Amount Of Graft Material Research Articles

The Importance of Sufficient Graft Material in Achieving Foot or Ankle Fusion.

Nonunion, an important complication following foot and ankle arthrodesis, causes substantial morbidity and disability. In patients undergoing hindfoot and ankle arthrodesis, autogenous bone graft (autograft) or a suitable alternative is often used to promote osseous fusion across the joint. This study assessed the importance of adequate graft material in the fusion space to achieve joint fusion during ankle and hindfoot arthrodesis. This study used data from a previously published clinical trial of grafting material (recombinant human platelet-derived growth factor-BB with beta-tricalcium phosphate [rhPDGF-BB/β-TCP] or autograft) for healing in hindfoot and ankle arthrodesis to correlate the amount of graft fill at 9 weeks with ultimate healing. Patients who received supplemental graft material for ankle or hindfoot arthrodesis for end-stage ankle or hindfoot arthritis were stratified according to nonunion risk factors and surgical fusion site. Patients underwent arthrodesis using standard rigid internal fixation. Graft fill was defined as "adequate" if the material occupied ≥50% of the cross-sectional area of the fusion space on a computed tomography (CT) scan made at 9 weeks. Fusion was defined as osseous bridging of ≥50% of each articulation on a CT scan made at 24 weeks. Three hundred and seventy-nine patients with 573 joints (383 managed with rhPDGF-BB/β-TCP and 190 managed with autograft) that underwent arthrodesis had complete follow-up with 9-week and 24-week CT scans available. Overall, 472 (82%) of 573 joints had adequate graft fill; of those, 383 (81%) were successfully fused at 24 weeks compared with 21 (21%) of 101 joints without adequate graft fill (p < 0.0001). Absolute fusion rate differences (joints with adequate fill minus those without adequate fill) were consistent across joints (61% to 63%) and for graft materials. The overall odds ratio (OR) of successful fusion in joints with adequate graft fill compared with those without adequate graft fill was 16.4 (95% confidence interval, 9.6 to 27.9). This study demonstrates an association between the amount of graft material and successful hindfoot and ankle arthrodesis. Graft material filling of ≥50% of the fusion space at 9 weeks, regardless of type or origin, was associated with significantly higher fusion rates at 24 weeks. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Dimensions of the Nasal Septal Cartilage: A Preliminary Study in Adult Filipino Malay Cadavers

Objective: This study aimed to measure the dimensions of the nasal septal cartilage in adult Filipino Malay cadavers and calculate the cartilage area and the amount of graft material that can be harvested from the septal cartilage.&#x0D; Methods:&#x0D; Study Design: Descriptive, cross-sectional &#x0D; Setting: Pamantasan ng Lungsod ng Maynila College of Medicine Anatomy Laboratory&#x0D; Subjects: Ten (10) preserved adult cadavers dissected within a period from September 2010 to October 2010. The septal cartilages were harvested and the lengths of the cephalic margin, dorsal margin, caudal margin, and ventral margin were measured. From these measurements, the total area of the cartilage and the amount of graft material that can be harvested were calculated.&#x0D; Results: The mean length of each margin of the septal cartilage was 25.9mm (cephalic edge), 22.3 mm (dorsal edge), 21.4mm (caudal edge) and 33.1 mm (ventral edge). The area of the septal cartilage had a mean value of 652.5 mm2. The amount of septal cartilage which can be harvested had a mean area of 403mm2. &#x0D; Conclusion: This study showed a slight decrease in septal cartilage area to 652.5 mm2 and in available graft material to 403 mm2. While this decrease may reflect the apparently smaller noses of native Southeast Asians compared to East Asians and South Asians, the difference in values can also be due to the difference in the number of subjects or in methods of measurement, and further studies are recommended to determine the extent of inter-racial variability.&#x0D; Keywords: Septal cartilage, autologous graft

Maxillary Sinus Anatomy: A Cadaveric Study With Clinical Implications

This study measured maxillary sinus volume, evaluated the location of the semilunar hiatus in correlation to the nasal floor, and the incidence, location, and height of antral septa and discusses their clinical implications. Maxillary sinus volume was quantified in 65 cadavers (130 sinuses) by water application through the semilunar hiatus and measuring the used amount. The location of the semilunar hiatus was identified as distance from the nasal floor. The septa were counted, evaluated, and the size measured from the antral floor. The medium maxillary sinus volume was 12.5 mL (range, 5-22 mL). The medium location of the semilunar hiatus was 25.6 mm above the nasal floor (range, 18-35 mm). Thirty-five septa were counted in 130 maxillary sinuses. This equals an incidence of 27%. The medium height of the septa was 5.4 mm (2.5-11 mm). The main location of the septa was the region of the first molar (29%), the second molar (23%), and the second premolar (23%). The height, location, and number of septa as well as the height of the semilunar hiatus and volume of the maxillary sinus have to be taken into consideration to correctly plan the procedure and amount of grafting material in maxillary sinus floor elevation operations.