Autogenous Graft Research Articles

Efikasiteti i aplikimit të plazmës të pasuruar me trombocite (PRP) si graft autolog në procedurën kirurgjikale për ngritjen e fundit të sinusit maksilar për vendosjen e implanteve dentare

Placement of dental implants in the upper jaw can pose difficulties due to insufficient bone volume caused by si- nus pneumatization and physiological bone resorption. The aim of this study was to evaluate the impact of using autologous platelet-rich plasma as a graft material for si- nus lift procedures. The mean height of the alveolar bone between the floor of the maxillary sinus and the alveolar crest was 2.50 ± 0.73 mm preoperatively, 16.90 ± 1.93 mm post-surgical procedure, and 14.4 mm after 6 months (p < 0.05). There were statistically significant differences in the changes of the values of the most mesial and distal distances in the augmented region. The average dimen- sions of the placed dental implants were 10 mm in length and 3.98 mm in diameter, with 88% high primary stabili- ty in the placed implants and 100% implant survival after a 6-month period. The application of platelet-rich plasma in maxillary sinus floor elevation procedures yields good results in terms of new bone formation, implant osseointe- gration, and positive clinical outcomes. However, further research is needed over a longer time interval to better understand the role and potential of this autogenous graft material in regenerative dentistry.

A randomized controlled trial comparing conventional and piezosurgery methods in mandibular bone block harvesting from the retromolar region

BackgroundAlthough piezosurgery is now commonly used for various applications in maxillofacial surgery, its advantages over conventional rotary instruments in terms of postoperative edema, ecchymosis, postoperative morbidity, and prolonged osteotomy time have been questioned.Materials and methodsThis study aimed to compare the efficiency, postoperative morbidity, and complication rates of piezosurgery and conventional methods in harvesting autogenous ramus grafts. In this randomized controlled trial, 21 patients (32 sides) underwent autogenous graft harvesting from the ramus area, with 16 sites treated using piezosurgery and 16 using the conventional method. The primary outcomes measured were osteotomy time, total operation time, and postoperative morbidity. Complication rates were also evaluated.ResultsThe final analysis encompassed 19 patients, accounting for a total of 30 donor sites, following the exclusion of two patients who were unable to attend the scheduled follow-up visits. A total of 19 patients (30 donor sites) were included in the final analysis. No statistically significant difference was found in the mean osteotomy time between the piezosurgery group (mean: 10.35, SD: 2.74 min) and the conventional group (mean: 8.74, SD: 2.74 min) (95% CI: -3.67 to 0.442, p = 0.119). The total operation time, postoperative pain, and swelling were not significantly different between the two groups (p > 0.05). The complication rates, including wound dehiscence and inferior alveolar nerve exposure, were similar in both groups.ConclusionsPiezosurgery can be safely used for harvesting autogenous ramus grafts and does not increase osteotomy or total operation time compared to the conventional method. The postoperative morbidity and complication rates were also similar, indicating that both techniques can be effectively employed in clinical practice.Clinical Trial RegistrationThe protocol was registered on clinicaltrials.gov (ID: NCT05548049, First registration date: 21/09/2022).

Evaluation of Modified Shell Technique in 3D Ridge Reconstruction: A Clinical and Radiographic Study

Introduction: As a result of tooth loss, alveolar ridge resorption sacrifices bone volume including bone width. In order to replace the lost dentition with implants functionally and esthetically, bone augmentation procedures are carried out. Materials and Methods: Fifteen patients were selected to treat mandibular alveolar ridge resorption with an autogenous block graft harvested using piezoelectric surgical tips and split into two shells using a diamond disk then fixated on the decorticated defective ridge. Particulate xenograft bovine bone was then inserted between the fixated shell and ridge, the second shell was used to roof the bone particles. Results: The modified shell technique could be an alternative to other ridge augmentation techniques. This study shows promising clinical and radiographic results that carry the advantages of being: safe and precise cutting using Piezoelectric tips, the statistical data showed a significant difference in 3D bone volume where no unfavorable complication was detected. Conclusion: The modified shell technique showed a reliable technique in cases of 3D ridge reconstruction since it holds the advantages of autogenous bone properties and the rigidity of the bone shells that maintain the space necessary for augmentation. The use of PRF can accelerate wound healing and minimize the risk of flap dehiscence as well as it can speed up bone formation.

Implants Placed with a Ring Technique Using Inlay and Onlay Block Xenografts in the Mandible of Rabbits

Background: Xenogenous bone has been proposed as an alternative to overcome the disadvantages of autogenous grafting. The aim of the present study was to study bone dynamics at inlay and onlay xenografts used for bone augmentation applying a ring technique. Methods: The bone at the lateral surface of the mandibular angle of 12 adult male New Zealand White rabbits was exposed bilaterally. The cortical layer received multiple perforations on one side of the mandible, and a xenograft block of collagenated cancellous equine bone, 7 mm in diameter and 3 mm in width, was fixed on the prepared surface using an implant (onlay group). On the opposite side, a defect 7 mm in diameter and 3 mm in depth was prepared, and the xenograft block was adapted to the defect and fixed with an implant (inlay group). Results: After ten weeks of healing, in the onlay grafts, new bone was mainly formed on the trabeculae surface, reaching in some specimens the most coronal regions of the block. In the inlay grafts, new bone was found arranged on the trabecular surfaces but also occupying the spaces among the trabeculae. The entrance of the defect was often found close to the top of the block by newly formed bone. A higher percentage of new bone was found in the inlay (19.0 ± 9.3%) compared to the onlay (10.4 ± 7.4%) groups (p = 0.031). The mean gain in osseointegration at the implant in relation to the base of the original 3 mm deep defect was 0.95 ± 1.05% in the onlay group and 0.78 ± 0.71% in the inlay group (p = 0.603). Conclusion: The inlay grafts exhibited a higher new bone percentage than the onlay block grafts possibly due to the defect conformation that presented more sources for bone growth. The trabecular conformation and the composition of the grafts made possible the expression of the osteoconductive properties of the material used. This resulted, in several specimens, in the growth of bone on the graft trabeculae toward the most superior regions in both groups and in the closure of the coronal entrance of the defects in the inlay group. The clinical relevance of this experiment is that the ring technique applied as an inlay method could be suitable for bone augmentation.

Featured Cover

AbstractThe cover image is based on the Original Article Full block or split block?—Comparison of two different autogenous block grafting techniques for alveolar ridge reconstruction by Christian Mertens DDS et al., https://doi.org/10.1111/cid.13263. image

Efficacy of autogenous particulated dentin graft for alveolar ridge preservation: A systematic review and meta-analysis of randomized controlled trials.

Autogenous particulate dentin (APD) has been used as a bone graft material for bone augmentation, but the specifics of its effect on alveolar ridge preservation (ARP) are uncertain. The aim of this study was to investigate the clinical and histomorphometric performance of APD compared with blood clot healing or other grafted materials in ARP. MEDLINE, Embase, Web of Science, Scopus and the Cochrane Library and citation databases were searched until August 2, 2023 to identify randomized controlled trials that employed APD for ARP. Two independent meta-analyses were performed based on the different control groups (Group I: blood clot healing; Group II: other grafted materials). Weighted or mean differences (MDs) and corresponding 95% confidence intervals (CIs) were calculated. The protocol was prospectively registered with PROSPERO (CRD42023409339). A total of 238 records were identified, of which ten studies with 182 participants were included. The meta-analysis indicated that APD resulted in fewer changes in horizontal ridge width (Group I: MD = 1.61, 95% CI 0.76-2.46; Group II: MD = 1.28, 95% CI 1.08-1.48) and labial bone height (Group I: MD = 1.75, 95% CI 0.56-2.94; Group II: P < .05) than the control treatments. Regarding histomorphometry, APD yielded a satisfactory proportion of vital bone area (MD = 10.51, 95% CI 4.70-16.32) and residual material area (MD = -8.76, 95% CI -12.81 to -4.71) in Group II, while there was no significant difference in Group I. Moreover, none of the secondary outcomes were significantly differed between groups. Within this study limitations, APD effectively maintained the horizontal and vertical dimensions of the extraction sockets and exhibited favorable osteogenic properties and degradation capacity. Further well-designed randomized controlled trials with larger samples and longer follow-up periods are needed to evaluate whether APD is superior to other substitutes for ARP.

Evaluation of changes in the length and cross-sectional dimension of autogenous grafts from semitendinosus and gracilis tendons used for anterior cruciate ligament (ACL) reconstruction in patients with active growth plates: MRI analysis

Introduction. In recent years, there has been an increase in anterior cruciate ligament (ACL) injuries during childhood and adolescence. Aim. The aim of this study is to observe the diameter and length of the graft change in the postoperative period. Materials and methods. The study group consisted of 21 adolescents (11 boys and 10 girls) who underwent ACL reconstruction using hamstring and gracilis tendon grafts. MRI evaluations were performed at 3-6 and 24-26 months postoperatively to assess the width and length of the graft. The graft cross-sectional dimension was measured at the mid-substance of the tendons on sagittal scans in T1 and T2-weighted sequences. Length measurement was performed on axial ACL scans at its central portion (assessing mid-substance length). The collected measurements from both postoperative periods were compared and statistically analysed. Results. MRI analysis conducted postoperatively showed a statistically significant decrease in graft cross-sectional dimension, from an average 7.21-5.82 mm. The intra-articular graft length measured in MRI at 3-6 months post-surgery averaged 21.52 mm, while the length measured at 24-26 months post-surgery averaged 22.42 mm. Conclusions. Postoperative MRI analysis of reconstructed ACLs in adolescents with active growth plates demonstrated a reduction in graft cross-sectional dimension and a slight increase in graft length.

Peripheral nerve regeneration by bioabsorbable nerve conduits filled with platelet-rich fibrin

PurposeTo repair peripheral nerve defects and seek alternatives for autografts, nerve conduits with various growth factors and cells have been invented. Few pieces of literature report the effect of nerve conduits plus platelet-rich fibrin (PRF). This study aimed to investigate the effectiveness of nerve conduits filled with PRF. MethodsThe model of a 10 mm sciatic nerve gap in a rat was used to evaluate peripheral nerve regeneration. The thirty rats were randomly divided into one of the following three groups (n = 10 per group). Autogenous nerve grafts (autograft group), conduits filled with phosphate-buffered saline (PBS) (PBS group), or conduits filled with PRF group (PRF group). We assessed motor and sensory functions for the three groups at 4, 8, and 12 weeks postoperatively. In addition, axon numbers were measured 12 weeks after repair of the peripheral nerve gaps. ResultsSignificant differences in motor function were observed between the autograft group and the other two groups at 12 weeks postoperatively. In the test to evaluate the recovery of sensory function, there were significant differences between the PBS group and the other two groups at all time points. The most axon number was found in the autograft group. The axon number of the PRF group was significantly more extensive than that of the PBS group. ConclusionsThe nerve conduit filled with PRF promoted the axon regeneration of the sciatic nerve and improved sensory function.

The Effectiveness of Autogenous Dentin Graft as a Biomaterial in Optimizing the Esthetic Outcomes of Immediate Dental Implants: A Prospective Clinical Study

Background: Immediate implant placement in the maxillary anterior region was challenging, especially with the jumping gap and limited primary implant stability. Objective: To assess the autogenous dentin graft biomaterial's ability to improve the esthetic outcomes of an immediately inserted implant. Methods: Twenty patients with non-restorable retained roots in the maxillary non-molar region surrounded by natural sound teeth were included in this study after a complete clinical and radiological examination, including patient health and clinical fitness for the immediate dental implant procedure. A single dental implant was inserted for each patient, and the resulting jump distance was filled with the mineralized dentin graft and covered by gel foam with the figure of eight suturing. The Pink Esthetic Score index of the implant-supported prostheses was evaluated six months after the initial surgery. Results: Twenty eligible patients were included in this study. The assessment of the clinical measurements of the alveolar ridge width and gingival biotype before surgical intervention and after 6 months showed no significant differences between them. The mean Pink Esthetic Score (PES) was 7.75. Only two patients achieved a total esthetic score of 10; another three patients had a score of 8, four with a score of 7, and the rest with a score of 6. Conclusion: An autogenous dentine graft effectively achieves acceptable esthetic results with an isolated immediate dental implant inserted in the anterior maxillary area.

The Utility of 3D Printing for Surgical Planning and Patient-Specific Implant Design in Maxillofacial Surgery: A Narrative Review.

Maxillofacial reconstructive implants are typically created in standard shapes and have a widespread application in head and neck surgery. During surgical procedures, the implant must be correctly bent according to the architecture of the particular bones. Bending takes practice, especially for untrained surgeons. Furthermore, repeated bending may increase internal stress, resulting in fatigue in vivo under masticatory loading and an array of consequences, including implant failure. There is a risk of fracture, screw loosening, and bone resorption. Resorption, infection, and displacement are usually associated with the use of premade alloplastic implants and autogenous grafts. Recent technological breakthroughs have led to the use of patient-specific implants (PSIs) developed by computer-designed additive manufacturing in reconstructive surgery. The use of computer-designed three-dimensional (3D)-printedPSI allows for more precise restoration of maxillofacial deformities, avoiding the common difficulties associated with premade implants and increasing patient satisfaction. Additive manufacturing is something that refers to a group of additive manufacturing methods. This technique has been quickly used in a variety of surgical procedures. The exponential expansion of this technology can be attributed to its enormous surgical value. Adding 3D printing to a medical practice can be a rewarding experience with stunning results.

Alveolar cleft reconstruction utilizing a particulate autogenous tooth graft and a novel split-thickness papilla curtain flap — A retrospective study

During secondary alveolar cleft grafting, the use of autogenous cancellous bone harvested from the iliac crest is still considered the gold standard. Due to the risk of donor-site morbidity and excessive graft resorption, alternative grafting materials (e.g. intraoral bone, xenografts) have been tested. Autogenous tooth bone graft (ATB) is a novel material derived from extracted teeth. ATB has successfully been used in pre-prosthetic and periodontal surgery for hard-tissue reconstruction.Seven patients with unilateral cleft lip and palate were treated with ATB, using their own deciduous teeth for grafting. Defects were accessed utilizing a novel split-thickness papilla curtain flap. Cone-beam computed tomography scans were taken prior to and 3 months following cleft surgery to assess graft integration, graft stability, and the volume of the newly formed hard tissues. Hard-tissue gain, as measured at the 3-month follow-up, averaged 0.65 cm3 ± 0.26 cm3. Results showed acceptable graft integration and stability at the 3-month follow-up, with no adverse effects or excessive resorption of the graft.The use of ATB might be a feasible alternative for alveolar cleft grafting. However, long-term studies using a large sample size are required to derive further conclusions.

Rat Calvaria Model Mimicking the Intraoral Lesion of Medication-Related Osteonecrosis in the Jaw: A Preliminary Test.

Numerous preclinical intraoral models have been proposed to study medication-related osteonecrosis of the jaws (MRONJ). However, an extraoral animal model is necessary to investigate the effects of interventions such as grafts or direct therapeutics. This study aimed to establish a MRONJ rat model on the calvaria. Seven rats were allocated to either the control or MRONJ group. The MRONJ group received injections of zoledronic acid and dexamethasone to induce osteonecrosis over 4 weeks. Two weeks after these injections, the maxillary first molar was extracted, and two calvaria defects were created using a 4 mm trephine burr. One defect was left untreated, while the other was filled with harvested calvaria bone. A histological examination of all calvaria in the MRONJ group revealed avascular necrosis and the destruction of cortical bone. An independent t-test and Pearson's correlation coefficient were used for statistical analysis and the evaluation of alveolar and calvaria defects. The total alveolar and calvaria defect volume in the control group was significantly smaller than that in the MRONJ group. A statistically significant correlation was observed between alveolar and calvaria defects (Pearson correlation = 0.6, p = 0.023). The autogenous grafts showed poor results in the MRONJ group since they failed to revascularize and exhibited necrosis. The calvaria in this study successfully mimicked MRONJ lesions with avascular necrosis. This preclinical model could be used to develop treatments that are applicable to MRONJ.

Utilização de proteína morfogenética associada ao enxerto xenógeno para reconstrução de maxila atrófica: relato de caso

With the loss of dental elements and subsequent bone resorption, the rehabilitation process in an atrophic maxilla becomes a challenge for professionals. Alternatives such as autogenous, xenogeneic and allogeneic grafts, as well as alloplastic biomaterials, have been used for bone volume gain. The technique of lifting the maxillary sinus to the posterior region of the maxilla is well described in the literature and does not present major complications. Morphogenetic proteins (BMPs) appear as adjuvants in this technique and can replace grafts or be combined with them. The objective of this study was to present the use of different materials for the reconstruction of the atrophic maxilla in order to give back to a patient the bone contour and volume she had lost. The reported case shows the employment of recombinant human bone morphogenetic protein 2 (rhBMP-2), associated with a particulate xenogeneic graft. The atrophic maxilla was reconstructed, and the indications, contraindications and possible limitations of the technique were discussed. It is possible to conclude that the technique used was satisfactory, the patient evolved well and is awaiting installation of an implant-supported prosthesis.

AUTOGENOUS RIB GRAFT FOR NASAL RECONSTRUCTION, PANORAMIC REVISION

Introduction: It is remarkable the increase in the last decades of rhinoplasties for aesthetic and functional reasons. Some congenital, iatrogenic or traumatic etiologies originate a deficient or deformed nasal dorsum that needs correction with a dorsal augmentation. A deficient osteocartilaginous dorsum is the most frequent drawback requiring augmentation with graft material. Objective: to detail the current information related to autogenous rib grafting for nasal reconstruction. Methodology: a total of 33 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 24 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, SciELO, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: graft, autologous, rhinoplasty, costal, nose, deformity. Results: Costal cartilage is a remarkable material in reconstructive septorhinoplasty, mainly in revision surgery because it requires large amounts of tissue. This autologous material presents a low incidence of complications. With increasing age it is more likely that this cartilage is calcified, so its procurement and manipulation will be more complex. The most commonly used cartilage is the septal cartilage, however, in several cases the septal cartilage may not be sufficient for the intervention, it may be very deteriorated or absent, so the costal cartilage is an essential support for very damaged noses or in case of secondary surgeries. Conclusions: the graft of choice is the septal cartilage due to its simple procurement and physical elastic properties, however its ration is scarce. Rib cartilage is a graft that provides a lot of material. The costal cartilage graft is a fruitful tool when facing complex surgeries or nasal reconstructions. Autologous rib cartilage graft is a viable alternative in reconstructive septorhinoplasty. The surgical technique is not complicated and has a low complication rate. KEY WORDS: autologous graft, rhinoplasty, nasal aesthetics, nasal deformity.

Comparative analysis of xenogeneic collagen matrix and autogenous subepithelial connective tissue graft to increase soft tissue volume around dental implants: a systematic review and meta-analysis

ObjectiveThe gold standard for a soft tissue augmentation around implants is a subepithelial connective tissue graft (CTG), but the xenogeneic collagen matrices (XCM) started to be used as an alternative. This systematic review aimed to assess the effectiveness XCM in comparison to CTG for the increasing the thickness of the soft tissue around implants.DataAll studies included at least two parallel groups comparing the use of CTG and XCM with a minimum follow-up of 3 months. As the primary outcome, the amount of soft tissue thickness gain after soft tissue augmentation with XCM or CTG was assessed. Secondary outcomes were clinical and patient-related outcomes; evaluation of aesthetic outcomes, patient-reported outcomes measures (PROMs) and complications. Eligible studies were selected based on the inclusion criteria. Meta-analysis was applied whenever possible. The quality of the evidence of studies including in meta-analysis was assessed using the GRADE approach.SourceA systematic literature search up to January 2022 was conducted using the following electronic databases: PubMed (MEDLINE), Scopus, Cochrane Library, LILACS, eLIBRARY.RU. Unpublished researches, the gray literature, nonprofit reports, government studies and other materials were reviewed electronically using an EASY search. An additional manual search was carried out in November 2022.Study selectionOf the 1376 articles from the initial search, 8 randomized controlled trials (RCTs) (306 patients and 325 implants) were included in this systematic review, and 7 studies were part of the meta-analysis. Meta-analysis revealed that XCM is less effective than the CTG in increasing soft tissue thickness around dental implants. However, XCM also provides soft tissue thickness gain and can be recommended for use in various clinical situations.Clinical significancePrevious systematic reviews and meta-analyses have shown that autologous grafts are more effective than collagen matrices in increasing soft tissue thickness, however, the latter can be used as an alternative. Studies included in previous systematic reviews varied in design, which could lead to limitations. The present systematic review and meta-analysis includes for the first time only randomized controlled clinical trials with collagen matrix of xenogeneic origin in the test group. Tight eligibility criteria were established, and the main parameter studied was soft tissue thickness. It was found that xenogeneic collagen matrix is effective for increasing soft tissue thickness around dental implants, however, the results obtained using an autogenous connective tissue graft are superior.

Better clinical outcomes and faster weight bearing after medial opening-wedge high tibial osteotomy using allogeneic than synthetic graft: A secondary analysis of a Francophone Arthroscopy Society Symposium

IntroductionAlthough an autogenous graft has the highest rate of bone union to fill the void created in medial opening wedge high tibial osteotomy (MOWHTO), it also has some disadvantages, such as prolonged surgical time, donor site pain and morbidity. Two possible candidates for ideal grafts to replace autogenous grafts are allogeneic and synthetic graft, which are free from donor site pain and morbidity. However, previous reports comparing the clinical results of allogeneic to synthetic graft have been limited and controversial. The purpose of this study is to compare radiological findings and clinical outcomes of using synthetic versus allogenic graft to fill the void created in MOWHTO. HypothesisThe present clinical study hypothesized that allogenic graft to fill the void would allow the higher rate of bone union and better clinical outcomes. Material and methodsThis study compared the clinical and radiological outcomes of 95 patients who received MOWHTO to fill the void with either synthetic or allogenic graft (44 in Syn group, 51 in Allo group). Preoperatively and postoperatively, all patients were clinically evaluated; Return to work, Tegner activity score, and the Western Ontario and Macmaster University scores were reported. Radiographically, osteoarthritis grade and pre- and postoperative parameters were reported, including Hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle, proximal posterior tibial angle, and limb length discrepancy. Perioperative details and complications were also reported. ResultsMean follow-up (months) were 24.0±1.3 in Syn group and 26.8±1.2 in Allo group (p=0.13). The postoperative improvement of pain and global WOMAC scores in Allo group were significantly better than in Syn group (ΔPain of WOMAC: Syn group 27.8±4.4, Allo group 49.3±3.8, p value <0.001*) (ΔGlobal score of WOMAC: Syn group 16.7±3.2, Allo group 37.4±4.9, p value=0.002*). The risk of hinge fracture in Syn group was significantly higher than in Allo group (Hinge fracture by Takeuchi grade (0/1/2/3): Syn group 37/3/3/1, Allo group 43/8/0/0, p value=0.04*). The timing of full weight bearing in Allo group was significantly earlier than in Syn group (Weight Bearing (1=FWB, 2=PWB 3wk, 3=PWB 6wk): Syn group 2.7±0.1, Allo group 2.3±0.1, p value=0.01*). DiscussionThe use of allogenic graft to fill the void in MOWHTO does not show superiority in bone union compared to synthetic graft, however it improves pain, function, decreases the risk of hinge fracture and allows faster weight bearing than synthetic graft. Level of proofIII; Case-control study.

Reconstruction of the Atrophic Ridge with Staged approaches with the Autogenous Bone Block and Dental Implant: Case Reports and Literature Review

&lt;p&gt;Dental implant is a common choice for rehabilitation of edentulous areas in modern dentistry. However, alveolar bone destruction due to severe periodontitis, trauma, or other pathological conditions may compromise implant placement in an idea position. Ridge augmentation with autogenous bone blocks can be used to reconstruct the deficiency of the alveolar bone. This article reviewed about the relevant literatures and reported two cases of severe ridge atro&amp;not;phy using staged approaches with ridge augmentation using autogenous bone block grafting and implant placement for reconstruction. Case 1 showed alveolar bone destruction caused by severe periodontitis at left maxillary region, which was augmented with the autogenous bone block harvested from mandibular symphysis in combination with FDBA and collagen membrane. Case 2 presented alveolar ridge deficiency after tooth extraction due to severe periodontitis. Ridge augmentation was performed using autogenous bone block harvested from the mandibular ramus along with FDBA and collagen membrane. Both cases showed increased bone volume after ridge augmentation. Implants were successful and presented stable bone level for a follow up period at least one year after implant surgery. The literature review and case reports suggest that with appropriate case selection, careful treatment, and regular maintenance, using autogenous block bone grafts harvested from the mandibular symphysis or ramus for ridge augmentation and implant placement can achieve predictable outcomes.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Different Configurations of Neoaortoiliac System Operation: An Institutional Experience

Abstract Background: Mycotic aortic aneurysm of the abdominal aorta is a rare entity. Repair of infected aneurysms is challenging because of the deleterious consequences of the usage of prosthetic material as an arterial conduit with limited availability of autogenous grafts. Aortic graft infection is one of the most morbid complications in vascular surgery. The main objective in treating aortic graft infection is to remove the infected graft material, thoroughly debride, and re-establish the vascular continuity. Neo-Aortoiliac system operation utilizes the femoropopliteal vein in various configurations, depending on the extent of infection and the availability of the conduit. Aim: This article aims to report our experience of various configurations of Neo aortoiliac system operation and various conduits used along with femoropopliteal vein, when the femoropoliteal vein is inadequate. Materials and Methods: The study was performed in a single tertiary care center. Between January 2022 and June 2023, 4 cases of Neo aortoiliac system operation were performed. The demographics, clinical presentation, operative data, and postoperative outcomes were subsequently collected and analysed. Results: 3 out 4 patients of Neo-Aortoiliac system operation survived, one patient had Major Adverse Limb Event and one patient succumbed to death due to sepsis.

Inflow Artery Aneurysmal Degeneration After Long Term Native Arteriovenous Fistula for Haemodialysis

Inflow arterial aneurysms are a rare but serious complication after long term arteriovenous fistulae (AVF), probably due to arterial wall remodelling after an increase in flow and shear stress, and kidney transplantation with immunosuppressive therapy. This study aimed to describe the outcomes of surgical treatment and long term follow up in a large cohort. This prospective cohort study collected data from patients with a true inflow artery aneurysm after AVF creation that was surgically repaired between 2010 and 2022. Anastomotic and infected aneurysms or post-puncture pseudoaneurysms were excluded. Demographic data, access characteristics, symptoms, treatment strategies, and long term follow up were recorded; patency was estimated using Kaplan-Meier survival analysis. During the study period, 28 patients (64% men, mean age 60.1 years) were treated surgically for aneurysmal degeneration of the axillary or brachial (n= 23) or radial (n= 5) artery after an AVF (10 distal, 18 proximal) performed a mean of 18.3 ± SD 7.9 years previously. Most AVFs were ligated or thrombosed, while all patients except one had previously received kidney transplants. Most of the cases (n= 18) were symptomatic: 13 with pain or swelling, four with distal embolisation, and one rupture. They were repaired by aneurysm partial excision and graft interposition (11 great saphenous vein, six ipsilateral basilic vein, three cephalic vein, and two PTFE graft), ligation (n= 3), or direct end to end anastomosis (n= 3). No major complications occurred before discharge, after a mean hospital stay of 2.4 days. After a mean follow up of 4.8 ± 3.3 years, three cases presented complications: two recurrent proximal brachial aneurysms were repaired with an additional proximal interposition graft (one with further late infected pseudoaneurysm) and an asymptomatic post-traumatic graft thrombosis. Five year primary and secondary patency was 84% and 96%, respectively. Aneurysmal degeneration of the inflow artery is an unusual complication during long term follow up of AVFs. Aneurysm excision and, in general, autogenous graft interposition using the saphenous or ipsilateral arm vein is a safe and effective strategy.

Treatment of Non-Union with Bone Loss in Femur Fracture Using Non-vascularized Fibular Graft: A Case Report

Abstract: Fibula is a very versatile source of autogenous graft and has been used for decades in the field of limb reconstruction. Bony defects of the lower extremity are usually the result of high-energy trauma, tumor resection, or severe sepsis. Non-vascularized fibular graft (NVFG) is useful in the reconstruction of skeletal defects, especially in cases of scarred and avascular recipient sites, or in patients with combined bone and soft tissue defects. This study aimed to assess the effectiveness of NVFG in the management of non-union bone fracture. We reported a 16-years-old male with non-union femur fracture. Debridements were applied at the first time of admission to the hospital. Open reduction of fracture with internal femur fixation. Fibula bone was extracted as the donor of vascularized graft for the bone loss. After two years of follow-up, the patient acquired his motor functions back well, and was able to carry out daily activities as expected. In conclusion, taking together the repair and reconstruction of non-union bone in the lower extremity with NVFG and internal fixation is an effective and important option for treating non-union femoral fracture. NVFG osteosynthesis has encouraging results in such instances. It is technically less demanding, simple, and can be performed in almost all centers where image intensifier is available. Keywords: bone fracture; non-vascularized fibular graft; reconstructive microsurgery; femoral non-union