Although autogenous bone graft remains the gold standard graft material, it is associated with an unacceptably high incidence of morbidity. Furthermore, operative time, blood loss, and length of hospitalization are often increased. In order for a graft substitute to replicate the optimal bone healing properties of autogenous graft, 3 essential elements must be present: scaffolding for osteoconduction, growth factors for osteoinduction, and progenitor cells for osteogenesis. A composite graft that combines a synthetic scaffold with osteoprogenitor cells from bone marrow aspirate (BMA) may potentially deliver the advantages of autogenous bone grafts without the procurement morbidity. Sixty consecutive patients with cavitary bone defects were treated with a composite of b-tricalcium phosphate (beta-TCP), Vitoss (Orthovita, Malvern, Pennsylvania), and BMA. The cavitary defects were measured on orthogonal views by experienced musculoskeletal radiologists. Radiographically, resorption and trabeculation increased steadily with time. This differential was slightly more noticeable in large defects with a central trabeculation occurring in advance of the peripheral region. The majority of patients progressed to unrestricted activities by 6 weeks and had returned to their usual activities by 12 weeks. No significant difference in graft incorporation rate was noted based on age, size of defect, or use of adjuvant local treatment. The use of a composite graft (ultraporous beta-TCP+BMA) in the treatment of cavitary lesions appears to be safe and effective.

Any entity receiving the billions of federal dollars designated for rebuilding southern Louisiana will wield tremendous power and dramatically influence the future of the region and the state. The entity's budget will dwarf that of the local governments, and its investment and development decisions could change the face of communities for generations to come. This is not a matter to be taken lightly.

Perhaps the highest priority for the Crescent City today is the creation of a unified vision and plan for redevelopment. The effort must begin with structure: the establishment of a rational, lucid, and clearly communicated planning structure that actively engages the citizenry. This will give residents needed reassurance, instill confidence in investors, and promote buy-in from the federal government. To lead the City's effort, Mayor Nagin has created the Bring New Orleans Back Commission. Its charge: "to finalize a master plan to advise, assist and plan the direct funding of the rebuilding of New Orleans culturally, socially, economically and uniquely for every citizen." The Commission consists of 17 community leaders and the Mayor. It has retained the Urban Land Institute to assist it. We are fortunate that the men and women of the Commission are willing to take a leading role in rebuilding New Orleans, even as they struggle with losses in their own businesses and personal lives. Many of them have made significant commitments to the effort, organizing task forces and assembling outside resources to address issues. The redevelopment effort will undoubtedly benefit greatly from their individual and collective efforts.

The Bureau of Governmental Research has sent a letter to the City's Office of Recovery Management (ORM) recommending a broad set of changes to the City's blighted property programs. BGR is sharing its observations with ORM and the public in anticipation of ORM's presentation to the City Council's Housing and Human Needs Committee, scheduled for December 17. The letter can be found on BGR's web site, www.bgr.org.