Y. Taguchi et al., AUTOCLAVED AUTOGRAFT BONE COMBINED WITH VASCULARIZED BONE AND BONE-MARROW, Clinical orthopaedics and related research, (320), 1995, pp. 220-230
In this study, the authors investigated enhancing the results of autoc
laved autograft bone by combining it with a vascularized bone graft an
d supplementing it with autogenous bone marrow for replacement of a 2-
cm tibial defect in the rabbit model. The study was divided into 4 gro
ups. Group I consisted of autoclaved autograft bone only; Group II, au
toclaved autograft bone and vascularized bone graft; Group III, autocl
aved autograft bone and autogenous bone marrow; and Group IV, autoclav
ed bone and autogenous bone marrow and vascularized bone graft. The va
scularized bone graft was provided by the ipsilateral fibula, pedicled
on the peroneal vessels, and transposed to sit alongside the autoclav
ed bone. In Group I, all grafts had nonunion at 16 weeks. In Group II,
new bone formation was seen at the proximal and distal site of the au
toclaved bone, host bone, and vascularized fibular graft junction as e
arly as 2 weeks, and bony union occurred at the 16th week. The autogen
ous bone marrow-supplemented groups (III and IV) had new bone formatio
n along the entire length of the autoclaved bone. Bony union at the pr
oximal and distal junction was seen as early as 4 weeks, extending to
the entire autoclaved bone by the eigth week (98% of the cases with 1
case of infection). Histologic examination showed revascularization an
d capillary ingrowth into the autoclaved bone at 16 weeks, with a sign
ificantly improved torsional stiffness when compared with the groups w
ithout autogenous bone marrow supplementation. The addition of vascula
rized bone graft resulted in an improved union rate as compared with t
he autoclaved bone alone. Autogenous bone marrow supplementation, in a
ddition to the vascularized bone graft, resulted in rapid new bone for
mation all around the autoclaved bone, early revascularization and inc
orporation of the autoclaved bone, and a significantly improved torsio
nal stiffness of the reconstruction.