Human skeletal tissues are now widely used in surgery as transplants to serve many purposes. The grafts are usually derived from the tissues of donors either patients or cadavers. Evidence exists that hammered gold plate was used to repair the frontal bone defect in Neolithic Peruvian chieftain93. The Aztecs of Central America 500 years ago gave an advice for the treatment of broken bone which is as follows: " First the broken bone should be splinted , extended and fitted together and if this is not effective, an incision should be made, the bone ends exposed and a branch of fir-wood should be inserted in the marrow cavity". The first documented bone graft was reported by Job van Meekeren of Amsterdam. A piece of bone from the dog skull was placed in the cranial defect of a nobleman named Butterlyn. The operation was successful, but it was not approved by the church and thus had to be removed, because dogs and Christians cannot go together in one skull. Nussbaum has the credit for the first successful limb Autograft in 1875. He rotated a fragment of Ulna to bridge a 2 inch defect in the bone, thus performing the first recorded bone Autograft on a human limb bone135. Bone grafting as a clinical procedure became possible only after the development of anesthesia (1846) and antiseptic (1864). Macewen (1881) has the credit to do the first successful bone Allograft in humans. He was the student of Lister at Glasgow and had the opportunity to use both the anesthesia and antisepsis. In fact the modern practice of bone grafting was invented by Macewen. He was the follower of the opinion that bone was a living tissue which possessed the power of surviving, reproducing itself and of this being able to serve as a graft. Lexer in 1925 performed 11 half joints and 23 whole joints transplantation using at times fresh cadaver tissue30. The researches of Bonfiglio, Herndon, Curtiss, Chalmers and Burwell all of whom carefully performed animal investigations, established a clear advantage of frozen preserved Allograft over fresh Allogenic bone and thus paved the way for utilization of massive grafts in clinical transplantation. In the 1930s and 1940s, Allograft of fresh bone ( usually procured from parent ) were utilized mainly in children for the treatment of Pseudoarthosis, cysts and tumors113,22,81. During world war II, Bush and Wilson working independently in New York modified the methods by storing the bone in air sealed glass containers at temperatures of -10?C to -25?C155. Urist developed a procedure for Chemosterlization, Autolysis and Antigen extraction of Allogeneic bone ( AAA bone ) that preserves the Bone Morphogenetic Protein ( BMP ) and sufficient mechanical strength as well126. The Preliminary results of spinal fusion127,125 in 33 bone graft operations using AAA bank bone was reported. Iwata84 reported 80% success. Alexis Carrell working at the Rockefeller Institute, investigated the preservation of human tissues34 while Albee, an Orthopaedic surgeon working at the New York hospital, developed what was perhaps the first US bone bank. In the early 1950s, bone banking on a large scale in which many tissues were banked in large quantities and were provided to numerous surgeons was begun by the Navy Tissue Bank71. The wide local resection of bone tumors in the Appendicular skeleton for the purpose of limb salvage has now been well accepted as a good Orthopaedic Oncological procedure51,49,136,137. Bone and joint defects left after tumor excision surgery pose a formidable challenge of restoring skeletal deficits with autogeneous bone grafts ( non vascularized or vascularized autogeneous bone grafts have been used extensively and successfully for this purpose51,136,137. Although they have the best healing potential, autogenous grafts have the disadvantage of limited quantity, possible donor site morbidity and hence they cannot be used to restore joint surfaces. Arington et al 1996 have reported a 15.8% complication rate following Iliac crest harvesting of bone. Prosthetic implants used in skeletal tumor surgery are usually of the custom prosthesis and are preferred over bone grafts by several groups15,116. Their limitations in addition to the waiting time required for the manufacture of a custom prosthesis are the long term problems of prosthesis replacement including bone loss, loosening and the potential need for revision. Allografts represent another alternative for the reconstruction of these large bone or joint defects.
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