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A technique for the compression and carriage of autogenous bone during bone grafting procedures
J Oral Maxlllofac 45968-989.
Surg
1987
A Technique for the Compression and Carriage of Autogenous Bone During Bone Grafting Procedures ROBERT E. MARX, DDS,* AND MARK E. WONG, DDSt
Several publications have identified a relationship between the cellular density of transplanted osteoprogenitor cells and the yield of bone in particulate cancellous bone grafts.1-3 In particular, increasing the numbers of endosteal osteoblasts and marrow mesenchymal osteoprogenitor cells has been shown to produce a greater bone yield in vitro.3 This principle has been applied clinically in facial bone reconstructions by meticulous bone condensation techniques in a variety of crib systems.4>5 We have developed a simple, inexpensive, and practical technique to enhance the cellular density of the bone graft material, that results in a transportable compacted graft of cellular cortico-cancellous bone.
introduced into the chamber of a disposable 10 ml plastic syringe from which the plunger has been removed. The plunger is then replaced, and firm, sustained digital pressure is applied until all the excess blood and tissue fluid has been expressed from the free end of the syringe (Fig. 1). Once this initial volume of bone has been satisfactorily compressed, the plunger is removed and a further quantity of uncompressed bone is introduced into the chamber of the syringe. The process is repeated until all the harvested bone has been compressed. Approximately 30 ml of uncompressed bone can be compacted in each 10 ml syringe and stored to await transplantation into the graft site. When the graft site has been adequately prepared for receipt of the harvested bone, a no. 10 stainless steel scalpel blade is used to remove the needle end of the syringe barrel, thereby enabling injection of the bone graft material into the recipient site (Figs. 2, 3). The bone can be further condensed into all regions of the recipient bed using any form of condensing instrument, such as a Penfield no. 2, or no. 3 elevator, or an amalgam plugger.
Technique To minimize the time the graft is left outside of the body, a second team of surgeons undertakes the task of harvesting and preparing the graft, while the recipient bed is prepared for the placement of the graft. The autogenous bone harvested from the donor site is placed immediately into a physiological solution of either normal saline or culture media. If cortical bone has been harvested along with the cancellous component, it is cut into particles with bone rongeur to a graftable size. The cancellous bone is also reduced to smaller proportions, with care taken not to unduly traumatize the resident population of cells. Once the graft material has been adequately prepared, a small amount is
Discussion There are several advantages of using this simple technique to compress and transport harvested autogenous bone to a recipient site. The instrumentation required for this technique is readily available in any operating room. The ability to compress the harvested bone into a consistently condensed graft matrix enhances the chances for a successful result by establishing a high cellular density. Furthermore, carriage of the graft to the recipient bed is facilitated by placing it in a syringe, reducing the risk of spillage from the operative field. The chances of contamination of the graft are also reduced by preparing and storing the bone in a sterile, semi-closed system. Finally, the ability to roughly measure the total volume of the graft from the gradations on the syringe chamber allows for a more precise estimation of the graft’s proportions in relation to the size of the bony continuity defect.
Received from the Center for Maxillofacial Reconstruction. Division of Oral and Maxillofacial Surgery, University of Miami School of Medicine, Miami Veterans Administration Hospital, Miami, Florida. * Associate Professor of Surgery, Director of Graduate Training and Research. t Chief Resident. Address correspondence and reprint requests to Dr. Marx: University of Miami School of Medicine, Department of Surgery, Division of Oral and Maxillofacial Surgery, 1611 NW 12th Avenue, Miami, FL 33136. 0278-2391187 $0.00 + .25
988
989
MARX AND WONG
FIGURE 1 (top left). Cancellous compressed in the syringe chamber.
bone being
Cancellous bone in cyFIGURE 2 (fop right). lindrical form after ejection from the syringe barrel. Both syringes have had the needle end removed. FIGURE 3 (bottom lefr). Ejection of cancellous bone into allogeneic bone crib during mandibular reconstruction. Further compaction may be accomplished with a Pentield no. 2 or no. 3 instrument.
References I. Burwell RG: Studies in the transplantation of bone. The fresh composite homograft: autograft of cancellous bone. J Bone Joint Surg 46: I IO, 1964 2. Axhausen W: The osteogenetic phases of regeneration of bone: a historical and experimental study. J Bone Joint Surg 38593, 1956
3. Friedenstein AJ, Piatetzky-Shapiro II, Petrakova DV: Osteogenesis in transplants of bone marrow cells. J Embryo1 Exp Morphol 16:381, 1966 4. Marx RE, Kline SN: Principles and methods of osseous reconstruction, in International Advances in Surgical Oncology, vol 6. New York, Liss, 1983, pp 167-228 5. Boyne PJ: Implants and transplants: review of recent research in the area of oral surgery. J Am Dent Assoc 87:1074,1973
Surg
1987
A Technique for the Compression and Carriage of Autogenous Bone During Bone Grafting Procedures ROBERT E. MARX, DDS,* AND MARK E. WONG, DDSt
Several publications have identified a relationship between the cellular density of transplanted osteoprogenitor cells and the yield of bone in particulate cancellous bone grafts.1-3 In particular, increasing the numbers of endosteal osteoblasts and marrow mesenchymal osteoprogenitor cells has been shown to produce a greater bone yield in vitro.3 This principle has been applied clinically in facial bone reconstructions by meticulous bone condensation techniques in a variety of crib systems.4>5 We have developed a simple, inexpensive, and practical technique to enhance the cellular density of the bone graft material, that results in a transportable compacted graft of cellular cortico-cancellous bone.
introduced into the chamber of a disposable 10 ml plastic syringe from which the plunger has been removed. The plunger is then replaced, and firm, sustained digital pressure is applied until all the excess blood and tissue fluid has been expressed from the free end of the syringe (Fig. 1). Once this initial volume of bone has been satisfactorily compressed, the plunger is removed and a further quantity of uncompressed bone is introduced into the chamber of the syringe. The process is repeated until all the harvested bone has been compressed. Approximately 30 ml of uncompressed bone can be compacted in each 10 ml syringe and stored to await transplantation into the graft site. When the graft site has been adequately prepared for receipt of the harvested bone, a no. 10 stainless steel scalpel blade is used to remove the needle end of the syringe barrel, thereby enabling injection of the bone graft material into the recipient site (Figs. 2, 3). The bone can be further condensed into all regions of the recipient bed using any form of condensing instrument, such as a Penfield no. 2, or no. 3 elevator, or an amalgam plugger.
Technique To minimize the time the graft is left outside of the body, a second team of surgeons undertakes the task of harvesting and preparing the graft, while the recipient bed is prepared for the placement of the graft. The autogenous bone harvested from the donor site is placed immediately into a physiological solution of either normal saline or culture media. If cortical bone has been harvested along with the cancellous component, it is cut into particles with bone rongeur to a graftable size. The cancellous bone is also reduced to smaller proportions, with care taken not to unduly traumatize the resident population of cells. Once the graft material has been adequately prepared, a small amount is
Discussion There are several advantages of using this simple technique to compress and transport harvested autogenous bone to a recipient site. The instrumentation required for this technique is readily available in any operating room. The ability to compress the harvested bone into a consistently condensed graft matrix enhances the chances for a successful result by establishing a high cellular density. Furthermore, carriage of the graft to the recipient bed is facilitated by placing it in a syringe, reducing the risk of spillage from the operative field. The chances of contamination of the graft are also reduced by preparing and storing the bone in a sterile, semi-closed system. Finally, the ability to roughly measure the total volume of the graft from the gradations on the syringe chamber allows for a more precise estimation of the graft’s proportions in relation to the size of the bony continuity defect.
Received from the Center for Maxillofacial Reconstruction. Division of Oral and Maxillofacial Surgery, University of Miami School of Medicine, Miami Veterans Administration Hospital, Miami, Florida. * Associate Professor of Surgery, Director of Graduate Training and Research. t Chief Resident. Address correspondence and reprint requests to Dr. Marx: University of Miami School of Medicine, Department of Surgery, Division of Oral and Maxillofacial Surgery, 1611 NW 12th Avenue, Miami, FL 33136. 0278-2391187 $0.00 + .25
988
989
MARX AND WONG
FIGURE 1 (top left). Cancellous compressed in the syringe chamber.
bone being
Cancellous bone in cyFIGURE 2 (fop right). lindrical form after ejection from the syringe barrel. Both syringes have had the needle end removed. FIGURE 3 (bottom lefr). Ejection of cancellous bone into allogeneic bone crib during mandibular reconstruction. Further compaction may be accomplished with a Pentield no. 2 or no. 3 instrument.
References I. Burwell RG: Studies in the transplantation of bone. The fresh composite homograft: autograft of cancellous bone. J Bone Joint Surg 46: I IO, 1964 2. Axhausen W: The osteogenetic phases of regeneration of bone: a historical and experimental study. J Bone Joint Surg 38593, 1956
3. Friedenstein AJ, Piatetzky-Shapiro II, Petrakova DV: Osteogenesis in transplants of bone marrow cells. J Embryo1 Exp Morphol 16:381, 1966 4. Marx RE, Kline SN: Principles and methods of osseous reconstruction, in International Advances in Surgical Oncology, vol 6. New York, Liss, 1983, pp 167-228 5. Boyne PJ: Implants and transplants: review of recent research in the area of oral surgery. J Am Dent Assoc 87:1074,1973