Free Autograft Research Articles

Using nerve segment insert grafting to reconstruct neural pathways of brain-derived paralysis

Since 1992, task groups have used free nerve auto grafts to bridge partially transected nerves from the dominant area of the normal cerebral cortex to nerves that innervate spastic muscles from a diseased cerebral cortex, using transplanting sutures to alleviate the muscle spasm of cerebral palsy caused by different diseases. This has facilitated rebuilding of some of its neurological function. In this study, 80 such patients were followed up, including 20 patients with traumatic brain injury, 32 patients with stroke, and 28 pediatric patients with cerebral palsy. After postoperative follow-up of 3 to 21 years, the efficacy rate of this operation was 100% and the excellent and good spasm relief rate was 82.5%.

The Reconstruction of Hepatic Arteries Using Extra-Anatomical Free Autografts in Living Donor Liver Transplantation

Objectives: In living-donor liver transplantation (LDLT), microsurgical reconstruction of a hepatic artery is essential but requires challenging techniques, because graft arteries are short and usable vessel grafts are limited. Furthermore, hepatic artery thrombosis can be a lethal complication. Extra-anatomical jump graft reconstruction using free grafts is reported to have a high reocclusion rate. However, this technique is necessary when there is no other option. We report 4 cases of LDLT that required extra-anatomical reconstruction technique using free autografting from the aorta to the hepatic artery. In this technique, we used the systemic administration of gabexate mesilate that is the strong serine protease inhibitor. Methods: From 1991 to 2015, we performed 164 LDLTs. We retrospectively investigated 4 cases of extraanatomical reconstruction of the hepatic artery using free autografting from the aorta to the hepatic artery. Results: Two cases initially underwent anatomical reconstruction, but the arteries occluded early, because of the dissection of recipient’s artery. There was no arterial graft, so we performed extra-anatomical reconstruction by using free autografting from the aorta to the hepatic artery. In the other two cases, the recipient arteries could not be used. Therefore, we initially performed extra-anatomical reconstruction by using radial artery free autografting as jump grafts from the aorta to the hepatic artery. In all cases, we used the systemic administration of gabexate mesilate, and could rescue all cases. Conclusion: We experienced and were able to salvage 4 cases that required free autografts. When there is no other means of reconstructing arteries, it is necessary to perform this procedure, depending on the condition of the intima of the recipient artery.

Клінічна ефективність методики хірургічного лікування птеригіуму з використанням високочастотного електрозварювання біологічних тканин для фіксації вільного лімбально-кон'юнктивального аутотрансплантата

Клінічна ефективність методики хірургічного лікування птеригіуму з використанням високочастотного електрозварювання біологічних тканин для фіксації вільного лімбально-кон'юнктивального аутотрансплантата

Press-fit fixation using autologous bone in the tibial canal causes less enlargement of bone tunnel diameter in ACL reconstruction--a CT scan analysis three months postoperatively.

BackgroundBone tunnel enlargement is a phenomenon present in all anterior cruciate ligament (ACL)- reconstruction techniques. It was hypothesized that press-fit fixation using a free autograft bone plug reduces the overall tunnel size in the tibial tunnel.MethodsIn a prospective cohort study twelve patients who underwent primary ACL reconstruction using an autologous quadriceps tendon graft and adding a free bone block for press-fit fixation (PF) in the tibial tunnel were matched to twelve patients who underwent ACL reconstruction with a hamstring graft and interference screw fixation (IF). The diameters of the bone tunnels were analysed by a multiplanar reconstruction technique (MPR) in a CT scan three months postoperatively. Manual and instrumental laxity (Lachman test, Pivot-shift test, Rolimeter) and functional outcome scores (International Knee Documentation Committee sore, Tegner activity level) were measured after one year follow up.ResultsIn the PF group the mean bone tunnel diameter at the level of the joint entrance was not significantly enlarged. One and two centimeter distal to the bone tunnel diameter was reduced by 15 % (p = .001). In the IF group the bone tunnel at the level of the joint entrance was enlarged by 14 % (p = .001). One and two centimeter distal to the joint line the IF group showed a widening of the bone tunnel by 21 % (p < .001) One and two centimeter below the joint line the bone tunnel was smaller in the PF group when compared to the IF group (p < .001). No significant difference for laxity test and functional outcome scores could be shown.ConclusionThis study demonstrates that press-fit fixation with free autologous bone plugs in the tibial tunnel results in significantly smaller diameter of the tibial tunnel compared to interference screw fixation.

Patellar tendon reconstruction with ipsilateral free semi-tendinosus and gracilis autograft for neglected patellar tendon rupture

Chronic patellar tendon ruptures are rare. Diagnosis is usually made on clinical background. The ideal method of treatment is a matter of debate. The management of neglected, chronic patellar tendon must address four difficulties: The proximally retracted patella, reconstruction of the patellar tendon, temporary protection of repair, patello-femoral tracking, and active full range of knee movement. By presenting a case of chronic patellar tendon rupture, the advantages of reconstruction with a free semi-tendinosus and gracilis autograft from an early rehabilitation are described.

Establishment of a novel rat extra-articular tendon-to-bone transplanting healing model

Objective To establish a novel rat tendon-to-bone healing model with a free tendon graft implanted into an extra-articular bone tunnel and to evaluate the effectiveness of this model for early tendon-to-bone healing process by histologic, biomechanical and radiological analysis. Methods Museulus flexor digitorum superficialis harvested from the left hind legs of 28 male Wistar rats were prepared as free autografts. Each autograft was implanted into a bone tunnel of 1.2 mm diameter created at ipsilateral proximal tibia1 metaphysis. The healing process of the tendon-to-bone interface tissuewas analyzed at week 1, 2, 4and 6 （n=4） after the transplantation. Biomeehanical test including maximum anti-pullout strength and failure mode were evaluated at week 2 and 6 （n=6） after transplantation. Immediately after the biomeehanical test, the samples were also taken by the high-resolu- tion radiography to observe the bone remodeling around the tunnel. Results At week 1, the interface between tendon graft and bone was primarily composed of a layer of amorphous fibrous granulation tissue. The thickness of the interface tissue decreased with the passage of time. This thinning tissue was gradually replaced by the newly formed bone tissue around the tunnel. The inter-face tissue almost disappeared at week 6 with a bunch of anchor fibers connecting the tendon with bone. The failure load-to-tunnel length ratio was significantly higher at week 6 [（1.00±0.30） N/mm] than that at week 2 [（0.35±0.17） N/mm]. The specimens of the tendon-to-bone complex failed by pull-out of the tendon from the bone tunnel at week 2, which translated into a break of the tendon at week 6. High-resolution X-ray imaging shows a clear gap around the bone tunnel at week 2. At week 6, the interface gap became blurred and the bone density at the tunnel site was similar to the surrounding bone tissue. Conclusion The healing pro-cess of a free tendon grant in an extra-articular bone tunnel is similar to that of the intra-articular anterior cruciate ligament recon-struction model. With simple surgical procedure and minimal influence to the postoperative activity, this tendon-to-bone healing model is of particular significance for early studies of tendon-to-bone healing process. Key words: Anterior cruciate ligament reconstruction; Models, animal; Rats

Microsurgically assisted bilamminar free rotrated papilla autograft (FRPA) procedure for root coverage

When esthetic demands of the patient require accentuated precision in surgical technique, incorporation of advanced surgical aids in general clinical practice becomes a necessity. Periodontal plastic surgical procedures have been reviewed in the dental literature and assessed for their validity so as to provide the practitioner with the knowledge required in making patient-centered, evidence-based decisions with respect to the treatment of gingival recession. Connective tissue grafts is considered the gold standard for root coverage procedures due to statistically significantly superior results compared to other procedures. However, the coverage of multiple tooth recessions and patient morbidity due to the need of larger second surgical wound at the donor site in the gingival recession reduction are the major shortcomings. A case report of multiple roots recession treated using a modified connective tissue grafting procedure, the free rotated papilla autograft using periodontal microsurgery has been presented here. The advantages are the use of a single surgical site, avoiding any palatal patient discomfort, good color compatibility with adjacent tissue and healing by primary intension.

The use of a structural free iliac crest autograft for the treatment of acetabular fractures

Bone and cartilage deficits in the posterior acetabular wall are severe complications resulting from the unsuccessful management or delayed treatment of acetabular fracture. This potentially disastrous condition cannot be treated reliably with the use of reconstruction plates and screws alone. Therefore, this technical report describes a modified anatomical reconstruction method that uses a structural iliac crest autograft and an acetabular tridimensional memory alloy fixation system (ATMFS) to treat late-stage deficits in the posterior wall of the acetabulum. This paper also describes a clinical study of 22 patients with an average of 6.3 years follow-up to evaluate the clinical outcomes of this method. Twenty-two patients, who had an acetabular reconstruction between January 2000 and December 2011 that used a structured free iliac crest autograft to treat late-stage bone and cartilage deficits in the posterior acetabular wall were followed annually with clinical and radiographic evaluations. The average age of the patients was 36.4 years at the time of the procedure, and the average time of follow-up was 6.3 years. None of the patients in this study lost reduction after surgery, and there were no cases of implant failure. Radiographic analysis using Matta's X-ray evaluation criteria were excellent in eleven cases, good in eight, and fair on three. The Merle D'Aubigné and Postel clinical outcomes at the final follow-up were as follows: seven cases were excellent, ten cases were good, three cases were fair and two cases were poor. The use of a modified iliac crest grafting and ATMFS fixation, as a biological method to reconstruct the acetabulum anatomically may offer better congruence of the joint surface and may ensure good hip joint stability during early postoperative exercise. The medium to long-term results of this method are encouraging.

Biological reconstruction of the femur using double free vascularized fibular autografts in a vertical array because of a large defect following wide resection of an osteosarcoma

Free vascularized fibular autograft transfer to the defect area after wide resection of bone sarcoma is one of many biological reconstruction methods. We report on an 8-year-old girl with 7 years of follow-up treated for right femur osteosarcoma. A 26 cm long tumor was resected with clear margins. Because the length of one fibular autograft was shorter than the defect length, bilateral free vascularized fibular autografts were used in a vertical array on top of one another, and placed inside a fresh-frozen femoral allograft. The original length of the femur was maintained by this technique.

Vascularized bone reconstructive approaches after tumor resection

Vascularized bone grafts frequently are used to reconstruct bone defects after tumor resection if the expected prognosis is good. The most used bone is the fibula; however, other donor sites are available. Their vascularities are maintained by both free autografts and pedicled flaps, which preserve the vascular supply for bone union while preventing infection. The vascularized fibular graft is used for both primary reconstruction and salvage of failed oncologic long bone reconstruction and pathologic fractures. Various combination procedures with vascularized fibular grafts also have been reported in the recent literature with satisfactory clinical results. The second most commonly used donor material for free-vascularized bone transfer is the iliac bone with the deep circumflex iliac artery. Harvesting the iliac bone is relatively sophisticated; however, it may become easier by using prospective CT angiography and confirming the vascular supply which aids in planning. The use of allograft shells with intramedullary free vascularized bone grafts for intercalary reconstruction after excision of bone malignancy has been reported recently and takes advantage of the combination of both the strong bone stock provided by the allograft and the biological potentials provided by the vascularized bone graft. This article examines various vascularized bone grafts used to reconstruct massive bone defects after tumor resection or reconstructive procedures.

Proximale und distale Ruptur des M. biceps brachii

Ruptures of the biceps tendon account for a high percentage of tendon ruptures. The aetiology of proximal ruptures of the long head of the biceps tendon is often degenerative and they are frequently associated with lesions of the rotator cuff. The clinical findings are often not specific and long lasting. Distal ruptures of the biceps tendon mostly occur during eccentric contraction of the biceps muscle.Clinical tests, the associated haematoma and a distalisation or proximalisation of the muscle belly in combination with ultrasound or MRI to rule out combined diseases lead to the diagnosis. The possible options include conservative and operative treatment. Tenotomy and tenodesis lead to comparable results in the literature. Therefore, conservative treatment is mostly recommended in proximal ruptures. Operative treatment is preferred in distal ruptures of the biceps tendon in order to achieve an anatomical reconstruction of the muscle function. Chronic ruptures of the distal biceps tendon can be successfully treated with free autografts or allografts.

In situ surgical procedures for locally advanced pancreatic cancer: partial abdominal evisceration and intestinal autotransplantation

Pancreatic cancers in which invasion to the root of the mesentery are suspected have been regarded as unresectable in general. We report the surgical techniques in two cases of locally advanced pancreatic cancer for which in situ surgical procedures including partial abdominal evisceration and intestinal autotransplantation were performed. The patients were a woman 57 years of age and a man 64 years of age. Both cases had a locally advanced cancer that had originated in the pancreatic uncus and was found to have invaded the root of the mesentery, as well as the superior mesenteric artery (SMA) and the superior mesenteric vein (SMV). The cancers in both patients were assessed as resectable because the jejunal artery and vein were secured intact at a site peripheral from the root of the mesentery, and the origin of the SMA along with the portal and splenic veins was intact at a proximal site, so pancreatectomy and resection of the transverse and ascending colons were performed. The SMA and the SMV were ablated just below each origin at a site proximal to the root of the mesentery. At a distal site, two jejunal arteries and one jejunal vein were kept intact and all the remaining arteries and veins were ablated. The remaining small intestine had become a free autograft. As for the portal and jejunal veins, end-to-end anastomosis was performed. Reconstruction of the SMA was achieved with an end-to-end anastomosis, using the right internal iliac artery as a graft. Reconstruction of the alimentary tract was achieved using small intestine as an autograft. Both patients survived the major operative procedures. Warm ischemia time was 84 min for the SMA and 12 min for the SMV-portal system in Case 1 while it was 30 min for the SMA and 25 min for the SMV-portal system in Case 2. No ex-vivo resection technique was used. Leakage occurred in both cases at the anastomotic lesion between the small intestine and the left colon. Abdominal drainage and conservative treatment were applied in both cases. Cure was achieved within 3 months postoperatively in Case 1 and within 2.5 months in Case 2. Subsequently, the patients returned to their preoperative lives. Case 1 died 11 months and Case 2 died 12 months after the operation due to abdominal dissemination and liver metastases. We were able to perform in situ procedures including partial abdominal evisceration and intestinal autotransplantation for two cases of pancreatic cancer with possible invasion to the root of the mesentery. There are few reports of such procedures. There has been one report of a case which applied an ex vivo technique. It is expected that the development of adequate adjuvant therapy will lead to further improvement in the prognosis of pancreatic cancers.

Pulmonary artery sling with tracheal stenosis

Pulmonary artery sling (PAS) is a rare congenital heart disease in which the left pulmonary artery (LPA) originates from the right pulmonary artery (RPA) and encircles the distal trachea and right mainstem bronchus as it courses between the trachea and esophagus. Typically, patients with PAS have some respiratory symptoms, either due to external tracheal compression that can be corrected by relief of the sling mechanism, or due to severe diffuse tracheal stenosis with complete rings (ring-sling complex). The diagnosis of PAS is optimally made by echocardiography, while bronchoscopy is the key to the assessment of tracheal stenosis. Diagnosis is indication for surgery. Repair using a strategy of median sternotomy, cardiopulmonary bypass, division of the LPA and reimplantation into the main pulmonary artery (MPA), and simultaneous tracheal repair takes preference. Tracheal repair should be considered only in clinically symptomatic patients. The techniques of free tracheal autograft plasty or slide tracheoplasty offer promising results, and the choice of tracheal reconstruction should be guided by the clinical experience of the surgeon. Coexisting intracardiac pathologies are repaired at the same time. Postoperative care requires close multidisciplinary effort to achieve the best long-term result.

A comparative study on repair of peripheral nerve defects by end-to-side anastomosis and free nerve autograft with blood supply

目的 通过神经端侧缝合与带血供的自体神经游离移植的对比观察,分析神经端侧缝合的修复效果.方法 选用SD大鼠20只,每只大鼠随机选择一侧下肢行神经端侧缝合,另一侧下肢建立带血运的神经游离移植模型.术后分笼饲养,观察肢体瘫痪及感觉恢复情况.术后6个月取缝合处以远腓总神经段标本切半薄切片,分别做甲胺蓝、变色酸2R-亮绿髓鞘染色和HE染色,测量神经横切面轴突数目、密度、直径等.超薄切片做透射电镜观察,测髓鞘厚度和有髓神经纤维面积.结果 所有大鼠伤口一期愈合,足部无溃疡形成,外观红润饱满.于术后3个月左右胫前肌肌力恢复,趾展反射出现.光镜检查见两种手术方式均有有髓神经纤维生长,再生纤维排列整齐密集,呈线形平行排列.电镜观察见髓鞘形态正常.两种术式轴突数目、密度、直径、髓鞘厚度差异均无统计学意义(P＞0.05).结论 神经端侧缝合后有有髓神经纤维生长,修复效果与带血供的自体神经游离移植无显著性差异.

1056 POSTER Free ileocolic autograft — the preferable method of reconstruction following advanced hypopharyngeal tumor resection

1056 POSTER Free ileocolic autograft — the preferable method of reconstruction following advanced hypopharyngeal tumor resection

Experimental study of free periosteal autograft: repair of major defects of cartilage of joint in rabbits of different ages

目的 研究比较自体骨膜移植软骨再生修复不同龄动物大块关节软骨缺损.方法用52只不同龄家兔自体骨膜游离移植修复大块关节软骨缺损,比较移植骨膜生发层朝向关节腔与松质骨时再生软骨的差别.结果经不同时期肉眼和组织学检查证实,幼年兔和成年兔的骨膜移植都能生成软骨,修复大块关节软骨缺损.在成年兔骨膜再生的软骨与成年兔本身周围正常软骨的厚度、组织结构一样.移植骨膜生发层朝向关节腔与松质骨二者间再生软骨结果无明显差别.结论骨膜具有再生软骨的能力,可用来移植修复关节软骨的缺损.骨膜移植生发层不同朝向对软骨再生无明显影响.成年后骨膜移植修复关节软骨缺损能够生成与自身相适应的软骨。

857The surgical treatment of peyronie's disease with the use of free auto graft of buccal mucosa

857The surgical treatment of peyronie's disease with the use of free auto graft of buccal mucosa

The Surgical Treatment of Peyronie's Disease: Replacement of Plaque by Free Autograft of Buccal Mucosa

Objectives: The aim of this work was the evaluation of clinical results of the use of buccal mucosa for replacement of Peyronie's disease plaque. Patients and methods: Twenty-six patients with Peyronie's disease were under observation. All the patients underwent the following investigations before and periodically within 3 years after the treatment: International Index of Erectile Function (IIEF-5), manual examination of plaque, autophotography of erect penis, conventional and power color Doppler sonography of penis, Peno-Brachial Index (PBI) before and its increase (IPBI) after the intracavernous injection of papaverin, Peak Systolic Velocity (PSV), end diastolic velocity (EDV), Resistance Index (RI), Sexual Encounter Profile questions (SEP-2 and SEP-3), measurements of penile length and curvature angle in the phase of rigidity. After stabilization in plaque's development (mean time 2.0 ± 0.1 years) the patients underwent a surgery by means of excision of plaque and its replacement by free autograft of buccal mucosa. Results: After the surgical treatment (with mean follow up observation of 3.2 ± 0.1 years) in 24 patients out of 26 (92.3%) the complete straightening of penis occurred, in two (7.7%) cases a residual curvature (<10°) remained, in four patients (15.4%) the shortening of penis (by 1 cm) and in two patients (7.7%) a partial reduction of erectile power were observed. Conclusion: Buccal mucosa showed high properties of adaptation and revascularization, good anatomical and functional clinical results by replacement of indurative plaque, it kept a stable elasticity without shrinkage; the method is simple and can be recommended for wide use in clinics for surgical treatment of Peyronie's disease.

Osteogenic ability of free perichondreal autografts in canine tibial defects: An experimental study

Summary This study set out to establish the effect of transplanting perichondreum on bone healing at sites of tibial bone defects in an experimental dog model. Transplantation of free, autologous, non-vascularised, perichondreal grafts to the distal of right anteromedial plane side of the tibia was compared with non-transplantation on the proximal side of the same bone. In experimental dogs (n = 7), a 5 cm piece segment of perichondreum, that has been excised from the thirteenth rib of the same animal, was transplanted to the middle defect fracture site of bone, but not to the control proximal defect fracture site. The dogs were allowed to recover from the operation and were kept 21 days in cages, with free-range. On days 30 (Group I) and 45 (Group II) after operations, the dogs were euthanatized. Histopathologically, defects in 30 days treated perichondreum group were filled by new ossified tissue while control defects in the same period were not fully resurfaced. The new ossified tissue consisted of a thin and inadequate trabeculae. In 45 days treated groups, defects with transplanting perichondreum were filled by thick trabeculae converting into a compact bone tissue. The control defects of this group, however, were filled by an extreme callus overflowing to medulla and bone surface. This study has provided evidence to show that autologous, non-vascularized perichondreum retains an osteogenic ability when transplanted to tibial bone defect sites. It appears that callus formation occurred within the perichondreum grafting which resembles that of enchondral and intramembranous ossification.

Another Autograft for Coronary Artery Bypass Grafting

To assess the possibility of using the descending branch of the lateral circumflex femoral artery as a free arterial autograft for coronary artery bypass grafting, the anatomy of this artery and its surrounding structures were studied in 19 cadavers. The artery was found to be situated in the groove between the rectus femoris and the vastus intermedius muscles. The mean length of the arterial trunk was 12 ± 2.36 cm (range, 9.2 to 15.1 cm). The diameter was 2.7 ± 0.35 mm at the origin and 2.2 ± 0.28 mm at the terminal end. The reflection of this artery on the body surface was easy to locate. It was concluded that the descending branch of the lateral circumflex femoral artery could be considered as a potential conduit for coronary revascularization.