When patients need a bone graft for a foot or ankle surgery, bone often is taken from another part of their body. Now surgeons are using new methods to get bone material and even stem cells right “off the shelf,” according to Glenn M. Weinraub, DPM, FACFAS, a California foot and ankle surgeon who is leading a discussion among surgeons on the next decade of bone healing at the American College of Foot and Ankle Surgeons’ (ACFAS) Annual Scientific Conference in Fort Lauderdale.
“Harvesting a patient’s own bone has always been considered the gold standard, but nowadays I think that concept should be thought of as the historical standard,” said Dr. Weinraub, president of ACFAS. “The quality of the material that is available in a prepackaged format has been shown to be just as effective for bone healing and may yield fewer complications for the patient.”
Bone grafts are generally used for large open fractures with segmental bone loss, broken bones that have not healed, bone tumors and reconstructive procedures, among other conditions. According to Weinraub, grafts are particularly helpful for patients who might not heal under normal conditions, such as smokers, diabetics, people who are obese or patients with nutritional deficits. “These are patients who may need a higher level of biologic activity to enhance bone healing potential,” Dr. Weinraub said.
Traditionally, surgeons would make an incision in the hip area, for example, and take out a portion of the bone to use in the foot or ankle. One advantage is that there is less risk of rejection because the bone comes from the patient’s own body. However, complications such as blood loss and infection can occur. “In addition, up to 25 percent of those people may have pain at the bone graft harvest site five years later,” Dr. Weinraub said.
Advances in science are also providing some other exciting bone healing alternatives.
Surgeons are now able to use stem cells, which are self-renewing cells found throughout the body, to assist the bone in healing. “These cells have the potential to become almost any other cell in the body and can actually form bone,” Dr. Weinraub explained.
Like bone graft material, stem cells can come from the patient or a lab, which harvests the cells from the bones of donors and makes billions of copies.
“The advantage of using lab-harvested stem cells in foot and ankle surgery is it allows us to skip the step of cell recruitment from the patient having the procedure. We’re putting the cells right there on the defect, and because they are in a bone environment, these cells may direct and partake in the process of bone formation,” Dr. Weinraub said.
SOURCE : American College of Foot and Ankle Surgeons