A novel strategy for prefabrication of large and axially vascularized tissue engineered bone by using an arteriovenous loop.

The repair of bone defects remains a major clinical challenge because none available reconstruction methods and biomaterials have been proved completely satisfactory. As a promising approach for bone regeneration, tissue engineered bone has become a technically feasible method to repair small to moderate sized bone defects in clinical practice, but it is difficult to repair large one, particularly when the recipient site is scarred by infection or radiation injury. Construction of large and vascularized tissue engineered bone may overcome the problems since vascularization is an essential prerequisite for the constructs to survive and integrate with existing host tissue. On the other hand, prefabrication large artificial bone in vivo bioreactor and axial vascularization by means of arteriovenous loop model in soft tissue have been proved to be feasible. Therefore, we hypothesize that combination of cells, solid scaffold, growth factors, and arteriovenous loop may eventually generate a large and vascularized tissue engineered bone flap in vivo bioreactor. Like vascularized autologous bone grafts, the new constructs could be transferred to the defect site by using microsurgical techniques. The strategy would facilitate clinical translation in bone tissue engineering and offer new therapeutic strategies for reconstruction of extended bone defects if the hypothesis proved to be practical.