Direct Grafting Research Articles

Review/Perspective: Incidence and treatment of CSF leaks/dural tears (DT) occurring during anterior cervical surgery

Background: The incidence of cerebrospinal fluid (CSF) leaks/dural tears (DT) occurring during anterior cervical diskectomy and fusion (ACDF) are typically relatively low. However, this frequency markedly increases when anterior corpectomy and fusion (ACF) are performed to address ossification of the posterior longitudinal ligament (OPLL). Methods: The reported frequencies of CSF leaks/DT occurring during elective ACDF (i.e. exclusive of trauma), ranges from 0.24% to 1.7%. Notably, this incidence substantially rises for multilevel ACF addressing anterior OPLL, markedly varying from 3.4 - 44.7%. Results: The classical risks of anterior cervical CSF leaks/DT with anterior cervical surgery may be minimized utilizing an operating microscope. For OPLL, careful evaluation of preoperative non-contrast CT studies is critical, especially to document whether any of the 3 signs of dural penetrance is present. Here, posterior operative choices should be strongly considered in the presence of sufficient lordosis and/or a Positive K Line (+ K Line) as this will avoid an anterior cervical CSF leak/dural fistula. Alternatively, for patients with kyphosis and a Negative K Line (- K Line), preoperative anticipation and planning to treat an intraoperative anterior CSF leak/DT (i.e. direct anterior primary dural graft repair with 7-0 Gore-Tex sutures, microdural staples, microfibrillar collagen, wound-peritoneal shunt, and lumbar drain or lumboperitneal shunt) are essential in the course of performing direct anterior OPLL resection. Conclusion: The incidence of anterior cervical CSF leaks/DT is relatively low (i.e. range 0.24 - 1.7%) where ACDF is performed for disc disease/spur/spondylosis exclusive of OPLL. However, where ACF is performed for multilevel OPLL, the risk of CSF Leaks/DT is substantially higher (i.e. range 4.3-44.7%).

Easy Direct Functionalization of 2D MoS2 Applied in Covalent Hybrids with PANI as Dual Blend Supercapacitive Materials

AbstractThe pressing demand for more sustainable energy provision and the ongoing transition toward renewable resources underline the critical need for effective energy storage solutions. To address this challenge, scientists persistently explore new compounds and hybrids and, in such a dynamic research field, 2D materials, particularly transition metal di‐chalcogenides (TMDCs), show great potential for electrochemical energy storage uses. Simultaneously, also conductive polymers (CPs) are interesting and versatile supercapacitor materials, especially polyaniline (PANI), which is extensively studied for this purpose. In this work, a powerful method to combine TMDCs and PANI into covalently grafted hybrids starting from aniline functionalized few‐layers 1T‐MoS2, attained by a facile direct arylation with iodoaniline, is presented. The hybrids provide circa 70 F g−1 specific capacitance in a pseudo device setup, coupled with a robust capacitance retention of well over 80% for up to 5000 cycles. These findings demonstrate the potential of similar covalent composites to work as active components for novel, innovative energy storage technologies. At the same time, the successful synthesis marks the efficacy of direct covalent grafting of conductive polymer on the surface of 2D TMDCs for stable functional materials.

Enhanced SERS performance of gold nanoparticle assemblies on a cysteine-mutant Tobacco mosaic virus scaffold

The employment of biomolecular templates for the synthesizing nanohybrid constructs is expanding, driven by their prospective uses in biosensing and biomedical fields. Gold nanoparticles (AuNPs) and, in particular, their assemblies are especially preferred for Surface Enhanced Raman Spectroscopy (SERS) because of their ability to amplify Raman signals through localized surface plasmon resonances, thus enabling the detection of molecules at exceedingly low concentrations. Our investigative approach is dedicated to studing the role of cysteine mutants in the nucleation and assembly of AuNPs on Tobacco mosaic virus (TMV-C, carrying T158C mutation) scaffolds. Employing biomineralization and direct grafting methods, we synthesized these nanohybrids and examined them using conventional transmission electron microscopy (TEM), in situ liquid TEM, and fluorescence spectroscopy. We demonstrated that the syntheses obtained with TMV-C give denser plasmonic nanostructures, with is ideal for SERS applications. The SERS performances of these novel nanohybrids with various AuNPs sizes and densities were evaluated, revealing excellent enhancement factors for the nanosystems obtained by direct grafting that highlight their potential for the detection of biomolecules in solution.

Direct anterior bone block grafting for treatment of bone defects and dysplasia of the coronoid process

The aim of the surgery was to treat an elbow instability caused by critical coronoid bone loss (CCBL), lateral ulnar collateral ligament (LUCL) insufficiency,and general hyperlaxity by performing adirect anterior coronoid bone graft (CBG) and LUCL reconstruction in the same setting. In cases with CCBL isolated ligament reconstruction harbors ahigh failure rate, necessitating supplementary bony procedures. The diagnosis of CCBL is confirmed through lateral radiographs and further quantified through computed tomography (CT) imaging. Objective assessment of instability is conducted with standardized arthroscopic tests. Performing an anterior approach for CBG offers distinct advantages, notably in terms of achieving precise positioning of plates and screws and providing access to the proximal radioulnar joint. Usual contraindications to surgery, coronoid bone loss less than 40%. The surgical procedure is thoroughly illustrated with avideo of the operation that can be accessed online: reconstruction of the LUCL with asemitendinosus allograft, harvesting of the graft from the iliac crest, exposure of the coronoid process with adirect anterior approach, freshening up of the graft bed. Temporary fixation of the graft with aKirschner wire. Assessment of joint congruency, stability and range of motion (ROM) prior to definitive fixation with a2.4 mm buttress plate and screws. Nonsteroidal anti-inflammatory drugs (NSAID) to prevent heterotopic ossification. Elbow mobilization in pronation from day1 with an overhead motion protocol. Removable splint for 4weeks, free mobilization at 6weeks, return to sport at 3months. Durable elbow stability was achieved along with free ROM and high patient satisfaction.

Durable, transparent and superhydrophobic coating with temperature-controlled dual-scale roughness by self-assembled raspberry nanoparticles

This study focuses on creating a superhydrophobic, durable, and exceptionally transparent coating with dual-scale roughness by naturally formed raspberry-like particles. This approach facilitates the management of surface roughness at both single and dual scales through variations in surface functionalization temperature. We illustrated that adjusting the temperature of organosilanes functionalization on the surface allows for various reactions, such as the direct grafting of metallic precursors or their polymerization on the surface, resulting in the formation of large raspberry-like particles.We investigated the impact of nanoparticle concentration, functionalization duration, and reaction temperature on surface properties. Our results reveal that a concentration of 1.5 % SiO2 nanoparticles, combined with surface functionalization using TCMS for 4 h at 3 °C, provides the optimal conditions for creating a surface that combines superhydrophobicity, transparency, and acceptable durability. The resulting surface exhibits an impressive contact angle of 158.9°, a sliding angle of 2°, and a transmittance rate of 82 %.Furthermore, the coating demonstrates remarkable resistance to abrasion for up to 35 cycles and can withstand temperatures up to 280 °C. It also offers enhanced protection against UV radiation for 50 h and improved resistance to sand abrasion for up to 30 s, enduring bombardment pressures of up to 6 bars. Moreover, the coating presents several advantages in terms of surface cleaning.

Amino‐functionalized nano‐hydroxyapatite boosts the grafting efficiency of poly (l‐lactic acid) to enhance interfacial bonding in composite bone scaffold

AbstractNano‐hydroxyapatite (nano‐HAP)/poly (l‐lactic acid) (PLLA) bone scaffold is expected to overcome the deficiencies and achieve the complementary advantages of individual constituents, but the weak interfacial bonding due to their thermodynamic incompatibility is detrimental to the mechanical properties. Herein, the PLLA chains were grafted onto nano‐HAP with 3‐aminopropyltriethoxysilane (KH550) as a coupling reagent to enhance the interfacial bonding with PLLA. Specifically, the silicon hydroxyl group produced by KH550 hydrolysis could form covalent bonding with the hydroxyl group of nano‐HAP, and the amino group of KH550 initiated the ring‐opening polymerization of l‐lactide monomers to graft PLLA chains onto nano‐HAP more effectively, leading to a higher grafting ratio of 16.7% compared with 7.2% in direct grafting without KH550 modification. Consequently, the tensile and compressive strength of the modified nano‐HAP/PLLA scaffold were improved by 40.8% and 59.5% enhancement due to the enhanced interfacial bonding in the composite scaffold, respectively, compared to the original nano‐HAP/PLLA scaffold. Additionally, the bone scaffold was conducive to cell adhesion and proliferation, making it an ideal candidate for bone defect repair.Highlights Amino‐functionalized nano‐HAP boosted the grafting efficiency of PLLA chains. Interfacial bonding between nano‐HAP and matrix was enhanced. Bone scaffold showed better mechanical properties and benign cytocompatibility.

Fournier's Gangrene Surgical Reconstruction: A Systematic Review.

Fournier's gangrene (FG) is a rare form of necrotizing fasciitis of the perineal, genital, or perianal region. It is characterized by an aggressive course and high mortality rate, over 20%. FG demands immediate treatment including resuscitation maneuvers, intravenous antibiotic therapy and early surgical debridement. Background/Objectives: The gold-standard treatment for FG is surgical reconstruction. However, up to date, no precise guidelines exist. Thus, we decided to systematically review the literature, focusing on FG contemporary approaches to reconstructive surgery, aiming to analyze the various reconstructive strategies and their specific indications. Methods: A systematic review was carried out according to the PRISMA statement by searching various databases from April 2014 to April 2024, using the terms ''Fournier Gangrene OR Fournier Gangrene Reconstruction OR Fournier Gangrene Treatment OR Fournier Gangrene Plastic Surgery OR Necrotizing Fasciitis OR Necrotizing Fasciitis AND Reconstruction". The eligibility criteria included original studies aimed at discussing FG reconstruction with at least three clinical cases. Results: The final synthesis included 38 articles, and 576 reconstructions were described. Of these, 77.6% were minimally invasive strategies (direct closure, secondary healing, grafts, and local random flaps), while more invasive reconstructions (loco-regional flaps based on known vascular anatomy) were adopted in 22.4%. No free flaps were reported. Conclusions: FG requires immediate medical interventions including broad-spectrum antibiotic therapy, surgical debridement, adjuvant therapies, and reconstructive surgeries. Taking into account the anatomical characteristics of the inguinal-crural region, skin grafts and local random flaps could offer versatile and effective reconstructions for most FG cases, while the more invasive strategies should be reserved for very few cases. Future research is warranted to define an FG dedicated reconstruction protocol.

Attenuated angiogenesis and macrophage infiltration during adipose tissue regeneration in a megavolume human fat grafting nude mouse model.

Survival and regeneration mechanisms of large (>250 mL) fat grafts remain incompletely understood. In fat grafts from volunteers with megavolume fat transfer breast augmentation, neovascularization and inflammatory cell infiltration decreased within 7 days according to histological analysis. We further investigated this phenomenon using a nude mouse model. To simulate clinical contexts, chambers containing 1 mL human fat were implanted into nude mice. Chambers allowed selective transfer of tissue fluid from recipient nude mice into chambers, but not capillaries or macrophages. Seven days later, fat was removed from the chamber and reimplanted into a new nude mouse in the open-chambered fat group (OCFG, n=45). Adipose samples from volunteers and explanted grafts from OCFG were subjected to histological analyses. Graft weight, vascularization, and immune response were also compared between the OCFG and conventional direct fat grafting (control group (CG)). Percent tissue integrity, percent fibrosis, adipocyte viability, and neovascularization did not significantly differ between volunteer samples and OCFG grafts at day 7. On day 90, OCFG retention rate was decreased relative to CG and the fibrosis area was larger in the OCFG than in the CG. However, the macrophage and capillary counts were lower in the OCFG group relative to CG at days 7 and 14 after transplantation. The present study provides histological analyses of megavolume fat grafts sampled from clinical breast augmentation tissues and a xenograft nude mouse model. However, these preliminary results in a small clinical cohort should be further assessed in large allogeneic animal models.

The Comparison between Direct Graft Fixation using a Biotenodesis Screw Combined with Early Mobilization versus a Traditional Knot Fixation with 6-Week Immobilization of Adams–Berger Triangular Fibrocartilage Complex Reconstruction

AbstractSeveral surgical techniques exist for triangular fibrocartilage complex (TFCC) reconstruction, one being the Adams–Berger technique. Direct graft fixation is an emerging option for this reconstructive technique. This study compared the outcomes of TFCC reconstruction according to the Adams–Berger technique using direct graft fixation with a biotenodesis screw and early mobilization against the traditional knot technique with a 6- week cast immobilization. Results demonstrated that the direct fixation technique with early mobilization led to significantly higher patient satisfaction and earlier return to work. A more rapid recovery of range of motion and grip strength, as well as reduced pain intensity, was also noted. The study supports the effectiveness of direct graft fixation with a biotenodesis screw and early mobilization in TFCC reconstruction, offering improved patient outcomes and potentially reducing health care costs. Further research with larger sample sizes is warranted to reconfirm these findings.

3D Lipogluing: Preliminary Results of a Novel Technique for Direct Three-dimensional Fat Grafting in Breast Reconstruction Surgery.

Lipofilling has emerged as an effective technique in breast reconstruction for enhancing aesthetic outcomes and addressing residual deformities. Traditionally, fat grafting has been performed as a secondary step in implant-based breast reconstruction during the replacement of the expander with a breast implant or as a revisional procedure. Our study investigates the technical feasibility and presents preliminary results of a new promising technique for delivering fat grafting in a three-dimensional (3D) shape, directly during mastectomy with immediate breast reconstruction or in delayed breast reconstructive procedures. Our new 3D lipogluing technique involves securing the fat tissue in a 3D manner using fibrin glue. This method enhances the coverage of soft tissues and provides improved volume and shape supplementation. In selected cases between December 2015 and September 2023, we treated 24 patients using the 3D lipogluing technique and five patients using 3D lipocubing (without use of fibrin glue).The patient cohort consisted of different indications for breast reconstructions: direct-to-implant, expander-based breast reconstruction, and "conservative" surgery. Preliminary findings suggest the technique is a safe and effective approach that can enhance the soft-tissue envelope of reconstructed breasts by acting as an autologous scaffold, owing to its regenerative properties. This technique not only improves the overall aesthetic outcome but also has the potential to reduce implant-related complications. Furthermore, ongoing studies are investigating methods to optimize the results and explore the potential application of 3D lipogluing and 3D lipocubing in breast-conserving oncoplastic surgery, cosmetic breast surgery, and other areas of plastic reconstructive and aesthetic surgery.

Li6.28La3Zr2Al0.24O12-reinforced Single-ion Conducting Composite Polymer Electrolyte for Room-Temperature Li-Metal Batteries

Composite polymer electrolytes composed of inorganic fillers and organic polymers are promising electrolyte candidates for Li metal batteries, with benefits of improved safety and suppressed lithium dendrite growth. However, a severe concentration polarization effect often occurs when using conventional dual-ion electrolytes, and the increase in internal impedance during cycling results in decreased lifespan of the battery. To address this challenge, a plasticized single-ion conducting composite polymer electrolyte (SICE) was designed and fabricated by polymerizing the monomers of lithium (4-styrenesulfonyl) (trifluoromethanesulfonyl) imide (LiSTFSI) and poly(ethylene glycol) methyl ether acrylate (PEGMEA), crosslinker poly(ethylene glycol) diacrylate (PEGDA), silane-modified Li6.28La3Al0.24Zr2O12 nanofibers (s@LLAZO NFs), along with a PEG-based plasticizer tetraethylene glycol dimethyl ether (TEGDME), by heat-initiation. The anions were restrained and delocalized so that only Li cation migration occurred during the charging/discharging process, leading to a superior lithium-ion transference number. The s@LLAZO NFs enabled direct monomer grafting with the polymer matrix, resulting in controlled formation of an organic-inorganic network with increased filler content and improved filler distribution in the SICE system. The SICE membrane exhibited high ionic conductivity at room temperature, reduced activation energy and excellent oxidation stability. Most importantly, the all-solid-state Li-metal batteries assembled with the fabricated SICE demonstrated stable long-term cycling performance and remarkable rate capability at room temperature.

The Heel Complex: Anatomy, Imaging, Pathologic Conditions, and Treatment.

The differential diagnosis for heel pain is broad but primarily involves abnormalities of the Achilles tendon, calcaneus, and plantar fascia. Achilles tendon disorders include tendinosis, tendinitis, and partial or complete tears. Tendinosis refers to tendon degeneration, while tendinitis is inflammation after acute overload. Untreated tendinosis can progress to partial or complete tears. Tendon disorders can be accompanied by paratenonitis or inflammation of the loose sheath enclosing the tendon. Initial management involves rehabilitation and image-guided procedures. Operative management is reserved for tendon tears and includes direct repair, tendon transfer, and graft reconstruction. The calcaneus is the most commonly fractured tarsal bone. The majority of fractures are intra-articular; extra-articular fractures, stress or insufficiency fractures, medial process avulsion, and neuropathic avulsion can also occur. Posterosuperior calcaneal exostosis or Haglund deformity, retrocalcaneal bursitis, and insertional Achilles tendinosis form the characteristic triad of Haglund syndrome. It is initially managed with orthotics and physiotherapy. Operative management aims to correct osseous or soft-tissue derangements. The plantar fascia is a strong fibrous tissue that invests the sole of the foot and contributes to midfoot stability. Inflammation or plantar fasciitis is the most common cause of heel pain and can be related to overuse or mechanical causes. Acute rupture is less common but can occur in preexisting plantar fasciitis. Conservative treatment includes footwear modification, calf stretches, and percutaneous procedures. The main operative treatment is plantar fasciotomy. Plantar fibromatosis is a benign fibroblastic proliferation within the fascia that can be locally aggressive and is prone to recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Efficient Approach for Direct Robust Surface Grafting of Polyethyleneimine onto a Polyester Surface during Moulding.

This paper uses a very effective way for surface modification of thermoplastic polymers during moulding. It is based on a grafting reaction between a thin layer of a functional polymer, deposited on a substrate in advance, and a polymer melt. In this paper, a glycol-modified polyethylene terephthalate (PETG) that was brought in contact with a polyethyleneimine layer during fused filament fabrication is investigated. The focus of this paper is the investigation of the reaction product. Grafting was realised by the formation of stable amide bonds by amidation of ester groups in the main chain of a PETG. XPS investigations revealed that the conversion of amino groups was very high, the distribution was even, and the quantity of amino groups per polyester surface area was still very high. The surface properties of the produced polyester part were mainly characterised by polyethyleneimine. The grafting was able to resist several cycles of extraction in alkaline solutions. The stability was only limited by saponification of the polyester. The degree of surface modification was dependent on the molar mass of polyethyleneimine. This could be rationalised, because grafting only occurred with the one polyethyleneimine molecule that is in close vicinity to the polyester surface when both components come in contact. Fused deposition modelling was chosen as the model process with control over each processing step. However, any other moulding process may be applied, particularly injection moulding for mass production.

Distal nerve transfers for peripheral nerve injuries: indications and outcomes.

Distal nerve transfer is a refined surgical technique involving the redirection of healthy sacrificable nerves from one part of the body to reinstate function in another area afflicted by paralysis or injury. This approach is particularly valuable when the original nerves are extensively damaged and standard repair methods, such as direct suturing or grafting, may be insufficient. As the nerve coaptation is close to the recipient muscles or skin, distal nerve transfers reduce the time to reinnervation. The harvesting of nerves for transfer should usually result in minimal or no donor morbidity, as any anticipated loss of function is compensated for by adjacent muscles or overlapping cutaneous territory. Recent years have witnessed notable progress in nerve transfer procedures, markedly enhancing the outcomes of upper limb reconstruction for conditions encompassing peripheral nerve, brachial plexus and spinal cord injuries.

ПРОГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ ПОКАЗАТЕЛЕЙ ДИНАМИКИ КОНЦЕНТРАЦИИ ТРОПОНИНА I ПОСЛЕ ВЫПОЛНЕНИЯ КОРОНАРНОГО ШУНТИРОВАНИЯ В УСЛОВИЯХ РАБОТАЮЩЕГО СЕРДЦА И ГИБРИДНОЙ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА

Objective. To assess the prognostic significance of dynamic indicators of troponin I concentration after off-pump coronary artery bypass grafting (CABG) and hybrid myocardial revascularization (HMR) and identification of factors influencing the development of postoperative complications. Methods. The prospective single-center randomized comparative study included 180 patients with multifocal coronary artery disease. Group 1 (n = 98) consisted of patients who underwent off-pump CABG. Group 2 (n = 82) included patients who underwent hybrid myocardial revascularization. HMR consisted of two stages. The 1st stage was minimally invasive direct mammary coronary bypass grafting with access through a left minithoracotomy. The 2nd stage, 1–3 days after the open surgery, was percutaneous coronary intervention using drug-eluting stents. Results. The highest concentrations of Tn and AUC Tn after CABG are characteristic of patients with a peak content of the cardiac marker in the bloodstream 24 hours after surgery, which indicates a longer and more intense release of it into the bloodstream after surgery. Prognostically unfavorable for patients who have undergone CABG is an increase in the concentration of Tn by 12 hours after surgery (Tn 12in /Tn in ) by 68 times or more. Patients with Tn 12 /Tn in ≥ 68 have a sharply reduced event-free survival within 12 months after CABG (p = 0.001). Patients with a combination of Tn 12 /Tn in ≥ 68 and a late peak Tn concentration are at high risk of adverse clinical outcomes after CABG. A high level of Tn by 24 hours after breast cancer is associated with impaired carbohydrate metabolism: the presence of type 2 diabetes (r pb = 0.41), BMI (r pb = 0.33), preoperative concentrations of glucose (r pb = 0.35) and glycated hemoglobin (r pb = 0.41). Prognostic criteria for a Tn concentration of more than 0.2 ng/ml by 24 hours after breast cancer are the presence of CKD and the number of stented arteries in patients with elevated levels of glycated hemoglobin. Conclusion. With unidirectional changes in the concentration of highly-sensitive Tn I after CABG and HMR, a less pronounced release of the cardiomarker into the bloodstream in patients after HMR indicates less myocardial trauma during hybrid myocardial revascularization.

Direct Anterior Bone Block Grafting for Coronoid Bone Loss and Dysplasia

Background: Critical coronoid bone loss (CCBL) can be the key factor of elbow instability, making bony reconstruction essential. Coronoid bone grafting (CBG) is challenging, with a paucity of descriptions in the literature. We present direct anterior CBG in a patient with instability, CCBL (>40%), lateral ulnar collateral ligament (LUCL) insufficiency, and ligamentous laxity who underwent LUCL reconstruction in the same setting. Indications: Isolated ligament reconstruction has a high failure rate in cases with CCBL and therefore requires additional bone grafting. The diagnosis of CCBL is made with lateral radiographs and further quantified by computed tomography imaging. Instability can be best assessed objectively during arthroscopy with a switching stick. CBG performed with an anterior approach facilitates direct access with advantages for plate and screw positioning and access to the proximal radio-ulnar joint. Technique Description: First, LUCL reconstruction was performed. After harvesting of the graft from the iliac crest, the coronoid was exposed with a direct anterior approach. The incision starts centrally medial to the biceps tendon (BT) in the flexion crease extending distally (9 cm). Ligation of multiple vessels (leash of Henry) is required. The deep dissection is continued between the bicipital aponeurosis and BT. Blunt and flat Langenbeck-type retractors are used with care, laterally (BT/radial nerve) and medially (aponeurosis/median nerve). The brachialis muscle is exposed and longitudinally split in line with its fibers, gaining access to the capsule. Harmful retraction on either side of the split has to be avoided. The capsule is incised as a Z-plasty, the coronoid exposed from the joint in the distal direction prior to freshening up the graft bed. The graft is held in place with a wire joystick, sculpted, and temporarily fixed. Joint congruency, stability, and a range of motion (ROM) are checked prior to definitive fixation with a 2.4-mm buttress plate and screws. Results: The coronoid process height was successfully reconstructed from <60% to 100% with durable elbow stability (>1 year), free ROM, and high patient satisfaction. Conclusion: CBG can be standardized and facilitated with a direct anterior approach as a key element for successful elbow stabilization in the setting of CCBL. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

RAFT Polymerisation by the Radical Decarboxylation of Carboxylic Acids.

The controlled grafting of polymers from small- and macro-molecular substrates is an essential process for many advanced polymer applications. This usually requires the pre-functionalisation of substrates with an appropriate functional group, such as a RAFT agent or ATRP initiator, which requires additional synthetic steps. In this paper, we describe the direct grafting of RAFT polymers from carboxylate containing small molecules and polymers via photochemical radical decarboxylation. This method utilises the innate functional groups present in the substrates, and achieves efficient polymer initiation in a single step with excellent control of molecular weight and dispersity.

RAFT Polymerisation by the Radical Decarboxylation of Carboxylic Acids**

AbstractThe controlled grafting of polymers from small‐ and macro‐molecular substrates is an essential process for many advanced polymer applications. This usually requires the pre‐functionalisation of substrates with an appropriate functional group, such as a RAFT agent or ATRP initiator, which requires additional synthetic steps. In this paper, we describe the direct grafting of RAFT polymers from carboxylate containing small molecules and polymers via photochemical radical decarboxylation. This method utilises the innate functional groups present in the substrates, and achieves efficient polymer initiation in a single step with excellent control of molecular weight and dispersity.

Rerouting bei Infektionen des vaskulären Zugangs unter Verwendung eines biosynthetischen Gefäßtransplantats (Omniflow® II)

Abstract Background Surgical treatment of infected arteriovenous grafts (AVG) while preserving the hemodialysis access remains a challenge. Partial graft excision (PGE) directly followed by interposition grafting (IG) is an established method but is associated with a high rate of local reinfection. This retrospective study investigated the technique of rerouting using a biosynthetic vascular graft (Omniflow® II). Methods This was a retrospective analysis of all patients at a tertiary referral center undergoing surgical treatment for AVG infections using PGE and IG with the rerouting technique using Omniflow® II between January 2009 and December 2018. Follow-up data were collected until May 2021. Results Fifteen patients (53% male, median age 62 years [range 49-81]) were identified for further analysis, thereof twelve received an Omniflow® II vascular graft. Eleven patients had positive local microbial cultures, with Staphylococcus aureus being the most frequently identified pathogen (9 cases). Mortality and reoperation rates within 30 days were both 0%. Median follow-up was 32 months (range 2–101 months) with a median follow-up index of 0.92 (range 0.18–1). During follow-up a surgical intervention for reinfection was necessary in 3 patients with Omniflow® II at a median of 304 days (range 298–485 days). Conclusion Partial graft excision and direct interposition grafting using a biosynthetic Omniflow® II vascular graft is a valid treatment option in selected patients with AVG infections when total graft excision can be avoided. Using a careful rerouting technique, while preserving clinically noninfected graft sections the risk of early reinfection can be minimized and the dialysis access maintained.

Updates in peripheral nerve surgery of the upper extremity: diagnosis and treatment options.

The loss of function resulting from peripheral nerve injuries confers a significant burden to the patient and society. The treatment of peripheral nerve injuries requires an accurate diagnosis and formulation of a functional reconstructive plan. Advances in peripheral nerve imaging complement electrodiagnostic studies, and provide us with detailed information regarding the status of nerve injury, repair, and regeneration in order to prognosticate recovery and determine the need for surgical intervention. When direct nerve repair is not possible, the methods for bridging a nerve gap are the nerve autograft, allograft and conduit. While current research supports the use of conduits and nerve allografts for shorter nerve gaps, the nerve autograft still remains the gold standard for bridging a nerve gap. When direct nerve repair or nerve grafting fails, or is anticipated to be insufficient, nerve transfers are an alternative for reconstruction. Knowledge of axonal counts, upper limb innervation patterns, location and clustering of upper limb peripheral nerves allows for the design of new nerve transfers. The options of nerve transfers for radial, ulnar and median nerve injuries are outlined, as well as their outcomes. Nerve transfers are an attractive option for restoring motor and sensory function while minimizing donor site morbidity. However, one must consider their limitations, and preserve donor sites for secondary tendon transfer options. This article presents the latest information regarding the imaging of peripheral nerves, methods to bridge a nerve gap, and nerve transfers to aid the peripheral nerve surgeon in choosing a reconstructive plan.