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Nicholas Makhoul, DMD, MD

McGill University

Nicholas Makhoul

Axially Vascularized 3D Printed Bone Flaps

Dr. Makhoul is an academic clinician-scientist at McGill University with a specialization in maxillofacial reconstructive surgery. His research interests include tissue engineering composite vascularized flap for complex facial reconstruction as well as outcomes studies in patients undergoing complex maxillofacial surgery.  Dr. Makhoul also heads the Maxillofacial surgery unit at McGill University and has an active clinical practice in a broad field of oral and maxillofacial surgery


The current gold standard for the reconstruction of critical-sized maxillofacial defects is the transfer of vascularized bone flaps. These flaps have significant limitations including donor site morbidity and compromised masticatory function. Bone tissue engineering presents a promising alternative. However, tissue engineered constructs have thus far failed to make a significant clinical translation, largely due to a lack of robust strategies to generate patent vascularization. In order to generate vessels large enough to perfuse clinically relevant scaffolds, two techniques exist: vessel grafting or collateralization. Much of what is known regarding collateralization is related to ischemic cardiac and brain injuries, where the occlusion of large vessels leads to the expansion of vestigial collateral vessels. Bone regeneration of segmental bone defects has not yet implemented this knowledge. Thus far, only the arteriovenous (AV) loop model has displayed the necessary pro-angiogenic properties to repair critical-sized defects. The aim of this study is to optimize vascularization of bioceramic scaffolds, grow new bone around these scaffolds and transplant this newly tissue engineered construct to repair a bone defect.


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