Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Derek M. Steinbacher

Subject Area(s)

Surgery

Abstract

COMPARING EFFICACY OF CALVARIAL TRANSPORT DISTRACTION OSTEOGENESIS WITH AND WITHOUT RADIATION AND SIMULTANEOUS ADIPOSE GRAFTING.

Mikell M. Yuhasz, Felix P. Koch, Anna Kwiatkowski, Calvin Young, James Clune, Rob Travesio, Kenneth Wong, Joshua van Houten, Zhen W. Zuang, and Derek M. Steinbacher. Section of Plastic Surgery, Department of Surgery, Yale University, School of Medicine, New Haven, Connecticut.

The purpose of this study is to: a) assess transport distraction using a novel, 3D wormgear device to reconstruct cranial defects in radiated and non-radiated fields b) examine the effect of adipose grafting on the bony regenerate and overlying wound, and c) elucidate the sources of bone formation during transport distraction osteogenesis.

Twenty-three male New Zealand white rabbits (3 months; 3.5kg) were used, 10 non-irradiated and 13 irradiated (17 treatment, 6 control) with a one-time fraction of 35Gy. A 16x16mm defect was created abutted by a 10x16mm transport disc 5 weeks after irradiation, and 11 animals were fat grafted at the distraction site. Latency (1 day), distraction (1.5 mm/day), and consolidation (4 weeks) followed. Two fluorochromes were injected subcutaneously. MicroCT, fluorescence, and histology were assessed.

In distracted animals without fat grafting, bone density measured 701.87 mgHA/ccm and 2271.95 mgHA/ccm in irradiated and non-irradiated animals. In distracted animals with fat grafting, bone density measured 703.23 mgHA/ccm and 2254.27 mgHA/ccm in irradiated and non-irradiated animals. Fluorescence revealed ossification emanating from the dura, periosteum, and transport segment with decreased formation in irradiated animals.

Transport distraction using our novel, 3D wormgear device is possible for cranial reconstruction in the irradiated field but near term osseous fill is significantly diminished. Adipose grafting enhances wound healing in previously irradiated wound beds but does not enhance ossification.

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