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Table 5 Summary of studies using resorbable membranes for long bone defect reconstruction in large animal models

From: The role of barrier membranes for guided bone regeneration and restoration of large bone defects: current experimental and clinical evidence

Author/Year [ref] Animal model Type of membrane Study design Assessment of bone regeneration Outcome
Dogs humerus Hyaluronan (Hyalonect) Periosteal reconstruction of bone defects filled with a variety of conventional bone filling compounds. Histological at six weeks Hyalonect was shown to allow the regeneration of bone within the humeral defects while preventing fibrotic tissue in-growth, and allowing regeneration of tissue which, by six weeks, had begun to resemble natural periosteal tissue.
2006 [128]
Dogs humerus betatricalcium phosphate and poly L-lactide-co-glycolide-coepsilon- caprolactone (TCP/PLGC) Partial bone defects
(length: a quarter of the full length of humerus, width: a quarter of middle diameter of the lateral aspect of humerus)
Control group: the contralateral humerus
Computed tomography (CT) at four and eight weeks and histological The result suggested that TCP/PLGC membrane is a good guided bone regeneration material to restore the original morphology of humerus in partial defect.
2003 [129]
Pig femur acellular dermal matrix
(GraftJacket Acellular Periosteum Replacement Scaffold)
Segmental bone defect Histological at six weeks The scaffold protects the bone defect site as revealed by new bone formation within the margins of the defect and adjacent to the scaffold has been shown.
Minimal to no soft tissue invasion into the defect site. Dermal membrane material may be used as a scaffold for periosteum regeneration by allowing for cellular repopulation, revascularization, and bone defect restoration.
2002 [130]
polylactide membranes
(L/DL-lactide) (80%-20%)
7-cm diaphyseal defect
Resorbable polylactide membranes +ABG or a vascularized periosteal flap.
four groups (fixation with a nail)
Clinical + post-mortem observation, radiological post-op and then weekly until week 16. Polymeric membranes of adequate composition and pore size combined with ABG or vascularized periosteum allow for rapid and stable defect regeneration.
2002 [131]
Sheep tibia bioabsorbable
polylactide membranes, with or without perforations,
Single or double-tube designs
six groups: Polylactide membranes
Single or double-tube designs +/_ cancellous bone grafting
Radiological (X-rays and CT) and histological at 16 weeks. In groups without bone grafting non-union developed and persisted until 16 weeks. Defect healing was only observed when ABG was used along with the single or double microporous-perforated membranes. (new bone formation by 'creeping substitution' of the graft)
1999 [132]
Sheep tibia poly(LDL-lactide) 4 cm diaphyseal segmental defects
1) a single microporous membrane
2) a microporous internal membrane, and a membrane on the outer surface of the cortex (external membrane)
3) an external membrane laser-perforated (800 to 900 micrometers openings)
4) ABG and a single perforated membrane
5) one perforated internal membrane into the medullary cavity and another membrane on the outer surface of the cortex
6) as Group 5 + ABG between the two membranes
Radiological and histological No bone healing in Groups 1, 2, 3, and 5. Only in Groups 4 and 6 the defects healed. In Group 4, new bone was dispersed across the 'medullary canal' formed by the membrane. In Group 6, the new bone had grown into the space between the outer and inner membranes, forming the 'neocortex'.
The resorbable polymeric implant consisting of two concentric perforated membranes (the tube-in-tube implant) used in combination with cancellous bone graft to treat segmental diaphyseal defects allows for the reconstitution of the 'neocortex' with well-defined thickness.