Revival by Adipose: From Bone Prefabrication to Treatment of Osteonecrosis

This lecture will first introduce the use of human adipose-derived cells to generate pre-vascularized truly osteogenic grafts, with improved engraftment and functionality upon in vivo implantation. The vasculogenic and osteogenic potential of adipose-derived cells will be discussed. Such grafts can be combined to arterio-venous bundles to engineer axially-vascularized osteogenic grafts able to treat and revitalize bone avascular necrosis in a rat model developed in our laboratory. The same principle was recently used as a surgical treatment to achieve improved oral rehabilitation and anatomical and functional reconstruction of a complex defect of the maxilla of a patient with a pedicled engineered composite graft. A pedicled graft was first generated ectopically and later transferred into the bone defect with his vascular pedicle and anastomosed to the vasculature at recipient site. A phase I clinical trial in preparation, following this approach and addressing mandibular reconstruction will also be described.