Donor Area Research Articles

Outcome of Perforator Based VY Advancement Fasciocutaneous Flap for Sacral Pressure Sore Reconstruction

Background: Pressure sores are an ancient medical problem; were even found in autopsies of Egyptian mummies. Sacral pressure sore is more common among paraplegic and bedridden patients. The principle of treatment is excision of all dead & devitalized tissue including scars, underlying bursa, and the involved bone, followed by durable coverage with Flap. Various flaps have been used to reconstruct the pressure sore, including Fasciocutaneous flaps, muscle flaps and free flaps. Among various local flaps, perforators based V-Y advancement fasciocutaneous flap is a reasonable and flexible option with good outcomes for sacral pressure sores reconstruction. Objectives: The purpose of this study was to evaluate the outcome of perforator based V-Y advancement fasciocutaneous flap for sacral pressure sores reconstruction concerning the sociodemographic characteristics of the patients, defect size, and outcome of surgery. Methods: This was a prospective observational study, conducted in the Burn & Plastic Surgery department of Rangpur Medical College Hospital, Rangpur over a period of three years from August 2018 to September 2021 through purposive sampling. Patients of all ages and sexes having grade IV sacral pressure sores were included in this study. In all cases, perforator- based V-Y advancement fasciocutaneous flaps were used. Surgical technique, patient demographics, and outcome were evaluated. Results: A total of 30 patients were operated on. The age range was 18 – 65 years, among them 43.33% of patients were in the age range of 31 – 40 years. 80% of patients in this series were male. Traumatic paraplegia was the main cause of sacral pressure sore, and it was 70%. This study showed that in context to the length and breadth of the wound, a majority (30%) of the patients had a wound dimension of 71–90cm2. The smallest wound dimension was (5x6) = 30cm2 and largest wound dimension was (10x16) = 160cm2. Twenty-one sores that ranged from 6cm to 10cm were reconstructed with unilateral flaps and 09 sores that ranged from 11cm to 16cm were reconstructed with bilateral flaps. In this study, 06 (20%) patients had complications and all were managed conservatively. Three patients had infections and were treated according to the culture sensitivity report. Two patients had marginal flap necrosis at the vertical limb of Y which healed conservatively. One patient developed a seroma due to a blockage of the drain tube, which was resolved spontaneously. There was no flap loss in our study. The average follow-up period was one year. No recurrence of pressure sore during this period. Conclusion: The simplicity of the surgical procedure, minimum or no morbidity in the donor area, and satisfactory outcome in terms of recurrence make this a reasonable option for the reconstruction of the sacral pressure sore. J Rang Med Col. September 2023; Vol. 8, No. 2: 20-24

Application of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose

To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose. The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed. Among them, there were 13 males and 5 females, the age ranged from 43 to 81 years, with an average of 63 years. There were 3 cases of nasal trauma, 4 cases of basal cell carcinoma, 8 cases of squamous cell carcinoma, 1 case of lymphoma, and 2 cases of large area solar keratosis. The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm; the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm, and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm. One patient developed skin flap necrosis after operation, and a frontal skin flap was used to repair the wound; 1 case gradually improved after removing some sutures due to venous congestion in the skin flap, and the wound healing was delayed after dressing change; the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention, without any "cat ear" malformation. All 18 patients had first intention healing in the donor area, leaving linear scars without obvious scar hyperplasia, and no facial organ displacement. All patients were followed up 3-12 months, with an average of 6 months. Due to the appropriate thickness of the flap, none of the 18 patients underwent secondary flap thinning surgery. All flaps had good blood circulation, similar texture and color to surrounding tissues, symmetrical bilateral nasolabial sulcus, and high patient satisfaction. The bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function, and the operation is relatively simple, with high patient satisfaction.

Outcomes of antegrade homodigital neurovascular island flap in fingertip amputations

BackgroundAntegrade homodigital neurovascular island flap (AHIF) is one of the methods used in fingertip amputations to cover the defect area, preserve finger length and obtain a painless and sensitive fingertip. The aim of this study was to evaluate the functional and sensory outcomes in patients who underwent AHIF for fingertip amputation and to analyze the relationship between patient satisfaction and outcome measures. MethodsTwenty patients with a mean age of 37 (18–63) years were analyzed retrospectively. The patients were evaluated in terms of hook nail development, active interphalangeal joint movements, cold intolerance, and sensory function of the flap covered area. Static two-point discrimination test and Semmes Weinstein monofilament test were performed for sensory evaluation. ResultsAll flaps survived completely at the end of follow-up (mean, 36 months; range 11–64 months). Five patients had cold intolerance and two had hook nails. In total, proximal interphalangeal or distal interphalangeal joint flexion contracture developed in 25 % of the patients. The mean static two-point discrimination score was 4.6 ± 1.6 (2–8) and Semmes–Weinstein monofilament test score was 3.48 ± 0.6 (2.44–4.17). Subjective satisfaction levels of the patients were found to be high and did not show a statistical relationship with the measured clinical outcome parameters (p > 0.05). ConclusionsSince AHIF contains a solid and continuous neurovascular pedicle, the probability of necrosis and loss of sensation is low in AHIF. In addition, the graft need of the donor area is not high. Its disadvantage is the rate of restriction of joint movements. Level of evidenceIV.

The effect of osteocyte-derived RANKL on bone graft remodeling: An in vivo experimental study.

Autologous bone is considered the gold standard for grafting, yet it suffers from a tendency to undergo resorption over time. While the exact mechanisms of this resorption remain elusive, osteocytes have been shown to play an important role in stimulating osteoclastic activity through their expression of receptor activator of NF-κB (RANK) ligand (RANKL). The aim of this study was to assess the function of osteocyte-derived RANKL in bone graft remodeling. In Tnfsf11fl/fl ;Dmp1-Cre mice without osteocyte-specific RANKL as well as in Dmp1-Cre control mice, 2.6 mm calvarial bone disks were harvested and transplanted into mice with matching genetic backgrounds either subcutaneously or subperiosteally, creating 4 groups in total. Histology and micro-computed tomography of the grafts and the donor regions were performed 28 days after grafting. Histology revealed marked resorption of subcutaneous control Dmp1-Cre grafts and new bone formation around subperiosteal Dmp1-Cre grafts. In contrast, Tnfsf11fl/fl ;Dmp1-Cre grafts showed effectively neither signs of bone resorption nor formation. Quantitative micro-computed tomography revealed a significant difference in residual graft area between subcutaneous and subperiosteal Dmp1-Cre grafts (p < .01). This difference was not observed between subcutaneous and subperiosteal Tnfsf11fl/fl ;Dmp1-Cre grafts (p = .17). Residual graft volume (p = .08) and thickness (p = .13) did not differ significantly among the groups. Donor area regeneration was comparable between Tnfsf11fl/fl ;Dmp1-Cre and Dmp1-Cre mice and restricted to the defect margins. The results suggest an active function of osteocyte-derived RANKL in bone graft remodeling.

Biomaterials derived from hard palate mucosa for tissue engineering and regenerative medicine.

Autologous materials have superior biosafety and are widely used in clinical practice. Due to its excellent trauma-healing ability, the hard palate mucosa (HPM) has become a hot spot for autologous donor area research. Multiple studies have conducted an in-depth analysis of the healing ability of the HPM at the cellular and molecular levels. In addition, the HPM has good maneuverability as a donor area for soft tissue grafts, and researchers have isolated various specific mesenchymal stem cells (MSCs) from HPM. Free soft tissue grafts obtained from the HPM have been widely used in the clinic and have played an essential role in dentistry, eyelid reconstruction, and the repair of other specific soft tissue defects. This article reviews the advantages of HPM as a donor area and its related mechanisms, classes of HPM-derived biomaterials, the current status of clinical applications, challenges, and future development directions.

Comparison of the Effect of Using Collective Plus Ag Dressing and Vaseline Gauze Dressing in the Donor of Split-Thickness Burn Grafts.

Skin graft involves removing a part of the skin and using it in another part of the body. One of the most common reasons for using a graft is burns. We aimed to compare the effect of Colactive plus Ag dressing with Vaseline gauze dressing in donor sites of split-thickness skin grafts of burned patients. The present study was conducted as a randomized clinical trial (RCT) in the Motahari burn Hospital, Tehran, Iran in 1401. The sampling method was done using Cochran's formula and available patients so 15 people were enrolled. The findings of the study were collected using a researcher-made form. The average duration of recovery, the amount and intensity of pain, and the amount of itching between the two types of Colative plus Ag plus Ag dressing with Vaseline gauze are statistically significant at the 95% confidence level. (P-value<0.05). In addition, the findings showed that the average amount of scar left by the wound in the two types of dressings examined is not statistically significant at the 95% confidence level (P-value > 0.05). The use of Colactive silver dressing has less pain, less itching in the donor area, and a shorter average recovery time than Vaseline gauze. The use of the Colactive plus Ag will be more effective than Vaseline gauze.

Preliminary study on restoration of tropical seagrass ecosystem through utilization of Enhalus acoroides seedling in Bintan Island, Indonesia

There has been a global decline in the area of seagrass ecosystems caused by the increasing number of human activities in coastal areas. It is suspected that the decline in the area of seagrass beds in Indonesia is 2%-5% per year. It takes an effort that can be used to restore the condition of seagrass beds. So far, efforts have been made to do seagrass transplants. There is a weakness in the transplant method, namely the reduction of seagrass stands in the origin (donor) area. Another effort that can be used is planting seagrass using seagrass seeds derived from seedlings. Seagrass seeds come from the seagrass, Enhalus acoroides, which is found throughout the year in the waters of Bintan Island. Furthermore, the seeds obtained will be sown for three months in the laboratory. Generally, the survival rate of seagrass seeds during the seedling process has a value of more than 90%, which is very good. Furthermore, the seeds produced from the nursery process are planted in the field. In this experimental study, 25 seedlings were planted. Seedlings were planted directly into the substrate at a depth of 10 cm (sprig method). During the four-month observation period, the survival rate declined to 20%. Several factors that affect the survival rate include the condition of the aquatic environment and human activities around it.

DESCRIPTION OF THE ONE FLAP TECHNIQUE FOR THE SURGICAL TREATMENT OF SYNDACTYLY

Syndactyly is a congenital defect of the fingers or toes that can cause aesthetic and functional problems. In this condition there is a defect in the separation of the parts, according to the Swanson Classification, determined between the sixth and eighth week of intrauterine life and representing approximately 20% of all hand malformations. This pathology is the second most common congenital anomaly of the hand and has an incidence of 1:2000 to 3000 live births. It is one of the most heterogeneous deformities known in the literature, with unilateral, bilateral, symmetrical and asymmetrical variations. It occurs twice as often in boys. The aim of this study is to describe a new skin flap design for the treatment of syndactyly. This is a descriptive study, as it aims to detail the surgical technique using different processes for the treatment of simple or complex, incomplete or complete syndactyly.The study maintains the principles of the digital commissure reconstruction approach, adequate skin coverage and reconstruction of the nail bed, presenting a new flap associated with polypropylene coverage, solving the disadvantages of using a skin graft, such as deformities at the recipient site and morbidity of the donor area.

Clinical application of posterior tibial artery or peroneal artery perforator flap in curing plate exposure after ankle fracture fixation.

The study aims to evaluate the clinical application of posterior tibial artery or peroneal artery perforator flap in the treatment of plate exposure after ankle fracture fixation. A posterior tibial artery or peroneal artery perforator flap was used on 16 patients with plate exposure after ankle fracture fixation in our hospital between July 2018 and July 2021. The time required to harvest the flap, the amount of intraoperative blood loss, the duration of postoperative drainage tube placement, the outcome of the flap and the healing observed at the donor site are reported. The sizes of the flaps were 2.5-7.0 cm × 5.0-18.0 cm and averaged 4.0 cm × 12.0 cm. The time required to harvest the posterior tibial artery or peroneal artery perforator flap ranged from 35 to 55 min and averaged 45 min. The amount of intraoperative blood loss ranged from 20 to 50 mL and averaged 35 mL. The duration of postoperative drainage tube placement ranged from 3 to 5 days and averaged 4 days. A total of 15 flaps survived and one flap had partial necrosis and survived after conservative treatment. All donor area defects were directly sewed and stitched without complications. There are multiple advantages of the posterior tibial artery or peroneal artery perforator flap, including simple preparation technique, reliable repair of the defects and without the need for performing microvascular anastomosis. It can be safely used in curing plate exposure after ankle fracture fixation and worth popularizing in grassroots hospitals.

Highly Ozonated Sunflower Oil Dose May Cause Oxidative Stress and Impact the Quality of Life After Palatal Graft Removal: Secondary Endpoints of a Randomized Controlled Clinical Trial

ABSTRACT The aim of this study was to evaluate the effect of highly ozonated sunflower oil on postoperative pain and quality of life in patients undergoing removal of a free gingival graft (FGG) in the donor area of the palate. After graft removal, the palatal wound was treated with highly ozonated sunflower oil with a peroxide index between 510 and 625 meq/kg in the test group (n = 14) and with non-ozonated sunflower oil in the control group (n = 14). These are the secondary endpoints of a randomized clinical trial. Questionnaires assessing oral health impact on quality of life (OHIP-14) and postoperative pain (VAS scale) were applied to all participants at day 7. The results did not reveal a statistically significant difference in the postoperative pain between groups in all periods (P>0.05). There was a significant positive correlation in both groups for pain and amount of analgesic consumption (P<0.0001). It was found that participants in the test group showed a higher overallscore for OHIP-14 than the control group (P < 0.05), with impact on unsatisfactory diet, meal interruptions and irritability (P < 0.05). MDA levels measured 7 days post-treatment were higher in the test group compared to those of the control group (P < 0.05). It can be concluded that high dose and overapplication of the ozonated sunflower oil had a negative impact on the quality of life of individuals after palatal graft removal, which might have been aggravated by oxidative stress. Trial Registration number NCT05620550/Date of registration: November 16, 2022

Customization of Soft Tissue Expanders: Improving Safety, Accuracy, and Efficiency for Treatment of Large and Complicated Skin Lesions.

Soft tissue expansion is a common technique for restoring large skin defects. Fixed-type expanders may be inappropriate for the following reasons: (1) the shapes and sizes of the defects vary in different patients; and (2) the bulged base of the fixed-type expander does not fit the curve of the human body, which may induce complications such as concave deformities or nerve palsy from continuous mechanical compression. The customized expander adjusts better to the shape and the topography of the expansion site compared with the fixed-type expander. It improves expansion efficiency and reduces complications caused by compression. Between 2016 and 2022, customized soft tissue expansion was performed in 38 patients with skin lesions, including giant congenital melanocytic nevi and postburn scars. This series of patients included patients with a specific donor site shape that is unsuitable for fixed-type expanders. An expander was customized according to the shape of the donor site and then implanted in the subcutaneous pocket. After the expander reached a sufficient volume, the expander was removed, and the extra expanded skin flap was transferred to resurface the skin lesion. In the follow-up, the outcome and the complications were recorded. All the customized expanders fit not only the dimension but also the topography of the donor site. During expansion, 2 patients experienced leakage of the expander, and 3 patients suffered a skin rupture. In the remaining 33 patients, the expansion was successfully completed, and the expanded flaps restored the skin lesions as designed. The color and texture of the skin flaps remained satisfactory after long-term follow-up. Unlike fixed-type expanders, our customized expanders make it possible for "accurate" expansion, irrespective of the dimension and topography of the donor area. Customization of the expander helps increase efficiency and reduce complications caused by undue compression.

Exposed Distal Tibia Coverage by Reversed Soleus Muscle Flap: Our Experiences

Reconstruction of the exposed lower third tibia and ankle region remains a difficult task and a challenge for reconstructive surgeons. Microsurgical flaps have been the method of choice for this reconstruction, but in our hospital, we do not have equipment or a microsurgical-trained team for this type of procedure. Moreover, free muscle flaps have more risk of failure and sometimes the patient's clinical condition does not allow a more complex surgery in some cases. Local muscle flaps are preferred in these situations. MethodologyThis study was carried out in the Burn and Plastic Surgery Department, Rajshahi Medical College Hospital, Rajshahi from July 2015 to December 2021 on 100 patients ( 89 males and 11 females with ages ranging between 21 and 62 years). Patients with tibial defects in the distal third of the tibia which need soft tissue coverage were selected. ResultsOur study shows that reversed medial hemisoleus muscle flap had an excellent outcome with short surgical duration, easy implementation, excellent resolution, and low morbidity of the donor area. Moreover, preservation of the lateral portion is suitable for plantar flexion showing a long arc of rotation. ConclusionMedial hemisoleus muscle flap is a reliable option for the reconstruction of soft tissue defects with the exposed bone of the distal leg based on perforators of the posterior tibial artery. Careful flap dissection with preservation of as many perforators as possible is the key to success.

Free posterior interosseous artery perforator flap in the treatment of finger with skin and soft tissue defect

To explore clinical effects of repairing skin and soft tissue defect of finger with free posterior interosseous artery perforator flap. Totally 8 patients with finger skin and soft tissue defect repaired with free posterior interosseous artery perforator flap were treated from May 2021 to November 2022, including 7 males and 1 female aged from 24 to 54 years old, and soft tissue defect area ranged from 3.0 cm×1.5 cm to 5.0 cm×3.0 cm. The time from injury to flap repair ranged from 3 to 83 h. The free posterior interosseous artery perforator flap was applied to repair finger defect, the area of the flap ranged from 3.5 cm×2.0 cm to 5.2 cm×3.5 cm, the donor area of flap was sutured directly. The survival, appearance, texture and donor complications of the flap were observed after operation, and Dargan functional standard was used to evaluate clinical effect of finger function. All flap of 8 patients were survived, and followed up from 3 to 12 months. There was no obvious swelling, soft texture, obvious pigmentation, linear intaglio in donor area only, and without obvious complications were found. Among them, 3 patients'skin flaps were repaired for the defect of palm of the fingers, and sensory recovery was good, two-point discrimination ranged from 5 to 9 mm. According to Dargan functional evaluation, 3 patients excellent, and 5 good. Free posterior interosseous artery perforation branch flap could be used to repair the defect of finger. The thickness of flap is moderate, operation is convenient, appearance and texture of the operative flap are good, and the donor site is small without obvious complications, and obtain satisfactory clinical effect.

Exploration of functional reconstruction and rehabilitation strategies for patients with destructive electric burns

Electric burn is a kind of three-dimensional destructive damage. It is necessary to attach great importance to the functional reconstruction and rehabilitation of patients with destructive electric burns. Wound repair and limb salvage are not the end of the treatment of destructive electric burns, but functional rehabilitation and reintegration into society of patients are the goals of treatment. This paper systematically discusses the early wound repair, late functional reconstruction and rehabilitation, limb salvage and amputation, minimized damage of donor area, psychological rehabilitation, and multi-disciplinary cooperation of destructive electric burns. Only by attaching great importance to the functional reconstruction and rehabilitation, and embedding these concepts in people's brains, perfect repair and rehabilitation of destructive electric burns can be realized.

Simplifying Forehead and Temple Reconstruction: A Narrative Review.

The forehead and temporal region are frequent areas of skin cancer development. After tumor removal, reconstruction must be performed, maintaining the frontal-temporal line of the scalp and symmetry of the eyebrows in an attempt to hide the scars within these marks or natural folds and wrinkles. Second wound healing and skin grafts generally do not produce an acceptable cosmetic result. When direct closure is not possible, the technique of choice is skin flaps. In the midfrontal line continuation of the glabella, there is a remnant of skin to be used as a donor area for local flaps; similarly, it occurs in the preauricular cheek, which can move toward the temple. In addition to the classic advancement and rotation flaps, the frontalis myocutaneous transposition flap is an excellent technique for closing defects which are wider than higher on the forehead. Its design is very versatile and can be performed between the two pupil lines at different heights depending on the location of the defect. On the other hand, the preauricular skin advancement flap with an infralobular Burow's triangle is also an excellent option for reconstructing tumors in the temporal area.

The Mastoid Skin Graft: A Fast, Efficient Donor Site for Auricle Reconstruction After Mohs Surgery.

Mohs micrographic surgery has been considered the gold standard for treating nonmelanoma skin cancers. Approximately 8% to 10% of skin cancers requiring Mohs surgery occur on the auricle. Skin grafts can be used to achieve optimal functional and cosmetic results. To describe a skin graft technique using the mastoid area as a donor site for auricular reconstruction following Mohs micrographic surgery, to achieve optimal esthetic results in functionally important areas. This retrospective study assessed the outcomes of patients who underwent MMS in an out-patient Mohs surgery clinic from 2010 to 2021. All patients had MMS of the auricle with reconstruction using a split thickness skin graft harvested from the mastoid area. A total of 154 patients were included. The average lesion diameter was 13.7 mm (range 5-30 mm), excised in an average of 1.9 rounds of MMS. Skin graft success rate was 96%. Complications included one patient with a hypertrophic scar. The cosmetic appearance of the recipient site was rated as excellent by 87.5% of patients. All patients rated the cosmetic appearance of the donor area as excellent and well-concealed. Split thickness skin grafts harvested from the mastoid area are a quick and efficient reconstruction method for post-Mohs auricular defects.

Research progress in nipple projection reconstruction based on tissue graft support

To review the advances in methods for reconstructing nipple projection based on tissue graft support. The literature related to nipple projection reconstruction based on tissue graft support was reviewed and summarized in terms of the advantages and disadvantages of various tissue grafts and the improved nipple projection results. Loss of nipple projection is a common cause of decreased patient's satisfaction. Reconstructing nipple projection based on tissue graft support is a more common clinical method and can be done with autologous and allogeneic tissues. Autologous tissue grafts include dermis, adipose tissue with dermis, adipose tissue, ear cartilage, rib cartilage, and contralateral nipple tissue. Autologous tissue grafts are easy to obtain and have no immune rejection, but may lead to donor area damage and prolong the surgical time for tissue collection. Allogeneic tissue grafts include acellular dermal matrix, lyophilized rib cartilage, and extracellular matrix collagen, and decellularized nipple tissue. Allogeneic tissue grafts do not cause additional donor area damage, are highly malleable, and can be designed to be utilized according to the recipient area, but the high cost often limits the development of this technique. There is no gold standard regarding tissue graft-assisted nipple projection reconstruction techniques, and there are advantages and disadvantages to both autologous and allogeneic tissue grafts. Surgeons should choose the appropriate graft based on the actual condition of the patient.

Reconstrucción nasal secundaria con injerto costal: caso clínico y revisión de la literatura

Introduction: Secondary rhinoplasty, or reintervention, is a surgery on a previously operated nose, which represents a greater surgical challenge compared to primary rhinoplasty. The ideal is the use of autologous cartilage graft since it meets biocompatibility characteristics and resembles an ideal graft. The costal cartilage is a good alternative since it has characteristics similar to septal cartilage, with the advantage of offering a larger amount of material to work with and it does not deform over time. Clinical case: male, 31 years old, admitted due to a hit to the face with a blunt object. It evidenced complex facial fracture, with Le Fort I components on the right and Le Fort III components on the left, as well as a left naso-orbital-ethmoid fracture. It performs reduction and intermaxillary fixation. It performs nasal reconstruction with a double nasal cartilage graft and bone graft for the back, and septal cartilage graft to construct the columella stem. It plans secondary rhinoplasty with a seventh rib graft correct the saddle nose defect. Outpatient follow-up at 14 and 30 days with favorable cosmetic results. Discussion: This procedure generally gives good results with a low complication rate. In the latest systematic reviews with an average follow-up of 14.4 months (6-96 months) they concluded that in the donor area the most frequent complication was the development of scars in the surgical site with 2.08% (0. 31-4.83%) and pneumothorax was close to 0% (0-0.46%). In the recipient area, the most frequent were graft retraction with 3.05% (1.35-5.19%) and 1.45% (0.34-3.06%) of infection of the recipient area. Conclusion: With the presentation of this clinical case, you can observed that the use of costal cartilage in secondary rhinoplasty is an achievable option, with good results in the short and medium term, in addition to having a low rate of complications, but a team of experienced plastic surgery must perform it.&#x0D; Fecha recepción: noviembre 2022 | Fecha aceptación: febrero

Dual-bionic regenerative microenvironment for peripheral nerve repair.

Autologous nerve grafting serves is considered the gold standard treatment for peripheral nerve defects; however, limited availability and donor area destruction restrict its widespread clinical application. Although the performance of allogeneic decellularized nerve implants has been explored, challenges such as insufficient human donors have been a major drawback to its clinical use. Tissue-engineered neural regeneration materials have been developed over the years, and researchers have explored strategies to mimic the peripheral neural microenvironment during the design of nerve catheter grafts, namely the extracellular matrix (ECM), which includes mechanical, physical, and biochemical signals that support nerve regeneration. In this study, polycaprolactone/silk fibroin (PCL/SF)-aligned electrospun material was modified with ECM derived from human umbilical cord mesenchymal stem cells (hUMSCs), and a dual-bionic nerve regeneration material was successfully fabricated. The results indicated that the developed biomimetic material had excellent biological properties, providing sufficient anchorage for Schwann cells and subsequent axon regeneration and angiogenesis processes. Moreover, the dual-bionic material exerted a similar effect to that of autologous nerve transplantation in bridging peripheral nerve defects in rats. In conclusion, this study provides a new concept for designing neural regeneration materials, and the prepared dual-bionic repair materials have excellent auxiliary regenerative ability and further preclinical testing is warranted to evaluate its clinical application potential.

Fibular Autograft as Medial Support with Proximal Humerus Locking Plate Construct in Comminuted Proximal Humerus Fractures: A Retrospective Analysis.

Varus collapse is one of the pivotal mechanisms of failure following surgical fixation of proximal humerus fractures. The aim of the present study was to evaluate functional and radiological outcomes of non-vascularized fibular autograft as medial support with locking plate construct for comminuted proximal humerus fractures (PHF's). We retrospectively evaluated 18 patients with unstable PHF's in the age group 50-70years with a minimum follow-up of two years. All thefracture patterns were classified according to Resch, Neer's and AO classification and either medial calcar compromise or comminution were present in all. Open reduction internal fixation (ORIF) with a locking plate was performed for all thepatients along with intramedullary fibular autograft to support medial calcar. Radiological outcome was assessed by neck-shaft angle (NSA) graded according to the Paavolainen grading method and difference in thehumeral head height (HHH). Functional outcome was assessed by shoulder range of motion (ROM), University of California-Los Angeles (UCLA) score and American shoulder and elbow surgeons score (ASES). Radiological union at the fracture site was achieved in all the patients at mean of 8months (range 6-12months). Range of movements were mean flexion of 123.89, extension 35.28, internal rotation 66.94, external rotation 57.78 and abduction of 115° at final follow-up. The average NSA was in the range of 120°-130° and none of the patients showed difference in HHH of ≥ 4mm in the immediate post-operative radiograph and that taken on final follow-up. The functional outcome assessed by ASES score (mean 89.44) and UCLA score (mean 29.61) suggested fair to good results. None of the patients has shown varus collapse and avascular necrosis. Neither there were any complications related to the donor area. In unstable proximal humerus fractures with calcar comminution or void, PHILOS plate fixation augmented with fibular autograft as a medialsupport reduces varus collapse and promotes early radiological union.