Autologous Bone Research Articles

Evaluating the clinical potential of bioceramic-rods for revascularization in osteonecrosis of the femoral head: a systematic review.

To evaluate the safety, reliability, and effectiveness of bioceramic rods (BR) in treating osteonecrosis of the femoral head (ONFH), compared with other treatments such as core decompression and autologous bone grafting. Systematic review and meta-analysis. Pubmed, Embase, and CNKI databases from January 2011 to July 2023. Included studies involved patients treated with bioceramic rods. Studies were required to have a follow-up time of more than six months and no statistically significant differences in baseline information between groups in controlled studies. Exclusions included literature reviews, case reports, conference abstracts, animal experiments, and studies without defined success criteria or lacking analysis on factors influencing efficacy. The primary outcome measure was the Harris Hip Score (HHS) improvement rate. Secondary outcomes included the femoral head stability and survival rate, alongside the hip replacement rate. The systematic review revealed significant improvements in symptom relief and functional recovery using BR for the treatment of ONFH. An average follow-up of 20.44 months showed an overall HHS improvement rate of 33.93%. Hip preservation efficacy with BR was superior to core decompression and autologous bone grafting. The overall femoral head survival rate was 84.42%, with results sustained for three years. The success rate of hip preservation was notably higher with early intervention, which showed better outcomes when the overall HHS improvement exceeded 27%, and rates of excellent and good outcomes approached 90%. Bioceramic rods offer a safe, minimally invasive, reliable, and effective treatment option for ONFH, ensuring substantial symptom relief and functional recovery. The technique's success in early disease stages suggests a strong potential for broader clinical adoption. Although additional benefits from combining BR with stem cells, platelet-rich plasma, and traditional Chinese medicine are noted, definitive conclusions on enhanced therapeutic effects remain inconclusive.

Pediatric Cranial Vault Lesions: A Tailored Approach According to Bony Involvement

Background: Cranial vault lesions are common in children, with dermoid and epidermoid cysts being the most frequent. Management is debated due to their slow growth, but early resection can prevent complications and provide a definitive histological diagnosis, which is sometimes linked to systemic diseases. Methods: A retrospective study of children treated surgically for cranial vault tumors from January 2011 to April 2023 was conducted. The data collected included age, gender, symptoms, comorbidities, lesion location, radiological features, surgical techniques, histopathology, and recurrence rates. Results: Eighty-eight children (mean age: 3.5 years, mean tumor size: 1.21 cm) underwent surgery. The most common locations were the frontal and occipital bones. The main diagnoses were dermoid cysts, myofibroma, and Langerhans cell histiocytosis. Gross total resection was achieved in 64 cases with simple skin incisions. In 13 cases, small cranioplasties with bone cement were used. Craniotomy and cranioplasty with autologous bone grafting were performed for 11 patients with lesions larger than 2 cm and full skull thickness erosion. Conclusions: Early resection is recommended for complete removal with minimally invasive surgery and to ensure histological diagnosis. For lesions larger than 2 cm with full skull erosion, cranioplasty with autologous bone is the preferred technique.

3D-Printed Bioceramic Scaffolds Reinforced by the In Situ Oriented Growth of Grains for Supercritical Bone Defect Reconstruction.

Porous calcium phosphate ceramics have attracted widespread attention owing to their excellent bioactivity. However, their poor mechanical properties severely limit their clinical applications. Significantly improving the mechanical strength of porous CaP ceramics while maintaining their bioactivity remains a major challenge. To address this issue, calcium sulfate is used to regulate the directional growth of hydroxyapatite grains during ceramic sintering. The in situ oriented grains can not only alleviate the stress concentration but also strengthen the bonding force between the ceramic grain boundaries. Calcium sulfate improves the release of active calcium ions from calcium phosphate ceramics, further enhancing their bioactivity and osteoinductivity in vivo. Transcriptome and proteome sequencing reveals that the in situ whisker-reinforced ceramics increase the expression of proteins related to calcium ion binding and promote the expression of osteogenesis-related proteins. In the supercritical bone defect repair model, repair of the defect is achieved within 3 months, with mechanical recovery reaching more than 70% of the autologous bone.

Comparative evaluation of autologous dental bone powder and deproteinized bovine bone mineral allografts for oral implant bone deficits.

To compare the effectiveness of autologous dental bone powder grafts with deproteinized bovine bone mineral (DBBM) allografts in oral implant bone deficiency. Between January 2021 and January 2023, we enrolled 120 patients with inadequate bone for oral implantation, dividing them into an experimental group and a control group (60 each). The experimental group received autologous dental bone powder grafts, while the control group received DBBM allografts. Wound healing was assessed using the early healing index (EHI) with 5 days of closure as the baseline timeline, as Grade I: full closure without a fibrin line, Grade II: closure with a fibrin line, and Grade III: closure with fibrin covering the incision. Additional outcomes included buccal and palatal alveolar bone height, alveolar bone width at 3 (W1), 7 (W2), and 11mm (W3) below the top of the alveolar ridge, and bone density measured before and 3 months after tooth extraction. The altered shape of the alveolar bone at the extraction site was assessed at 3- and 6-months post-extraction. Implant success rate was also evaluated at 15 days and 1 month after implantation. Comparisons were made using independent t-tests, paired t-tests, χ² tests, and Z tests, as appropriate. The experimental group had a lower wound healing time and a greater prevalence of EHI categorization class I compared to the control group (P < 0.05). Three months after tooth extraction, there was no statistically significant difference in buccal and palatal alveolar bone heights between the experimental group and the pre-treatment measurements (P > 0.05). However, the control group showed a decrease in buccal and palatal alveolar bone heights compared to the pre-treatment period, while the experimental group had greater bone heights than the control group (P < 0.05). Three months after extraction, the widths of W1, W2, and W3 decreased in both groups. However, the experimental group maintained greater widths compared to the control group (P < 0.05). At 3 months post-extraction, both groups showed an increase in alveolar bone density at the extraction site. Notably, the experimental group had a higher bone density compared to the control group as well as new bone contour score of the alveolar bone at the extraction site (P < 0.05). However, at 6 months after extraction, there was no statistically significant difference in the new bone contour score of the alveolar bone at the extraction site between the two groups (P > 0.05). There was no significant difference in the implant success rate between the two groups. (P > 0.05). Autologous dental bone powder grafting promotes initial alveolar bone regeneration, enhances wound healing, and increases new bone density, providing favorable surgical conditions for dental implants. However, by 6 months, there was no significant difference in bone contour compared to DBBM allografts, indicating similar long-term clinical outcomes for both materials.

CTNI-08. DOSE ADJUSTED TEDDI-R FOR PRIMARY CNS DIFFUSE LARGE B-CELL LYMPHOMA

Abstract We report our initial experience treating 4 patients with the dose adjusted TEDDI-R protocol as reported by Dunleavy et al in 2015. The median age was 63 years, 2 patients were male, median KPS 60. Two patients were newly diagnosed: one of these had inadequate renal function for methotrexate; and the other had experienced acute methotrexate leukoencephalopathy. Two patients were treated for their first recurrence, having progressed during therapy with the MT-R protocol; one of these received salvage WBRT prior to starting. The protocol consisted of temozolomide 90 mg/sq m IV, cycles 1-6, days 2-5; etoposide 45 mg/sq m/day IV cycles 1-6, Days 2-5; liposomal doxorubicin 40 mg/sq m IV, cycles 1-6, day 2; dexamethasone 10 mg PO bid, cycles 1-6, days 1-5; ibrutinib 560 mg qd starting 3 days before cycle 1, day 1, then 560 mg qd, cycles 1-6, days 1-10; rituximab 375 mg/sq m IV cycles 1-6, days 1-2; and cytarabine 70 mg via Ommaya reservoir, cycles 2-6, days,1 and 5. Aspergillosis prophylaxis with isavuconazonium 372 mg mg PO bid was used. Overall, only 1 patient completed all 6 planned cycles; the median number of cycles completed was 4.5. Both newly diagnosed patients died during therapy; one died after 1 cycle from CMV colitis, and the other after 5 cycles from tumor recurrence, pneumonia, and septic shock. One patient with recurrent disease achieved a complete response and went on to high dose chemotherapy and autologous bone marrow transplantation; the other had a partial response after 4 cycles but died from pulmonary embolism. Median PFS for the newly diagnosed patients was 177 days, and for the recurrent patients, 221 days. Median OS for the cohort was 242 days. These preliminary data suggest that the TEDDI-R protocol was relatively toxic, especially for patients with poor neurological function, but can be an effective salvage therapy after progression on methotrexate-based therapy.

IMPACTO DA MUCOSITE ORAL EM PACIENTES TRANSPLANTADOS DE MEDULA ÓSSEA AUTÓLOGO E O PAPEL DO CIRURGIÃO DENTISTA

The Haematopoietic Stem Cell Transplantation (HSCT) is a form of treatment used for some types of hematological cancers in which the patient is both a donor and recipient. The most relevant side effect of this therapy for dentistry is oral mucositis, which in addition to causing mucosal irritation, delay and interruption of the chemotherapy cycle, can be a gateway to opportunistic infections and lead to a death outcome. As a dental surgeon increasingly active in the multidisciplinary team, the importance of dental care in the trans-HSCT phase has been widely reported in the literature. Thus, the general objective of the present work was to carry out a literature review on the impacts of oral mucositis in autologous bone marrow transplant patients, as well as the specific objective of highlighting the importance of the dental surgeon in the care of these patients. Thus, for the design of the research, the descriptors Stomatitis, Hospital Dental Team, Hematopoietic Stem Cell Transplantation, Autologous Transplantation, through DeSC; PubMed, Scielo and Lilacs databases and the Boolean operators AND, OR and NOT were used as a search strategy in the time period from 2004 to 2022. Concluding that the impacts of oral mucositis in patients undergoing auto-HSCT are pathophysiological, of morbidity, mortality and financial loss. However, the presence of the dental surgeon in the multidisciplinary team brought clinical relevance to reduce the impacts caused by oral mucositis, acting, even in a preventive way, with qualitative and quantitative reduction of the condition.

Morphological remodeling of the repaired sigmoid sinus bone wall in patients with pulsatile tinnitus after successful surgical reconstruction: an ultra-high-resolution CT study.

Sigmoid sinus wall reconstruction (SSWR) is an effective treatment for pulsatile tinnitus (PT). However, follow-up postoperative imaging manifestations have not been extensively reported. To evaluate the morphological changes in patients with PT after successful SSWR using ultra-high-resolution computed tomography (U-HRCT). Data were retrospectively analyzed from 10 patients with PT who underwent successful SSWR primarily with autologous bone powder. U-HRCT scans were performed within 3 days of surgery and repeated 6 months later. The integrity, relative density, extent, and shape of the repaired wall were analyzed. The chi-square test was used to compare the categorical variables and the Phi (φ) coefficient was used to represent the magnitude of the correlation. Among the 10 patients with PT, 1 (10%) achieved complete coverage of the defect with the residual bone, 8 (80%) had partial coverage, and 1 (10%) showed complete separation. A gap between the repaired wall and residual bone in the initial U-HRCT was linked to incomplete defect coverage in the subsequent U-HRCT scan (P < 0.001, φ = 0.903). The repaired wall shrank from the periphery to the center and the density increased. The repaired wall compressed into the sigmoid sinus retracts over time, reshaping into a naturally curved sigmoid sinus sulcus. Morphological remodeling is a typical characteristic of the repaired sigmoid sinus wall in patients with PT. Short-term incomplete repair may imply incomplete coverage of the defect in the future, but this is not correlated with recurrence.

Arthroscopic Management of Juxta-Articular Proximal Tibial Chondroblastoma: A Case Report and Literature Review.

Chondroblastoma is a rare bone tumor that originates from the epiphysis, constitutes around 1% of all primary bone tumors and is recognized for its tendency to exhibit local invasiveness, as well as the possibility of metastasis and recurrence in nearby areas. Currently, the main surgical treatment for chondroblastoma is open surgery, involving excision of the lesion. There are relatively few reports on arthroscopic surgery for the treatment of chondroblastoma. However, open surgical curettage is associated with operation-related trauma and potential for damage to the osteoepiphysis resulting in growth disturbances. This case study presents the application of an arthroscopic technique in a 14-year-old male patient with chondroblastoma affecting the proximal tibia and tibial eminence. The procedure involved thorough removal of the lesion using direct visualization with the management of the cavity utilizing a substitute for autologous bone graft. After 1 year of follow-up, the patient remains free from symptoms, exhibits normal knee functionality, and radiographic analysis reveals a good autologous bone graft fusion without any signs of recurrence. Based on the existing cases of arthroscopic treatment for chondroblastoma and the report of this case, arthroscopic treatment for chondroblastoma can be considered as a specific treatment option for certain patients. In some cases, this technique could be an effective alternative to open surgery.

Lost in translation: the lack of agreement between surgeons and scientists regarding biomaterials research and innovation for treating bone defects

BackgroundWith over 2 million grafts performed annually, bone ranks second only to blood in the frequency of transplants. This high demand is primarily driven by the persistent challenges posed by bone defects, particularly following trauma or surgical interventions such as tumour excision. The demand for effective and efficient treatments has increased exponentially in the twenty-first century. Limitations associated with autologous bone grafts drive exploration into replacements, including allografts, synthetic substitutes, and 3D-printed scaffolds. This research aimed to unravel disparities in the knowledge and evaluation of current and future bone defect treatments between surgeons and biomaterial scientists.MethodsA prospective cross-sectional survey, pre-registered with the OSF (https://osf.io/y837m/?view_only=fab29e24df4f4adf897353ac70aa3361) and conducted online from October 2022 to March 2023, collected data on surgeons’ views (n = 337) and scientists (n = 99) on bone defect treatments.ResultsScientists were significantly more optimistic than surgeons regarding the future replacement of autologous bone grafts with synthetic or tissue-engineered substitutes (p < 0.001). Accordingly, scientists foresee a paradigm shift from autologous bone grafts to biomaterial and tissue-engineered solutions, reflecting their confidence in the ongoing advancements within this field.Furthermore, regulatory trepidations for 3D-printed bone scaffolds were acknowledged, with scientists emphasizing the need for a more significant focus on clinical relevance in preclinical studies and regulatory clarity. In a ranked categorical assessment, witnessing the technology in action was deemed most influential in adopting new bone regeneration methods by both scientists and surgeons.ConclusionsTo conclude, this study was conducted through a web-based survey, highlighting a substantial translational gap. It underscores the immediate need (“call to action”) for meaningful interdisciplinary collaboration between surgeons and scientists, often referred to as the need to “walk the talk”. The findings underscore the critical importance of aligning clinical needs, research outcomes, and regulatory frameworks to improve the development and implementation of biomaterial-based bone graft substitutes that demonstrate efficacy and efficiency in bone defect treatment.

Magnesium Membrane Shield Technique for Alveolar Ridge Preservation: Step-by-Step Representative Case Report of Buccal Bone Wall Dehiscence with Clinical and Histological Evaluations

Background/Objectives: Despite the increased use of new resorbable magnesium membranes, there are no reported cases or studies on the use of resorbable magnesium membranes in combination with bone grafts for alveolar ridge preservation (ARP) in cases with severe buccal bone wall dehiscence. This case report aimed to evaluate the effectiveness of the magnesium membrane shield technique in conjunction with bone grafting for ARP, assessing both clinical outcomes and histological bone regeneration. Methods: A 44-year-old female patient presented with a vertical fracture on tooth 24 (FDI Notation System) accompanied with complete destruction of the buccal bone wall. The treatment plan included tooth extraction, ARP using a combination of anorganic bovine bone and autologous bone grafting, and the application of a magnesium membrane as a shield to the pre-existing buccal wall. Six months post-procedure, a bone biopsy was taken from the implant site using a trephine bur. Results: Clinical and radiological evaluations six months after the procedure demonstrated sufficient bone volume for implant placement. Additionally, in the next three months, soft tissue conditioning with a provisional crown resulted in an aesthetically and functionally satisfactory outcome. Histological analysis of the bone biopsy revealed well-formed new bone in direct contact with residual biomaterial, with no signs of inflammation. Osteocytes were clearly visible within the newly formed bone matrix, indicating successful bone maturation. Active osteoblasts were observed along the bone-biomaterial interface, suggesting ongoing bone remodeling and integration. Additionally, histomorphometric evaluation revealed 47% newly formed bone, 32% soft tissue, and 19% residual biomaterial. Conclusions: This case demonstrates the potential of the magnesium shield technique as an ARP technique in cases with severe buccal wall dehiscence. The technique yielded satisfactory clinical outcomes and promoted successful bone regeneration, as confirmed by histological analysis.

The role of autologous bone in cranioplasty. A systematic review of complications and risk factors by using stored bone.

Autologous bone cranioplasty is associated with a high complication rate, particularly infections and bone resorption. Although there are studies on the incidence and risk factors for complications following autologous bone cranioplasty, the study design is typically limited to retrospective analysis with multiple statistical explorations in small cohorts from single centers. Thus, there is a need for systematic analysis of aggregated data to determine the rate and risk factors for cranioplasty complications. To determine the incidence and risk factors for complications after autologous bone cranioplasty. In this systemic review, we conducted a Medline, Embase, Cochrane, and Web of Science search: 11,172 papers were identified. Duplicates were removed and only articles on complications following autologous bone cranioplasty between the years 2000 and 2022 were included. After title, abstract, and article screening, 132 papers were included for further analysis. In total, the 132 studies are based on 13,592 patients (14960 implants). One third of the studies include patients with less than 3 months of postoperative follow-up. Complication management (flap removal, revision without flap removal, and conservative treatment) of infection, bone resorption, and hematoma/seromas are not reported in 19-30% of the studies. In the studies with defined complications management, the overall complication rate is 7.6% (95% Confidence Interval (CI) [7.1-8.2]) for infection, 14.4% (95% CI [13.7-15.2]) for bone resorption with indication for reconstruction, and 5.8%, (95% CI 5.2-6.5) for hematoma/seromas. Factors such as younger age, an extended interval between craniectomy and cranioplasty, the use of a fragmented bone implant, a larger implant size, and shunt treatment are linked to an increased risk of postoperative bone resorption. The lack of consistent definitions of complications, variations in follow-up time, and small study cohorts limit the external validity of many studies. Overall, the rate of bone flap resorption that required reoperation is high, while the rate of infectious complications is comparable to synthetic implants. Thus, autologous bone should preferably be used in cases without strong risk factors for bone necrosis.

Pectoralis Major and Abdominis Rectus Musculocutaneous Flap Reconstruction for Sternal Wound Closure in Ectopia Cordis

Summary: Ectopia cordis is a rare congenital condition resulting in extrathoracic positioning of the heart. The severity of presentation may vary with partial or complete displacement through sternal or diaphragmatic defects. Operative management is typically required, but due to the rarity of the condition, no standard exists for optimal closure. Reconstruction techniques can include compound local flap placement including pectoralis major, rectus abdominis, or latissimus dorsi flaps as well as synthetic material placement, autologous bone, and cartilage grafts to correct sternal deformity. This case report outlines the successful utilization of bilateral composite pectoralis major and rectus abdominal musculocutaneous flaps for complex staged closure of a sternal wound after creation of a cavopulmonary anastomosis in a 5-year-old patient with concomitant single-ventricle congenital heart disease. This single-staged closure after cardiac repair was performed without intra- or postoperative complications, and the patient demonstrated satisfactory healing with stable cardiac coverage at follow-up visit. This technique may present as an effective approach in complex sternal wound closure in patients with ectopia cordis.

Accelerating Fracture Healing in Delayed Uniting Fractures: A Clinical Study

Background: Delayed union fractures pose a significant clinical challenge, often requiring enhanced treatment modalities to accelerate healing and improve patient outcomes. Various techniques, including autologous bone grafting and biologic agents like platelet-rich plasma (PRP) and bone morphogenetic proteins (BMPs), have been employed to stimulate bone regeneration. However, the optimal approach remains debated. Objective: This study aimed to compare the efficacy of autologous bone grafting, biologic agents, and combined therapies in promoting fracture healing, reducing pain, improving functional outcomes, and enhancing patient satisfaction in delayed union fractures. Methods: A prospective study was conducted on 80 patients with delayed union fractures. Patients were randomly assigned to one of four groups: standard care (control), autologous bone grafting, biologic agents (PRP and BMPs), or a combination of bone grafting and biologic agents. Radiographic healing was assessed at 6, 12, and 24 weeks. Pain intensity was measured using the Visual Analog Scale (VAS), functional outcomes were assessed using the AAOS lower limb function scale, and patient satisfaction was evaluated using a Likert scale. Results: The combined therapy group exhibited significantly faster radiographic healing, with 80% of patients showing callus formation at 6 weeks and 95% achieving complete union at 24 weeks, compared to 35% in the control group. The combined group also reported the greatest reduction in VAS pain scores, with a mean decrease from 7.8 to 1.5 at 24 weeks (p&lt;0.001). Functional outcomes were significantly improved in the combined group, with a mean AAOS score of 100 at 24 weeks, compared to 70 in the control group (p&lt;0.001). Additionally, 90% of patients in the combined group reported high satisfaction, compared to 40% in the control group. Conclusion: The combination of autologous bone grafting and biologic agents, such as PRP and BMPs, significantly accelerates ..........

Proximal tibia for alveolar augmentation and augmentative rhinoplasty—a suitable option? A retrospective clinical study on donor and recipient site morbidity

BackgroundAutologous bone grafts are essential in reconstructive oral and maxillofacial surgery, and depending on the donor site, they can be associated with specific harvesting morbidities. One of the most commonly applied bone grafts is the iliac crest bone graft, irrespective of other grafts, which might be associated with an easier surgical procedure or the possibility of harvesting them under local anaesthesia. Objective of the study is the clinical evaluation of proximal tibia bone grafts regarding their eligibility for maxillofacial bone grafting.MethodsIn this retrospective study, proximal tibia bone grafts were examined with regard to associated donor and recipient site morbidity and their suitability for alveolar ridge augmentation and rhinoplasty.ResultsIn total, 21 tibia grafts were included. Fifty-seven percent of the bone grafts were used for alveolar ridge reconstruction, and 43% were used for augmentative rhinoplasty. No significant complications occurred during or after harvesting, but in 14.3% of the patients, minor wound healing disorders were recorded at the donor site, and in 19% of the patients, they were recorded at the recipient site. Statistically, patient sex, age, nicotine and alcohol abuse and metabolic diseases had no significant influence on the complication rate. Graft harvesting under local anaesthesia and at summer temperatures was associated with significantly more complications at the harvesting site (p < 0.05). In cases of dental implant insertion into augmented sites, the implants (n = 31) were followed up for a median period of 40.5 months, during this time 86.7% of the implants survived.ConclusionThe proximal tibia is a suitable donor site for harvesting autologous bone grafts for alveolar ridge augmentation or rhinoplasty because the donor site morbidity is low, and in contrast to iliac crest bone grafts, they can be harvested under local anaesthesia, which might be advantageous for outpatient surgeries.

A Comparative Evaluation of Allogenic Cancellous Particulate Chips and Autologous Bone Graft From Symphysis in the Regeneration of Periodontal Intrabony Defect: A Randomized Controlled Clinico-Radiographic Study

A Comparative Evaluation of Allogenic Cancellous Particulate Chips and Autologous Bone Graft From Symphysis in the Regeneration of Periodontal Intrabony Defect: A Randomized Controlled Clinico-Radiographic Study

New titanium mesh design method in customized bone regeneration of the jaws: preliminary study on a sample of 11 patients

The aim of this study is 1) to present a new method of virtually-designed custom made scaffolds to be employed in customized bone regeneration (CBR) for segmental jaw atrophies and 2) to evaluate long-term clinical results in terms of bone regeneration success and implant rehabilitation success. A total of 11 patients with edentulousness and bone atrophy in a localized area of the mandible or the maxilla were recruited for the study. To fulfill the research inquiries, CT images of the pre-regeneration mandibular or maxillary arch of each patient were collected. A dedicated Mevislab 2.4 software was employed to virtually design custom bone regeneration meshes designed to fit the atrophic sector of each patient's mandible or maxilla. Subsequently, a second Meshmixer software was used to refine the margins of each of the designed meshes. All patients underwent oral surgery, during which a mixture of autologous and heterologous bone in a 1:1 proportion was grafted into the atrophic site, a custom-made mesh was placed, and a resorbable membrane was inserted. The mesh was removed after this procedure, and implant rehabilitation was performed. All patients underwent the bone regeneration procedure, with eight undergoing titanium mesh removal. A total of seven patients completed implant rehabilitation. Average horizontal bone augmentation was 3.525 ± 1.36 mm; average vertical bone augmentation was 4.45 ± 2.22 mm. Implant survival was 92.85%. During the healing phase, complications occurred in 9.09% of patients. The use of dedicated software, Mevislab 2.4 and Meshmixer, for titanium mesh design is an accurate, predictable, effective, and quick-to-use method. The learning curve for design is uncomplicated and rapid. Mesh exposure does not necessarily lead to bone graft failure; this complication can be treated by chlorhexidine aids.

Comparative assessment of the effectiveness of hemapoyesis restoration in patients with multiple myeloma at autologous bone marrow transplantation using frozen and native stem cells

Purpose of the study. To compare the effectiveness and safety of using autologous hematopoietic stem cells without freezing in multiple myeloma.Materials and methods. The study was carried out in the transplantation department of the Republican Scientific and Practical Medical Center of the Ministry of Health of the Republic of Uzbekistan. The study included 82 patients with multiple myeloma who underwent autologous bone marrow transplantation between 2014 and 2020 and was retrospective in nature based on medical records. The patients were divided into 2 groups – I without freezing (40 patients), II – with freezing of stem cells (42 patients). The average age was 47±4.5 years, the male to female ratio was 32 (39%) and 50 (61%), respectively. The timing of hematopoietic restoration, length of hospital stay, viability of hematopoietic cells and 5-year overall and relapse-free survival in both groups were analyzed.Results and discussion. In the study groups, immediately after apheresis of peripheral hematopoietic stem cells, viability was 96-98%. In group I, at the time of administration, the number of living cells in the graft was the same 96-98%, and in group II, at the time of transplantation, viability was at the level of 79-93%, which was associated with cell loss during freezing, thawing and exposure to Dimethylsulfoxide. Also, the use of an unfrozen transplant increased the recovery time of hematopoiesis after transplantation to 11 days, while the frozen transplant was restored by the 15th day. Complications associated with preservative toxicity occurred in group II in 100% of patients. The study did not reveal any difference in 5-year overall and disease-free survival. In group I, relapse-free survival was 63%, in group II -60% (p = 0.2). When assessing overall 5-year survival between groups I and II, there was also no significant difference: 78% and 74% (p = 0.1).Conclusions. The data obtained in the study allow us to conclude that transplantation with non-frozen peripheral hematopoietic stem cells is an effective and safe method and does not have a significant difference when comparing long-term results in cryofrozen peripheral hematopoietic stem cells.

Management of Extradural Dead Space During Cranioplasty—A Scoping Review

Background: Cranioplasty after craniectomy restores cerebral spinal fluid (CSF) flow dynamics, protects the brain from trauma, and restores skull contour. However, post-cranioplasty extradural dead space may persist, leading to infection and necessitating further surgical interventions. The purpose of this scoping review was to identify and analyze the existing peer-reviewed literature discussing the management of extra-dural dead space during cranioplasty. Methods: A systematic review of the literature was performed via searches of Embase, Cochrane, and PubMed in accordance with PRISMA guidelines. Included studies focused on managing extradural dead space in supratentorial cranioplasty using rigid implants or autologous bone. Studies solely using soft tissue repairs or non-primary studies were excluded. Data extraction covered study characteristics, management techniques, complications, and patient outcomes. Results: Out of 2196 articles, 135 underwent full-text review, and 28 were included, discussing 117 patients. Indications for dead space management included intractable infection (86%), syndrome of the trephined (25%), high-volume dead space (18%), persistent CSF leak (18%), and scarred dura (7%). Management techniques included muscle flaps (46%), omental flaps (14%), fat grafts (7%), and placement of non-organic materials (11%). Complications occurred in 32% of studies, including flap failure, hematoma, and CSF leak. Muscle flaps had a 22% complication rate but led to a high rate of infection resolution (97%). Conclusions: Managing extradural dead space with vascularized flaps during cranioplasty can reduce infection risk but may be associated with high complication rates. The lack of standardized practices and limited high-quality studies highlight the need for further research to establish the safety, efficacy, and best patient selection criteria for these techniques.

Talar head replacement for treatment of Müller – Weiss syndrome: three clinical cases

Introduction Müller – Weiss syndrome is a rare condition that is characterized by avascular necrosis of the navicular bone leading to severe foot deformity, pain disturbing activities of daily living. There is no generally accepted treatment for avascular necrosis of the scaphoid, and the available treatments have disadvantages, which necessitates the need for new options.The objective was to present short-term results of three patients with osteonecrosis of the scaphoid and local necrosis of the talar head treated with ceramic talar head prosthesis, plastic surgery, metal osteosynthesis of the scaphoid and related surgical techniques.Material and methods Three patients diagnosed with Müller – Weiss syndrome were treated with ceramic talar head replacement, autologous bone grafting and metal osteosynthesis of the scaphoid bone with accompanying surgical techniques. Severity of pain and the condition of patients were assessed with the VAS and AOFAS AH scores.Results Short-term results showed consolidation at the site of metal osteosynthesis in all patients with no signs of instability of the talus hemiprosthesis. VAS and AOFAS AH scores indicated decrease in the pain and improved condition of the patients.Discussion Hemiarthroplasty of the talar head combined with plastic surgery and restoration of a congruent joint surface of the scaphoid, and associated surgical techniques may become an effective alternative to existing treatments for patients with Müller – Weiss syndrome, with further study.Conclusion The short-term findings showed that hemiarthroplasty was practical for restoration of the talonavicular mobility maintaining stable fixation of the talus.

P09.02.A A WINDOW TO THE BRAIN: MONITORING THE HUMAN BRAIN USING FUNCTIONAL ULTRASOUND (FUS)-IMAGING IN FREELY MOVING SUBJECTS WITH AN ACOUSTICALLY FAVORABLE SKULL IMPLANT

Abstract BACKGROUND To this day, the mainstay of human neuroimaging remains (functional) Magnetic Resonance Imaging (fMRI), where subjects are asked to lie completely still and silent in a noisy scanner. Many key questions in clinical care and neuroscience remain poorly studied because of fMRI’s inability to facilitate natural behavior such as locomotion or even verbal speech. What is more, due to the cost and size of an (f)MRI-machine, monitoring of morphological (i.e. tumor regrowth) or functional changes in the human brain, pre- and post-tumor resection, is often spread out over intervals of many months, leaving patients in suspense about possible tumor regrowth.With the advent of ultrafast ultrasound imaging, a new high-resolution, depth-resolved and mobile neuro-imaging technique called functional Ultrasound (fUS) has emerged. In the last decade, fUS has been applied successfully in awake neurosurgical contexts to map out hemodynamics-based functional brain activity as well as tumor tissue at a mesoscopic scale. However, given the significant aberration of ultrasound signal through human skull bone, fUS is not available outside of OR as of yet. As a first step outside of the OR, we aimed to apply fUS in freely moving subjects with a skull bone defect covered by PEEK, an acoustically favorable material. MATERIAL AND METHODS Two subjects with PEEK-implants were repeatedly imaged over a period of &amp;gt;1 year. One of the subjects received a PEEK-implant after infection of the autologous bone, post-resection of an astrocytoma. Each subject received a custom-fitted 3D-printed helmet based on their MRI to fixate the probe and to attach the geometry needed for optical tracking. Using an optical tracking camera, the position of the Power Doppler Image (PDI) relative to CT/(f)MRI-volumes of the subject could be determined in real-time. Images were acquired using an experimental research system (Vantage-256, Verasonics) interfaced with a 9L-D linear array (GE, 5.3 MHz). All scans were acquired with a PRF of 800 Hz. The PDIs and angle compounded beamformed frames were stored for offline processing, consisting of 3D-vascular reconstructions and functional mapping. Functional tasks focused on the sensorimotor area of the lip. For measurements outside of the lab, the acquisition system was transformed into a mobile cart, which could be pushed by the subject itself. RESULTS Trans-PEEK imaging resulted in PDIs with highly detailed vasculature of healthy brain tissue and the resection cavity, up to several centimeters in-depth, reproduced reliably over a period of &amp;gt;12 months. In sedentary, standing and walking conditions, we were able to produce consistent functional maps of the human brain. CONCLUSION Our current work demonstrates how fUS has the potential to become a powerful window to the brain, both in terms of vascular monitoring of tumor regrowth, as well as functional brain mapping, outside of the operating room.