To fold or not to fold?

An exploration of deployable porous biomaterials for the treatment of large bone defects

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Without our musculoskeletal system, which consists of bones, joints, and muscles, we would not be able to live. Our bones are responsible for the protection of our organs, the support of our body, and they enable our mobility. Therefore, it is important to keep them healthy. This is done by cells who repair small cracks and fractures caused by our daily activities through continuous remodeling of the skeleton. However, severe bone damage and defects can occur, for example, due to trauma (e.g., car accidents) and bone tumor resection. In this case, the defects are too large for the cells to repair and surgical intervention is required to support the bone regeneration process. Bone substitutes or porous biomaterials are used to fill these defects to help the cells to regenerate the bone. Bone substitutes require implantation via open surgery due to their large dimensions and rigidity. This causes great damage to the body, which results in a long recovery time for the patient and increases the risk of infections. To reduce the invasiveness of the implantation process, minimally invasive surgery (MIS) could be used. MIS techniques make it possible to perform surgical treatments through specific minimally invasive tools that are inserted into the body through small incisions. In order to make minimally invasive implantation possible, the dimensions of porous biomaterials should be reduced to fit through these small incisions. In addition, it has been demonstrated that the bone regeneration process can be optimized and infections could be prevented by applying precisely controlled nanopatterns to the surface of bone substitutes. However, surface patterning techniques can only be applied to flat surfaces. Therefore, it is not possible to apply surface patterns to the inner surfaces of three-dimensional porous structures, such as those fabricated through 3D printing techniques. To resolve