Table 5

Summary of studies using resorbable membranes for long bone defect reconstruction in large animal models

Author/Year [ref]

Animal model

Type of membrane

Study design

Assessment of bone regeneration

Outcome


Rhodes

2010

[127]

Dogs humerus

Hyaluronan (Hyalonect)

Periosteal reconstruction of bone defects filled with a variety of conventional bone filling compounds.

Histological at six weeks

Hyalonect was shown to allow the regeneration of bone within the humeral defects while preventing fibrotic tissue in-growth, and allowing regeneration of tissue which, by six weeks, had begun to resemble natural periosteal tissue.


Oh

2006 [128]

Dogs humerus

betatricalcium phosphate and poly L-lactide-co-glycolide-coepsilon- caprolactone (TCP/PLGC)

Partial bone defects

(length: a quarter of the full length of humerus, width: a quarter of middle diameter of the lateral aspect of humerus)

Control group: the contralateral humerus

Computed tomography (CT) at four and eight weeks and histological

The result suggested that TCP/PLGC membrane is a good guided bone regeneration material to restore the original morphology of humerus in partial defect.


Beniker

2003 [129]

Pig femur

acellular dermal matrix

(GraftJacket Acellular Periosteum Replacement Scaffold)

Segmental bone defect

Histological at six weeks

The scaffold protects the bone defect site as revealed by new bone formation within the margins of the defect and adjacent to the scaffold has been shown.

Minimal to no soft tissue invasion into the defect site. Dermal membrane material may be used as a scaffold for periosteum regeneration by allowing for cellular repopulation, revascularization, and bone defect restoration.


Gerber

2002 [130]

Sheep

Tibia

bioabsorbable

polylactide membranes

(L/DL-lactide) (80%-20%)

7-cm diaphyseal defect

Resorbable polylactide membranes +ABG or a vascularized periosteal flap.

four groups (fixation with a nail)

Clinical + post-mortem observation, radiological post-op and then weekly until week 16.

Polymeric membranes of adequate composition and pore size combined with ABG or vascularized periosteum allow for rapid and stable defect regeneration.


Gugala

2002 [131]

Sheep tibia

bioabsorbable

polylactide membranes, with or without perforations,

Single or double-tube designs

six groups: Polylactide membranes

Single or double-tube designs +/_ cancellous bone grafting

Radiological (X-rays and CT) and histological at 16 weeks.

In groups without bone grafting non-union developed and persisted until 16 weeks. Defect healing was only observed when ABG was used along with the single or double microporous-perforated membranes. (new bone formation by 'creeping substitution' of the graft)


Gugala

1999 [132]

Sheep tibia

poly(LDL-lactide)

4 cm diaphyseal segmental defects

1) a single microporous membrane

2) a microporous internal membrane, and a membrane on the outer surface of the cortex (external membrane)

3) an external membrane laser-perforated (800 to 900 micrometers openings)

4) ABG and a single perforated membrane

5) one perforated internal membrane into the medullary cavity and another membrane on the outer surface of the cortex

6) as Group 5 + ABG between the two membranes

Radiological and histological

No bone healing in Groups 1, 2, 3, and 5. Only in Groups 4 and 6 the defects healed. In Group 4, new bone was dispersed across the 'medullary canal' formed by the membrane. In Group 6, the new bone had grown into the space between the outer and inner membranes, forming the 'neocortex'.

The resorbable polymeric implant consisting of two concentric perforated membranes (the tube-in-tube implant) used in combination with cancellous bone graft to treat segmental diaphyseal defects allows for the reconstitution of the 'neocortex' with well-defined thickness.


Dimitriou et al. BMC Medicine 2012 10:81   doi:10.1186/1741-7015-10-81

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