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Prefabricated construction, increasingly recognized as a sustainable method, enhances productivity while mitigating the drawbacks of traditional approaches. Lean construction, pivotal for sustainability, targets waste reduction and cost efficiency while delivering value to customers. In India's prefabrication sector, numerous barriers impede the implementation of lean principles, necessitating their identification and resolution to advance lean practices. This study aims to identify and analyze primary barriers to implementing lean principles within India's prefabrication industry, focusing on professionals' perceptions. Employing exploratory factor analysis, it examines these barriers' interconnections and causal relationships, providing actionable recommendations for enhanced lean construction effectiveness. Through a review of the literature, 26 significant barriers were identified and primary data was obtained with the help of a questionnaire. 25 barriers were discerned after pre-exploratory factor analysis, culminating in ten common components. Notably, the study highlights a primary barrier: understanding of lean construction. Drawing from expert insights, substantial recommendations are provided, intending to guide the prefabricated building sector in overcoming barriers to on-site lean construction. These findings and recommendations offer valuable direction for industry stakeholders.

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Construction and demolition activities are significant contributors to waste generation worldwide. As population growth accelerates worldwide, the amount of construction and demolition waste (C&DW) will increase proportionally unless proactive measures are implemented. This study analyzes the evolving research landscape on utilizing Building Information Modeling (BIM) technologies to advance sustainable C&DW management practices. A comprehensive text-mining analysis is conducted on 493 scholarly publications covering evolutions from January 2009 to February 2024 using the PRISMA framework. The research objectives are: (i) to identify key themes in domain of BIM technology in C&DW management using VOSviewer, (ii) to map the temporal evolution of research focus using SciMAT, and (iii) to identify emerging thematic trends.Co-occurrence analysis reveals three major research themes: (i) the use of digital twins and prefabrication for waste reduction, (ii) integrating environmental impact assessments, and (iii) data-driven decision-making. Strategic diagrams produced by SciMAT software uncover shifting priorities over the study period, with "reuse and recycling" emerging as motor themes, and "Prefabrication" (CIT = 481), "Decision Making" (CIT = 66), "Material Passport" (CIT = 92), and "Digital Twin" (CIT = 44) emerging as high-centrality and transversal themes. Temporal evolution mapping unveiled progressive integration of BIM tools such as (i) digital twins (TLS = 34, OCC = 9) and (ii) prefabrication (TLS = 40, OCC = 14), presenting opportunities to optimize waste reduction. This study offers a robust overview of the field, aiming to inform a diverse audience, including researchers from various disciplines, policymakers and industry professionals interested in advancing sustainable practices in C&DW management through innovative digital solutions.

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The architecture, engineering, and construction industry is undergoing a significant shift, steering buildings away from resource-intensive processes toward becoming instruments for climate mitigation. In this transformative landscape, integrating circular bio-based alternatives and reducing emissions through biotechnological and enzymatic processes have significant potential. Specifically, mycelium-bound composites have emerged as renewable alternatives for new materials and added-value wood products. Despite their numerous advantages, integrating these materials into current engineering practices presents challenges deriving from the complex nature of the material´s production process and the transfer from the laboratory to the industrial scale. In this regard, the design and engineering of novel controlled environments are fundamental in maintaining optimal growth conditions during material production. This, in turn, influences the overall material performance and potential use in construction.

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Acute burn reconstruction involves intricate strategies such as skin grafting and innovative technologies, addressing challenges in coverage and minimizing donor site morbidity. Despite being rarely used, flap reconstruction becomes necessary when critical structures are exposed, offering robust coverage and reducing complications. However, free flaps in acute burns face challenges, including a higher failure rate attributed to hyperinflammatory states and hypercoagulability. Surgical optimization strategies involve careful timing, patient preparation, and meticulous postoperative care. In delayed burn reconstruction, free flaps proved effective in functional and aesthetic restoration, with low flap loss rates and minimal contracture recurrence. Prefabricated and prelaminated flaps emerged as a solution for complex cases, ensuring the best functional and aesthetic possible outcomes in challenging facial burn reconstructions.

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BACKGROUND: Functional humeral bracing of midshaft humeral fractures has been widely accepted as a gold standard for nonoperative treatment. Despite reported high union rates, there is no proven superiority of any orthosis. Here we aim to compare the outcomes after the use of custom-made thermoplastic vs. commercial humeral brace with regard to time to union, nonunion rates, types of nonunion, and conversion to surgery. METHODS: Patients with humeral fractures treated between 2018 and 2021 were identified retrospectively by electronic records. Only diaphyseal humerus fractures (AO 12) were included in the study. Proximal (AO 11) or distal (AO 13) fractures, open fractures, pathologic fractures, bilateral fractures, multiple fractures, and patients lost to follow-up were excluded. Patients attending one center received a custom-made thermoplastic splint, whereas those at the other center had an off-the-shelf humeral brace applied. Radiologic union was defined as healing of at least 3 of 4 cortices determined from follow-up radiographs. Data calculations were performed using the χ2 test. RESULTS: A total of 53 patients treated with a thermoplastic brace and 43 with a commercial brace were identified. A total of 52 men were included, and the cohort's mean age was 60.1 years (standard deviation: 16.1 years). Both groups had similar gender and age distributions. More patients achieved union with a thermoplastic brace (79.2%) than those with a commercial brace (76.7%), which was statistically significant (χ2, P = .04). Although time to union was similar both clinically and radiologically, patients with a commercial brace converted to surgical treatment more frequently (11 vs. 14 cases). CONCLUSION: Thermoplastic custom-made braces provide better fracture stability, allowing for statistically significantly higher rates of fracture union during a similar treatment period to commercially available splints. Patients wearing a commercial splint were significantly more likely to develop hypertrophic nonunion requiring surgery.

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BACKGROUND: The two-staged prefabricated vascularized fibula free flap is used in maxillofacial reconstruction. We describe the possible cause and management of two cases of fibula fracture after implant placement. METHODS: The patients were treated with two-stage reconstruction with a prefabricated vascularized fibula free flap. Six dental implants were placed in both fibulas. Fibula fractures occurred during the osseointegration period before the second procedure. The reconstruction was continued as planned. RESULTS: Both fibulas fractured in the distal segment, possibly due to a thinner cortex more distally. Harvesting of a fractured fibula flap is more difficult than normally due to callus formation and fibrosis. Both transplants became fully functional with extended healing and additional surgery. CONCLUSION: The fracture apparently did not compromise the vascularisation of the fibula and proved still sufficient for successful harvest and transfer of the flap. The patient should be made aware that additional corrective surgery may be indicated.

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The study aimed to evaluate an angiogenic effect of adipose-derived stem cells (ASCs) seeding and surgical prefabrication (placing a vascular pedicle inside the scaffold) on developed composite scaffolds made of poly-ε-caprolactone (PCL), ß-tricalcium phosphate (ß-TCP), and poly (lactic-co-glycolic acid) (PLGA) (PCL+ß-TCP+PLGA). Moreover, we aimed to compare our data with previously tested PCL scaffolds to assess whether the new material has better angiogenic properties. The study included 18 inbred male WAG rats. There were three scaffold groups (six animals each): with non-seeded PCL+ß-TCP+PLGA scaffolds, with PCL+ß-TCP+PLGA scaffolds seeded with ASCs and with PCL+ß-TCP+PLGA scaffolds seeded with ASCs and osteogenic-induced. Each rat was implanted with two scaffolds in the inguinal region (one prefabricated and one non-prefabricated). After 2 months from implantation, the scaffolds were explanted, and vessel density was determined by histopathological examination. Prefabricated ASC-seeded PCL+ß-TCP+PLGA scaffolds promoted greater vessel formation than non-seeded scaffolds (19.73 ± 5.46 vs 12.54 ± 0.81; p = .006) and those seeded with osteogenic-induced ASCs (19.73 ± 5.46 vs 11.87±2.21; p = .004). The developed composite scaffold promotes vessel formation more effectively than the previously described PCL scaffold.

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Background: The combined use of various flap techniques has rapidly improved the reconstruction quality of auricle defects that are complicated by a scarcity of periauricular skin after severe burns. Nevertheless, there is still no preferable method when the optimal alternative skin to cover the auricular framework is unavailable and the periauricular vascular network is devastated. Case Description: Copious scars were observed in the periauricular region, neck, forearm, and supraclavicular region of a 19-year-old man. He had been burned by high-voltage electricity and exhibited a right auricular defect. We innovatively created a prefabricated expanded island flap constructed with an anastomosed vascular pedicle buried in the anterior thoracic chest, followed by flap transfer, tissue re-expansion, and sculpted autologous costal cartilage implantation. The remnant ear was successfully reconstructed in a three-stage surgical procedure. Conclusions: All the flaps survived well without any complications. The reconstructed right ear had a natural shape and a clear structure without apparent displacement and deformation during follow-up. The patient was satisfied with the final appearance, and his neck mobility markedly improved. Advantages and disadvantages were discussed. This procedure explored a novel solution to construct an auricular framework covering for patients who do not have high-quality donor skin and lack anastomotic vessels in the recipient area.

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In the context of carbon peak and carbon neutral policies, low-carbon construction has been the focus of most countries worldwide. As one of the most effective ways to achieve green construction, many countries have launched low-carbon policies to promote the development of prefabrication. However, the effectiveness and influencing factors of low-carbon policies on prefabrication need to be further verified under the dynamic game between the government and the construction enterprise. Therefore, this study considered subsidy and carbon tax policies and developed an evolutionary game model to promote the development of the prefabricated construction market. The evolutionary stable strategy of the government and construction enterprise under different scenarios was obtained. Subsequently, a numerical analysis was conducted to further investigate the impact of the key factors on the stable strategy. The results showed that an appropriate hybrid policy of subsidies and taxes could positively promote the prefabrication implementation of the construction enterprise. The government should adopt an appropriate policy intensity according to the maturity of the market. This study can provide effective guidance and practical enlightenment for the government to achieve low-carbon, green, and sustainable construction.

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BACKGROUND: To evaluate and compare the clinical outcomes of digitally prefabricated and conventionally fabricated implant-supported full-arch provisional prostheses. METHODS: In this retrospective study, a total of 39 patients (22 males and 17 females) who underwent implant-supported full-arch rehabilitation using the All-on-4 concept with an immediate loading protocol were included: 20 patients treated with digitally prefabricated provisional prostheses were assigned into Group A, and 19 patients treated with conventionally fabricated provisional prostheses were assigned into Group B. Implant/provisional prosthesis survival rates and complications were reviewed. Marginal bone loss (MBL) was investigated by CBCT. Surgical time, restorative time, and total operative time were analyzed. Postoperative pain and swelling were evaluated with the visual analog scale (VAS). The oral health impact profile (OHIP) questionnaire was administered before and after surgery. RESULTS: The implant/provisional prosthesis survival rate was 100%, and complications appeared with low frequency in both groups, while the mean MBL was 0.30 ± 0.29 mm in Group A and 0.31 ± 0.41 mm in Group B after 3~ 6 months (P > 0.05). The average restorative time in Group A (116.16 ± 16.61 min) was significantly shorter than that in Group B (242.11 ± 30.14 min) (P < 0.05). Patients in Group A showed lower pain/swelling VAS scores after surgery than Group B (P < 0.05). Low OHIP scores with high satisfaction with the overall effects were shown in both groups. CONCLUSION: Prefabricated prostheses reduced the prosthetic time and postoperative discomfort in patients whose immediate rehabilitation was based on the All-on-4 concept. This prefabrication technology may be a predictable alternative to improve the short-term clinical outcome of implant-supported full-arch provisional rehabilitation.

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Reconstruction of critical-sized bone defects remains a tremendous challenge for surgeons worldwide. Despite the variety of surgical techniques, current clinical strategies for bone defect repair demonstrate significant limitations and drawbacks, including donor-site morbidity, poor anatomical match, insufficient bone volume, bone graft resorption, and rejection. Bone tissue engineering (BTE) has emerged as a novel approach to guided bone tissue regeneration. BTE focuses on in vitro manipulations with seed cells, growth factors and bioactive scaffolds using bioreactors. The successful clinical translation of BTE requires overcoming a number of significant challenges. Currently, insufficient vascularization is the critical limitation for viability of the bone tissue-engineered construct. Furthermore, efficacy and safety of the scaffolds cell-seeding and exogenous growth factors administration are still controversial. The in vivo bioreactor principle (IVB) is an exceptionally promising concept for the in vivo bone tissue regeneration in a predictable patient-specific manner. This concept is based on the self-regenerative capacity of the human body, and combines flap prefabrication and axial vascularization strategies. Multiple experimental studies on in vivo BTE strategies presented in this review demonstrate the efficacy of this approach. Routine clinical application of the in vivo bioreactor principle is the future direction of BTE; however, it requires further investigation for overcoming some significant limitations.

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BACKGROUND: Angiogenesis plays an important role in determining the fat graft survival. However, clinical preconditioning techniques that target angiogenesis during fat grafting have not been established so far. Adenosine has emerged as a regulator of angiogenesis under hypoxic conditions; therefore, the aim of this study was to investigate the effects and underlying mechanisms of adenosine prefabrication on fat graft survival. METHODS: In the first animal study, a total of 32 mice were transplanted with fat prefabricated with vehicle (Control, N = 16) or adenosine (Adenosine, N = 16). In the second animal study, 24 mice were divided into three groups based on the type of fat graft: Control (N = 8), Adenosine (N = 8), and Axitinib (cotreatment of adenosine with axitinib, N = 8). At 1- and 4-weeks post-transplantation, grafts were evaluated by histopathological and biochemical assessment. Adenosine-induced vascular endothelial growth factor (VEGF) production and angiogenesis were determined using cell cultures. RESULTS: The retention volumes of fat grafts in the adenosine group were significantly increased until 4 weeks. Fat grafts from the adenosine group exhibited greater structural integrity, reduced fibrosis, and increased blood vessels. The expression levels of angiogenesis-related genes, Vegfa, Vegfr1, Vegfr2, and Vwf, were elevated in the adenosine group. Furthermore, adenosine upregulated VEGF production in preadipocytes, thereby enhancing the migration of endothelial cells. Treatment with the axitinib, VEGF receptor inhibitor, abrogated the adenosine-induced angiogenesis in the fat grafts. CONCLUSION: Adenosine prefabrication in fat improved the graft survival by enhancing angiogenesis through the VEGF/VEGFR axis in the preadipocytes and endothelial cells. Therefore, this method may be used as a novel strategy to increase the retention rate in fat grafts.

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The aim of this report is to introduce the use of the dermal substitute Integra® in the context of free fibula flap prelamination for mandibular reconstruction. Three cases of mandibular reconstruction with prefabricated and Integra-prelaminated vascularized fibula flaps are reported in this article. The patients reported in this case series presented with the following tumours: an extensive cemento-ossyfying fibroma, a multicystic ameloblastoma and an extensive calcifying epithelial odontogenic tumour. Virtual three-dimensional (3D) planning and 3D-printed cutting guides were used for the mandibulectomies, the flap harvest and the positioning of the implants. The dermal substitute Integra was used for prelamination instead of skin grafts. Treatment of all 3 patients was performed in two stages; the first consisted of the fibula prefabrication (dental implant insertion) and prelamination, and the second consisted of tumor resection and reconstruction with the vascularized implant-bearing fibula flap. Integra was shown to be able to generate complete mucosa-like tissue over the fibula flaps and in the peri-implant areas. The patients have been followed up for 1, 3 and 7 years, respectively, with satisfactory prosthetic, functional and aesthetic results. None of the patients developed peri-implant disease. It was observed that prelamination with the dermal substitute Integra leads to development of mucosal lining with clinical features similar to oral mucosa. In this report of three cases, use of Integra as part of the prelamination and prefabrication process, instead of skin grafts, appears able to clinically generate mucosal lining with avoidance of skin grafts.

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The utilization of prefabricated components is taken as a potential way to reduce carbon emissions from the construction industry, and the prefabrication rate may be a factor that influences the mitigation efficiency. This study develops an assessment method to compare carbon emissions of a building in the construction stage when it is built with multiple different prefabrication rates. Firstly, two carbon sources (building materials and machineries) and three construction sub-phases (production of materials and components, transportation, and on-site construction) are determined to clarify the calculation boundary. Then, a carbon emission measurement model for prefabricated buildings in the construction stage is developed by using a process-based method. A dormitory building in Chongqing, China, is selected to conduct a case study to show the application of the provided model. The result shows that the carbon emission of prefabricated buildings is higher compared to that of traditional cast-in situ buildings. Moreover, the emission of prefabricated buildings decreased slightly with the increase in the prefabrication rate. A detailed discussion is followed to investigate the reason why the carbon emission does not decrease with the utilization of prefabricated units. Based on the discussion, some suggestions are given to improve the carbon emission reduction efficiency of prefabrication techniques.

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In vivo bioreactors serve as regenerative niches that improve vascularization and regeneration of bone grafts. This study has evaluated the masseter muscle as a natural bioreactor for ßTCP or PCL/ßTCP scaffolds, in terms of bone regeneration. The effect of pedicle preservation, along with sole, or MSC- or rhBMP2-combined application of scaffolds, has also been studied. Twenty-four mongrel dogs were randomly placed in six groups, including ßTCP, ßTCP/rhBMP2, ßTCP/MSCs, PCL/ßTCP, PCL/ßTCP/rhBMP2, and PCL/ßTCP/MSCs. During the first surgery, the scaffolds were implanted into the masseter muscle for being prefabricated. After 2 months, each group was divided into two subgroups prior to mandibular bone defect reconstruction; one with a preserved vascularized pedicle and one without. After 12 weeks, animals were euthanized, and new bone formation was evaluated using histological analysis. Histological analysis showed that all ß-TCP scaffold groups had resulted in significantly greater rates of new bone formation, either with a pedicle surgical approach or non-pedicle surgical approach, comparing to their parallel groups of ßTCP/PCL scaffolds (p ≤ .05). Pedicled ß-TCP scaffold groups that were treated with either rhBMP2 (48.443% ± 0.250%) or MSCs (46.577% ± 0.601%) demonstrated the highest rates of new bone formation (p ≤ .05). Therefore, masseter muscle can be used as a local in vivo bioreactor with potential clinical advantages in reconstruction of human mandibular defects. In addition, scaffold composition, pedicle preservation, and treatment with MSCs or rhBMP2, influence new bone formation and scaffold degradation rates in the prefabrication technique.

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Adoption of prefabrication is essential for improving the urban built environment. However, the existing prefabrication market in China is far from mature. As the stakeholder who conducts construction activities, the contractor is facing a dilemma of lacking steady prefabricated components supply. In this circumstance, a potential solution is that contractors open their own prefabrication factories to guarantee stable component supply. The aim of this research is exploring the key factors for contractors to open prefabrication factories. Firstly, a total of 28 influencing factors were identified from literature. Then, the identified factors were divided into four categories: policy environment, market environment, technological environment, and enterprise internal environment. Through interviews with experienced professionals, a total of 19 factors were selected for future analysis. Based on the 19 factors, a questionnaire was designed and distributed to the experts to rate the degree of mutual influences. The collected data were analyzed using Ucinet6.0 software, and the adjacency matrix and the visual models were established. Finally, through the analysis of node centrality, betweenness centrality, and closeness centrality, the four key influencing factors were determined including mandatory implementation policy, precast concrete component's price, market demand, and contractor's strategic objectives. The results of this study could assist contractors in making decisions of opening their own prefabrication factories toward more sustainable environment.

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The clinical translation of bone tissue engineering for reconstructing large bone defects has not advanced without hurdles. The in vivo bioreactor (IVB) concept may therefore bridge between bone tissue engineering and reconstructive surgery by employing the patient body for prefabricating new prevascularized tissues. Ideally, IVB should minimize the need for exogenous growth factors/cells. Periosteal tissues are promising for IVB approaches to prefabricate tissue-engineered bone (TEB) flaps. However, the significance of preserving the periosteal vascular supply has not been adequately investigated. This study assessed muscle IVB with and without periosteal/pericranial grafts and flaps for prefabricating TEB flaps to reconstruct mandibular defects in sheep. The sheep (n = 14) were allocated into 4 groups: muscle IVB (M group; nM = 3), muscle + periosteal graft (MP group; nMP = 4), muscle + periosteal flap (MVP group; nMVP = 4), and control group (nControl = 3). In the first surgery, alloplastic bone blocks were implanted in the brachiocephalic muscle (M) with a periosteal graft (MP) or with a vascularized periosteal flap (MVP). After 9 wk, the prefabricated TEB flaps were transplanted to reconstruct a mandibular angle defect. In the control group, the defects were reconstructed by non-prevascularized bone blocks. Computed tomography (CT) scans were performed after 13 wk and after 23 wk at termination, followed by micro-CT (µCT) and histological analyses. Both CT and µCT analysis revealed enhanced new bone formation and decreased residual biomaterial volume in the MVP group compared with control and MP groups, while the M group showed less new bone formation and more residual biomaterial. The histological analysis showed that most of the newly formed bone emerged from defect edges, but larger areas of new bone islands were found in MP and MVP groups. The MVP group showed enhanced vascularization and higher biomaterial remodeling rates. The periosteal flaps boosted the reconstructive potential of the prefabricated TEB flaps. The regenerative potential of the periosteum was manifested after the transplantation into the mechanically stimulated bony defect microenvironment.

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Prefabrication is a promising method for minimizing construction waste since it is conducted in a controlled environment. This paper develops a simulation model for quantitatively evaluating the potential of prefabrication on construction waste reduction by considering interaction behaviors among factors influencing the application of prefabrication and construction waste reduction during the design stage. The theory of planned behavior is applied to determine the system boundary, and a system dynamic model is applied for establishing the simulation model. A case project in Anhui, China, is selected for demonstrating the established model. Results show that the (1) Application of prefabrication method contributes to construction waste reduction by reducing material wastes and reworking due to design changes. (2) Impacts of prefabrication method on concrete waste reduction is the most significant. (3) Increasing investment on designers' professional training and strengthening policies is two efficient strategies to make full use of the potential of the prefabrication method on construction waste reduction during the design stage. The developed model can offer designers as well as policymakers with references for applying prefabrication method for construction waste reduction by comparing outcomes under various scenarios with different strategies and policies ahead of implementation.

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The study investigated the osteogenic capacity of a prefabricated periosteal flap created using only skeletonized pedicle transfer without fascia or muscle for vascular induction in rabbit calvarium. A critical-sized bone defect was made in the parietal bone centered on the sagittal suture, and the demineralized bone matrix was implanted. The periosteofascia over the defect was used as a form of prefabricated periosteofascial flap (PPF group, N=10), conventional periosteofascial flap (CPF group, N=10), and nonvascularized free periosteofascial graft (FPG group, N=6). The prefabricated flap was designed via vascular induction by transferring the central artery and vein of the right auricle onto the periosteofascia for 4 weeks prior to flap elevation. A quantitative comparison of volume restoration and radiodensity in the bone defect and a histological study were performed after 6 weeks of covering the bone defect with periosteofascia. The volume restoration of the bone defect covered with the PPF (43.4%) was not different from that of the CPF (46.2%), but significantly increased compared with that of the FPG (24.6%). The radiodensity of the bone defect covered with the PPF (-186.3 HU) was not different from that of the CPF (-153.6 HU), but significantly increased compared with that of the FPG (-329.8 HU). The results were based on adequate vascular development of the periosteum and were closely related to the osteogenic changes in the implanted demineralized bone matrix (DBM). In conclusion, even in the PPF created by transferring only skeletonized vascular pedicles, the osteogenic capacity of the periosteofascial flap is well maintained.

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The reconstruction of complex midface defects is a challenging clinical scenario considering the high anatomical, functional, and aesthetic requirements. In this study, we proposed a surgical treatment to achieve improved oral rehabilitation and anatomical and functional reconstruction of a complex defect of the maxilla with a vascularized, engineered composite graft. The patient was a 39-year-old female, postoperative after left hemimaxillectomy for ameloblastic carcinoma in 2010 and tumor-free at the 5-year oncological follow-up. The left hemimaxillary defect was restored in a two-step approach. First, a composite graft was ectopically engineered using autologous stromal vascular fraction (SVF) cells seeded on an allogenic devitalized bone matrix. The resulting construct was further loaded with bone morphogenic protein-2 (BMP-2), wrapped within the latissimus dorsi muscle, and pedicled with an arteriovenous (AV) bundle. Subsequently, the prefabricated graft was orthotopically transferred into the defect site and revascularized through microvascular surgical techniques. The prefabricated graft contained vascularized bone tissue embedded within muscular tissue. Despite unexpected resorption, its orthotopic transfer enabled restoration of the orbital floor, separation of the oral and nasal cavities, and midface symmetry and allowed the patient to return to normal diet as well as to restore normal speech and swallowing function. These results remained stable for the entire follow-up period of 2 years. This clinical case demonstrates the safety and the feasibility of composite graft engineering for the treatment of complex maxillary defects. As compared to the current gold standard of autologous tissue transfer, this patient's benefits included decreased donor site morbidity and improved oral rehabilitation. Bone resorption of the construct at the ectopic prefabrication site still needs to be further addressed to preserve the designed graft size and shape.