Application of the skin and bone integrated pylon with titanium oxide nanotubes and seeded with dermal fibroblasts.

Background: Direct skeletal attachment of limb prostheses is associated with high rate of transcutaneous infection and loosening of the fixture in the medullary canal prompting for careful assessment of various means for enhancing the skin-device and bone-device interface. The skin and bone integrated pylon system constitutes a technological platform for different modifications being evaluated previously. Objectives: The current study assessed the combination of nano-treatment skin and bone integrated pylon with its pre-seeding with dermal fibroblasts. We hypothesized that this combination will enhance cell interaction with skin and bone integrated pylon compared to nano-treatment and the fibroblast seeding when done separately. Study design: The feasibility and safety of in-bone implantation of the skin and bone integrated pylon with nanotubes was investigated in vitro and in vivo in the animal model. Methods: TiO2 nanotubes were fabricated on the skin and bone integrated pylon, and the fibroblasts taken from rabbit's skin were cultured on the pylons before implantation. Results: The in vitro experiments demonstrated higher cellular density in the samples with a nanotubular surface than in the non-modified pylons used as control. There were no postoperative complications in any of the animals during the 6-month observation period. Subsequent scanning electron microscopy of the pylon extracted from the rabbit's femur showed the stable contact between the pylon and soft tissues in comparison to control samples where the patchy fibrovascular ingrowth was detected. Conclusion: The promising results prompt further investigation of the integrative properties of the nanotextured skin and bone integrated pylon system seeded with dermal fibroblasts and its optimization for clinical application. Clinical relevance The study is devoted to the development of more safe and efficient technology of direct skeletal attachment of limb prostheses aimed in improving quality of life of people with amputations.