Current Methods of Treatment
Current treatment options focus on an aesthetically pleasing and immediate solution; however, inducing bone growth provides a long-lasting, integrative solution. Several biological solutions exist for craniofacial defects with area less than 25cm2. Patients may receive an autograft, which is considered the gold standard of biologic bone replacement, where a piece of bone harvested from various sources in the patient’s body, usually from the fifth to seventh rib or from the ilium of the hip, is restructured to fill the calvarial defect void., While autologously harvested bone decreases the risk of bodily rejection and has high rates of bone fusion, the procedure increases the risk of infection from the graft site, produces multiple incisions which may prolong recovery, and lacks the specific mechanical and geometric properties required to heal the calvarial defect. Similarly, patients may receive grafts from other humans or animals, known respectively as allografts and xenografts. Conversely to the autograft, these grafts have a much higher rate of rejection and more malleable mechanical properties, but do not achieve as high rates of bone fusion. Successful fusion of an allograft or xenograft helps to heal a calvarial defect, but patients may have a lifelong prescription of immunosuppressants to curb the threat of rejection which may lead to greater risks of contracting other illnesses. Synthetic substitutes incorporate a mesh mold covered with polymethyl methacrylate (PMMA) as a personalized mold for the missing skull. Synthetic solutions may have manufactured ideal strength and cosmetic appearance, but lack the integration of bone with the mold and bone growth and have the potential to elicit an immune response for rejection. Larger injuries may require treatment that can structurally handle the load, namely metal meshes which have many of the same positives and negatives of synthetic treatments,.
Current treatment options focus on an aesthetically pleasing and immediate solution; however, inducing bone growth provides a long-lasting, integrative solution. Several biological solutions exist for craniofacial defects with area less than 25cm2. Patients may receive an autograft, which is considered the gold standard of biologic bone replacement, where a piece of bone harvested from various sources in the patient’s body, usually from the fifth to seventh rib or from the ilium of the hip, is restructured to fill the calvarial defect void., While autologously harvested bone decreases the risk of bodily rejection and has high rates of bone fusion, the procedure increases the risk of infection from the graft site, produces multiple incisions which may prolong recovery, and lacks the specific mechanical and geometric properties required to heal the calvarial defect. Similarly, patients may receive grafts from other humans or animals, known respectively as allografts and xenografts. Conversely to the autograft, these grafts have a much higher rate of rejection and more malleable mechanical properties, but do not achieve as high rates of bone fusion. Successful fusion of an allograft or xenograft helps to heal a calvarial defect, but patients may have a lifelong prescription of immunosuppressants to curb the threat of rejection which may lead to greater risks of contracting other illnesses. Synthetic substitutes incorporate a mesh mold covered with polymethyl methacrylate (PMMA) as a personalized mold for the missing skull. Synthetic solutions may have manufactured ideal strength and cosmetic appearance, but lack the integration of bone with the mold and bone growth and have the potential to elicit an immune response for rejection. Larger injuries may require treatment that can structurally handle the load, namely metal meshes which have many of the same positives and negatives of synthetic treatments,.
Figure 1 - An autograft (left) and a synthetic mesh (center) are two typical treatment options for typical calvarial defects (right).
Benefits of Personalized Medicine
While the current bone healing market has many treatment options available, all have benefits and faults, namely the risk of an immune response for rejection and a lack of personalized fit for optimal mechanical properties for the calvarial defect.
While the aforementioned solutions all provide adequate treatment for patients with calvarial defects, our stakeholders voiced a concern that personalized medicine provides optimal treatment for patients. Dr. David Eckmann of the Department of Bioengineering and Anesthesiology of the University of Pennsylvania advocated for the benefits of personalized medicine stating that patients respond better to personalized treatment. Dr. Ari Brooks of the University of Pennsylvania Department of Clinical Surgery echoed Dr. Eckmann’s sentiments about personalized medicine, and stated that using cheaper materials such as polycaprolactone (PCL) to develop the scaffold will make the treatment less expensive without taking away from the benefits. Personalized medicine and low cost treatment extend well beyond the scope of this course, and ideally, our project will provide better treatment for a lower cost to people around the globe with calvarial defects.
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