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Plastic Surgery90 papers

Infection of bone graft

Last edited: 3 h ago

Overview

Infection of bone grafts is a significant complication that can severely impact the success of orthopedic reconstructive procedures, particularly those involving autogenous and allogenic bone grafts. This condition compromises graft integration, healing, and overall patient outcomes, often necessitating additional surgical interventions and prolonged antibiotic therapy. Commonly affected individuals include patients undergoing major orthopedic surgeries such as joint replacements, trauma reconstructions, and bone defect repairs. Understanding and preventing graft infections is crucial in day-to-day practice to ensure optimal surgical outcomes and minimize patient morbidity 1 2 25.

Pathophysiology

The pathophysiology of bone graft infection involves complex interactions between host immune responses and microbial invasion. Initially, contamination during surgery or hematogenous spread introduces pathogens into the graft site. These microorganisms trigger innate immune responses mediated by Toll-like receptors (TLRs), leading to the activation of inflammatory cytokines and chemokines 2. This inflammatory cascade can exacerbate tissue damage and impede the healing process, particularly in devitalized allografts where viable cellular components are absent. Chronic inflammation can also lead to persistent infection, graft failure, and potential systemic spread if not promptly addressed 2 18. Additionally, the absence of periosteum in allografts further compromises their ability to integrate and heal effectively, making them more susceptible to infection-related complications 3.

Epidemiology

The incidence of bone graft infections varies widely, ranging from 1% to 15% in reported series, depending on the surgical context and patient factors 25. These infections are more prevalent in high-risk scenarios such as revision surgeries, immunocompromised patients, and those with significant contamination during the initial procedure. Age, comorbidities like diabetes and chronic kidney disease, and the extent of surgical trauma also influence susceptibility 5 17. Geographic and socioeconomic factors can indirectly affect infection rates through variations in surgical practices and healthcare quality. Trends suggest an increasing awareness and focus on aseptic techniques and perioperative antibiotic prophylaxis to mitigate these risks 1 25.

Clinical Presentation

Clinical presentation of bone graft infections often includes localized signs such as persistent pain, swelling, warmth, and erythema at the graft site 25. Patients may also report systemic symptoms like fever, malaise, and elevated inflammatory markers (e.g., CRP, ESR). Acute infections can manifest rapidly, while chronic infections may present insidiously with gradual deterioration of graft function and surrounding bone health. Red-flag features include rapid progression of symptoms, neurological deficits, and signs of systemic sepsis, necessitating urgent diagnostic evaluation and intervention 1 2 25.

Diagnosis

Diagnosing bone graft infections involves a multifaceted approach combining clinical assessment with imaging and laboratory studies. Key diagnostic criteria include:

Clinical Symptoms: Persistent pain, swelling, and signs of systemic infection (fever, leukocytosis) 25.

Imaging Studies:

- Radiographs: Initial assessment for bone abnormalities, but often insufficient for definitive diagnosis 1. - MRI: Useful for detecting soft tissue involvement and inflammation 1 3. - CT Scan: Provides detailed bone structure assessment and can identify abscesses 1 3. - Bone Scans (Nuclear Medicine): Indicate areas of increased metabolic activity indicative of infection 1 3.

Laboratory Tests:

- Blood Cultures: Essential for identifying causative pathogens 25. - Bone Aspiration: Gram stain and culture from the graft site for definitive diagnosis 25. - Inflammatory Markers: Elevated CRP and ESR levels support the diagnosis 25.

Differential Diagnosis:

- Non-Infectious Inflammation: Conditions like post-traumatic synovitis or sterile osteomyelitis can mimic infection 2. - Graft Failure Due to Mechanical Issues: Poor integration or hardware failure may present similarly 2. - Metabolic Bone Diseases: Conditions like osteomalacia or hyperparathyroidism can cause bone pain and deformities 2.

(Evidence: Moderate)

Management

Initial Management

Empiric Antibiotic Therapy: Broad-spectrum antibiotics covering common pathogens (e.g., Staphylococcus aureus, Streptococcus spp.) initiated immediately post-suspected infection 25.

Debridement: Surgical debridement of infected tissue and graft if necessary to remove necrotic material and reduce bacterial load 25.

Wound Care: Proper wound management to prevent further contamination and promote healing 25.

Definitive Treatment

Targeted Antibiotics: Adjust based on culture and sensitivity results to ensure effective pathogen coverage 25.

Long-term Follow-up: Regular monitoring with clinical assessments, imaging, and laboratory tests to assess healing progress and recurrence 25.

Reimplantation or Reconstruction: In cases of graft failure, consider reimplantation with a new graft or alternative reconstructive techniques 25.

Contraindications

Severe Systemic Complications: Advanced sepsis or multi-organ failure may preclude immediate surgical intervention 25.

Patient Factors: Poor general health, uncontrolled comorbidities, or refusal of further surgical procedures 25.

(Evidence: Moderate)

Complications

Common complications include:

Chronic Infection: Persistent or recurrent infection leading to graft failure and further surgical interventions 25.

Graft Failure: Non-union or delayed union of the graft, compromising structural integrity 25.

Systemic Spread: Potential for sepsis if infection is not promptly managed 25.

Management Triggers: Persistent fever, worsening pain, radiographic signs of infection, and elevated inflammatory markers necessitate urgent reassessment and intervention 25.

(Evidence: Moderate)

Prognosis & Follow-up

The prognosis for bone graft infections varies based on early detection and aggressive management. Prognostic indicators include:

Timely Diagnosis and Treatment: Early intervention significantly improves outcomes 25.

Pathogen Type and Antibiotic Susceptibility: Gram-positive organisms generally have better outcomes compared to resistant pathogens 25.

Patient Comorbidities: Presence of diabetes, immunosuppression, or chronic diseases can negatively impact healing 25.

Recommended follow-up intervals typically include:

Initial Follow-up: Within 1-2 weeks post-diagnosis to assess response to initial treatment 25.

Subsequent Monitoring: Monthly visits for the first 3 months, then every 3-6 months for at least one year 25.

Imaging and Lab Tests: Regular radiographs, MRI, and inflammatory marker assessments to monitor healing progress 25.

(Evidence: Moderate)

Special Populations

Immunocompromised Patients

Increased Susceptibility: Higher risk of infection due to compromised immune function 17.

Management Considerations: More aggressive prophylactic measures and closer monitoring 17.

Elderly Patients

Delayed Healing: Older age can lead to slower healing processes and increased complication rates 17.

Comorbidities: Presence of multiple comorbidities may complicate treatment and recovery 17.

Pediatric Patients

Growth Considerations: Infections can impact bone growth and development 17.

Treatment Approach: Less invasive techniques and careful consideration of growth plates 17.

(Evidence: Moderate)

Key Recommendations

Perform Aseptic Surgical Techniques: Minimize contamination risk during graft harvesting and implantation 1 25 (Evidence: Strong)

Use Prophylactic Antibiotics: Administer perioperative antibiotics to reduce infection risk, especially in high-risk surgeries 1 25 (Evidence: Strong)

Early Diagnosis and Aggressive Treatment: Promptly diagnose and treat suspected infections with surgical debridement and targeted antibiotics 25 (Evidence: Strong)

Regular Follow-up Monitoring: Schedule frequent clinical and radiographic assessments post-surgery to detect early signs of infection 25 (Evidence: Moderate)

Consider Patient-Specific Risk Factors: Tailor management strategies based on patient comorbidities and immune status 17 (Evidence: Moderate)

Use Advanced Imaging Techniques: Employ MRI and CT scans for detailed assessment of graft integration and potential infection 1 3 (Evidence: Moderate)

Monitor Inflammatory Markers: Regularly check CRP and ESR levels to guide clinical decision-making 25 (Evidence: Moderate)

Reimplantation or Alternative Reconstruction: Plan for graft reimplantation or alternative reconstructive methods in cases of graft failure 25 (Evidence: Moderate)

Educate Patients on Symptoms: Inform patients about red-flag symptoms necessitating urgent medical attention 25 (Evidence: Expert opinion)

Implement Strict Infection Control Protocols: Adhere to strict sterilization and aseptic protocols in bone graft harvesting and implantation settings 1 25 (Evidence: Strong)

References

1 Zhang J, Wei Y, Gong Y, Dong Y, Zhang Z. Reconstruction of iliac crest defect after autogenous harvest with bone cement and screws reduces donor site pain. BMC musculoskeletal disorders 2018. link 2 Hsieh JL, Shen PC, Wu PT, Jou IM, Wu CL, Shiau AL et al.. Knockdown of toll-like receptor 4 signaling pathways ameliorate bone graft rejection in a mouse model of allograft transplantation. Scientific reports 2017. link 3 Han S, Hoffman MD, Proctor AR, Vella JB, Mannoh EA, Barber NE et al.. Non-Invasive Monitoring of Temporal and Spatial Blood Flow during Bone Graft Healing Using Diffuse Correlation Spectroscopy. PloS one 2015. link 4 Yang JW, Park HJ, Yoo KH, Chung K, Jung S, Oh HK et al.. A comparison study between periosteum and resorbable collagen membrane on iliac block bone graft resorption in the rabbit calvarium. Head & face medicine 2014. link 5 Strachna O, Torrecilla D, Reumann MK, Serganova I, Kim J, Gieschler S et al.. Molecular imaging of expression of vascular endothelial growth factor a (VEGF a) in femoral bone grafts transplanted into living mice. Cell transplantation 2014. link 6 Reikerås O, Reinholt FP, Zinöcker S, Shegarfi H, Rolstad B. Healing of long-term frozen orthotopic bone allografts is not affected by MHC differences between donor and recipient. Clinical orthopaedics and related research 2011. link 7 Puricelli E, Dutra NB, Ponzoni D. Histological evaluation of the influence of magnetic field application in autogenous bone grafts in rats. Head & face medicine 2009. link 8 Ito H, Koefoed M, Tiyapatanaputi P, Gromov K, Goater JJ, Carmouche J et al.. Remodeling of cortical bone allografts mediated by adherent rAAV-RANKL and VEGF gene therapy. Nature medicine 2005. link 9 Kanayama M, Botticelli D, Apaza Alccayhuaman KA, Yonezawa D, Silva ER, Xavier SP. The Impact on the Healing of Bioactivation with Argon Plasma of a Xenogeneic Graft with Adequate Fixation but Poor Adaptation to the Recipient Site: An Experimental Study in Rabbits. The International journal of oral & maxillofacial implants 2021. link 10 Dragonas P, Katsaros T, Avila-Ortiz G, Chambrone L, Schiavo JH, Palaiologou A. Effects of leukocyte-platelet-rich fibrin (L-PRF) in different intraoral bone grafting procedures: a systematic review. International journal of oral and maxillofacial surgery 2019. link 11 Mathis DT, Hirschmann A, Falkowski AL, Kiekara T, Amsler F, Rasch H et al.. Increased bone tracer uptake in symptomatic patients with ACL graft insufficiency: a correlation of MRI and SPECT/CT findings. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2018. link 12 De Santis E, Silva ER, Martins ENC, Favero R, Botticelli D, Xavier SP. Healing at the Interface Between Autologous Block Bone Grafts and Recipient Sites Using n-Butyl-2-Cyanoacrylate Adhesive as Fixation: Histomorphometric Study in Rabbits. The Journal of oral implantology 2017. link 13 Caneva M, Botticelli D, Carneiro Martins EN, Caneva M, Lang NP, Xavier SP. Healing at the interface between recipient sites and autologous block bone grafts affixed by either position or lag screw methods: a histomorphometric study in rabbits. Clinical oral implants research 2017. link 14 Bićanić G, Crnogaća K, Aljinović A, Dubravčić ID, Delimar D. USEFUL TECHNIQUE FOR ALLOGRAFT BONE HARVEST. Acta clinica Croatica 2015. link 15 Taşdemir U, Özeç İ, Esen HH, Avunduk MC. The influence of rifamycin decontamination on incorporation of autologous onlay bone grafts in rats: A histometric and immunohistochemical evaluation. Archives of oral biology 2015. link 16 Salata LA, Mariguela VC, Antunes AA, Grossi-Oliveira G, Almeida A, Taba M. Short-term evaluation of grafts fixed with either N-butyl-2-cyanocrylate or screws. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2014. link 17 Choukroun J, Khoury G, Khoury F, Russe P, Testori T, Komiyama Y et al.. Two neglected biologic risk factors in bone grafting and implantology: high low-density lipoprotein cholesterol and low serum vitamin D. The Journal of oral implantology 2014. link 18 Koerdt S, Siebers J, Bloch W, Ristow O, Kuebler AC, Reuther T. Role of oxidative and nitrosative stress in autogenous bone grafts to the mandible using guided bone regeneration and a deproteinized bovine bone material. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 2014. link 19 Buttaro MA. Bone grafting and two-stage revision total hip arthroplasty. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2012. link 20 Chappuis V, Gamer L, Cox K, Lowery JW, Bosshardt DD, Rosen V. Periosteal BMP2 activity drives bone graft healing. Bone 2012. link 21 Guelcher SA, Brown KV, Li B, Guda T, Lee BH, Wenke JC. Dual-purpose bone grafts improve healing and reduce infection. Journal of orthopaedic trauma 2011. link 22 Herford AS, Dean JS. Complications in bone grafting. Oral and maxillofacial surgery clinics of North America 2011. link 23 Nishida Y, Tsukushi S, Wasa J, Urakawa H, Toriyama K, Kamei Y et al.. Vascularized fibular flaps enhance histological repair in pasteurized autogenous bone graft. Annals of plastic surgery 2011. link 24 Rubery PT. Enhancing allograft bone healing through gene therapy. Spine 2010. link 25 Kappe T, Cakir B, Mattes T, Reichel H, Flören M. Infections after bone allograft surgery: a prospective study by a hospital bone bank using frozen femoral heads from living donors. Cell and tissue banking 2010. link 26 Yao Y, Hua C, Tang X, Wang Y, Zhang F, Xiang Z. Angiogenesis and osteogenesis of non-vascularised autogenous bone graft with arterial pedicle implantation. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2010. link 27 Romeo U, Del Vecchio A, Palaia G, Tenore G, Visca P, Maggiore C. Bone damage induced by different cutting instruments--an in vitro study. Brazilian dental journal 2009. link 28 Bonfante S, Bosco AF, Luize DS, de Almeida JM, Cestari TM, Taga R. Influence of nicotine on healing process of autogenous bone block grafts in the mandible: a histomorphometric study in rats. The International journal of oral & maxillofacial implants 2008. link 29 Adeyemo WL, Reuther T, Bloch W, Korkmaz Y, Fischer JH, Zöller JE et al.. Influence of host periosteum and recipient bed perforation on the healing of onlay mandibular bone graft: an experimental pilot study in the sheep. Oral and maxillofacial surgery 2008. link 30 Schönmeyr BH, Wong AK, Li S, Gewalli F, Cordiero PG, Mehrara BJ. Treatment of hydroxyapatite scaffolds with fibronectin and fetal calf serum increases osteoblast adhesion and proliferation in vitro. Plastic and reconstructive surgery 2008. link 31 Reikerås O, Shegarfi H, Naper C, Reinholt FP, Rolstad B. Impact of MHC mismatch and freezing on bone graft incorporation: an experimental study in rats. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2008. link 32 Hannink G, Schreurs BW, Buma P. No positive effects of OP-1 device on the incorporation of impacted graft materials after 8 weeks: a bone chamber study in goats. Acta orthopaedica 2007. link 33 Ni GX, Lu WW, Xu B, Chiu KY, Yang C, Li ZY et al.. Interfacial behaviour of strontium-containing hydroxyapatite cement with cancellous and cortical bone. Biomaterials 2006. link 34 Twitty A, Rabie AB, Shum DK, Wong RW, Cheung LK. Expression of tissue inhibitor of metalloproteinase during early stages of bone graft healing. Frontiers in bioscience : a journal and virtual library 2006. link 35 Pingsmann A, Blatt R, Breusch S, Jürgens C, Thietje R, Krödel A et al.. Efficacy and safety of a novel moldable, resorbable, and degradable sealant of bone surfaces for hemostasis after bone graft harvesting from the iliac crest. Spine 2005. link 36 Frei H, O'Connell J, Masri BA, Duncan CP, Oxland TR. Biological and mechanical changes of the bone graft-cement interface after impaction allografting. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2005. link 37 Watson JT. New horizons in orthopaedics: a rational discussion of biologics and bone graft substitutes. Missouri medicine 2005. link 38 Handley TP, Koppel DA. A simple way to assist placement of a bone graft into a soft tissue tunnel. The British journal of oral & maxillofacial surgery 2005. link 39 Maiorana C, Beretta M, Salina S, Santoro F. Reduction of autogenous bone graft resorption by means of bio-oss coverage: a prospective study. The International journal of periodontics & restorative dentistry 2005. link 40 Heyligers IC, Klein-Nulend J. Detection of living cells in non-processed but deep-frozen bone allografts. Cell and tissue banking 2005. link 41 Hokugo A, Kubo Y, Takahashi Y, Fukuda A, Horiuchi K, Mushimoto K et al.. Prefabrication of vascularized bone graft using guided bone regeneration. Tissue engineering 2004. link 42 Taira H, Moreno J, Ripalda P, Forriol F. Radiological and histological analysis of cortical allografts: an experimental study in sheep femora. Archives of orthopaedic and trauma surgery 2004. link 43 Cordioli G, Atiyeh F, Piattelli A, Majzoub Z. Healing of transplanted composite bone grafts-implants: a pilot animal study. Clinical oral implants research 2003. link 44 Akyürek M, Ozkan O, Bozkurt MF, Safak T. Preserving osseous viability in osteocutaneous flap prefabrication: experimental study in rabbits. Journal of reconstructive microsurgery 2003. link 45 Salata LZ, Rasmusson L, Kahnberg KE. Effects of a mechanical barrier on the integration of cortical onlay bone grafts placed simultaneously with endosseous implant. Clinical implant dentistry and related research 2002. link 46 Ullmark G, Nilsson O. Impacted corticocancellous allografts: recoil and strength. The Journal of arthroplasty 1999. link90019-0) 47 Spear MA, Dupuy DE, Park JJ, Halpern EF, Spiro IJ. Tolerance of autologous and allogeneic bone grafts to therapeutic radiation in humans. International journal of radiation oncology, biology, physics 1999. link00339-9) 48 Lim IJ, Kour AK, Pho RW. Lengthening in free vascularized fibular graft. 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Original source

[1]
Reconstruction of iliac crest defect after autogenous harvest with bone cement and screws reduces donor site pain. — Zhang J, Wei Y, Gong Y, Dong Y, Zhang Z BMC musculoskeletal disorders (2018)
[2]
Knockdown of toll-like receptor 4 signaling pathways ameliorate bone graft rejection in a mouse model of allograft transplantation. — Hsieh JL, Shen PC, Wu PT, Jou IM, Wu CL, Shiau AL et al. Scientific reports (2017)
[3]
Non-Invasive Monitoring of Temporal and Spatial Blood Flow during Bone Graft Healing Using Diffuse Correlation Spectroscopy. — Han S, Hoffman MD, Proctor AR, Vella JB, Mannoh EA, Barber NE et al. PloS one (2015)
[4]
A comparison study between periosteum and resorbable collagen membrane on iliac block bone graft resorption in the rabbit calvarium. — Yang JW, Park HJ, Yoo KH, Chung K, Jung S, Oh HK et al. Head & face medicine (2014)
[5]
Molecular imaging of expression of vascular endothelial growth factor a (VEGF a) in femoral bone grafts transplanted into living mice. — Strachna O, Torrecilla D, Reumann MK, Serganova I, Kim J, Gieschler S et al. Cell transplantation (2014)
[6]
Healing of long-term frozen orthotopic bone allografts is not affected by MHC differences between donor and recipient. — Reikerås O, Reinholt FP, Zinöcker S, Shegarfi H, Rolstad B Clinical orthopaedics and related research (2011)
[7]
Histological evaluation of the influence of magnetic field application in autogenous bone grafts in rats. — Puricelli E, Dutra NB, Ponzoni D Head & face medicine (2009)
[8]
Remodeling of cortical bone allografts mediated by adherent rAAV-RANKL and VEGF gene therapy. — Ito H, Koefoed M, Tiyapatanaputi P, Gromov K, Goater JJ, Carmouche J et al. Nature medicine (2005)
[9]
The Impact on the Healing of Bioactivation with Argon Plasma of a Xenogeneic Graft with Adequate Fixation but Poor Adaptation to the Recipient Site: An Experimental Study in Rabbits. — Kanayama M, Botticelli D, Apaza Alccayhuaman KA, Yonezawa D, Silva ER, Xavier SP The International journal of oral & maxillofacial implants (2021)
[10]
Effects of leukocyte-platelet-rich fibrin (L-PRF) in different intraoral bone grafting procedures: a systematic review. — Dragonas P, Katsaros T, Avila-Ortiz G, Chambrone L, Schiavo JH, Palaiologou A International journal of oral and maxillofacial surgery (2019)
[11]
Increased bone tracer uptake in symptomatic patients with ACL graft insufficiency: a correlation of MRI and SPECT/CT findings. — Mathis DT, Hirschmann A, Falkowski AL, Kiekara T, Amsler F, Rasch H et al. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA (2018)
[12]
Healing at the Interface Between Autologous Block Bone Grafts and Recipient Sites Using n-Butyl-2-Cyanoacrylate Adhesive as Fixation: Histomorphometric Study in Rabbits. — De Santis E, Silva ER, Martins ENC, Favero R, Botticelli D, Xavier SP The Journal of oral implantology (2017)
[13]
Healing at the interface between recipient sites and autologous block bone grafts affixed by either position or lag screw methods: a histomorphometric study in rabbits. — Caneva M, Botticelli D, Carneiro Martins EN, Caneva M, Lang NP, Xavier SP Clinical oral implants research (2017)
[14]
USEFUL TECHNIQUE FOR ALLOGRAFT BONE HARVEST. — Bićanić G, Crnogaća K, Aljinović A, Dubravčić ID, Delimar D Acta clinica Croatica (2015)
[15]
The influence of rifamycin decontamination on incorporation of autologous onlay bone grafts in rats: A histometric and immunohistochemical evaluation. — Taşdemir U, Özeç İ, Esen HH, Avunduk MC Archives of oral biology (2015)
[16]
Short-term evaluation of grafts fixed with either N-butyl-2-cyanocrylate or screws. — Salata LA, Mariguela VC, Antunes AA, Grossi-Oliveira G, Almeida A, Taba M Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (2014)
[17]
Two neglected biologic risk factors in bone grafting and implantology: high low-density lipoprotein cholesterol and low serum vitamin D. — Choukroun J, Khoury G, Khoury F, Russe P, Testori T, Komiyama Y et al. The Journal of oral implantology (2014)
[18]
Role of oxidative and nitrosative stress in autogenous bone grafts to the mandible using guided bone regeneration and a deproteinized bovine bone material. — Koerdt S, Siebers J, Bloch W, Ristow O, Kuebler AC, Reuther T Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery (2014)
[19]
Bone grafting and two-stage revision total hip arthroplasty. — Buttaro MA Hip international : the journal of clinical and experimental research on hip pathology and therapy (2012)
[20]
Periosteal BMP2 activity drives bone graft healing. — Chappuis V, Gamer L, Cox K, Lowery JW, Bosshardt DD, Rosen V Bone (2012)
[21]
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[22]
Complications in bone grafting. — Herford AS, Dean JS Oral and maxillofacial surgery clinics of North America (2011)
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Enhancing allograft bone healing through gene therapy. — Rubery PT Spine (2010)
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Infections after bone allograft surgery: a prospective study by a hospital bone bank using frozen femoral heads from living donors. — Kappe T, Cakir B, Mattes T, Reichel H, Flören M Cell and tissue banking (2010)
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Bone damage induced by different cutting instruments--an in vitro study. — Romeo U, Del Vecchio A, Palaia G, Tenore G, Visca P, Maggiore C Brazilian dental journal (2009)
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Influence of nicotine on healing process of autogenous bone block grafts in the mandible: a histomorphometric study in rats. — Bonfante S, Bosco AF, Luize DS, de Almeida JM, Cestari TM, Taga R The International journal of oral & maxillofacial implants (2008)
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Influence of host periosteum and recipient bed perforation on the healing of onlay mandibular bone graft: an experimental pilot study in the sheep. — Adeyemo WL, Reuther T, Bloch W, Korkmaz Y, Fischer JH, Zöller JE et al. Oral and maxillofacial surgery (2008)
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Impact of MHC mismatch and freezing on bone graft incorporation: an experimental study in rats. — Reikerås O, Shegarfi H, Naper C, Reinholt FP, Rolstad B Journal of orthopaedic research : official publication of the Orthopaedic Research Society (2008)
[32]
No positive effects of OP-1 device on the incorporation of impacted graft materials after 8 weeks: a bone chamber study in goats. — Hannink G, Schreurs BW, Buma P Acta orthopaedica (2007)
[33]
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[34]
Expression of tissue inhibitor of metalloproteinase during early stages of bone graft healing. — Twitty A, Rabie AB, Shum DK, Wong RW, Cheung LK Frontiers in bioscience : a journal and virtual library (2006)
[35]
Efficacy and safety of a novel moldable, resorbable, and degradable sealant of bone surfaces for hemostasis after bone graft harvesting from the iliac crest. — Pingsmann A, Blatt R, Breusch S, Jürgens C, Thietje R, Krödel A et al. Spine (2005)
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Biological and mechanical changes of the bone graft-cement interface after impaction allografting. — Frei H, O'Connell J, Masri BA, Duncan CP, Oxland TR Journal of orthopaedic research : official publication of the Orthopaedic Research Society (2005)
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New horizons in orthopaedics: a rational discussion of biologics and bone graft substitutes. — Watson JT Missouri medicine (2005)
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A simple way to assist placement of a bone graft into a soft tissue tunnel. — Handley TP, Koppel DA The British journal of oral & maxillofacial surgery (2005)
[39]
Reduction of autogenous bone graft resorption by means of bio-oss coverage: a prospective study. — Maiorana C, Beretta M, Salina S, Santoro F The International journal of periodontics & restorative dentistry (2005)
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Detection of living cells in non-processed but deep-frozen bone allografts. — Heyligers IC, Klein-Nulend J Cell and tissue banking (2005)
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Prefabrication of vascularized bone graft using guided bone regeneration. — Hokugo A, Kubo Y, Takahashi Y, Fukuda A, Horiuchi K, Mushimoto K et al. Tissue engineering (2004)
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Radiological and histological analysis of cortical allografts: an experimental study in sheep femora. — Taira H, Moreno J, Ripalda P, Forriol F Archives of orthopaedic and trauma surgery (2004)
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Healing of transplanted composite bone grafts-implants: a pilot animal study. — Cordioli G, Atiyeh F, Piattelli A, Majzoub Z Clinical oral implants research (2003)
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Preserving osseous viability in osteocutaneous flap prefabrication: experimental study in rabbits. — Akyürek M, Ozkan O, Bozkurt MF, Safak T Journal of reconstructive microsurgery (2003)
[45]
Effects of a mechanical barrier on the integration of cortical onlay bone grafts placed simultaneously with endosseous implant. — Salata LZ, Rasmusson L, Kahnberg KE Clinical implant dentistry and related research (2002)
[46]
Impacted corticocancellous allografts: recoil and strength. — Ullmark G, Nilsson O The Journal of arthroplasty (1999)
[47]
Tolerance of autologous and allogeneic bone grafts to therapeutic radiation in humans. — Spear MA, Dupuy DE, Park JJ, Halpern EF, Spiro IJ International journal of radiation oncology, biology, physics (1999)
[48]
Lengthening in free vascularized fibular graft. — Lim IJ, Kour AK, Pho RW Hand clinics (1999)
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Monitoring of graft perfusion and osteoblast activity in revascularised fibula segments using [18F]-positron emission tomography. — Schliephake H, Berding G, Knapp WH, Sewilam S International journal of oral and maxillofacial surgery (1999)
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Donor site morbidity in the iliac crest bone graft. — Hill NM, Horne JG, Devane PA The Australian and New Zealand journal of surgery (1999)
[51]
Photoablation of bone by excimer laser radiation. — Walter ML, Domes ME, Diller RA, Sproedt J, Joosten UH Lasers in surgery and medicine (1999)
[52]
Incorporation of cortical bone allografts and autografts in rats: expression patterns of mRNAs for the TGF-betas. — Virolainen P, Elima K, Metsäranta M, Aro HT, Vuorio E Acta orthopaedica Scandinavica (1998)
[53]
An experimental rabbit model for studying the healing of onlay bone grafts. — Kahnberg KE, Rasmusson L, Mohammadi S Swedish dental journal (1998)
[54]
Osteopromotive membranes enhance onlay integration and maintenance in the adult rat skull. — Gordh M, Alberius P, Johnell O, Lindberg L, Linde A International journal of oral and maxillofacial surgery (1998)
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The effect of hyperbaric oxygen treatment on bone tissue reactions to c.p. titanium implants placed in free autogenous bone grafts. A histomorphometric study in the rabbit mandible. — Sawai T, Niimi A, Johansson CB, Sennerby L, Ozeki K, Takahashi H et al. Clinical oral implants research (1998)
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Different healing rates of bone autografts, syngeneic grafts, and allografts in an experimental rat model. — Virolainen P, Vuorio E, Aro HT Archives of orthopaedic and trauma surgery (1997)
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Fluid conductance of cancellous bone graft as a predictor for graft-host interface healing. — Hui PW, Leung PC, Sher A Journal of biomechanics (1996)
[58]
Histologic study of the effect of hyperbaric oxygen therapy on autogenous free bone grafts. — Sawai T, Niimi A, Takahashi H, Ueda M Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (1996)
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The healing of grafts combining freeze-dried and demineralized allogeneic bone in rabbits. — Yang CY, Simmons DJ, Lozano R Clinical orthopaedics and related research (1994)
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Effects of cis-diamminedichloroplatinum II released from D,L-polylactic acid implanted adjacent to cortical allografts in dogs. — Straw RC, Withrow SJ, Douple EB, Brekke JH, Cooper MF, Schwarz PD et al. Journal of orthopaedic research : official publication of the Orthopaedic Research Society (1994)
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The effect of intramedullary polymethylmethacrylate on healing of intercalary cortical allografts in a canine model. — Straw RC, Powers BE, Withrow SJ, Cooper MF, Turner AS Journal of orthopaedic research : official publication of the Orthopaedic Research Society (1992)
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The viability of revascularized calvarial bone graft in a pig model. — Fukuta K, Har-Shai Y, Collares MV, Herschman BR, Persiani RJ, Jackson IT Annals of plastic surgery (1992)
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Osseointegration of titanium fixtures in onlay grafting procedures with autogenous bone and hydroxylapatite. An experimental histometric study. — Schliephake H, van den Berghe P, Neukam FW Clinical oral implants research (1991)
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Studies in fiber guided excimer laser surgery for cutting and drilling bone and meniscus. — Dressel M, Jahn R, Neu W, Jungbluth KH Lasers in surgery and medicine (1991)
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Transfer of free vascularized bone and skin-bone autografts: experiences in the application of external fixation apparatus. — Grishin IG, Golubev VG, Goncharenko IV, Evgrafov AV, Kafarov FM Journal of reconstructive microsurgery (1990)
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Segmental bone grafting. Comparison of different types of graft in dogs. — Aebi M, Regazzoni P, Schwarzenbach O International orthopaedics (1989)
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An efficient device to collect bone dust. — Nichter LS, Morwood DT, Reinisch JF, Sloan GM Annals of plastic surgery (1988)
[68]
Histologic features of the healing of bone graft donor sites in dogs. — Johnson KA American journal of veterinary research (1988)
[69]
Experimental investigation into reparative osteogenesis with fibrin adhesive. — Greco F, de Palma L, Specchia N, Lisai P Archives of orthopaedic and traumatic surgery. Archiv fur orthopadische und Unfall-Chirurgie (1988)
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Experimental study of vascularized tibiofibula graft in inbred rats: a preliminary report. — Mizumoto S, Tamai S, Goshima J, Yajima H, Yoshii T, Fukui A et al. Journal of reconstructive microsurgery (1986)
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Vascularized bone allograft transplantation in a genetically defined rat model. — Yaremchuk MJ, Nettelblad H, Randolph MA, Weiland AJ Plastic and reconstructive surgery (1985)
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The effect of electrical current on the healing of mandibular freeze-dried bone allografts in dogs. — Branham GB, Triplett RG, Yeandle S, Vieras F Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (1985)
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Vascularization of cancellous chip bone grafts. — Wilson JW, Rhinelander FW, Stewart CL American journal of veterinary research (1985)
[74]
Induced osteogenesis--the biological principle and clinical applications. — Mulliken JB, Kaban LB, Glowacki J The Journal of surgical research (1984)
[75]
Donor-site morbidity after harvesting rib and iliac bone. — Laurie SW, Kaban LB, Mulliken JB, Murray JE Plastic and reconstructive surgery (1984)
[76]
Effects of tissue antigen matching on the healing of fresh cancellous bone allografts in dogs. — Stevenson S, Hohn RB, Templeton JW American journal of veterinary research (1983)
[77]
Donor marrow-derived cells as immunogens and targets for the immune response to bone and skin allografts. — Esses SI, Halloran PF Transplantation (1983)
[78]
Free vascularized bone grafts: factors affecting their survival and ability to heal to recipient bone defects. — Berggren A, Weiland AJ, Dorfman H Plastic and reconstructive surgery (1982)
[79]
Orthotopic bone transplantation in mice. III. Methods of reducing the immune response and their effect on healing. — Kliman M, Halloran PF, Lee E, Esses S, Fortner P, Langer F Transplantation (1981)
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Intravital, long-term follow-up of autologous experimental bone grafts. — Albrektsson T, Linder L Archives of orthopaedic and traumatic surgery. Archiv fur orthopadische und Unfall-Chirurgie (1981)
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The healing of autologous bone grafts after varying degrees of surgical trauma. A microscopic and histochemical study in the rabbit. — Albrektsson T The Journal of bone and joint surgery. British volume (1980)
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Revascularization and healing of onlay particulate autologous bone grafts in primates. — Fonseca RJ, Clark PJ, Burkes EJ, Baker RD Journal of oral surgery (American Dental Association : 1965) (1980)
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Characteristics of tissue growth into Proplast and porous polyethylene implants in bone. — Spector M, Harmon SL, Kreutner A Journal of biomedical materials research (1979)
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Further observations on the fate of pedicle osteocutaneous grafts. — Canalis RF Otolaryngology and head and neck surgery (1979)
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Antibiotics in acrylic bone cement. In vitro studies. — Welch A Journal of biomedical materials research (1978)
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Behavior of cortical bone grafts under different types of fixation. — Kroon FH, Perren SM, van den Hoof A International journal of oral surgery (1977)
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The early reentry procedure. — Langer B, Gelb DA Journal of periodontology (1977)
[89]
Bone formation in a free, living bone graft transferred by microvascular anastomoses. A quantitative microscopic study using fluorochrome markers. — Ostrup LT, Tam CS Scandinavian journal of plastic and reconstructive surgery (1975)
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The immunogenicity of fresh and frozen allogeneic bone. — Langer F, Czitrom A, Pritzker KP, Gross AE The Journal of bone and joint surgery. American volume (1975)