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PubMedDate not supplied

[Deep freeze bank bone material for maxillofacial reconstructions].

The use of deep freeze bank bone grafts in maxillofacial surgery is described. The prerequisites for establishing a bone bank and the selection of bone graft material and donors are discussed. The use of deep freeze graft material is possible in virtually any area of maxillofacial surgery. Thus, patients with minor defects can be spared the stress of autogenous bone removal. The potential risk of disease transmission is emphasized.

Bone Transplantation↗
PubMed1991

Organisation, operational aspects and clinical experience of National University of Singapore Bone Bank.

The National University of Singapore (NUS) Bone Bank was started in October 1988 and is the first such bank in Singapore. Two Revco Freezers were installed to store bones at -80 degrees C. The NUS Bone Bank Protocol follows the multi-centre protocol in USA with Massachusetts General Hospital as the Central Registry. It strictly follows the guidelines for banking of musculo-skeletal tissues set up by the American Association of Tissue Banks. Strict donor selection is practised including screening for Aids, hepatitis, syphilis and infection. It does not provide for storage of articular cartilage. Currently, procurement is obtained from living donors. Mainly femoral heads have been obtained (63 donors to date). One whole tibia, one whole fibula, one lower end of femur have also been procured. Bone allograft transplantation has been safely performed in 14 recipients--mainly spinal fusions (seven cases), Sub-talar joint fusion in children (three cases) and packing Giant Cell tumors (two cases). Other cases include revision hip surgery (one case) and augmenting of hypoplastic mandible (one case). The biggest problem faced by the NUS Bone Bank is lack of donors. There is definitely a need for bone allografts in Singapore where such transplantation is legal. Presently, there is also a demand for whole bones to bridge large bone defects resulting from tumour resection and for reconstructing post-traumatic defects. This can only be met if we can procure more whole bones especially from cadaveric donors.

Bone Transplantation↗
PubMedDate not supplied

[Cost analysis of a bone bank].

The costs of a bone-bank working in accordance with the guidelines of the german federal chamber of physicians are described. Establishing a bone-bank storing deep-frozen bone is not very expensive. The main costs are due to laboratory costs for excluding HIV, hepatitis, syphilis and bacterial contamination of bone grafts. In our experience with 206 bone grafts about 20% of them are to be discharged because of positive laboratory tests. The costs of each bone graft are DM 327. A second HIV-Test of the donor 3 months after explantation of a bone graft will cause rising of costs up to 47%. About 20-30% of bone graft donors will probably not carry out this test. In this case discharging of the bone graft is necessary.

Bacteria↗
PubMed1996

[Bone bank management using a thermal disinfection system (Lobator SD-1). A critical analysis].

In the study presented on 380 allogenic bone donations from living and organ donors, we analyzed the safety of allograft handling bone-band documentation, logistics and costs. For transplant treatment we routinely used a thermal disinfection system (Lobator SD-1). From 380 allograft donors, 400 bone transplants were gained. The rejection rate was 12.2%. After thermal disinfection for 1 h at 80 degrees C, the grafts were cryopreserved at -80 degrees C and released from the bone bank for potential transplantation after 14-16 days. Five of 730 microbiological specimens showed bacterial contamination after thermal graft decontamination. The bacterial species found on the allografts normally have an inactivation temperature under 80 degrees C. Therefore, only secondary contamination can explain the positive bacteriological test results. With reform of the health care system the economical aspects of bone banking have triggered more interest. The cost for one bone transplant released from the bone bank was 424.75 DM: the overall cost for the bone bank in one year was 75,076 DM. Laboratory (58.2%) and material costs (22.5%) were the major factors. Personnel costs and apparatus costs were relatively low (< 20%). With introduction of the thermal disinfection system (Lobator SD-1) into the bone bank, the safety of allogenic bone transplants was greatly improved. Clinical and serological donor screening must be performed according to international bone bank directives. Considering the low rejection rate and the short turnover rate, the economical costs could be reduced. Using an appropriate disinfection system (thermal disinfection at 80 degrees C), laboratory tests covering venereal diseases, malaria and cytomegalia are no longer required. Also, secondary HIV testing of living donors can be omitted without reducing the safety of the transplant.

Bone Banks↗
PubMed1994

[Bone banks: medicolegal aspects].

Heterologous bone grafting has increased considerably due to improved preservation and the development of bone banks. We analyzed the forensic aspects of organ procurement, transformation, processing and preservation specifically related to bone grafts. Topics considered included the organization of the responsible authorities and their activities in the context of ethical medical considerations. The surgeon is often faced with a complex heterogeneous situation without clear legal requirements.

Bone Transplantation↗
PubMed1995

Lipid extracted bank bone. Bone conductive and mechanical properties.

Lipid extraction by chloroform methanol previously has been found to increase the incorporation of frozen bone allografts. This effect may be because of a decreased immunologic response. In the present study, the ingrowth capacity into a grafted bone defect was investigated by using the bone harvest chamber model in rabbits. In a series of experiments, defatted and frozen allografts were compared at 1, 2, and 3 weeks; defatted allografts and defatted autografts were compared at 3 weeks; and frozen or defatted allografts and nongrafted defects were compared at 3 weeks. Evaluation was performed through histology, histomorphometry, and 99mTc-MDP scintimetry. The incorporation was better with defatted grafts: by histology at 1 week, mesenchymal tissue filled the intertrabecular space in defatted specimens and new bone formation started to occur. In contrast, frozen specimens showed a central soft tissue necrosis surrounded by inflammatory cells. Histomorphometry showed more new bone and more graft resorption in defatted allografts. At 2 and 3 weeks, there was no significant difference in new bone area, but at 3 weeks the scintimetric activity was higher in defatted allografts, probably caused by an increased remodeling rate. Since defatting did not cause increased scintimetric activity in previous autograft studies, these findings could indicate that there is a detrimental immunologic influence on frozen allografts. There were no differences between defatted autografts and allografts. In a second experiment, the biomechanical properties of defatted bone were investigated with a compression test on defatted and frozen bone cylinders taken from the calf femoral neck. No difference in biomechanical properties was found. It was concluded that lipid extraction produced a graft that was better incorporated than a nondefatted graft, with no loss of mechanical function.

Animals↗
PubMed1995

Increased bone ingrowth distance into lipid-extracted bank bone at 6 weeks. A titanium chamber study in allogeneic and syngeneic rats.

In previous rabbit chamber experiments, lipid extraction has been shown to increase bank bone incorporation, as measured by scintimetric activity at 3 weeks. In the present study, the new bone ingrowth distance was measured by histomorphometry at 6 weeks using a titanium chamber model in rats. By insertion into bilateral bone conduction chambers, frozen grafts were compared with grafts that had been processed by lipid extraction. To evaluate the effects of lipid extraction further, the group of 26 rats was divided into three subgroups according to MHC haplotype, namely a heterogeneous group (outbred Sprague-Dawley rats), a mismatched group, and a syngeneic group. In the total material, defatted grafts showed a 58% greater new bone ingrowth distance and a 31% higher scintimetric activity over controls. The effect of defatting was not shown to be due to immunologic factors. In general, rats with a lower capacity to incorporate bone grafts showed a larger positive effect of defatting.

Analysis of Variance↗
PubMed1988

Bone banks and allografts in community practice.

The increasing volume of orthopaedic reconstructive procedures requiring replacement of bone stock justifies the initiation of programs of bone banking in community hospitals. Provided that strict criteria are followed to assure rigorous screening of donor bone and the reliable preservation of bone graft material, community banking is safe and cost-effective. Banked allograft bone can be used successfully in a wide variety of orthopaedic procedures performed in community hospitals. In general, the best uses are filling bone cavities, buttressing, and augmenting the quantity of autograft bone. In revision reconstructive surgery of the hip, bank bone is used to replace bone stock in protrusio, acetabular dysplasia, and proximal femoral deficiency. The best and most common indication for the use of bank bone in tumor surgery is after curettage or excision of benign lesions. Allografts may be used to reconstruct bony defects after excision of malignant tumors and in the surgical treatment of metastatic disease. These instances require larger bone bank facilities than those commonly available in a community hospital setting. Medicolegal considerations related to bone banking and the use of allografts in community practice include the regulatory requirements outlined in the UAGA, questions concerning negligence liability, and theories of strict product liability. Overall, good medical practice and obtaining informed consents will minimize legal risks related to bone banking and transplantation in a community setting.

Bone Transplantation↗
PubMed1987

Methods of banking bone and cartilage for allograft transplantation.

Storage of bone for use as allograft has become an important endeavor because banked bone is becoming increasingly useful and popular as a substitute for, or as a supplement to, autograft bone. Methods have been developed for safe and reliable bone banking, including standard criteria for acceptable donors, proven techniques of retrieval of tissue, and appropriate storage facilities and conditions. In contrast, cartilage banking is still an investigative procedure, but current research may provide more effective approaches to maintaining viable cells during freezer storage of osteochondral allografts.

Animals↗
PubMed1990

[The bone bank--a standardized procedure? Results of a federal survey of German surgical clinics].

An inquiry at German surgical departments about their bone bank techniques showed that 45% of clinical hospitals use allogeneic bone implants among other implants. In 1989, the year of the official survey, allogeneic bone was transplanted about 6000 times in these clinical hospitals. Despite of this high transplantation frequency important differences turn out regarding selection and testing of recipients, transplantation storage and treatment. A lot of clinical hospitals do not perform important donor examinations inspite of proven transmission risks of bacterial and viral diseases by deep frozen bone. A trend analysis shows that despite of the risk of an HIV-transmission and the resulting difficulties in the logistic of the bone bank, the transplantation frequency allogeneic bone stays constant. The official surveys prove the large range of bone bank techniques and should give rise to make efforts to take note of the recommendations for bone banking techniques.

Bone Transplantation↗
PubMed1991

Organizational and investigational aspects of bone banking in Belgium.

Our experience with the bone banking methodology that we have used over the last years is reported. The technical and investigational aspects of the procurement, storage and treatment of the donor bone and related tissues are presented. For different purposes, we have prepared sterile and nonsterile procured implants. Appropriate donor selection and sterility controls remain the two major concerns of bone banking activities.

Belgium↗
PubMed1991

[The organization and utilization of a bone bank with femur heads].

In 1984 a "bone bank" containing femoral heads taken from live donors was created at the 2nd Orthopaedic Department of the University of Florence. The authors emphasize that these bones are very easy and inexpensive to obtain and store. They describe the organization of the "bone bank" and present the results of its first four years of activity.

Femur Head↗
PubMed1991

[Organization of a bone bank].

The transmission of infectious diseases by allografts from bone banks has led to considerable restrictions on bone transplantations. HIV and hepatitis are considered to be the most dangerous diseases transmitted in this way. To prevent the transmission of any infections, extensive precautions have to be applied when allografts are taken and during their storage. Donors have been checked for infectious diseases at the time of collection and 3 months later. In addition, the donated grafts must be cultured for aerobic and anaerobic bacteria. This elaborate series of tests can only be mastered if the bone bank is tightly organised. The number of available grafts also be increased by sterilisation and the use of demineralised bone matrix.

Acquired Immunodeficiency Syndrome↗