Donor Site Pain Research Articles

Evaluating topical opioid gel on donor site pain: A small randomised double blind controlled trial

BackgroundAutologous donor skin harvested for transplantation is a common procedure in patients with burns, and patients often feel more pain at the donor site than is justified by the extent of trauma. Topical morphine gels have been thought to have an effect on peripheral opioid receptors by creating antinociceptive and anti-inflammatory effects, which could potentially reduce the systemic use of morphine-like substances and their adverse effects. MethodsWe therefore did a paired, randomised, double-blind placebo study to investigate the effect of morphine gel and placebo on dual donor sites that had been harvested in 13 patients. Pain was measured on a visual analogue scale (VAS) 15 times in a total of 5 days. ResultsThe mean (SD) VAS was 1.6 (2.3) for all sites, 1.5 (2.2) for morphine, and 2.0 (2.5) for placebo. The pain relieving effects of morphine gel were not significantly better than placebo. ConclusionThe assessment of pain at donor sites is subjective, and more systematic and objective studies are needed.

Donor-Site Morbidity after Partial Second Toe Pulp Free Flap for Fingertip Reconstruction.

BackgroundIn this study, we characterize the morbidity at the donor-site of partial second toe pulp free flaps in terms of wound management as well as long-term outcomes.MethodsA single-institutional retrospective review was performed for patients who had undergone partial second toe pulp free flap transfer to the fingertip. Patient charts were reviewed for infection, skin necrosis, wound dehiscence, and hematoma for the donor site. Additionally, a questionnaire survey was given to patients who had a follow-up of longer than 1 year to characterize long-term postoperative pain and appearance.ResultsThe review identified a total of 246 cases. Early wound complications were significant for wound dehiscence (n=8) and hematoma (n=5) for a wound complication rate of 5.3%. The questionnaire was distributed to 109 patients, and 54 patients completed the survey. Out of these 54 patients, 15 patients continued to have donor-site pain (28%) at a mean follow-up period of 32.4 months. However, the pain intensity was relatively low in the range between 2 to 5, on a 0–10 scale. None of these patients felt this donor-site pain interfered significantly with daily activity, nor did any patient require pain medications of any type. Donor-site appearance was satisfactory to most patients.ConclusionsThe partial second toe pulp flap was associated with low rates of wound complications and favorable long-term outcomes. Given the functional and aesthetic gain in the recipient finger, donor-site morbidities appear acceptable in this patient population. This study can be helpful in counseling patients regarding donor-site morbidity during the informed consent process.

Current Status of Adipose-Derived Mesenchymal Stem Cells in Cartilage Repair

Mesenchymal stem cells (MSCs) have gained increased attention in the treatment of injury-related cartilage damage. Most of the literature has focused on the use of bone marrow MSCs for chondrogensis; however its clinical use has presented consequences of donor site morbidity and pain as well as low cell number during harvest. Adipose tissue offers an abundant source of mesenchymal stem cells (MSCs), showing promise for the treatment of cartilaginous injuries. Numerous studies have focused on the safety and efficacy of adipose-derived mesenchymal stem cells (ADSC) in the form of the stromal vascular fraction (SVF), supporting its use in future clinical applications. While reports of ADSC potential for cartilage repair have been encouraging, the lack of standardization among studies, as well as the confusing terminology describing the different forms of ADSC presents cause for deeper investigation of those studies reporting clinical success. Overall, ADSCs show significant potential as an alternative and/or adjunctive treatment of cartilaginous injuries.

Autologous bone graft versus PEKK cage for vertebral replacement after 1- or 2-level anterior median corpectomy.

OBJECT Anterior cervical corpectomy with fusion has become the most widely used procedure for the treatment of multilevel cervical stenosis. Although an autologous bone graft is the gold standard for vertebral replacement after corpectomy, industrial implants have become popular because they result in no donor-site morbidity. In this study, the authors compared clinical and radiological results of autologous iliac grafts versus those of bone-filled polyetherketoneketone (PEKK) cage implants. METHODS The clinical and radiological data of 46 patients with degenerative multilevel cervical stenosis and who underwent 1- or 2-level anterior median corpectomy between 2004 and 2012 were analyzed. The patients in Group 1 were treated with vertebral replacement with an autologous iliac graft, and those in Group 2 were treated with a PEKK cage implant. Each patient also underwent osteosynthesis with an anterior plate-screw system. Visual analog scale (VAS) and European Myelopathy Scale scores, loss of height and regional cervical lordosis angle, and complication rates of the 2 groups were compared. RESULTS The mean follow-up time was 20 months. In both groups, the VAS and European Myelopathy Scale scores improved significantly. The loss of height was 3.7% in patients with iliac grafts and 5.3% in patients with PEKK implants. The rates of osseous fusion were similar in Groups 1 and 2 (94.7% and 91.3%, respectively). At the end of the follow-up period, none of the patients complained about donor-site pain. One patient in Group 1 suffered a fracture of the iliac bone that required osteosynthesis. Four patients in Group 2 had to receive revision surgery for cage and/or plate-screw dislocation and new neurological deficit or intractable pain. CONCLUSIONS Preoperative pain and radicularand myelopathic symptoms improve after decompression irrespective of the material used for vertebral replacement. The use of PEKK cages for vertebral replacement seems to result in a higher risk of implant-related complications. A prospective randomized study is necessary to supply evidence for the use of autografts and artificial implants after anterior cervical corpectomy with fusion.

Clinical Outcome and Changes of Foraminal Dimension in Patients With Foraminal Stenosis After ACDF.

Prospective study. To determine the clinical outcome and change in foraminal dimension after anterior cervical discectomy and fusion (ACDF) and to investigate the correlation between clinical outcome and foraminal dimension. No previous studies have evaluated the correlation between clinical outcome and foraminal dimension after ACDF in foraminal stenosis. A consecutive series of 44 patients (114 foramina) undergoing planned ACDF due to foraminal stenosis were studied. Clinical outcomes included the neck pain visual analogue scale (VAS), arm pain VAS, neck disability index (NDI), subjective improvement rate, dysphasia, and donor site pain. Radiologic outcomes included anterior and posterior disk height, height of foramen and anterior-posterior diameter of the foramen, and the Cobb angle of the fusion segment. Foraminal dimension was calculated. The neck pain VAS decreased from 3.7 preoperatively to 2.3 postoperatively. Likewise, arm pain VAS decreased from 7.2 to 2.2, and NDI decreased from 31.0% to 17.2%. Mild dysphasia occurred in 3 patients. There was no donor site pain. Subjective improvement rate was 79.3%. The anterior disk height increased from 4.75 mm preoperatively to 7.01 mm postoperatively. Likewise, posterior disk height increased from 4.11 to 5.74 mm, height of foramen increased from 7.30 to 9.25 mm, anterior-posterior diameter of foramen increased from 3.56 to 4.92 mm, dimension of foramen increased from 20.50 to 35.58 mm, and segmental angle of fusion segment increased from 2.87 to 4.95 degrees. Posterior disk height was positively correlated with foraminal dimension. An increased segmental angle was negatively correlated with foraminal dimension. The foraminal dimension was negatively correlated with the arm pain VAS. ACDF in cervical foraminal stenosis was a useful surgical option to improve clinical outcomes and widen the foraminal dimension. The foraminal dimension was negatively correlated with the arm pain. Restoration of posterior disk height was necessary to widen the foraminal dimension, whereas increased lordosis of the fusion segment did not help to widen the foraminal dimension.

Cleft Patient-Reported Postoperative Donor Site Pain Following Alveolar Autologous Iliac Crest Bone Grafting

Autologous bone grafting is still considered the standard method for alveolar cleft repair. However, donor site morbidities remain a relevant problem in cleft care. Thus, the authors assessed postoperative donor site pain in cleft patients who underwent alveolar cleft repair by iliac crest bone graft transferring through a prospective randomized study comparing 2 minimally invasive harvesting techniques. Fifty-six consecutive patients with cleft lip and palate who underwent iliac crest bone grafting for alveolar cleft repair were randomly divided into 2 groups: bone graft harvested by minimally invasive techniques without (group 1) and with (group 2) periosteum elevation. Postoperative donor site pain was evaluated using a unidimensional numerical pain intensity rating scale (0, "no pain;" 10, "worst pain imaginable") at 1, 3, 6, 9, and 12 hours after the procedures and on the 3rd, 7th, 14th, 21st, and 28th days after surgeries. Intergroup comparisons were performed. The mean measurements of donor site pain revealed no significant differences (all P > 0.05) in any of the evaluated postoperative period comparisons between groups 1 and 2. There was a greater number (P < 0.05) of group 1 patients who reported "no pain" in the donor site compared with group 2, suggesting that periosteum elevation may play a role in pain intensity measurement. This prospective randomized study showed no difference in pain intensity among cleft patients who had postoperative pain. However, a greater number of patients in group 1 reported "no pain" in comparison to patients in group 2.

Challenging the Conventional Therapy: Emerging Skin Graft Techniques for Wound Healing.

Split-thickness skin grafting is the current gold standard for treatment of major traumatic skin loss. However, split-thickness skin grafting is limited by donor-skin availability, especially in large burns. In addition, the donor-site wound is associated with pain and scarring. Multiple techniques have been developed in the past to overcome these limitations but have been unable to achieve clinical relevance. In this study, the authors examine the novel emerging skin grafting techniques, aiming to improve the utility of split-thickness skin grafting. An extensive literature review was conducted on PubMed, MEDLINE, and Google Scholar to look for new skin grafting techniques. Special focus was given to techniques with potential for large expansion ratio and decreased donor-site pain. The new modalities of modified skin grafting technique, discussed in this article, include (1) Xpansion Micrografting System, (2) fractional skin harvesting, (3) epidermal suction blister grafting, and (4) ReCell technology. These techniques are able to achieve significantly increased expansion ratios compared with conventional split-thickness skin grafting and also have decreased donor-site morbidity. These techniques can be used separately or in conjunction with split-thickness skin grafting to overcome the associated pitfalls. Further studies and clinical trials are needed to define the utility of these procedures and where they fit into routine clinical practice.

Complications Associated With the Use of Autologous Costal Cartilage in Rhinoplasty: A Systematic Review.

Autologous costal cartilage grafts are common in rhinoplasty. To date, no formal systematic review of complications associated with autologous costal cartilage grafting in rhinoplasty exists. The authors review current literature to examine the rates of donor and recipient site complications associated with autologous costal cartilage in rhinoplasty. Databases (EMBASE, PubMed, MEDLINE, and Cochrane Database of Systematic Reviews) and references of pertinent articles were searched between January 1980 to July 2014 to find studies evaluating rates of complications with autologous costal cartilage grafting in rhinoplasty. These studies were then screened with specific inclusion/exclusion criteria, and data were extracted from included studies and pooled for analysis. A total of 21 eligible studies were included. Pooled donor site complication incidence was pneumothorax (0.1%), pleural tear (0.6%), infection (0.6%), seroma (0.6%), scar-related problems (2.9%), and severe donor site pain (0.2%). Pooled recipient site complications were as follows: warping (5.2%), infection (2.5%), displacement/extrusion (0.6%), graft fracture (0.2%), and graft resorption (0.9%). Autologous costal rhinoplasty remains a safe procedure, but is associated with not insignificant rates of minor recipient site complications, such as warping. 4 Therapeutic.

Iliac Crest Bone Graft in Lumbar Fusion: The Effectiveness and Safety Compared with Local Bone Graft, and Graft Site Morbidity Comparing a Single-Incision Midline Approach with a Two-Incision Traditional Approach.

Study Design Systematic review. Clinical Questions (1) Is autologous local bone (LB) graft as safe and effective as iliac crest bone graft (ICBG) in lumbar spine fusion? (2) In lumbar fusion using ICBG, does a single-incision midline approach reduce postoperative iliac crest pain compared with a two-incision traditional approach? Methods Electronic databases and reference lists of key articles were searched up to October 2014 to identify studies reporting the comparative efficacy and safety of ICBG versus LB graft or comparing ICBG harvest site for use in lumbar spine surgery. Studies including allograft, synthetic bone, or growth factors in addition to ICBG and those with less than 80% of patients with degenerative disease in the lumbar spine were excluded. Two independent reviewers assessed the level of the evidence quality using the Grades of Recommendation Assessment, Development and Evaluation criteria, and disagreements were resolved by consensus. Results Seven studies were identified as using ICBG fusion for degenerative disease in the lumbar spine. There were no differences in the fusion, leg pain, low back pain, or functional outcomes between patients receiving LB versus ICBG. There was a higher incidence of donor site pain and sensory loss in patients receiving ICBG, with no donor site complications attributed to LB. Compared with patients with the graft harvested through the two-incision traditional approach, patients with the graft harvested through the single-incision midline approach had lower mean pain scores over the iliac crest, with a higher proportion reporting no iliac crest tenderness. In patients with ICBG harvested through the single-incision midline approach on either the right or the left side of the ilium, only 36% of the patients were able to correctly identify the side when asked whether they knew which iliac crest was harvested. Only 19% of the patients with ICBG harvested through the single-incision midline approach on either the right or the left side of the ilium reported pain that was concordant with the side that was actually harvested. Conclusions LB is as safe and efficacious as ICBG for instrumented fusion in the lumbar spine to treat degenerative disease. When ICBG is used, graft harvest through the single-incision midline approach reduces postoperative iliac crest pain compared with a two-incision approach.

Review of the analgesia options for patients undergoing TRAM and DIEP flap breast reconstruction

The mainstay of autologous breast reconstruction involves abdominal wall-based tissue transfer in the form of free or pedicled TRAMs or more recently free DIEP flaps. Although excellent choices for breast reconstruction, all of these techniques do have significant morbidity when considering donor-site pain. This can lead to other complications such as reduced mobility, deep vein thrombosis, pulmonary emboli, respiratory infections, heavy opiate use, constipation and prolonged in hospital stay. Minimising postoperative donor-site pain is therefore of paramount importance. This article provides a review of the forms of analgesia available in the literature and in use in clinical practise. It is a summary of the published studies and exciting future options in this field. A literature search was performed through Medline, EMBASE, Cochrane database and Google Scholar for any previous research publications pertaining to postoperative analgesia in patients undergoing autologous breast reconstruction using abdominal tissue. We reviewed all articles with the aim to evaluate the current knowledge and evidence of analgesic techniques in autologous breast reconstruction including benefits, limitations, indications and patient outcomes. The literature search yielded a total of 31 articles identifying 6 analgesic techniques: patient-controlled analgesia (PCA), epidural analgesia, continuous wound infusion with local anaesthetic, intermittent boluses of local anaesthetic, transverse abdominis plane (TAP) blocks and slow release bupivicaine. Various anaesthetic techniques are used to reduce postoperative mortality in autologous breast reconstruction. Knowledge of these techniques is paramount as it reduces complications and expedites discharge in this group of patients. Level of Evidence: Not ratable.

Modifications of the deep circumflex iliac artery free flap for reconstruction of the maxilla

The deep circumflex iliac artery (DCIA) free flap remains underused in maxillectomy reconstruction. A number of surgical techniques have been described however, maxillary defects vary greatly and modifying techniques to account for such variation can be challenging. This article presents the first standardized approach to DCIA free flap modification for maxillary reconstruction where graded modifications are made to a standard procedure based on defect grade. A review of 11 cases that underwent maxillectomy reconstruction with this technique is presented. Defect complexity is stratified according to the Brown Classification System and graded modifications of increasing complexity are made to a standard harvest and flap inset technique. Modifications include increasing the depth of the harvested iliac crest bone to correspond to the height of the anterior maxillary wall defect, addition of a titanium mesh plate to reconstruct the orbital floor and harvest of the internal oblique muscle to fill the orbital cavity. Short and long-term outcomes and complications of 11 cases that underwent maxillectomy reconstruction according to this technique were documented. Defects ranged from Brown Class I-IV, b-c. All but two patients had malignant diagnoses with squamous cell carcinoma (n = 5) being the most prevalent. Short-term flap related complications were neck cellulitis (n = 1) and donor site haematoma (n = 2) whilst long-term flap related complications were mild trismus (n = 1) and donor site pain (n = 1). There were no reported problems with speech, swallowing or vision. This stepwise approach to DCIA free flap modification for maxillectomy defect reconstruction may be used as a guide for future maxillary reconstruction.

Radiographic and Functional Evaluation of the Iliac Bone Graft in the Treatment of Adolescent Idiopathic Scoliosis

Introduction This study aimed to assess the impact of the use of an additional iliac bone graft on functional and radiographic results after thoracic spine arthrodesis with pedicle screws in patients with adolescent idiopathic scoliosis. Patients and Methods Participants were divided into two groups: a control group that received only local bone (CG; n = 19) and a second group that, in addition to this procedure, received an iliac graft (IG; n = 22). The evaluations were performed on preoperative, immediate postoperative, and last follow-up (mean 29.7 months; minimum 12 months). Radiographic evaluations included the loss of correction and the presence of nonunion. The functional outcome was evaluated using the Scoliosis Research Society-30 questionnaire. Surgical complications and the presence of iliac donor site pain were also described. Results There were no significant differences between groups in the pseudoarthrosis rate, loss of correction over time, and quality of life. The loss of correction was 5.9% in IG and 7.5% in CG ( p = 0.504). There was one case of pseudoarthrosis on IC and consolidation rate was 95.4% in IG and 100% in the CG ( p = 0.537). Functional evaluation, using the SRS-30 questionnaire, showed no differences between groups. At the end of follow-up, all the patients of both groups presented good scores regarding satisfaction with the treatment. Conclusion We concluded that the addition of bone graft from the iliac yielded no benefit in terms of the fusion rate and functional outcomes. The appropriate facetectomy, bed preparation, and filling with a local bone graft must be adequate to achieve an adequate fusion on surgical treatment of adolescent idiopathic scoliosis.

Mesenchymal Stem Cells Derived from Vertebrae Show Best Biological Properties

Introduction Due to their properties and characteristics, human mesenchymal stem cells (MSCs) appear to have great therapeutic potential, because they can contribute to the tissue regeneration. Many different populations of MSCs that differ for the embryonic origin and the anatomical localization have been described and to understand whether they have equivalent biological properties is a critical issue for their therapeutic application. Spine fusion is frequently used to treat traumatic, degenerative, and oncological spine diseases. Autologous bone graft has been considered the gold standard for spine fusion procedures because of its osteogenic, osteoinductive, and osteoconductive ability. However, its use is associated with significant disadvantages, including donor site pain, increased operative time, insufficient availability, and nonunion postlumbar fusion. Various bone substitutes have been developed to promote spinal fusion. Also, MSCs have been successfully tested for spinal fusion in several small and large animal models. Material and Methods To define the properties of MSCs for the use in clinical applications, we proposed to analyze the cellular and molecular characteristics of human adult MSCs derived from different body locations, such as bone marrow from the iliac crest (Ic-MSCs), sternum (St-MSCs), and vertebrae (vMSCs), as well as colon (Co-MSCs) and dental pulp (DPSCs), to identify the cell population showing better biological properties for spine fusion clinical application. Results MSCs from different sources presented very different growth kinetics. While iliac crest and sternum-derived MSCs could be maintained in culture for about 3 months, undergoing a limited expansion, mesenchymal cultures derived from dental pulp and colon grew much more rapidly, but could not be maintained longer. Strikingly, vMSCs continued to propagate at high rate even after 3.5 months ex vivo. MSCs from different sources were also induced to osteogenic, adipogenic, and chondrogenic differentiation following exposure to specific inducing agents. We observed that vMSCs generate mature cells of all mesenchymal lineages with greater efficiency, resulting into the best population both in terms of expansion and differentiation. Conclusion This finding could be very interesting and open new perspectives for the improvement of spine fusion, which is a mandatory step for the success of spinal surgical procedures. In the course of a surgical procedure for spinal fusion, vertebral bone marrow can be harvested simultaneously with the preparation of the site for pedicle screw insertion. Then multipotent MSCs can be isolated from vertebral bone marrow during the progress of the surgical procedure and reintroduced in the fusion site (using homologous or autologous bone tissue or biomaterials as scaffold), without any additional surgical time or any other donor site involvement.

Reduction of pain via platelet-rich plasma in split-thickness skin graft donor sites: a series of matched pairs.

In the past decade, autologous platelet-rich plasma (PRP) therapy has seen increasingly widespread integration into medical specialties. PRP application is known to accelerate wound epithelialization rates, and may also reduce postoperative wound site pain. Recently, we observed an increase in patient satisfaction following PRP gel (Angel, Cytomedix, Rockville, MD) application to split-thickness skin graft (STSG) donor sites. We assessed all patients known to our university-based hospital service who underwent multiple STSGs up to the year 2014, with at least one treated with topical PRP. Based on these criteria, five patients aged 48.4±17.6 (80% male) were identified who could serve as their own control, with mean time of 4.4±5.1 years between operations. In both therapies, initial dressing changes occurred on postoperative day (POD) 7, with donor site pain measured by Likert visual pain scale. Paired t-tests compared the size and thickness of harvested skin graft and patient pain level, and STSG thickness and surface area were comparable between control and PRP interventions (p>0.05 for all). Donor site pain was reduced from an average of 7.2 (±2.6) to 3 (±3.7), an average reduction in pain of 4.2 (standard error 1.1, p=0.0098) following PRP use. Based on these results, the authors suggest PRP as a beneficial adjunct for reducing donor site pain following STSG harvest.

The donor site pain assessment of the patients who were reconstructed split-thickness graft

In this study we examined the donor site pain intensity of the patients who were reconstructed by split thickness skin graft (STSG) due to tissue defect. This descriptive study was performed in a Plastic and Reconstructive Surgery Clinic of a State Hospital in Istanbul. Sampling selection wasn't made, all (31) cases were studied with STSG in 2013. As data collection forms, we used Patient Information Form and Visual Analog Scale (VAS). In the analysis of the data percentage, Kruskal-Wallis and Mann-Whitney-U tests were used. 38.71% of the patients were female and 61.29% were male. It was determined that grafting application was mostly made in the lower extremity and 61% of the patients were able to perform individual functions independently. It was observed that pain intensity increased as the donor area expanded. It was also determined that semi-dependent patients' pain intensity was higher than independent patients'. In 64.52% of the patients graft donor area was wider than 10cm². The postoperative pain intensity of the patients who were reconstructed by STSG in the lower extremity was higher than patients who were reconstructed by STSG in the upper extremity area. It was observed that the donor area pain intensity of patients was the most severe on the first day after surgery and the least severe on the sixth day after surgery. In conclusion, the pain evaluation of the donor area has to be assessed by the nurse on the first day after surgery.

Comparative study of collagen and paraffin gauze dressing on skin graft donor site

Background: The major morbidity of split skin graft is donor site pain, soaking and delayed healing. Numerous donor site dressing modalities are available, but the ideal material remains elusive. Method: We compared the effect of bovine type 1 collagen dressing to conventional paraffin impregnated gauze dressing in 20 patients. After harvesting graft by standard technique, one-half was covered by collagen sheet and other half by paraffin gauze. Pain was assessed daily by Visual Analog Scale. Any soaking of dressing was noted. The dressing was removed on 10th day and both areas were inspected for the amount of epithelization. Results: The pain was less in the collagen area when compared to the paraffin gauze area. The difference was highest for the first 3 days (2.16 vs. 5.86, P 0.02). Seven patients had soaking limited to paraffin gaze area whereas two patients had soaked in both areas. On removal of dressing on 10th day, average epithelization was slightly higher in collagen area (98%) compared with the paraffin gauze area (95%). Conclusion: Bovine type 1 collagen reduces pain and soaking at skin graft donor site with minimal effect on the rate of epithelization.

Application of Collagen Implants in Achilles Tendon Injuries

Achilles tendon injuries are common and complex especially in athletes and active people. Healing process occurs via scar tissue formation leading to poor outcomes for patients. Current surgical and non-surgical treatment modalities lead to sub-optimal tendon healing and each of them have complications. Therefore, to repair and restore tendon structure and function, a tendon graft is needed; therefore autografts, allografts and xenografts have been used. However, each of these grafts is associated with several limitations such as donor site morbidity and pain, poor biocompatibility, disease transmission and immune reaction which lead to graft rejection and failure. Tissue engineering is an advancing field that can either augment surgical repair or provide an alternative method for Achilles tendon repair. Among the components of tissue engineering technologies, the present article has discussed scaffolds and emphasized on collagen-based biomaterials. This article illustrated the causes behind the essential need for tissue engineering in Achilles tendon repair. Furthermore, it described the current literature regarding the use of collagen in Achilles tendon repair and the main points regarding application of collagen biomaterials and scaffolds in tendon tissue engineering.

Olecranon bone grafting in neglected forearm fractures

Background: Autogenous bone grafts are widely used to augment union in fractures. Of all the available donor sites, the iliac bone grafts are the most commonly used. Olecranon bone grafts are rarely used to augment union in long bone fractures along with plate osteosynthesis. Methods: Twenty patients of which 18 were male and 2 were female with 9 injuring their right side and 11 injuring their left side, were treated in Mahatma Gandhi Medical College, Pillaiyarkuppam, Pondicherry, India, during the period from January 2012 to December 2014. The fractures were classified as neglected if the duration was more than 4 weeks after the injury. The reason for delay in seeking treatment was indigenous treatment by native bone setters. Results: All had complete union at an average of 3 months (2 and half - 4 months). All had complete range of elbow and wrist flexion and extension by 1 month. No patient complained of bone graft donor site pain. The outcome was excellent and all the fractures united at an average time of 3 months. There was no donor site morbidity. Conclusions: Despite lack of popularity, olecranon bone grafts are an excellent option for augmenting union in fractures of the forearm as these grafts are easily obtained and cause no donor site complications.

Short term outcome of posterior dynamic stabilization system in degenerative lumbar diseases.

Background:Decompression and fusion is considered as the ‘gold standard’ for the treatment of degenerative lumbar diseases, however, many disadvantages have been reported in several studies, recently like donor site pain, pseudoarthrosis, nonunion, screw loosening, instrumentation failure, infection, adjacent segment disease (ASDis) and degeneration. Dynamic neutralization system (Dynesys) avoids many of these disadvantages. This system is made up of pedicle screws, polyethylene terephthalate cords, and polycarbonate urethane spacers to stabilize the functional spinal unit and preserve the adjacent motion after surgeries. This was a retrospective cohort study to compare the effect of Dynesys for treating degenerative lumbar diseases with posterior lumbar interbody fusion (PLIF) based on short term followup.Materials and Methods:Seventy five consecutive patients of lumbar degenerative disease operated between October 2010 and November 2012 were studied with a minimum followup of 2 years. Patients were divided into two groups according to the different surgeries. 30 patients underwent decompression and implantation of Dynesys in two levels (n = 29) or three levels (n = 1) and 45 patients underwent PLIF in two levels (n = 39) or three levels (n = 6). Clinical and radiographic outcomes between two groups were reviewed.Results:Thirty patients (male:17, female:13) with a mean age of 55.96 ± 7.68 years were included in Dynesys group and the PLIF group included 45 patients (male:21, female:24) with a mean age of 54.69 ± 3.26 years. The average followup in Dynesys group and PLIF group was 2.22 ± 0.43 year (range 2-3.5 year) and 2.17 ± 0.76 year (range 2-3 year), respectively. Dynesys group showed a shorter operation time (141.06 ± 11.36 min vs. 176.98 ± 6.72 min, P < 0.001) and less intraoperative blood loss (386.76 ± 19.44 ml vs. 430.11 ± 24.72 ml, P < 0.001). For Dynesys group, visual analogue scale (VAS) for back and leg pain improved from 6.87 ± 0.80 to 2.92 ± 0.18 and 6.99 ± 0.81 to 3.25 ± 0.37, (both P < 0.001) and for PLIF, VAS for back and leg pain also improved significantly (6.97 ± 0.84–3.19 ± 0.19 and 7.26 ± 0.76–3.56 ± 0.38, both P < 0.001). Significant improvement was found at final followup in both groups in Oswestry disability index (ODI) score (both P < 0.001). Besides, Dynesys group showed a greater improvement in ODI and VAS back and leg pain scores compared with the PLIF group (P < 0.001, P = 0.009 and P = 0.031, respectively). For radiological, height of the operated level was found increased in both groups (both P < 0.001), but there was no difference between two groups (P = 0.93). For range of motion (ROM) of operated level, significant decrease was found in both groups (P < 0.001), but Dynesys showed a higher preservation of motion at the operative levels (P < 0.001). However, no significant difference was found in the percentage change of ROM of adjacent levels between Dynesys and PLIF (0.74 ± 8.92% vs. 0.92 ± 4.52%, P = 0.91). Some patients suffered from degeneration of adjacent intervertebral disc at final followup, but there was no significant difference in adjacent intervertebral disc degeneration between two groups (P = 0.71). Moreover, there were no differences in complications between Dynesys and PLIF (P = 0.90), although the incidence of complication in Dynesys was lower than PLIF (16.67% vs. 17.78%).Conclusion:Dynamic stabilization system treating lumbar degenerative disease showed clinical benefits with motion preservation of the operated segments, but does not have the significant advantage on motion preservation at adjacent segments, to avoid the degeneration of adjacent intervertebral disk.

Anterior cervical discectomy and fusion with “mini-invasive” harvesting of iliac crest graft versus polyetheretherketone (PEEK) cages: A retrospective outcome analysis

Background: Limited outcome data suggested a minimal evidence for better clinical and radiographic outcome of polyetheretherketone cages compared with bone grafts in the anterior cervical discectomy and fusion. We proposed a “mini-invasive” surgical technique for harvesting iliac crest grafts that provides bicortical autografts of sufficient size to be used in multilevel cervical procedures and is not associated with long-term significant donor site pain. Methods: All patients undergoing discectomy and fusion during a three years period were consecutively extracted from computer database and retrospectively evaluated by means of telephonic interview, independently from surgical procedure (iliac crest autograph or prosthesis). Two procedure-blinded neurologists retrieved baseline clinical-demographic data and pre-surgical scores of routinely performed scales for pain and functional abilities. Afterwards, a third blinded neurologist performed clinical follow up by a semi-structured interview including Verbal Analog Scale for pain and Neck Disability Scale for discomfort. Results: 80 patients out of 115 selected cases completed the follow up. 40 patients had been treated by mini-invasive bone graft harvesting and 40 with PEEK cages for cervical fusion. VAS for both neck and arm pain were significantly reduced within groups. Patients did not complaint any significant pain and/or paraesthesias at donor site from the first week after intervention. Neck Disability Scale was significantly lower at the end of follow up in both groups. Conclusions: “Miniinvasive” bicortical autografts is a less invasive, inexpensive technique to harvest iliac graft that may produce a reduced amount of general and local donor-site complications without outcome differences with prosthetic cages.