Musculoskeletal tissue banking in Singapore: 15 years of experience (1988-2003)

Journal of Orthopaedic Surgery,  Dec 2004  by Nather, A

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For massive bone reconstructions, 2 surgical teams are needed, a recipient team performing the transplantation and reconstruction, and a donor team for meticulous preparation of the donor allograft. A separate trolley with separate instrumentation is necessary for such allograft preparation. The allograft to be used must first be thawed for at least one hour before the start of surgery. It is then soaked for about half an hour in a basin containing one litre of normal saline, 500 mg of ampicillin, and 500 mg of cloxacillin. The donor surgeon then strips completely all periosteum and soft tissues from the cortical surface of the graft. The exact length of the graft needed is measured, marked, and cut using an oscillating saw. Its medullary canal is then reamed using a manual intramedullary nail reamer to remove all the marrow contents. The meticulously cleaned bone is then jet flushed with one to 2 litres of normal saline to remove all blood, debris, and soft tissues until all returning fluid is clear. Finally, the bone is soaked in another litre of normal saline containing 500 mg of ampicillin and 500 mg of cloxacillin for about 30 minutes before it is transplanted.

The same procedure is used for preparing deep-frozen femoral heads. The sterile double jar is allowed to thaw for at least one hour before starting the operation. The femoral head is then soaked in about 200 ml of saline in a kidney dish containing 250 mg of ampicillin and 250 mg of cloxacillin for about 30 minutes on the donor trolley. In addition to removing periosteum and soft tissues from the bone, all articular cartilage must be meticulously removed from the femoral head using a bone nibbler. The bone is cut into small pieces using an oscillating saw and again jet flushed with normal saline. Finally, these small pieces are then soaked in 200 ml of normal saline containing antibiotics for another 30 minutes before being used. If smaller pieces are needed, the bone is shredded using a sterile bone mill.

Postoperative regime

Prophylactic antibiotics are recommended in all cases of musculoskeletal allograft transplantation. Intravenous cefazolin 1 g 6 hourly for 48 hours followed by oral ceporex 500 mg 6 hourly for 2 weeks is given until the wound has healed. A redivac drain is inserted before closing the wound.

RESULTS

Musculoskeletal procurement

Up to 30 June 2003, 440 bones, mainly femoral heads (297), were procured from 440 living donors (Table 1), whereas 1055 bone and soft-tissue specimens were procured from 63 deceased donors (Table 2). Tissues from the lower limbs were procured from all deceased donors. However, bones from upper limbs were procured from only 16 deceased donors. After retrieval of bones and soft tissues, lower limbs are reconstructed with a plastic femur and tibia arthrodesed together at the knee using one roll of a 6-inch plaster of Paris and the soft tissues closed in 2 layers over this plastic bone reconstruction. For the upper extremities, after procurement of bones, reconstruction is performed using plastic humerus, radius, and ulna bones.