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Objectives and questions: The osteogenic regeneration potential of surgical site release tissue has been established through various studies. On the contrary, the avital nature of bone substitute materials limits them in their application as bone grafts. We therefore result on the use of autologous bone grafts, that despite the comorbidities associated to their application still remain the gold standard on daily practice. We investigate the potential use of avital bone substitutes (beta-tricalcium-phosphate, allograft) in combination to surgical site release tissue harvested under vacuum using a special suction handle device to treat large bone defects.

Material and methods: We present a prospective study of 63 patients (19 m./45 f.), ranging from ages from 11–90 years, with an average age of 56 years, with bone defects of a critical size or defects at risk of non-healing (pseudarthroses, enchondroma, osteonecrosis) to whom bioactivated bone substrate was applied. In those cases, ceramic scaffolds, mainly with beta-TCP and HA were used. Before they were applied, all porous bone substitutes were impregnated with autologous surgical-site released tissue under vacuum. A surgical suction handle device (BoneFlo^®), qualified for usage in orthopaedic surgery was used. The patients were monitored over a minimal follow-up of 6 months. We analyzed patient-related data, perioperative complications, bone formation and healing (radiographs) as well as functional outcome as patient report outcome measurements (PROMS), along with the safety and use of the system.

Results: The BoneFlo^® used for biomaterial coating allowed a safe, complete, and fast sheathing of applied bone substitutes with autologous tissue collected intraoperatively (bone fragments, blood, fat). The coating process lasted on average 15 minutes. There was no device-related complication. The clinical outcome (wound healing, pain, function) was excellent in 94% of the probands compared to historical controls. The rest of the probands scored a “moderate” result. In addition, a modified RUST scoring system was used to assess the overall bone formation and healing on site. The ceramic scaffolds showed a high degree of osseous integration and a progressive resorption in accordance to the Bergland Score. Three cases presented with delayed/incomplete bone healing.

Discussion and conclusions: Our data suggest that the surgical suction set applied is able to collect surgical site released tissue and is useful to bioactivate bone substitute material, in turn to be successfully reintroduced in the bone site. In reference to the clinical data and recent data from the literature there is evidence that bioactivated bone substitute can promote bone healing.