Wound healing: Bone and biomaterials

No treatise on wound healing would be complete without a discussion of the exceptional reparative properties of bone - a tissue that can heal without scar and alter in response to functional demand. Because of the inherent vascularity of tissues in the face, fractured facial bones are asssumed to be more resilient and forgiving to varied techniques of repair. Whatever benefit this lush blood supply might offer, it is probably necessary in order to compensate for the inherent difficulty in facial fracture stabilization and the close proximity to the contaminated mouth and sinuses. Therefore, specific clinical principles of osseous repair should be adhered to lest the healing pattern go awry. The salient concern for proper fracture repair can be better understood by a review of the physiology of bone repair. Following this the clinical implications in fracture repair are discussed and, finally, the events that occur when complications ensue, such as osteomyelitis and osteoradionecrosis.