Bone transplantation and tissue engineering, part III: allografts, bone grafting and bone banking in the twentieth century.

During the 20th century, allograft implantation waned in popularity as a clinical activity. Reports appeared in the literature describing several small series of patients in whom bone was obtained from amputation specimens or recently deceased individuals. The concept of bone banking became a reality during and after World War II when the National Naval Tissue Bank was established in Bethesda and a number of small banks sprang up in hospitals throughout the world. Small fragments, either of cortical or medullary bone, from these banks were used heterotopically to augment spinal fusions, to implant into cyst cavities, or to serve as a scaffolding for repair of non- or delayed union of fractures of the long bones.

Bone transplantation and tissue engineering. Part II: bone graft and osteogenesis in the seventeenth, eighteenth and nineteenth centuries (Duhamel, Haller, Ollier and MacEwen).

In the 18th century, the fate of allografts and their role in bone formation became of interest to many orthopaedic surgeons. A controversy over the science of osteogenesis, the formation of bone, had emerged following the opposing views of Duhamel and von Haller. Duhamel noted that the periosteum had a deep osteogenic layer, which he termed the "cambium layer". However, von Haller claimed the opposite: the periosteum was not osteogenic. In the 19th century, Ollier performed comprehensive studies on the periosteum. Ollier's experiments were published in two volumes entitled "Traite Experimental et clinique de la regeneration des os" in 1867. His conclusion was that transplanted periosteum and bone survived and could become osteogenic under proper conditions. The controversy was furthered by MacEwen who believed, contrary to Duhamel and Ollier, that the periosteum had no osteogenetic power and was purely a limiting membrane giving direction to bone growth but taking no active part in it. This manuscript describes this period of controversies about the osteogenesis of the transplanted bone, marrow and periosteum that would eventually die or not and be replaced by surrounding tissue or be active for osteogenesis. Whether bone grafts are a form of passive scaffolding or active in osteogenesis was the main question about auto and allografts in the 18th and 19th centuries. In response to this challenge, many papers were written to defend each side of the argument.

Bone transplantation and tissue engineering, part IV. Mesenchymal stem cells: history in orthopedic surgery from Cohnheim and Goujon to the Nobel Prize of Yamanaka.

In 1867 the German pathologist Cohnheim hypothesized that non-hematopoietic, bone marrow-derived cells could migrate through the blood stream to distant sites of injury and participate in tissue regeneration. In 1868, the French physiologist Goujon studied the osteogenic potential of bone marrow on rabbits. Friedenstein demonstrated the existence of a nonhematopoietic stem cell within bone marrow more than a hundred years later. Since this discovery, the research on mesenchymal stem cell (MSC) has explored their therapeutic potential. The prevalent view during the second century was that mature cells were permanently locked into the differentiated state and could not return to a fully immature, pluripotent stem-cell state. Recently, Japanese scientist (first orthopaedist) Shinya Yamanaka proved that introduction of a small set of transcription factors into a differentiated cell was sufficient to revert the cell to a pluripotent state. Yamanaka shared the Nobel Prize in Physiology or Medicine and opened a new door for potential applications of MSCs. This manuscript describes the concept of MSCs from the period when it was relegated to the imagination to the beginning of the twenty-first century and their application in orthopaedic surgery.

Materials used in cranioplasty: a history and analysis.

Cranioplasty, one of the oldest surgical procedures used to repair cranial defects, has undergone many revolutions over time to find the ideal material to improve patient prognosis. Cranioplasty offers cosmetic and protective benefits for patients with cranial defects. The first primitive cranioplasty procedures date back to 7000 bc and used metal and gourds to repair cranial defects. Cranioplasty was first documented by Fallopius who described repair using gold plates; the first bone graft was documented by van Meekeren. The first significant improvement for this procedure began with experimentation involving bone grafts in the late 19th century as a more natural approach for repairing cranial defects. The next impetus for advancement came because of wartime injuries incurred during World Wars I and II and involved experimentation with synthetic materials to counter the common complications associated with bone grafts. Methyl methacrylate, hydroxyapatite, ceramics, and polyetheretherketone implants among other materials have since been researched and used. Research now has shifted toward molecular biology to improve the ability of the patient to regenerate bone using bone growth factors. This paper reviews the evolution of materials used over time in addition to the various advantages and pitfalls associated with each change. It is important for neurosurgeons to be mindful of how these techniques have evolved in order to gain a better understanding of this procedure and how it has been adapted.

An orthopaedic conquest: the first inter-human tissue transplantation.

UNLABELLED: Nineteenth century Scottish surgeon William Macewen performed, in 1879, the first inter-human living donor transplantation in medical history. It was a bone allograft performed on a 3-year-old boy affected by a huge humeral bone loss. This paper analyses the historical context around Macewen, briefly introducing his life and the discoveries made by Lister and by the pioneers of anaesthesia. It focuses on the details of the bone allograft procedure invented by Macewen. He was both a basic researcher and a skilled surgeon, a combination that is rare nowadays. The paper includes a description of the surgical procedure and is also enriched by the reproduction of the original image used by Macewen in his 1881 article to explain the clinical evolution. William Macewen was one of the greatest pioneers in musculoskeletal medicine whose brilliant intuition led to the origin and development of bone grafting, one of the most common orthopaedic procedures in the world today. LEVEL OF EVIDENCE: V.

Bone transplantation and tissue engineering, part I. Mythology, miracles and fantasy: from Chimera to the Miracle of the Black Leg of Saints Cosmas and Damian and the cock of John Hunter.

The replacement of diseased organs and tissues by the healthy ones of others has been a unique milestone in modern medicine. However, even though cloning, member transplantation and regenerative therapies with stem cells are available in the twentieth and twenty-first centuries, one should remember that all these techniques were in the imagination more than 2,000 years ago. For centuries, transplantation remained a theme of mythology, miracle or fantasy and was found only in literature and arts. This first paper explains the concept of tissue transplantation from the period when it was relegated to the imagination to the work of the Scottish surgeon and anatomist, John Hunter, who demonstrated the viability of bone allograft.

The classic: Case of bone transference. Use of a segment of fibula to supply a defect in the tibia. 1905.

This Classic Article is a reprint of the original work by T. W. Huntington, Case of bone transference. Use of a segment of fibula to supply a defect in the tibia. An accompanying biographical sketch of T. W. Huntington is available at DOI 10.1007/s11999-012-2495-0 . The classic article is 1905 and is reprinted courtesy of Wolters Kluwer Lippincott Williams & Wilkins from Huntington TW. Case of Bone Transference. Use of a Segment of Fibula to Supply a Defect in the Tibia. Ann Surg. 1905;41:249-251.

The development of guided regeneration: making the impossible possible and the unpredictable predictable.

Using their perspectives as early participants in guided regeneration development, the authors review the history of guided regeneration: from the precursive studies leading to the development of guided tissue regeneration for periodontium, through the development of guided bone regeneration for implants, to the long-term performance studies validating effectiveness. Landmark publications, original patents, and reviews are used to trace the therapy's development. By examining key studies and the scientists and clinicians who conducted them, the authors present clinical and biomaterials lessons learned and discuss developments that could shape the next guided regeneration developments.

On the transplantation, regeneration and induction of bone: the path to bone morphogenetic proteins and other skeletal growth factors.

The clinical and experimental transplantation of bone dates back to the seventeenth century and human allogeneic (homogeneic) bone has been successfully used as an alternative to autogenous bone since 1878, when Sir William Macewen reconstructed the right humerus of William Connell. This review describes how subsequent studies of bone transplantation led to the eventual discovery of a new family of secreted signalling molecules--the bone morphogenetic proteins (BMPs), and the realisation of the important role of polypeptide growth factors in mediating the growth, remodelling and regeneration of the skeleton. The development of suitable alternatives to both autogenous and allogeneic bone has been a goal of bone and biomaterials research for more than 30 years. The first requirement is a biocompatible, bioresorbable, osteoconductive framework supporting the ingrowth of host cells from the recipient bed. Many materials including collagen, calcium phosphate ceramics and synthetic polymers have been widely tested experimentally with varying success. The discovery of osteoinductive BMPs and their availability in recombinant human forms has given considerable impetus to the field. However, progress to date in engineering significant quantities of functional bone tissue in vivo has been disappointing; finding suitable carriers for BMPs has proven to be a greater challenge than expected. The dilemma for the clinician and the biotechnology industry, at present, is that, while recombinant human growth factors are readily available for clinical use, the lack of delivery systems that can adequately mimic both the physical properties and release kinetics of bone matrix remains a major handicap.

Development of homologous skin, bone and other soft tissues transplantation in Slovenia.

In Slovenia, transplantation of tissues such as skin and bone was successfully following global trends throughout its history. First documented homologous skin graft was already mentioned back in 1901. Alongside with new discoveries in immunology and advancements in burn surgery, skin transplantation development surged in the second half of 20th century. Slovenia's first and currently the only skin bank was established in 1973, in Ljubljana. Throughout its existence it always managed to supply skin grafts for patients that were in vast majority burn victims. The bone bank was established twenty years earlier, in 1952. Homologous bone grafts helped patients with trauma injuries and tumour resections. Besides skin and bone grafts, cartilage and other soft tissues have also been used for transplantation - tympanic membrane and cartilage transplants being used in ear surgery. International inclusion of Slovenian physicians allowed comparable results and introduction of new methods at home and around the world.

Vascularised bone transfer: History, blood supply and contemporary problems.

BACKGROUND: Since the description of the free fibula flap by Taylor in 1975, many flaps composed of bone have been described. This review documents the history of vascularised bone transfer and reflects on the current understanding of blood supply in an effort to define all clinically described osseous flaps. METHODS: A structured review of MEDLINE and Google Scholar was performed to identify all clinically described bone flaps in humans. Data regarding patterns of vascularity were collected where available from the anatomical literature. RESULTS: Vascularised bone transfer has evolved stepwise in concert with advances in reconstructive surgery techniques. This began with local flaps of the craniofacial skeleton in the late 19th century, followed by regional flaps such as the fibula flap for tibial reconstruction in the early 20th century. Prelaminated and pedicled myo-osseous flaps predominated until the advent of microsurgery and free tissue transfer in the 1960s and 1970s. Fifty-two different bone flaps were identified from 27 different bones. These flaps can be broadly classified into three types to reflect the pedicle: nutrient vessel (NV), penetrating periosteal vessel (PPV) and non-penetrating periosteal vessel (NPPV). NPPVs can be further classified according to the anatomical structure that serves as a conduit for the pedicle which may be direct-periosteal, musculoperiosteal or fascioperiosteal. DISCUSSION: The blood supply to bone is well described and is important to the reconstructive surgeon in the design of reliable vascularised bone suitable for transfer into defects requiring osseous replacement. Further study in this field could be directed at the implications of the pattern of bone flap vascularity on reconstructive outcomes, the changes in bone vascularity after osteotomy and the existence of "true" and "choke" anastomoses in cortical bone.

History of osteochondral allograft transplantation.

Osteochondral defects or injuries represent the most challenging entities to treat, especially when occur to young and active patients. For centuries, it has been recognized that such defects are almost impossible to treat. However, surgeons have never stopped the effort to develop reliable methods to restore articular cartilage and salvage the endangered joint function. Osteochondral allograft transplantation in human was first introduced by Eric Lexer in 1908. Since that era, several pioneers have been worked in the field of osteochondral allotransplantation, presenting and developing the basic research, the methodology and the surgical techniques. Herein we present in brief, the history and the early clinical results of osteochondral allograft transplantation in human.

Lower jaw reconstruction and dental rehabilitation after war injuries: The experience of Paul Tessier in Iran in the late 1980s.

Iraq-Iran war resulted in more than 400,000 people requiring prolonged medical care in Iran. An international team of prominent reconstructive surgeons led by Paul Tessier, the founder of craniofacial surgery, was invited to Iran during the war by official organizations entitled to support war victims. This team provided up-to-date oral and maxillofacial rehabilitation to patients with severe trauma defects in the lower third of the face. We collected the medical notes of 43 patients operated on by the Tessier team in Iran in the 1980s (files property of AFCF). The parameters we collected were: age of the patient, nature of the trauma (when available), previous procedures, number of implants placed (mandibular and maxillary), associated procedures (bone grafts, soft-tissue procedures, orthognathic surgery). A protocol based on soft-tissue rehabilitation using local flaps, parietal or iliac bone grafts and implant placement 6 months later was used in all patients. Paul Tessier's approach emphasizes the importance of keeping high standards of care in difficult situations and maintaining standard protocols.

Repairing holes in the head: a history of cranioplasty.

Cranioplasty is almost as ancient as trephination, yet its fascinating history has been neglected. There is strong evidence that Incan surgeons were performing cranioplasty using precious metals and gourds. Interestingly, early surgical authors, such as Hippocrates and Galen, do not discuss cranioplasty and it was not until the 16th century that cranioplasty in the form of a gold plate was mentioned by Fallopius. The first bone graft was recorded by Meekeren, who in 1668 noted that canine bone was used to repair a cranial defect in a Russian man. The next advance in cranioplasty was the experimental groundwork in bone grafting, performed in the late 19th century. The use of autografts for cranioplasty became popular in the early 20th century. The destructive nature of 20th century warfare provided an impetus to search for alternative metals and plastics to cover large cranial defects. The metallic bone substitutes have largely been replaced by modern plastics. Methyl methacrylate was introduced in 1940 and is currently the most common material used. Research in cranioplasty is now directed at improving the ability of the host to regenerate bone. As modern day trephiners, neurosurgeons should be cognizant of how the technique of repairing a hole in the head has evolved.

Electrical bone graft stimulation for spinal fusion: a review.

Although electrical stimulation to aid bone fusion is well established in the treatment of long-bone fractures, its use as an aid in spinal fusion is not as well documented. This article presents the history and scientific basis of electrical stimulation to aid bone fusion and extensively reviews the clinical literature. It is intended to provide an objective review of the indications and limitations of electrical stimulation to enhance spinal fusion and to serve as a reference source for further study.

The evolution of posterior cervical and occipitocervical fusion and instrumentation.

The past several decades have been the setting for a remarkable evolution of spinal instrumentation technology. The advancements that have been made have allowed previously complex disorders of the cervical spine, the atlantoaxial articulation, and the occipitocervical junction to be managed more effectively with direct methods of internal fixation and arthrodesis. This has resulted in improvements in patient outcomes and fusion success rates. The improved strength of instrumentation constructs allows minimal, if any, external bracing, obviating the need for a halo orthosis in many cases. In this paper the authors review key events that have occurred in neuroimaging, biomechanical testing, and the development of fusion and instrumentation constructs.

Bone grafting. Principles and applications in the lower extremity.

Bone grafting techniques have progressed in the twentieth century, leading to results that are more predictable. A complete understanding of the entire healing process has broadened indications while decreasing complications. Numerous possibilities are available to the foot and ankle surgeon for reconstruction or trauma scenarios. Combining the art (knowing when to use specific grafting techniques) with the science of graft healing will provide satisfactory results.

Localisation and William Macewen's early brain surgery Part I: the controversy.

Neurosurgery for the removal of brain tumours based on localising signs is usually dated from the 1884 operation by Bennett and Godlee. However, within weeks of that operation claims were made on behalf of William Macewen, the Glasgow surgeon, to have been the real pioneer of such surgery. According to Macewen's protagonists, he had conducted seven similar operations earlier than Bennett and Godlee and, in a notable 1888 address, Macewen described these seven pre-1884 cases and a number of others operated on after 1884. This paper, which is in two parts, contains an evaluation of the claims made for the priority of Macewen's pre-1884 operations. Part I deals mainly with Macewen's work in fields other than brain surgery that are relevant to it and sets out the facts of the controversy. It begins with a brief biography of Macewen, describes his pioneering work in antiseptic and aseptic surgery, his work on osteotomy and bone regeneration, and his use in brain surgery of the knowledge so gained. Part I concludes with an examination of the battle waged in the newspapers between Macewen's and Bennett's and Godlee's supporters, and of previously unpublished correspondence between Macewen himself, David Ferrier and Hughes Bennett. The primary records of the patients on whom Macewen operated, together with other materials relevant to the controversy, are examined in Part II.