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Reconstruction of infected mandibular defects is challenging due to the size and possible irregular shapes of defects, presence of pathogens, and the availability of suitable donor tissue. We have developed a 2-stage tissue engineering approach in which: (1) an antibiotic-releasing space maintainer is inserted in the mandibular defect to support the formation of a healthy soft tissue envelope and locally eliminate infection and (2) the implantation of a 3-dimensional–printed bioreactor in the ribs to grow a vascularized autologous bony tissue flap of customized geometry. In a second surgery, the space maintainer is removed and replaced with tissue from the bioreactor.

A 2-stage Approach to Craniofacial Reconstruction in an Infected Ovine Mandibular Defect Model