Department of Traumatology and
Orthopedics,
Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. The massive bone defects after trauma, in congenital anomaly, tumors, infections
or nonunions is a real dilemma for reconstructive surgery of the locomotor system.
Contemporary methods that are usually used for reconstruction of the bone structure are: bone
transplant, cryopreserved allografts, autograft or prosthesis, having high levels of morbidity and
complication rates. Their common features are bad blood circulation and unviability, resulting in
mechanical instability and poor bone consolidation (periprosthetic fractures, stress fractures,
pseudoarthrosis, sepsis).
Aim of the study. To determine what are the different methods used in reconstruction of massive
bone defects.
Materials and methods. Scientific papers and research results regarding bone defects
reconstruction methods were reviewed.
Review. A vascularized bone graft, reclosed microsurgicaly in the circuit, has a good potential
for regeneration, plasticity, and a post-graft mechanical stiffness. The vascular bone autograft,
with all biological and mechanical characteristics is considered the "gold standard" in the
treatment of small bone defects. However, it becomes insufficient in size, shape and cellular
repair capacities in the case of massive bone defects due to the increased circulatory needs of the
injured segment. Maintaining the osteoplastic properties of the vascularized autograft and
combining them with the orthotopic characteristics of an allogene bone or bone segment would
be a successful alternative for the reconstructive surgery of the locomotor. The dilemma imposed
by vascularized composite allotransplantation (VCA), is immunosuppression (IS) and
immunomodulation for life, which is not justified in case of vital organs (heart, liver, kidneys)
transplants, because of adverse effects risk (systemic complications, sepsis, neoplasms). Without
an IS, the immune cascade will cause vascular endothelial cell lysis, compromise
microcirculation with necrosis of the graft. The last studies, describe the surgical
neoangiogenesis typical of the host in VCA with a short-term IS - 14 days, as an effective one,
with results that allow consolidation and mechanical stability. Studies are performed
preclinically on rats, rabbits and pigs. Other studies present decelularization methods of the
vassel while preserving vascular stiffness.
Conclusions. A perfect alternative in treatment of the massive bone defects is using a vascular
allograft, without associated immunosuppression
