Case Report: Reconstruction of a Large Maxillary Defect With an Engineered, Vascularized, Prefabricated Bone Graft

Tarek Ismail; Alexander Haumer; Alexander Lunger; Rik Osinga; Alexandre Kaempfen; Franziska Saxer; Anke Wixmerten; Sylvie Miot; Florian Thieringer; Joerg Beinemann; Christoph Kunz; Claude Jaquiéry; Thomas Weikert; Felix Kaul; Arnaud Scherberich; Dirk J Schaefer; Ivan Martin

doi:10.3389/fonc.2021.775136

Case Report: Reconstruction of a Large Maxillary Defect With an Engineered, Vascularized, Prefabricated Bone Graft

Front Oncol. 2021 Dec 6:11:775136. doi: 10.3389/fonc.2021.775136. eCollection 2021.

Authors

Tarek Ismail^{1

2}, Alexander Haumer^{1

2}, Alexander Lunger¹, Rik Osinga^{1

3}, Alexandre Kaempfen^{1

2}, Franziska Saxer⁴, Anke Wixmerten², Sylvie Miot², Florian Thieringer⁵, Joerg Beinemann⁵, Christoph Kunz⁵, Claude Jaquiéry⁵, Thomas Weikert⁶, Felix Kaul⁶, Arnaud Scherberich^{1

2}, Dirk J Schaefer^{1

3}, Ivan Martin²

Affiliations

¹ Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
² Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland.
³ Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland.
⁴ Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland.
⁵ Clinic for Craniomaxillofacial and Oral Surgery, University Hospital Basel, Basel, Switzerland.
⁶ Department of Radiology, University Hospital Basel, Basel, Switzerland.

Abstract

The reconstruction of complex midface defects is a challenging clinical scenario considering the high anatomical, functional, and aesthetic requirements. In this study, we proposed a surgical treatment to achieve improved oral rehabilitation and anatomical and functional reconstruction of a complex defect of the maxilla with a vascularized, engineered composite graft. The patient was a 39-year-old female, postoperative after left hemimaxillectomy for ameloblastic carcinoma in 2010 and tumor-free at the 5-year oncological follow-up. The left hemimaxillary defect was restored in a two-step approach. First, a composite graft was ectopically engineered using autologous stromal vascular fraction (SVF) cells seeded on an allogenic devitalized bone matrix. The resulting construct was further loaded with bone morphogenic protein-2 (BMP-2), wrapped within the latissimus dorsi muscle, and pedicled with an arteriovenous (AV) bundle. Subsequently, the prefabricated graft was orthotopically transferred into the defect site and revascularized through microvascular surgical techniques. The prefabricated graft contained vascularized bone tissue embedded within muscular tissue. Despite unexpected resorption, its orthotopic transfer enabled restoration of the orbital floor, separation of the oral and nasal cavities, and midface symmetry and allowed the patient to return to normal diet as well as to restore normal speech and swallowing function. These results remained stable for the entire follow-up period of 2 years. This clinical case demonstrates the safety and the feasibility of composite graft engineering for the treatment of complex maxillary defects. As compared to the current gold standard of autologous tissue transfer, this patient's benefits included decreased donor site morbidity and improved oral rehabilitation. Bone resorption of the construct at the ectopic prefabrication site still needs to be further addressed to preserve the designed graft size and shape.

Keywords: bone–soft tissue interface; complex 3D bone defect; graft prefabrication; regenerative surgery; vascularized composite graft.

Publication types

Case Reports