliminary data indicated that laser Doppler scanning can detect flow through 5 mm of muscle tissue, and Melnyk et al [27] report laser penetration of bone to 2 mm depth and skin/muscle to 6 mm. Perfusion images are weighted projections of perfusion as a function of depth (i.e., deeper vessels appear to have less flow).…”

Section: Discussionmentioning

confidence: 56%

Characterising neovascularisation in fracture healing with laser Doppler and micro-CT scanning

Macdonald

Shefelbine

2013

Med Biol Eng Comput

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“…In fracture healing blood flow in the affected area is markedly reduced after injury (44,45). During the fracture repair circulation increases (46), and blood supply peaks above pre-injury level during the healing process (47).…”

Section: A Inflammation In Bone Regenerationmentioning

confidence: 99%

Boon and Bane of Inflammation in Bone Tissue Regeneration and Its Link with Angiogenesis

Schmidt‐Bleek

Kwee²,

Mooney³

et al. 2015

Tissue Engineering Part B: Reviews

139

131

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Delayed healing or nonhealing of bone is an important clinical concern. Although bone, one of the two tissues with scar-free healing capacity, heals in most cases, healing is delayed in more than 10% of clinical cases. Treatment of such delayed healing condition is often painful, risky, time consuming, and expensive. Tissue healing is a multistage regenerative process involving complex and well-orchestrated steps, which are initiated in response to injury. At best, these steps lead to scar-free tissue formation. At the onset of healing, during the inflammatory phase, stationary and attracted macrophages and other immune cells at the fracture site release cytokines in response to injury. This initial reaction to injury is followed by the recruitment, proliferation, and differentiation of mesenchymal stromal cells, synthesis of extracellular matrix proteins, angiogenesis, and finally tissue remodeling. Failure to heal is often associated with poor revascularization. Since blood vessels mediate the transport of circulating cells, oxygen, nutrients, and waste products, they appear essential for successful healing. The strategy of endogenous regeneration in a tissue such as bone is interesting to analyze since it may represent a blueprint of successful tissue formation. This review highlights the interdependency of the time cascades of inflammation, angiogenesis, and tissue regeneration. A better understanding of these inter-relations is mandatory to early identify patients at risk as well as to overcome critical clinical conditions that limit healing. Instead of purely tolerating the inflammatory phase, modulations of inflammation (immunomodulation) might represent a valid therapeutic strategy to enhance angiogenesis and foster later phases of tissue regeneration.

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“…In the final period of the catabolic phase, extensive vascular remodelling takes place in which the increased vascular bed regresses and the high vascular flow rate returns to its pre-injury level. 13,14 Although these processes take place consecutively, they overlap substantially and are a continuum of changing cell populations and signalling processes within the regenerating tissue. A temporal overview of the biological events of fracture healing, and the cell types involved at each stage of fracture healing, are presented in Figure 2.…”

Section: Introductionmentioning

confidence: 99%

Fracture healing: mechanisms and interventions

2014

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Fractures are the most common large-organ, traumatic injuries to humans. The repair of bone fractures is a postnatal regenerative process that recapitulates many of the ontological events of embryonic skeletal development. Although fracture repair usually restores the damaged skeletal organ to its pre-injury cellular composition, structure and biomechanical function, about 10% of fractures will not heal normally. This article reviews the developmental progression of fracture healing at the tissue, cellular and molecular levels. Innate and adaptive immune processes are discussed as a component of the injury response, as are environmental factors, such as the extent of injury to the bone and surrounding tissue, fixation and the contribution of vascular tissues. We also present strategies for fracture treatment that have been tested in animal models and in clinical trials or case series. The biophysical and biological basis of the molecular actions of various therapeutic approaches, including recombinant human bone morphogenetic proteins and parathyroid hormone therapy, are also discussed.

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Revascularisation during fracture healing with soft tissue injury

Cited by 47 publications

References 39 publications

Characterising neovascularisation in fracture healing with laser Doppler and micro-CT scanning

Characterising neovascularisation in fracture healing with laser Doppler and micro-CT scanning

Boon and Bane of Inflammation in Bone Tissue Regeneration and Its Link with Angiogenesis

Fracture healing: mechanisms and interventions

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