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Chapter 8: Bone Graft Basics and Biology

“one or more of these is missing”
Start every graft decision from this: name what is missing, then choose the graft.
“living cells”
Definition: Osteogenesis
“Only fresh autograft, marrow and vascularized bone”
Everything processed (allograft, DBM, xenograft, substitutes) has no living cells.
“signals (growth factors)”
Definition: Osteoinduction
“scaffold”
Definition: Osteoconduction
“directly to an implant”
Definition: Osseointegration
“Oxygen can diffuse only about 0.1 to 0.2 mm from a capillary.”
Evidence: This is why large non-vascularized grafts fail in the center.
“critical-size defect”
Definition
Start here: what is missing?
8.1 Introduction
Know these four definitions
8.2 What a graft must supply

Chapter 8B: Orthobiologics

“It has no cells and no strength.”
Caution: Needs a bed with good blood supply and cells.
“Bone fill 95% with BMP and 63% with iliac graft”
Evidence: Dickinson 2008, skeletally mature cleft patients, n = 21. Off-label.
“Swelling”
Caution: Dangerous near the airway. FDA warning 2008.
“Use in cleft and craniofacial surgery is off-label”
Caution
“53 united”
Evidence: Hernigou 2005: 60 atrophic tibial nonunions. Failures had fewer stem cells.
“supportive, not osteoinductive”
Caution: PRP: growth factors for cell migration and vessels only.
“optional additions to a graft, never the graft itself”
“Wait 6 to 8 weeks.”
Evidence: Induced membrane forms around the cement spacer.
“is the flap cover in stage 1”
Question: Likely question: what is our role in the Masquelet technique?
Off-label in cleft surgery
8B.2.2 Bone morphogenetic protein (BMP)
Our role: the flap
8B.5 Creating the vascular bed: the induced membrane (Masque

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