Craniofacial Reconstruction

Massive bone and tissue loss to the face and head is a large problem of blast injuries for Warfighters. During the current conflicts, more than 25% of Wounded Warriors treated in U.S. military facilities have sustained craniomaxillofacial injuries. It is a complex area to address since multiple levels and tissue types are involved (i.e. simple fractures to extensive bone defects, severe burns and tissue avulsions) and therefore require different strategies for repair. A Warfighter with a significant craniomaxillofacial injury is not only affected by the physical pain of the injury but also psychologically as these injuries are disfiguring and may limit the clarity of communication that too may further confound a Warfighter’s ability to reintegrate into society.

Currently available synthetic materials do not remodel and integrate with host tissue and can become infected and require extensive, multiple revision surgeries. Metallic devices lack controlled delivery capability for biological factors and only transiently restore anatomical form but with limited function. Contemporary treatments do not restore neurogenic competence or mitigate against scar formation. Transplanted human tissues may represent the most promising option but are inadequate to treat craniofacial deficits incurred in combat in their current state.

The Craniomaxillofacial Regeneration Program will design, develop and provide the treating surgeon with therapies for the Wounded Warrior that will:

• Regenerate bone and soft tissue (i.e. muscle) form and function to calvarial-, upper- and mid-facial anatomies and mandible
• Restore sensory and motor competencies through repair of peripheral nerve gaps to afford appropriate muscle reinervation which may improve downstream rehabilitation
• Repair vascular defects and restore blood flow to regions compromised by trauma to enable craniomaxillofacial recovery and support bone and soft tissue regeneration
• Mitigate against scar formation
• Prevent infection
• Regenerate "high quality" skin to address the unique and complex architecture of the face (i.e. elastic and pigmented with sweat glands and hair follicles) and eliminate esthetic skin coverage deficit through tissue engineering

This creation and delivery of new polymers and tissues will preserve and regenerate bone and soft tissue. These new biomaterials are also capable of administering cellular therapies, angio-osteogenic factors, bone derivatives and drugs. This program is closely integrated with other approaches utilized by other programs and will advance by leveraging from these discoveries.

References:

• Lew TA, et al. J Oral Maxillofacial Surg. 2010 Jan; 68(1):3-7
• Owens BD, et al. J Trauma 2008 Feb; 64(2):295-299