Soluble and insoluble signals sculpt osteogenesis in angiogenesis

Figure 8 Prefabricated osteogenic protein-1/macroporous coral-derived hydroxyapatite implant pedicled into a vascularized bone flap transplanted into a mandibular defect of a human patient. A: Surgical insertion of L-shaped blocks of coral-derived macroporous constructs into the muscular tissue of the chest of a human patient after ablative mandibular surgery for neoplastic mandibular lesion[79]. The implanted macroporous constructs were preloaded with recombinant hOP-1 before implantation into the left pectoralis major muscle; B: Skeletal scintigraphy demonstrates osteogenesis in the L-shaped pectoralis implant (arrow); C: Surgical debridement of the newly engineered construct; D, E: Preparation of the recipient mandibular bed; F: Placement and insertion of the pedicled flap into the previously operated left mandible[79]. Prefabricated bone flaps exploit the highly vascularized muscular tissue to generated osseous constructs for later transplantation in autogenous skeletal deficiencies.