Is there a potential need for proangiogenic therapy in posttraumatic musculoskeletal trauma regeneration to improve bony healing?

3^rd International Conference on Tissue Science & Regenerative Medicine

September 24-26, 2014 Valencia Convention Centre, Spain

Soenke Percy Frey

Accepted Abstracts: J Tissue Sci Eng

Abstract :

H igh-energy injuries like open fractures of the lower extremity are devastating injuries associated with soft-tissue damage, bone defects and impaired local perfusion. Initial treatment of this fracture type includes radical soft-tissue and bone debridement, acute shortening to close bone defects and stabilisation with an external fixator. But the trauma itself and the following debridement lead to impaired biological properties which are essential for regeneration. Complications like non unions, infections, osteomyelitis or secondary amputations can arise. From an socioeconomic point of view patients often drop out their former social environment and return late to work. Fracture healing and muscle regneration are deteriorated. This is aggravated by the fact that the complex process of inflammation, angiogenesis, chondrogenesis, enchondral ossification and bone remodelling is disturbed by the injury. Elevated compartment pressure impairs bone and soft-tissue perfusion, which improves when the limb is shortened about 10%. One treatment option for restoring the original length is a distraction procedure, normally using a second osteotomy near the metaphyseal region. Alternatively, distraction osteogenesis at the fracture site can gain bone regeneration in a shorter period of time without the necessity for further operations. Microvascularisation and microcirculation are crucial for fracture repair and bone regeneration. Soft-tissue trauma and elevated compartment pressure are two of the main reasons for regional hypoxia. Also, initial fracture haematoma, eliminated by surgery, consists of a variety of phyisiological growth factors important for angio- and vasculogenesis and fracture repair, which are then missing at the fracture site. Previously, we demonstrated that acute soft-tissue trauma significantly compromises callus formation in a rabbit tibia after primary acute limb shortening and secondary distraction. In animals with soft-tissue trauma and elevated compartment pressure, normalised mechanical values of the newly reconstructed tibia and average normalised callus diameters were smaller than in animals without soft-tissue trauma.