Rizzo MI1*, Rajabtork Zadeh O1, Spuntarelli G1, Stefano Ceccarelli S2, De Vito R3, Marino SFM1 and Zama M1
1Deaprtment of Plastic and Maxillofacial Surgery, Bambino Gesù Children’s Hospital, Italy
2Transfusion Medicine, Bambino Gesù Children’s Hospital, Italy
3Unit of Pathology, Bambino Gesù Children’s Hospital, Italy
Large calvarial bone defects represent a significant challenge in children. Often complicated by a shortage of bone and a contraindication to the use of synthetic materials. All strategies show limitations. This study proposes an effective method for large/complicated/stable cranial defects based on the synergistic combination of Platelet Rich Plasma (PRP) with autogenous bone chips. PRP has been used in alveolar bone regeneration and in orthopedic surgery. Autogenous bone grafts has been used in specific bone reconstruction (e.g. plastic surgery). We hypothesized that addition of growth factors would enhance the in vivo effects of bone grafts in promoting skeletal tissue repair. We compared the in vivo osteogenic potential of iliac bone particulate compared with calvarian bone shavings (generated by using bone scraper) both associated to PRP. The case study is the skull regeneration in an 11-years-old girl with complex and severe established craniolacunia after bone destruction caused by Candida, in which PRP with particulate bone grafts reconstructed the anterior defect, and PRP with shavings bone grafts reconstructed the posterior defect. Big cranial defects were filled and minimal unfilled defects served as controls. After 4 weeks, only those defects filled showed significantly increased bone regeneration, compared to unfilled control defects, as judged using radiology and histology. CT images showed the remarkable potencies of PRP used in conjunction with bone autograft, to fill a large calvarial defect and to stimulate osteogenesis. Successful bone regeneration was achieved with an expansive bone formation, which went on six months after the procedure, and evident bridges of osteointegration, in both anterior and posterior defects. Histology examination by biopsy demonstrated the presence of vascularized cortical and spongy bone. These data suggest that assembling PRP and autogenous bone is a suitable cellular scaffold for regeneration of cranial bone tissue in a one surgical step, in a one therapeutic approach. The study showed an effective cranioplasty for stable large cranial defects both with particulate and with shavings. This evidence has a positive effect on the clinical practice because the bone scraper allows an easy and safe harvesting of grafts avoiding the creation of minor resistance areas and obtaining a large volume of bone substance.
Skull reconstruction; Bone regeneration; Calvarial/cranial defects; Platelet rich plasma; Bone graft; Bone scraper
Rizzo MI, Rajabtork Zadeh O, Spuntarelli G, Stefano Ceccarelli S, De Vito R, Marino SFM, et al. The Synergistic Osteogenic Potential of Platelet Rich Plasma (PRP) and Bone Chips Autograft Promotes Bone Regeneration In vivo: A Complex Large Cranial Defect Study in Child and Review of the Literature. Clin Surg. 2019; 4: 2608..