Bioreactor-Assisted Mandibular Reconstruction

After 9 weeks, the reconstruction surgery was performed as previously described [3 (link)]. The bioreactor on the fifth rib was utilized for the reconstruction, assuming bone growth could be observed and the vascular supply could be located. Briefly, two incisions were created over ribs 4 and 8, the bioreactors on ribs 3, 5, 7, and 9 were located by blunt dissection. The bioreactor on rib 5 was isolated with its adjacent intercostal artery and vein. All other bioreactors were harvested without vasculature and fixed in 10% neutral buffered formalin prior to analysis of bone formation characteristics.
An incision was created at the inferior border of the mandible. The lateral plate, bicortical screws, and space maintainer were removed. In the event of an infection around the space maintainer, the defect area was debrided and irrigated with copious amounts of normal saline. If a mucosal dehiscence was present, the mucosal opening was sutured closed. The vascular anastomoses were performed to branches of the facial artery and vein using a surgical microscope (Leica Microsystems). As all sheep had developed a robust callus medially that provided sufficient mechanical support for the mandible, smaller monocortical self-tapping screws and lateral plate (as in the partial segmental defect [3 (link), 10 (link)]) were utilized to hold the transferred bioreactor tissue in place.