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PubMed2003

Periosteal cells in bone tissue engineering.

In 1742, H.L. Duhamel published a report in which the osteogenic function of periosteum was described. In 1932 H.B. Fell was the first to successfully culture periosteum; Fell concluded that this tissue might have the capability to form mineralized tissue in vitro. In the 1990s the research group of A.L. Caplan pioneered work exploring the osteogenic potential of periosteal cells in the field of bone engineering. On the basis of these studies a number of research groups have developed hard tissue generation concepts that aim to repeat the clinical success of bone autografts by culturing cells from periosteum and seeding a sufficient quantity of those cells into scaffolds made of biomaterials of natural and synthetic origin. The highly porous matrices support the induction of bone regeneration by creating and maintaining a space that facilitates progenitor cell migration, proliferation, and differentiation as well as graft revascularization. In this way, a host tissue-scaffold cell interphase might be created that allows reproduction of the intrinsic properties of autogenous bone, including the ability to be incorporated into the surrounding host bone and to continue normal bone-remodeling processes. This review discusses the history and state of the art of bone tissue engineering from a periosteum and periosteal cell source point of view and attempts to indicate future research directions.

Animals↗
PubMed1998

Callotasis in nonvascularized periosteal bone grafts and the role of periosteum: a new contribution to the concept of distraction osteogenesis.

Bone lengthening by slow, progressive distraction has gained widespread acceptance. In this study we investigated the possibility of distraction osteogenesis in nonvascularized periosteal bone grafts, and assessed callus formation and callotasis by means of radiological and histological examination with the aim of determining the role of the periosteum. The process of distraction osteogenesis in nonvascularized bone grafts was studied histologically and radiologically in 22 growing rabbits. The metatarsal bone grafts taken from the rabbits were divided into two groups. Group 1 contained 15 bone grafts covered with periosteum and group 2 (the control group) contained 7 bone grafts without periosteum. These grafts were subjected to osteotomy and then placed in the lumbar pocket. After 10 days, distraction was started and continued at 0.5 mm per day for 10 days. Thus an elongation of 4 to 6 mm was achieved in both groups. Radiological examination was performed postoperatively and after 10, 15, 20, and 30 days of starting the distraction. Histological examination was performed after 15, 20, and 30 days. Radiologically, progressive calcification and, histologically, both intramembranous and endochondral ossification were detected in group 1. However, in the control group (group 2), bone lengthening failed. Our study demonstrated the possibility of distraction osteogenesis in periosteal bone grafts, and provides information regarding the importance of periosteum as well as its osteogenic capacity.

Animals↗
PubMed2002

Evaluation of osteogenic/chondrogenic cellular proliferation and differentiation in the xenogeneic periosteal graft.

To determine whether grafted young periosteum can induce new bone formation in elderly patients, this preliminary study evaluated cell proliferation and differentiation in xenogeneic periosteal grafts in old rats radiographically, histologically, and immunohistochemically. Periosteum harvested from the tibia of young Japanese white rabbits were grafted into old Sprague-Dawley rats with or without administration of 1.0 mg per kilogram per day immunosuppressant FK506. Autogenous old periosteal tissue grafts were also evaluated as a control. Grafted tissue was extirpated after 7, 14, 21, and 45 days. In the xenogeneic group, proliferative cell nuclear antigen-positive cells were observed 7 days after surgery, which differentiated into chondroblasts with bone morphogenetic protein-2 expression and finally formed cartilage by 14 days. Endochondral ossification was observed at 21 days, and bone replacement was completed by 45 days. No osteogenic cell activity was observed in the two other groups. Xenogeneic young periosteum thus maintained its osteogenic/chondrogenic potentiality in older rats.

Age Factors↗
PubMedDate not supplied

Experimental studies on an artificial trachea of collagen-coated poly(L-lactic acid) mesh or unwoven cloth combined with a periosteal graft.

Artificial tracheas were fabricated from poly(L-lactic acid) mesh or unwoven cloth coated with collagen in order to reconstruct the respiratory airway by self regeneration without retaining the prosthesis at the replacement site, thus preventing infection, air leakage, granulation tissue formation, and displacement of the prosthesis. Nine weeks after placing a periosteal autologous graft from the tibia around the cervical trachea of a rabbit, bone rings formed without infection. Two weeks after replacement of an 8 X 8 mm window-shaped section of the cervical trachea with autologous periosteum, the internal surface of the trachea was well epithelialized without local complications, but ossification was not seen. One week after cervical substitution with our 2 cm long artificial trachea combined with the periosteal graft, cartilage was produced around the mesh material but neither ossification nor epithelization was observed thereafter, probably due to local infection. On the other hand, cartilage, bone, and epithelium did not form around the unwoven cloth artificial trachea after the substitution, probably because of severe infection due to collapse of the tracheal lumen. However, the formation of bone rings around the trachea suggests preservation of the neotracheal lumen, which may have potential for the treatment of tracheomalacia and/or bronchomalacia.

Animals↗
PubMed2000

Periosteal glomus tumor of the femur: a case report.

Osseous abnormalities produced by glomus tumors located in soft tissues of the periungual region have been described. More rare is the location of a glomus tumor within bone, which usually is located in the phalanx of the fingers. However, to the authors' knowledge, there is no previous description of a glomus tumor located in a periosteal location of a long bone. A 50-year-old man with a glomus tumor in a periosteal location of the lower metaphysis of the femur without neoplastic erosion of the cortical surface is reported. Magnetic resonance imaging and intraoperative ultrasonography were needed to locate the lesion.

Femoral Neoplasms↗
PubMed2005

Delayed stimulatory effect of low-intensity shockwaves on human periosteal cells.

We investigated the effect of shockwaves on cells explanted from normal human periosteum to study the potential mechanisms of their responses and to determine suitable treatment settings. The cells were subjected to one shockwave treatment with systematic combinations of energy intensities (range, 0.05-0.5 mJ/mm) and number of shocks (range, 500-2000) whereas control cells received no treatment. The immediate effect on cell viability and the long-lasting effect on proliferation, viable cell number at Day 18, and mineralization at Day 35 were assessed. We observed an immediate dose-dependent destructive effect of shockwaves. Energy intensity and number of shocks contributed equally to viability. Total energy dose (intensity x number of shocks) was a better reference for determining the shockwave effect. We also found a long-term stimulatory effect on proliferation, viable cell number, and calcium deposition of human periosteal cells. At the same total energy dose, low-intensity shockwaves with more shocks (0.12 mJ/mm at 1250 shocks) were more favorable for enhancing cellular activities than high-intensity waves with fewer shocks (0.5 mJ/mm at 300 shocks). These findings document some of the biochemical changes of periosteal cells during shockwave treatments.

Cell Proliferation↗
PubMedDate not supplied

Circumferential periosteal sleeve resection: results in limb-length discrepancy secondary to poliomyelitis.

We report the results of circumferential periosteal sleeve resection of lower-limb bones for mild degrees of limb-length discrepancy (mean, 3.5 cm) secondary to postpolio residual paralysis in 23 patients. Results were expressed by calculating percentage of length discrepancy of the operated-on limb with respect to the normal limb and gain in length in centimeters of the operated-on limb over the normal limb. All patients had a uniform trend of gain in length with response in the femur lasting for approximately 1 year, whereas that in the tibia persisted >2 years. Circumferential periosteal sleeve resection is a safe and reliable method of longitudinal bone-growth stimulation, providing consistent results, especially for mild to moderate discrepancies.

Child↗
PubMed2000

Effect of soft-tissue trauma on the early periosteal response of bone to injury.

OBJECTIVE: To determine whether the periosteal response to skeletal trauma is impaired when muscle is also injured, thereby providing a possible explanation for why fractures with extensive soft-tissue damage may take longer to heal. METHODS: A bone defect was made in the tibia of male Fisher rats, and the proliferative response, osteoblast concentration, and callus formation that occurred within 7 days were measured in the presence and absence of simultaneously administered model soft-tissue injury (removal of 10% of the anterior tibialis muscle from a region within 2 to 3 mm of the bone defect). Measurements were made by using autoradiography, quantitative histology, and morphometry. RESULTS: Addition of the muscle injury increased proliferation in the cambium and in the fibrous periosteum on day 1, but had no effect thereafter; proliferation of fibroblasts in the loose connective tissue above the periosteum was not affected. Addition of the muscle injury resulted in increased osteoblast levels 2 to 5 days after injury but had no effect on the amount of callus produced. CONCLUSION: The inflammatory milieu created by the muscle injury unexpectedly resulted in an increased periosteal response to skeletal trauma, suggesting that inflammatory mediators generated in response to wounding of soft tissues are unlikely to account for delayed fracture healing. These findings may indicate that surgical trauma associated with internal fixation by using plates and screws may not be as deleterious to the fracture-healing response as previously thought.

Animals↗
PubMed1980

Vascularized rib-periosteal and osteocutaneous reconstruction of the maxilla and mandible: an assessment.

Three approaches to provide rib-periosteal or osteocutaneous composite tissue in maxillary or mandibular reconstruction are presented. All methods appear to be useful in replacing viable osteocytes and improving vascularity of maxillary or mandibular defects. Disadvantages include the bulk of the transplanted tissue, volume deficiency of bone, and the unreliability in viability of the associated cutaneous tissue, especially with the posterior and posterolateral approach. Significant patient morbidity and pulmonary complications in our series should indicate caution when considering these methods of reconstruction. At present, rib-periosteal transplantation is most often indicated to replace segmental defects of mandibular continuity when the recipient bed is avascular but the quantity of cutaneous cover is adequate. In those patients with deficient soft tissue and a small segmental mandibular loss, reconstruction with musculocutaneous flaps and nonvascularized bone grafts is indicated. With extensive deficiencies of both soft tissue cover and mandibular or maxillary continuity, an iliac osteocutaneous flap based on the deep circumflex iliac vessels may be the most effective. Lower patient morbidity statistics should be anticipated.

Evaluation Studies as Topic↗
PubMed1989

Scanning electron microscopy and gel electrophoresis of vascularized periosteal autografts.

This study was devised to investigate the morphologic and biochemical sequence of events occurring during early periosteal osteogenesis in vascularized periosteal flaps. A pleuroperiosteal flap based on the intercostal vessels was developed and rotated onto the chest wall in 12 adult dogs. Animals were sacrificed at intervals between 7 and 60 days, and the flaps were removed with the underlying muscular bed. Specimens were studied by tetracycline uptake, gel electrophoresis, light microscopy, and the scanning electron microscope. Osteoprogenitor cells were seen as early as 7 days after transfer. Collagen fiber deposition was vigorous and noted in all specimens with rapid mineralization by 9 to 15 days. There was no structural or vascular interaction between the flaps and the recipient muscular bed. Gel electrophoresis confirmed the presence of type I and III collagen, with an increase in type I collagen over time. The pattern of collagen deposition and the final bony architecture resembled that of woven bone.

Animals↗
PubMed2004

Postauricular periosteal-pericranial flap for mastoid obliteration and canal wall down tympanomastoidectomy.

OBJECTIVE: To describe an effective technique for mastoid cavity obliteration in canal wall down tympanomastoidectomy for chronic otitis media and review its efficacy in producing a dry, low-maintenance, small mastoid cavity. DESIGN: : Retrospective clinical study of a consecutive series of procedures from 1995 to 2000. SETTING: Tertiary referral center and institutional academic practice in otology and neurotology. PATIENTS: Sixty consecutive procedures for active chronic otitis media with a minimum follow-up of 12 months (mean, 31 mo; range, 12-80 mo). INTERVENTION: All patients had canal wall down mastoidectomy with simultaneous tympanoplasty including split-thickness skin grafting. An inferiorly pedicled, periosteal-pericranial flap was used in conjunction with autologous bone pate to obliterate the mastoid cavity. The additional length provided by the pericranial extension of the flap permitted it to reach superior to the lateral canal and into the sinodural angle, with improved coverage of bone pate and better reduction of cavity size. OUTCOME MEASURES: The primary outcome measure was control of suppuration and creation of a dry, low-maintenance mastoid cavity, which was assessed using a previously developed semiquantitative scale. This scale includes a temporal dimension to assess control of infection. Secondary outcome measures included postoperative complications (i.e., hematoma, infection, flap necrosis, and meatal stenosis) and incidence of recurrent or residual cholesteatoma. RESULTS: Forty-nine ears (82%) maintained a small, dry, healthy mastoid cavity. Five ears (8%) had intermittent otorrhea easily controlled by topical treatment. Six ears (10%) had suboptimal control of otorrhea, of which four had meatal stenosis. There were no residual or recurrent cholesteatomas. Outcomes remained stable over progressively longer follow-up, up to 80 months. CONCLUSION: Obliteration of a canal wall down mastoid cavity by a postauricular periosteal-pericranial flap with autologous bone pate is a reliable and effective technique that results in a dry, trouble-free mastoid cavity in 90% of patients with active chronic otitis media.

Adolescent↗
PubMed2006

Deep temporal fascial-periosteal flap for canal wall down mastoidectomy.

It is very important to make a safe, dry, trouble-free ear for the canal wall down mastoidectomy. Although fascia graft is the most common material used for the repair of the perforated tympanic membrane, it is usually too small to cover the whole mastoid cavity in canal wall down mastoidectomy. The presence of exposed bone delays the epithelialization and results in prolonged otorrhea. We present a new simple technique that uses a postauricular, inferiorly based pedicled flap. Although our deep temporalis fascial-periosteal flap is not bulky, it is large enough to obliterate a sclerotic mastoid cavity without the need for additional flaps. It shrinks much less than a muscular flap during the healing period. In addition to reducing the cavity volume, this flap promotes the epithelialization over the bone and the shortening of the healing time. Although only a small number of patients were included in this study, coverage of a canal wall down mastoid cavity by a deep temporalis fascial-periosteal flap is expected to be a reliable and effective technique that results in a dry, trouble-free mastoid cavity.

Chronic Disease↗
PubMed2003

Effect of unilateral partial facial paralysis on periosteal growth at the muscle-bone interface of facial muscles and facial bones.

In a previous study, the influence of the midfacial musculature upon growth and development of the maxilla and mandible was established macroscopically. Dry skull measurements revealed a reduced premaxillary, maxillary, mandibular, and anterior corpus length with a simultaneous increase in mandibular ramal height on the paralyzed side. It was demonstrated that these reduced premaxillary and maxillary lengths were among others the result of reduced nasofrontal growth, whereas the increased ramal height was accompanied by condylar growth alterations. This study investigated whether the growth alterations at the mandibular corpus region could be explained by altered periosteal growth at the muscle-bone interface of the zygomatico-auricular muscle and the mandibular corpus, caused by altered muscle activity acting upon the periosteal sleeve. Fifty-six 12-day-old New Zealand White rabbits were randomly assigned to either a control or an experimental group. In the experimental group, left-sided partial facial paralysis was induced surgically when the animals were 12 days old. To study the muscle-bone interface, seven follow-up time intervals were defined between 3.5 and 60 days following the surgery. At these time intervals, four randomly selected control animals and four randomly selected experimental animals were killed. The anterior mandibular corpus region with the muscle-bone interface of the left control hemimandible and the left and right experimental hemimandibles was processed for undecalcified tissue preparation. Quantitative analysis of the total bone area at the muscle-bone interface revealed no significant differences between the left control hemimandible and the left and right experimental hemimandibles. Also, qualitative study of the histologic sections showed no major changes in the appearance or development of the trabecular pattern between the groups. However, slight differences in the distribution pattern of osteoblasts and osteoclasts along the bony surface were found between the left control hemimandible and the left and right experimental hemimandibles, which seemed to explain the alterations in mandibular corpus shape between these groups. It was suggested that these changes in the distribution pattern of osteoblasts and osteoclasts were the result of changes in the loading distribution pattern acting upon the mandible, caused by an altered neuromuscular recruitment pattern of the remaining functionally intact, mandibularly attached muscles. The latter was probably the result of adaptive mandibular positioning in response to an altered occlusal relationship, which was induced by the abnormal maxillary growth as a result of the unilateral partial facial paralysis.

Animals↗
PubMed1984

Transient idiopathic periosteal reaction associated with dysproteinemia.

Periosteal reaction with new bone formation in a child is a radiographic finding with an extensive differential diagnosis. The present case is that of a child who presented with a clinical syndrome of fever, bone pain in the forearm and leg, bony tenderness in these areas, radiographic evidence of a periosteal reaction in both tibiae and ulnae, and an abnormality of serum proteins. It was a self-limited disease process requiring no specific treatment, with eventual return to normal of both the radiographic and serum protein abnormalities. Its relationship to Caffey's disease remains to be defined.

Child↗
PubMed2004

Periosteal grafts as barriers in periradicular surgery: report of two cases.

AIM: To describe the usefulness of periosteal grafts as barriers for bone regeneration in periradicular surgery when advanced periodontal breakdown occurs. SUMMARY: The treatment of advanced periodontal breakdown as a result of an associated endodontic lesion constitutes a multifaceted challenge to the clinician. If the source of the irritation cannot be removed by orthograde endodontic treatment, nonsurgical and surgical endodontic/periodontal intervention may be required. Two cases with suppurative chronic apical periodontitis with apicomarginal communication are described. Clinical and radiological evaluations were completed immediately prior to surgery, a week later and every 2 months after surgery for 10 months. Both patients were treated using split-thickness flaps and lateral displacement of the periosteum prior to suturing, in order to close the communication between the oral and the periapical surroundings. A remission of the clinical signs and symptoms, and successful healing in the short-term were achieved in these cases. KEY LEARNING POINTS: Periapical and periodontal lesions are closely related through pathways of communication. Disruption of the cortical plate and the presence of dentoalveolar sinus tracts can have a deleterious effect on the regeneration process after periradicular surgery. The adoption of supplementary periodontal surgical techniques may help to solve some of the difficulties in the healing process in periradicular surgery. Periosteal grafts have been shown to have the potential to stimulate bone formation when used as a graft material.

Adult↗
PubMedDate not supplied

Effect of cerclage wires on periosteal bone in growing dogs.

Three diameters of wire were placed circumferentially around the femora of six 22 week old puppies. The wires were placed over the periosteum on one limb and under the periosteum on the other limb. The effect of the wires on actively growing bone was evaluated 3 and 8 weeks after placement. Diffuse growth of periosteal new bone occurred in immature dog femora in which cerclage were placed under the periosteum. This reaction corresponded with dramatically increased medullary and periosteal microvascularity coupled with histologic active trabecular bone formation. In femora in which wires were placed over the periosteum, even though the placement of the wires should supposedly have been the most detrimental, there were active vessels within the cortex directly under all wires. In both preparations, cerclage wires were becoming encased in the growing cortical bone 8 weeks after placement. Cerclage wires did not devitalize immature bone nor did it restrict adjacent appositional bone growth.

Angiography↗
PubMed1998

Sphingosine kinase mediates cyclic AMP suppression of apoptosis in rat periosteal cells.

Prostaglandin E stimulates bone formation in humans and animals, and increases intracellular cAMP in osteoblastic cells. We found that cAMP inhibits apoptosis in osteoblastic cells, and examined the mechanism of this effect. We report that the cAMP elevating agent, forskolin, increases cell number in the rat periosteal cell line (RP-11), by suppressing apoptosis in a cell type-specific manner. In RP-11, forskolin transiently up-regulates extracellular signal-regulated kinase activity, a known suppressor of apoptosis. PD98059, a selective inhibitor of the extracellular signal-regulated kinase pathway, only partially reverses the antiapoptotic effect of forskolin, which suggests an additional mechanism for cAMP action. We found that forskolin stimulates cytosolic sphingosine kinase (SPK) activity in these cells; in two other osteoblastic cell lines, however, forskolin does not suppress apoptosis. In contrast to the partial opposing effect of PD98059 to forskolin action, N, N-dimethylsphingosine, a specific inhibitor of SPK, completely reverses the antiapoptotic effect of forskolin, and has no effect on apoptosis in the absence of forskolin. These findings show for the first time that cAMP activates SPK in a cell-type-specific manner, and suggest that cAMP suppression of apoptosis in RP-11 periosteal cells is mediated by its stimulation of SPK.

Animals↗