bone graft

bone graft - BoneGraftingand Reconstruction Introduction

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    Bone Grafting and  Reconstruction
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Introduction Historical background: Surgeons have gained their experience in  reconstruction from the numerous wars  Civilian injuries produces the largest number  and the most extensive tissue loss almost  indistinguishable from ware injuries 
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Introduction It started in WW I and concentrated around reconstruction of the mandible but without antibiotic support In WW II distant bone blocks were transplanted from the ilium, rib and tibia with routine use of antibiotic No cancellous cellular marrow
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Introduction Mowlem in 1944, introduced the concept of “Iliac cancellous bone chips” beginning the evolution of predictable bony reconstruction of the jaw bone Boyne brought about the “use of particulate bone and cancellous marrow” with metallic trays splinted to large acellular cortical bone
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Biology of bone grafting Three biological mechanism are involved: Osteogenesis: Is the production of new bone by proliferation, osteoid production and mineralization Osteoconduction: Is the production of new bone and migration of local osteocompetent cells along a conduit e.g. fibrin, blood vessel or even certain alloplast material like hydroxyapatite Originate from the endostium or residual periostium of the host bone Osteoinduction: Is the formation of bone by stem cells transforming into osteocompetent cells by BMP It induct the recipient tissue cells to form periostium and endostium
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The Rib
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Surgical anatomy      The Rib The first, eleventh and  twelfth ribs are atypical A typical rib has a head, a  neck and a shaft.  The shaft slopes down and  laterally to an angle and  then curve forward  The upper border is blunt  and lateral to the angle the  lower border form a sharp  ridge sheltering a costal  groove This feature identify right  from left ribs 
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Surgical anatomy      The Rib Typical rib: The head: Bevelled by two articular  facets that slope away from  a dividing ridge. The lower one is vertical  and articulate with the upper  border of its own vertebra The upper facets faces up  and articulate with the lower  border of the vertebra above Each form a synovial joint  separated by a ligament  attached to the ridge 
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Surgical anatomy      The Rib The neck: Is flattened with its upper  border curving into a thin,  prominent ridge, the crest The tubercle: Shows two small facets lying  medial and lateral The medial one is covered with  hyaline cartilage and form  synovial joint with the  transverse process of its  vertebra The lateral facet is smooth  surfaced and receive the  costotransverse ligament
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Surgical anatomy      The Rib Costal cartilages: They form a primary 
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bone graft - BoneGraftingand Reconstruction Introduction

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