Invited commentary

Invited commentary 10. Reyenders P, Becker J, Broos P (1998) The osteogenic poten- 19. Törmälä P, Vainionpää S, Kilpikaru J, Rokkanen P (1987) The tial of free periosteal autografts in tibial fractures with severe effects of fibre reinforcement and gold plating on the flexural soft tissue damage: an experimental study. Acta Orthop Belg and tensile strength of PGA/PLA copolymer materials in vitro. 64(2): 184–192 Biomaterials 8: 42–5 11. Rich D, Johnson E, Zhou L, Grande D (1994) The use of peri- 20. Törmälä P, Vasenius J, Vainionpää S, Laiho J, Pohjonen T, osteal cell/polymer tissue constructs for the repair of articular Rokkanen P (1991) Ultra-high-strength absorbable self-rein- cartilage defects. 40th Annual meeting, Orthopaedic Research forced polyglycolide (SR-PGA) composite rods for internal Society, New Orleans, Louisiana, 21–24 February 1994 fixation of bone fractures: in vitro and in vivo study. J Biomed 12. Ritsilä V, Alhopuro S, Rintala A (1972) Bone formation with Mater Res 25(1): 1–22 free periosteum. Scand J Plast Reconstr Surg 6: 51–56 21. Törmälä P (1992) Biodegradable self-reinforced composite 13. Ritsilä V, Santavirta S, Alhopuro S, Poussa M, Jaroma H, materials; manufacturing structure and mechanical properties. Rubak J, Eskola A, Hoikka V, Snellman O, Österman K Clin Mater 10: 29–34 (1994) Periosteal and perichondral grafting in reconstructive 22. Uddströmer L, Ritsilä V (1978) Osteogenic capacity of perios- surgery. Clin Orthop 302: 259–265 teal grafts. A qualitative and quantitative study of membra- 14. Romana M, Masquelet A (1990) Vascularized periosteum as- nous and tubular bone periosteum in young rabbits. Scand J sociated with cancellous bone graft: an experimental Study. Plast Reconstr Surg 12:207–214 Plast Reconst Surg 85(4): 587–592 23. Vacanti C, Upton J (1994) Tissue-engineered morphogenesis 15. Ruuskanen M (1991) Perichondral proliferation guided by ab- of cartilage and bone by means of cell transplantation using synthetic biodegradable polymer matrices. Clin Plast Surg sorbable implants. An experimental study. PhD thesis, Oulu University, Oulu, Finland 21(3): 445–462 16. Santavirta S, Konttinen Y, Saito T, Grönblad M, Partio E, 24. Vacanti C, Kim W, Upton J, Vacanti M, Mooney D, Schloo B, Kemppinen P, Rokkanen P (1990) Immune response to poly- Vacanti J (1993) Tissue-engineered growth of bone and carti- glycolic acid implants. J Bone Joint Surg 72B (4): 597–600 lage. Transpl Proc 25(1): 1019–1021 17. Sasserath C, Reck van J, Gitani J (1991) Utilisation d’ une 25. Vacanti C, Kim W, Schloo B, Upton J, Vacanti P. (1994) Joint membrane d’ acide polyglycolique dans les reconstructions de resurfacing with cartilage grown in situ from cell-polymer plancher orbitaire et dans les pertes de substances osseuses de structures. Am J Sports Med 22(4): 485–488 la sphère maxillo-faciale. Acta Stomatol Belg 88(1): 5–11 18. Takato T, Harii K, Nakatsuka T, Ueda K, Ootake T (1986) Vascularized periosteal grafts: an experimental study using two different forms of tibial periosteum in rabbits. Plast Re- constr Surg 78(4): 489–497 Puumanen et al. describe modern tissue engineering as 101.567–576, 1998) and others have shown that cranial “combining living tissues or cells with biodegradable periosteal osteoblasts can be isolated, cultured, and seed- materials.” They wish to engineer bone for engraftment. ed onto carefully designed PLGA scaffolds. These stud- The living tissue they use is periosteum and the biode- ies commonly incorporate signaling molecules, such as gradable material is an off-the-shelf PLGA mesh. Anoth- cytokines, BMPs (bone morphogenetic protein), of TGFs er term often applied to PLGA and other biodegradable (transforming growth factor), or antibiotics. It is not materials in the tissue engineering context is “scaffold.” clear what molecules the authors anticipate the perioste- This implies an adequate geometry for both cell seeding um or other nearby cells will release to signal initiation and the desired tissue formation. The authors do not dis- of a bony healing response. cuss why they find this particular PLGA mesh geometry The authors clearly anticipate the formation of fully an attractive scaffold, or whether it would be expected to functional bone. However, the histological basis for the promote vascular ingrowth or the layering of cells re- authors’ citation of bone marrow formation is unclear. quired for stable bone formation. The figures suggest Another common concern for the formation of bone that that the new bone in this study is limited to the interstiti- can function as a graft is strength. What biomechanical al space between the periosteum and the PLGA rather demands do the authors anticipate for their tissue engi- than invading and replacing the construct. A 10,000 Dal- neered bone? Previous intra-muscularly generated bone ton molecular weight is cited for the PLGA; however, flaps have proved friable and difficult to manipulate. there is no discussions as to whether this molecular weight will ensure a graceful degradation rate into the expected lactic acid by-product. It is not clear whether References the bone loss between 6 and 12 weeks is due to declining pH or possibly the normal state following a periosteal re- Breitbart AS, Grande DA, Kessler R, Ryaby JT, Fitzsimmons RJ, active response. Grant RT (1998) Tissue engineered bone repair of calvarial de- fects using cultured periosteal cells. Plast Reconstr Surg In addition to scaffold geometries, contemporary 101:567–576 tissue engineering is equally concerned with isolation, tissue expansion, and signaling differentiation of D. Dean stem cells. Breitbart et al. [1](Plast Reconstr Surg Cleveland, Ohio, USA European Journal of Plastic Surgery Springer Journals

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