Full-thickness Graft Research Articles

Sternal cleft reconstruction with acellular dermal matrix and full-thickness calvarial graft.

We describe reconstruction of a sternal cleft in a neonate using acellular dermal matrix, full-thickness calvarial bone graft and myocutaneous pectoralis flaps.

Development of a full-thickness acellular dermal graft from human skin: Case report of first patient rotator cuff patch augmentation repair

The processing and initial testing of a new human tissue preparation is described. Full-thickness Acellular Dermal Matrix (ftADM) is the extracellular matrix (ECM) obtained by decellularization of full-thickness human skin from cadaveric donors. The safety, stability and usability of the graft are discussed with respect to the results of the residual cellular content, maintenance of ECM components, and biomechanical properties. Quantitative and qualitative analysis of the ECM demonstrated the absence of cell debris, while the native structure of human dermis was maintained. Biomechanical testing showed stiffness values comparable to other commercial products used for tendon reinforcement, suggesting that our ftADM could be successfully used not only in soft tissue regeneration surgeries, but also in tendon reinforcement. First case of ftADM in rotator cuff augmentation is described. Technical management of the patch during surgery and clinical outcomes are discussed.

Double Stiletto Flap for Soft Tissue Cover as a Firebreak Following Contracture Release of Digits and Full-Thickness Grafting: A Surgical Technique

Contracture release followed by full-thickness skin grafting is often performed while releasing severe contracture of the digits. We report a technique for flexion contracture of the finger, by using two triangular flaps from either side of the digit as a firebreak over the proximal interphalangeal (PIP) joint while using a skin graft following contracture release. We reviewed the medical records of patients who underwent contracture release at our institution from January 2018 to July 2021, and this technique was used for the release of flexion contracture of the five digits belonging to four patients. Our technique used triangular flaps from either side of the digit, which were rotated and brought over the PIP region, and hence, a single sheet of graft spanning the PIP joint is avoided. We believe that this acts as a firebreak and thus reduces the recurrence of contracture at the PIP joint.

Technological advances in three-dimensional skin tissue engineering

Abstract Tissue engineering is an enabling technology that can be used to repair, replace, and regenerate different types of biological tissues and holds great potential in various biomedical applications. As the first line of defense for the human body, the skin has a complex structure. When skin is injured by trauma or disease, the skin tissues may regenerate under natural conditions, though often resulting in irreversible and aesthetically unpleasant scarring. The development of skin tissue engineering strategies was reviewed. Although the traditional approaches to skin tissue engineering have made good progress, they are still unable to effectively deal with large-area injuries or produce full-thickness grafts. In vitro three-dimensional (3D) skin constructs are good skin equivalent substitutes and they have promoted many major innovative discoveries in biology and medicine. 3D skin manufacturing technology can be divided into two categories: scaffold-free and scaffold-based. The representatives of traditional scaffold-free approaches are transwell/Boyden chamber approach and organotypic 3D skin culture. Because of its low cost and high repeatability, the scaffold-free 3D skin model is currently commonly used for cytotoxicity analysis, cell biochemical analysis, and high-throughput cell function. At present, many drug experiments use artificial skin developed by traditional approaches to replace animal models. 3D bioprinting technology is a scaffold-based approach. As a novel tissue manufacturing technology, it can quickly design and build a multi-functional human skin model. This technology offers new opportunities to build tissues and organs layer by layer, and it is now used in regenerative medicine to meet the increasing need for tissues and organs suitable for transplantation. 3D bioprinting can generate skin substitutes with improved quality and high complexity for wound healing and in vitro disease modeling. In this review, we analyze different types of conventional techniques to engineer skin and compare them with 3D bioprinting. We also summarized different types of equipment, bioinks, and scaffolds used in 3D skin engineering. In these skin culture techniques, we focus on 3D skin bioprinting technology. While 3D bioprinting technology is still maturing and improvements to the techniques and protocols are required, this technology holds great promise in skin-related applications.

Is "Initial Size of the Graft the Real Culprit behind Primary Contraction of Full-Thickness Skin Graft"? - A Cross-Sectional Study.

Background Primary contraction of full-thickness graft has been traditionally quoted to be 40%. There are lacunae in literature to elaborate on the factors influencing it ever since. Methods About 75 subjects who underwent full-thickness grafting procedures to resurface small defects were included in the study. The initial and final graft dimensions after primary contraction were traced on X-ray templates and the percentage of contraction was evaluated using the graphical method. This was further correlated with age, collagen, elastic matrix metalloproteinases-1 (MMP-1) and -2 content along with dermal thickness of the skin specimen sent from the graft. Results The primary contraction of the graft had a very significant correlation only with the initial size of graft harvested with a linear regression of 33.3% and a Spearman's correlation of 0.587 significant at a p -value of 0.001. Conclusion This study though preliminary tries to highlight an important factor that primary contraction of grafts is a physical phenomenon independent of its contents like collagen, elastin, or MMP-1 and -2 or age and dependent on its initial size of harvest instead.

A 5-year follow-up of Achilles tendon reconstruction using a full-thickness graft processed with the clearant method and retrograde fixation in the calcaneus: a case study of an amateur soccer player

We present a case of a 41-year-old male amateur soccer player with no comorbidities, who experienced a rerupture of the Achilles tendon 5 years after his initial end-to-end plasty. To address this, we opted for a full-thickness reconstruction using a graft under the Clearant Process of the Achilles tendon. As an innovative approach, we proposed an alternative fixation technique, employing a Bio Composite Arthrex 9 mm x 35 mm interference screw, placed at the apex of the calcaneus body. For a period of 5 years, the patient underwent regular imaging follow-ups with Magnetic Resonance Imaging (MRI) and clinical assessments using the Foot and Ankle Ability Measure Activity Subscale Score and Foot and Ankle Ability Measure Sports Subscale Score. This case highlights the importance of exploring novel fixation methods for Achilles tendon reconstruction, particularly in cases of rerupture. The use of the Bio Composite Arthrex screw, in conjunction with the Clearant Process graft, demonstrated promising results both in imaging and functional outcomes, but more case studies with positive results are needed to evaluate the effectiveness of this reconstruction.

A Retrospective Case Series in Fournier's Disease: And Its Emergency Management et Grafting Technique for Penis Coverage.

Fournier's gangrene is a necrotizing soft tissue infection of the genital, perineal, and perirectal areas. A primary isolated involvement of the penis is rare, but it can be affected in some circumstances. The purpose of this case series is to present the findings of our thirteen years' experience in the reconstruction of the penis in Fournier's gangrene and our full-thickness grafting technique to cover the penis rod. We retrospectively reviewed patient data who underwent a penis reconstruction following Fournier's gangrene in 2018. The data was analyzed to report the estimated percentage of complications, of patients with primary or secondary gangrene of the penis, the number of reinterventions, and finally the percentage of deaths or recovery. 23 patients underwent reconstruction with our technique of full-thickness skin graft. In all cases, the skin graft was harvested from the upper arm with an arrow shape mark. No further penile revision surgery was required, and neither patient complained about retraction, nor traction, or pain during erection. The donor site healed without any complications. We believe that the coverage of the penis using our grafting technique is safe, easily reproducible, and demonstrates excellent esthetic and functional results.

Similar collagen distribution in full-thickness skin grafts in intraperitoneal and onlay positions, an experimental mice-study

PurposeAutologous full-thickness skin grafting (FTSG) has the potential to become an option in abdominal wall repair. An understanding of tissue remodelling in the extracellular matrix (ECM) is crucial as this interplay determines such parameters as tissue strength and flexibility. This cross-sectional preclinical laboratory study in mice provides information on the distribution of collagen types and matrix metalloproteinases (MMPs) in the ECM of FTSGs in the intraperitoneal and onlay positions compared with internal controls. The aim was to evaluate morphologic changes after tissue remodelling and repair in FTSGs applied in the two positions and to detect any adverse host response.MethodsECM components were evaluated as follows: qualitative examination of collagen bundle thickness using Picrosirius Red staining (collagen types I, III and IV); and evaluation of collagen types IV and V, as well as MMPs 1, 8 and 9 using immunohistochemical staining. Full-thickness grafts transplanted between female twin mice were examined as this best mimics autologous transplantation.ResultsAt 8 weeks, FTSGs in the intraperitoneal position did not show any noticeable differences in morphologic appearance to those in the onlay position. Both intraperitoneal and onlay FTSGs showed increases in the amount of thick collagen bundles compared to internal controls. No correlation was seen between distribution of MMPs 1, 8 or 9 and distribution of collagen types I, III, IV or V.ConclusionThis preclinical study shows that FTSGs in both intraperitoneal and onlay positions are possible application site options and, by extension, promising application site options for abdominal wall reinforcement in hernia surgery. Clinical studies in humans are required to confirm these findings.

Titanium Powder 3D-Printing Technology for a Novel Keratoprosthesis in Alkali-Burned Rabbits.

PurposeTo evaluate the surgical technique, clinical performance, and biocompatibility of a novel keratoprosthesis (KPro) named KPro of Brazil (KoBra) in an alkali-burned rabbit model.MethodsTwo-piece three-dimensional-printed titanium powder and polymethyl methacrylate KPros were implanted into 14 alkali-burned corneas of 14 rabbits using an autologous full-thickness corneal graft as the KPro carrier. Rabbits were examined weekly for 12 months to evaluate retention and postoperative complications. Anterior segment optical coherence tomography (AS-OCT) and scanning electron microscopy (SEM) were performed at the end of the experiment to evaluate the relationship between the KoBra and the carrier graft.ResultsAll surgeries were performed without intraoperative complications, and the immediate postoperative period was uneventful. In 12 eyes (85.7%), the implanted KPros integrated into the operated eyes and maintained clear optics without extrusion or further complications over 12 months. Two eyes presented late postoperative complications that progressed to KPro extrusion: one had a presumed infectious keratitis, and the other had sterile stromal necrosis. AS-OCT demonstrated the correct relationship of the device and carrier graft in all remaining animals at the final follow-up. SEM findings indicate the integration of the porous structure of the back plate into the surrounding tissue.ConclusionsClinical evaluations, AS-OCT, and SEM findings indicate good biointegr-ation of the implanted device into the corneal carrier graft. KoBra has the advantage of using recipients’ own corneas as the prosthesis supporter, and its surgical procedure is relatively simple and safe.Translational RelevanceTitanium three-dimensional-printed technology used in an animal limbal stem-cell deficiency model holds great promise for the treatment of corneal blindness in humans.

TU7.11 Skin Grafts Vs. Local Skin Flaps in Management of Contracted Scar Finger

Abstract Introduction In our study, we reviewed the outcome of using skin grafts and different regional flaps of the hand in order to correct flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. In both techniques, vigorous postoperative exercises were advised for an interval of time between 3–6 months. Patients and Methods 16 patients were included. All the scar tissue was excised, and the resultant raw area was covered. In Group A consisting of 8 patients, skin grafts were used. Split thickness grafts were selected in 3 cases and full thickness grafts in 5 cases. While in group B, Z-plasty and Cross finger regional flaps were used in 4 cases per each flap. The cause of the contracture was thermal burn in 8 patients, mechanical trauma in 7 cases, and a case of contracture secondary to dupytrene's disease. The mean follow-up period was 6 months. Results The mean flexion contracture/further flexion in the joints were improved markedly at the last follow-up. More extension was gained by exercising after the operation. Near full ROM was achieved in 15 cases with strong hand grip and cosmetic satisfaction. There were no major complications. Conclusion Wise selection between different skin grafts and regional skin flaps is important, to achieve best outcome in managing finger contractures and gain satisfactory ROM. Choosing the best reconstruction method depend on the size, extent and depth of the raw area. Exposure of the deep structures is an indication to use skin flaps over grafts. Vigorous extension exerc

EP-94 To see or not to see: A case of complex multidisciplinary surgical reconstruction

Abstract A 4 year-old child suffered catastrophic 60% total body surface area burn injuries affecting head and neck, trunk and limbs following sulphuric acid burns. He underwent limited treatment in his country consisting of first aid and debridement and grafting in upper and lower limbs and trunk, but no treatment to the facial and ocular areas. He was referred for assessment and reconstruction in the United Kingdom. Even though there were widespread burn scar contractures, his most severe injuries involved both eyes and adnexal structures with evidence of severe bilateral cicatricial ectropion and threat to vision. He required multidisciplinary plastic surgery and ophthalmic complex bilateral eyelid reconstruction in two separate procedures to restore anatomical and cosmetic integrity to both eyes. The initial procedure involved examination under anaesthesia of both eyes, release of the left upper and lower eyelids burns scar ectropion and resurfacing of the resulting defect with full thickness grafts from the left clavicular area. The grafts had full take with no evidence of infection and excellent cosmesis. A similar procedure was performed to reconstruct the right eyelids 6 weeks later. The vision of this eye was beyond salvage but the need for cosmetic eyelid symmetry was considered as an appropriate indication to proceed to reconstruction. This was found to be successful with excellent graft take and parental satisfaction. This case required coordination, expert holistic approach, complex surgery and extra efforts from the team to ensure compliance, communication and positive outcomes and highlights the importance of multidisciplinary team effort.

Application of VSD technique in adults with chronic osteomyelitis of the extremities combined with soft tissue defects.

To investigate the clinical application of vacuum sealing drainage (VSD) in chronic osteomyelitis of the extremities combined with soft tissue defects in adults. This study retrospectively included 32 adult patients with clearly diagnosed chronic osteomyelitis of the extremities combined with local soft tissue defects, and the trauma was covered by VSD after debridement, osteotomy, and vancomycin-laden bone cement filling of the occupancy, and the trauma was covered by selecting a suitable flap transfer repair according to the site and extent of the soft tissue defect after the trauma condition was suitable, and the secondary trauma was taken from the abdominal full-thickness skin free skin slice graft, according to whether the skin graft area was performed. The skin flap hematoma and infection rate, as well as the skin flap survival rate and implant fixation time were compared and analysed between the two groups. The primary outcome is the implant fixation time, and the secondary outcome is the skin fragment survival rate. In 32 patients, VSD was performed on the bone cement surface to cover the trauma, and 33.2 to 39.8kPa continuous vacuum sealing drainage was set. The average VSD time duration before soft tissue coverage was 47.87 ± 23.14 days, and the average number of VSD use was 7.18 ± 3.23. The use of VSD before soft tissue coverage did not cause complications such as negative pressure could not be maintained, vacuum sealing drainage was not smooth, skin blistering, trauma. Among the 32 patients, 12 cases of soft tissue coverage were followed by trauma free skin grafting with packing + VSD, and 20 cases were fixed with packing alone, and the duration of continuous packing and fixation of free skin pieces in the VSD group was significantly less than that in the control group (P=.006). The survival rate was significantly higher than that of the control group (P=.019). VSD in adult patients with chronic osteomyelitis of the extremities combined with soft tissue defects can effectively improve the trauma condition, provide the possibility of second-stage soft tissue coverage, and significantly shorten the preparation time for soft tissue coverage. In addition, when soft tissue coverage trauma is performed, VSD combined with skin graft packing technique can significantly improve the survival rate of skin pieces, shorten the time of skin graft fixation.

Clinical features, surgical outcomes and genetic analysis of ectodermal dysplasia with ocular diseases.

To report on the clinical features, surgical outcomes and gene mutation analysis of three ectodermal dysplasia probands with ocular diseases. A case-note review of three unrelated probands diagnosing with ectodermal dysplasia with ocular diseases was undertaken. Patient clinical features and the outcomes of surgery were analysed. The suspected pathogenic genes were analysed by whole exome sequencing from patients with ectodermal dysplasia and Sanger sequencing from family members. The ocular clinical features of ectodermal dysplasia with ocular diseases mainly include eyelid ectropion, lagophthalmos and absence of lacrimal punctum. All the probands underwent surgeries of full-thickness free skin flap grafting to correct ectropion. They achieved good recovery, and there were no obvious complications during the follow-up. The gene sequencing results did not show any meaningful genetic mutations. Lid ectropion is one of the key clinical traits of ectodermal dysplasia with ocular diseases. Ectropion correction with full-thickness free skin flap grafting is an effective procedure to correct ectropion for ectodermal dysplasia patients with ichthyosis-like tissue. The suspected pathogenic genes of ectodermal dysplasia with ectropion should be further verified or confirmed by large samples of the family.

3D Bioprinting of Prevascularized Full-Thickness Gelatin-Alginate Structures with Embedded Co-Cultures.

The use of bioprinting allows the creation of complex three-dimensional cell laden grafts with spatial placements of different cell lines. However, a major challenge is insufficient nutrient transfer, especially with the increased size of the graft causing necrosis and reduced proliferation. A possibility to improve nutrient support is the integration of tubular structures for reducing diffusion paths. In this study the influence of prevascularization in full-thickness grafts on cell growth with a variation of cultivation style and cellular composition was investigated. To perform this, the rheological properties of the used gelatin-alginate hydrogel as well as possibilities to improve growth conditions in the hydrogel were assessed. Prevascularized grafts were manufactured using a pneumatic extrusion-based bioprinter with a coaxial extrusion tool. The prevascularized grafts were statically and dynamically cultured with a monoculture of HepG2 cells. Additionally, a co-culture of HepG2 cells, fibroblasts and HUVEC-TERT2 was created while HUVEC-TERT2s were concentrically placed around the hollow channels. A static culture of prevascularized grafts showed short-term improvements in cell proliferation compared to avascular grafts, while a perfusion-based culture showed improvements in mid-term cultivation times. The cultivation of the co-culture indicated the formation of vascular structures from the hollow channels toward avascular areas. According to these results, the integration of prevascular structures show beneficial effects for the in vitro cultivation of bioprinted grafts for which its impact can be increased in larger grafts.

Nonreplantable Total Scalp Avulsion Reconstruction with Acellular Biologic Matrix and Long-Term Outcome

Total scalp avulsion is a significant injury typically occurring as a result of industrial accidents involving high-speed rotary machines. Although ideal, scalp replantation is uncommon secondary to the nature of the injury and lack of viable microvas-cular anastomosis targets. Therefore, these defects are often reconstructed with microvascular free tissue transfer, with or without skin grafting. We present a unique case of a patient with total scalp avulsion achieving complete, stable skin coverage over partially intact periosteum using only spare parts of the amputated scalp as a temporary full-thickness graft and porcine urinary bladder matrix, thus, avoiding significant donor site morbidity or extensive surgery. At 4 years postoperative, the scalp coverage remains stable.

DMEK after penetrating keratoplasty: cohort with DMEK grafts and descemetorhexis larger than full-thickness graft

PurposeThe study aims to evaluate visual outcome, central corneal thickness, and rebubbling rate in a cohort with oversized DMEK grafts after failed penetrating keratoplasty (PK). The unique feature of the study is a descemetorhexis diameter larger than the full-thickness graft, i.e., peripheral to the PK interface.MethodsA monocentric, retrospective evaluation of all patients with endothelial graft failure after PK treated with an oversized DMEK graft and descemetorhexis outside of the PK interface (i.e., in host tissue) between January 2015 and July 2019 at the Department of Ophthalmology at the University of Düsseldorf (Germany) was performed.ResultsEleven eyes of 10 patients were identified. Mean age was 69 years. On average (arithmetic mean ± standard deviation), 1.7 ± 1.0 previous PKs have been performed per eye in this cohort. The mean time between last PK and DMEK was 10.1 ± 7.3 years (range 2 to 23 years). In all cases, the graft diameter exceeded the diameter of the previous PK and descemetorhexis was performed in host tissue, that is, peripheral to the graft-host interface. Rebubbling was performed in 18.2% of the patients (n = 2 eyes) because of central graft detachment. Mean central corneal thickness showed a statistically significant improvement at 5.3 ± 3.5 months after surgery from 688.23 ± 151.01 to 527.75 ± 88 µm (p = 0.002).Visual acuity increased significantly by 5 lines from 1.24 ± 0.5 logMAR (range from 0.5 to 2) to 0.73 ± 0.76 logMAR (range from 0.1 to 2) within 3 months (p = 0.006). Excluding patients without visual potential and transplant failure, visual acuity improved significantly by 8 lines (p < 0.001), and stayed stable until the last follow-up at 15.1 ± 11.4 months (range 6 to 39 months, p < 0.001, n = 8) after surgery.ConclusionDMEK can be successfully used to treat endothelial cell failure after PK, and can provide good postoperative results with regards to visual acuity. This study shows that stripping of Descemet’s membrane (DM) peripheral to the PK interface is surgically feasible. Overlapping, larger DMEK grafts with more endothelial cells can be used without increasing rebubbling rates and may potentially improve long-term graft survival.

500 Return To Work After A Burn Injury: Even The Small Burns Need Attention

IntroductionAn important part of burn recovery and reintegration involves the return to meaningful employment. Studies have determined that the workman’s compensation burn patient faces multiple barriers to return to work (RTW). Factors that increase time to RTW include increased TBSA burns, full thickness depth and grafting, burns to the hands and feet, and increased age. We hypothesize that patients with grafted burns, hand and feet burns, or psychological disorders following injury take longer to return to work.MethodsA retrospective analysis was performed of burn patients seen in the outpatient burn clinic with work related injuries equal to or less than 5% TBSA, from 11/1/2016 to 5/31/2021. In addition to demographic data, also collected were locations of burns, dates of RTW, and positive PTSD and depression symptoms on screening.Medians with interquartile ranges are reported due to nonnormal distribution, Wilcoxon Mann Whitney tests were performed using StataCorp. burn patients seen in the outpatient burn clinic with work related injuries.ResultsOf 118 patients, more injuries occurred in males (89%) than females with a median age of 36.5 years (IQR 26-49). The median TBSA was 1% (IQR .025-1.5) and the median time to return to work was 34 days (IQR 16-75). The 21 patients that were grafted took significantly longer to return to work (median 107.5 days; IQR 60-199.5) compared to 97 patients that were not grafted (median 28 days; IQR 13-59; p=0.0000]. Presence of a hand/foot burn trended towards increased time to RTW but was not significant, median 37 days (IQR 19-81) vs 26 days (IQR 14-61; p =.0306).Patients with PTSD and depression (n=16) also took longer to return to work (Median 66; IQR 33-89.5) compared to patients (n=90) that showed no symptoms on screening (median 30.5; IQR 14-72; p=0.032).ConclusionsThe increased RTW for grafted, hand and foot burns is supported in the current research, however the addition of PTSD and depression and its interplay with RTW has not yet been fully vetted in determining return to work readiness. Within our population, positive screens for these psychological stressors profoundly affected their ability to return to employment. This study continues to validate the need for early screening and intervention in our population and the need to intervene as early as possible with psychological support services.

Восстановительное хирургическое лечение тяжелой инъекционной травмы кисти высоким давлением

Introduction High-pressure injection injuries to the hand result from injection of substances by high-pressure industrial devices. These are rare lesions with high risk of substantial long-term morbidity. Tissue defects resulting from staged debridement require skin grafting or vascularized island flap coverage. Hand therapy is an important part of the complex rehabilitation of such patients. The objective is to present complex surgical reconstruction of severe high-pressure injection injury of the hand aimed at preserving limb function. Material and methods Methods and results of surgical reconstruction of a patient with severe high-pressure injection injury of the hand treated at the Research Institute – S.V. Ochapovsky Regional Clinic Hospital No.1 in 2018–2019. Results Short-term result of surgical treatment demonstrated complete skin restoration and maximum possible preservation of underlying deep anatomical structures of the hand. Subsequent surgical interventions were aimed at restoring the hand function. Conclusion The restorative treatment of a high-pressure injection injury of the hand includes the earliest possible primary surgical treatment of the wound with wide revision, maximum removal of the injected substance and non-viable tissues and prevention of secondary injuries and infection in the wound. Nonfree vascularized flaps, full-thickness free grafts or split-skin autografts are used for skin reconstruction. Restoration of other functionally significant structures can be considered at a long term with wounds healed and autografts completely implanted. Hand therapy is integral to the comprehensive functional rehabilitation of the high-pressure injection injuries to the hand.

Full-Thickness Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction

Background: Quadriceps tendon autograft is used increasingly worldwide for primary anterior cruciate ligament (ACL) reconstruction, but remains at the third place after patellar tendon and hamstring grafts. It has shown very good results in biomechanical and clinical studies, but most of the authors describe a partial thickness tendon graft. Indications: This presentation describes the technique for a full-thickness quadriceps tendon autograft with an original technique of fixation on the femur and provides tips and tricks to avoid pitfalls. Technique Description: Arthroscopic preparation of the tunnel is performed before graft harvesting, to obtain the exact length of the graft needed. The femoral tunnel is drilled through the anteromedial portal, 30 to 40 mm long. For the tibial tunnel, a classic drill guide system is used, set at an inclination of 40°. The total length from the tibia to the femur is measured, which allows to position the femoral fixation on the cortex without pulling it into the soft tissue. Harvesting of the graft is done using a double-bladed scalpel, using the entire thickness of the quadriceps tendon. The bone block is detached with an oscillating saw and osteotome, and the defect in the quadriceps tendon closed in 2 layers. The graft is calibrated according to the tunnel preparation and sutured on the bony end with non-absorbable sutures tied to an endobutton. Tibial fixation is achieved by tying 2 non-absorbable sutures over a cortical screw in maximum tension with a sliding type knot, to automatically adjust the tension. Final fixation is performed with a titanium interference screw. Results: In the senior author series over the last 20 years, there was only 1 intraoperative patella fracture, treated with osteosynthesis. In accordance with the literature, full-thickness quadriceps tendon graft is strong and allows back to play at the same level as before the injury, in most cases, with lower donor site morbidity than patellar tendon and hamstrings grafts, without a difference in muscle strength compared with partial thickness grafts. Discussion/Conclusion: ACL reconstruction with full-thickness quadriceps tendon has shown very good clinical outcomes, with very few complications. It can be recommended for primary and revision ACL reconstruction.

P092 EVOLUTIVE MANAGEMENT OF THE OPEN ABDOMEN WITH POSTERIOR SEPARATION TECHNIQUE FOR DEFINITIVE RECONSTRUCTION

Abstract Aim Traumatic evisceration in politrauma patients is rare, with a prevalence of 1 in 40,000 trauma patients. The main mechanism is high-energy trauma to an acute surface. Our objective is to apply theoretical knowledge regarding the complex abdominal wall as an independent entity, analyzing the particular case of a patient operated in our center. Material and Methods Description of a clinical case using data extracted from the electronic medical record and bibliographic search in Pubmed. Results The reviewed literature was applied to a traumatic evisceration case with a Grade IV on the Dennis Abdominal Trauma Scale. The decisions made during the different stages in the multidisciplinary management of the traumatic evisceration were discussed. The role of Negative Pressure Therapy, the use of biological meshes, full thickness grafts and / or the Posterior Separation of Components were used to achieve a continent and functional abdomen after an injury of that magnitude during a 4-year follow-up with excellent results. Conclusions At the moment there is no consensus on the management of these traumatic evisceration situations. It depends in many cases on the experience of the surgeon. These cases should be treated individually based on the size and location of the lesions. The approach must be carried out in different stages, always thinking about achieving an early closure of the abdomen and preserving the anatomy of the abdominal wall. The best strategy for open abdomen reconstruction is not well defined, but we believe that Posterior Component Separation is a good option.