Graft Bed Research Articles

A Prospective Study on Return of Protective Tactile Sensations in Split-Thickness Skin Grafts

In the long evolution of world surgery, split-thickness skin grafting has distinguished itself as an age-old clinical tool utilised for soft tissue coverage. However, the scanty endorsement of return of protective tactile sensations in these split-thickness skin grafts seems mired between therapeutic subservience and clinical necessity. The objective of this study was to evaluate recovery of tactile protective sensations in split-thickness skin grafts. A total of 100 patients were recruited for the study. Prospective analysis of demographics, pre- and post-operative variables was done to evaluate the return of tactile sensations by two-point discrimination and cotton touch. Males represented 69% of the patients with a mean age of 49.04 (± 16.34) years. Early recovery of two-point discrimination at the periphery of the split-thickness skin graft was observed in 1 week in 23.9% and cotton touch in 61.4% of patients. Over a follow-up period of 1 year, 60% patients had recovery of two-point discrimination and 92.8% for cotton touch. The return of sensation at the centre of the graft was delayed and at 1-year follow-up, 67% developed tactile sensations. The rate of change of two-point discrimination with respect to time was significant (F = 5.74, P = 0.018). Delayed recovery of sensations was observed in patients who developed graft bed oedema or had a scarred graft bed. The encouraging early return of tactile sensation furnishes the split-thickness skin graft with a protective capability against shear, often offered as a reason for graft loss in contemporary wisdom. The findings of a delayed return in a scarred and oedematous graft bed can be expressed as clinical underpinnings and these observations should expand the myriad uses a split thickness skin graft can be put to in soft tissue coverage.

What does a (general and abdominal) surgeon need to know on plastic surgery?

Plastic surgery was first introduced as a sub-specialty of general surgery in Germany in 1978. Since then, this surgical subspecialty/discipline has evolved enormous potential, e.g. in collaboration with other disciplines such as general andabdominal surgery. To highlight and summarize the basic potential, technical options and novel aspects of plastic surgery, which are relevant for the common interdisciplinary surgical strategies of plastic and general as well as abdominal surgery in clinical practice. Short and compact narrative review based on 1) a selection of relevant references from the medical scientific literature and 2) surgical experiences obtained in daily practice. R esults (selected corner points): 1) Biological protection procedures in vascular surgery by flap coverage after meticulous debridement with or without autogenic vascular reconstruction are used to overcome infection of a vascular prosthesis, a serious problem, associated with the risk of anastomotic rupture and bleeding by transfer of immunological competence due to tissue coverage and finally to induce healing in the area of an infected vascular prosthesis. 2) Fistula treatment for aorto-tracheal or aorto-duodenal fistulas, a big challenge for the referring general surgeon, can be treated by flap coverage, i.e. interposition of the pectoralis-major flap and the omentum-majus flap, respectively. 3) With regard to nerve surgery, encouraging results have been reported after early microsurgical recurrent laryngeal nerve repair, i.e. improved subjective voice quality or reconstitution of respiratory capacity in diaphragmatic. 4) Lymphatic surgery for lymphedema occurring either primarily due to an absence or lack of lymphatic vessels or secondarily due to infection, trauma, radiation therapy or surgery can be indicated in specialized microsurgical centers, e.g. for surgical repair of the lymphatic pathway: I) the interrupted lymphatic system can be reconstructed by an interposition, or II) the lymphatic fluid can be drained extraanatomically (e.g. by a lymphatic-venous anastomosis). Further techniques are the following: free lymph node transplantation included in a free vascularized groin flap or autologous lymphatic vessel transfer or vein graft interposition (used for lymphatic vessel interposition). 5) Mass reduction such as dermolipectomy with subsequent split-thickness is a valuable option, which provides excellent volume reduction. 6) Defect coverage: A. Split- or full-thickness skin grafts are a common method of defect coverage (in cases of clean and well-vascularized wound bed and lacking donor skin, or if the graft bed is of questionable quality) using various allogenic or xenogenic skin substitute materials. B. Further methods offer a wide-range armamentarium of local and free fasciocutaneous and musculocutaneous flaps, e.g. after abdomino-perineal rectum extirpation using the vertical rectus-abdominis myocutaneous flap (VRAM) or propeller flaps according to the "angiosome". 7) Abdominal wall hernia closure with instable skin coverage, flap closure, either alone or in combination with mesh is superior to mesh closure only. 8) Free flaps: If there is no option for a local or pedicled flap available, free flaps can be well used for abdominal wall defect closure (complication rate in experienced hands is low). Plastic surgery is an indispensable partner for specific surgical problems and clinical situations of general and abdominal surgery, which indicates that each general and abdominal surgeon should be well notified on great options and surgical techniques offered by modern plastic surgery to achieve best outcomes and quality of life for patients and should combine the expertise of these two surgical disciplines.

Local VEGF-A blockade modulates the microenvironment of the corneal graft bed.

The microenvironment plays an important role in several immunological processes. Vascular endothelial growth factor-A (VEGF-A) not only regulates angiogenesis, but is known as a modulator of the immune microenvironment. Modulating the site of transplantation might be beneficial for subsequent transplant survival. In this study, we therefore analyzed the effect that a local blockade of VEGF-A in the inflamed cornea as the graft receiving tissue has on the immune system. We used the murine model of suture-induced neovascularization and subsequent high-risk corneal transplantation, which is an optimal model for local drug application. Mice were treated with VEGFR1/R2 trap prior to transplantation. We analyzed corneal gene expression, as well as protein levels in the cornea and serum on the day of transplantation, 2 and 8weeks later. Local VEGF depletion prior to transplantation increases the expression of pro-inflammatory as well as immune regulatory cytokines only in the corneal microenvironment, but not in the serum. Furthermore, local VEGFR1/R2 trap treatment significantly inhibits the infiltration of CD11c+ dendritic cells into the cornea. Subsequent increased corneal transplantation success was accompanied by a local upregulation of Foxp3 gene expression. This study demonstrates that locally restricted VEGF depletion increases transplantation success by modulating the receiving corneal microenvironment and inducing tolerogenic mechanisms.

Biodegradable temporising matrix for necrotising soft tissue infections: a case report

Necrotising soft tissue infection (NSTI) is a rapidly progressing disease that presents a surgical emergency. Timely antibiotics, radical debridement of infected tissues and adjuvant hyperbaric oxygen therapy are the foundations of its treatment. Split-skin graft (SSG) is the main reconstruction technique due to its simplicity and dependability. Dermal substitutes, as well as creating a suitable wound bed for grafting, aim to recreate the inherent thickness and pliability of skin. One innovation, Novosorb™ (produced by PolyNovo Ltd, Port Melbourne, Australia), is a biodegradable temporising matrix (BTM) that is an entirely synthetic implantable dermal matrix that creates a neo-dermis in complex wounds.

Vessel-sparing Excision and Primary Anastomosis.

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short bulbar or posterior urethral strictures, urethroplasty by excision and primary anastomosis (EPA) is recommended. As EPA only requires the excision of the narrowed segment and the surrounding spongiofibrosis, a full-thickness transection of the corpus spongiosum, as performed in the traditional transecting EPA (tEPA), is usually unnecessary. Jordan et al. introduced the idea of a vessel-sparing approach in 2007, aiming to reduce surgical trauma, especially to the dual arterial blood supply of the urethra, and, thus, potentially reducing the risk of postoperative erectile dysfunction or glans ischemia. This approach could also be beneficial for subsequent urethral interventions such as redo urethroplasty using a free graft, in which a well-vascularized graft bed is imperative. Nevertheless, these potential benefits are only assumptions as prospective studies comparing the functional outcome of both techniques with validated questionnaires are currently lacking. Moreover, vessel-sparing EPA (vsEPA) should at least be able to provide similar surgical outcomes as tEPA. The aim of this paper is to give an elaborate, step-by-step overview of how to manage patients with isolated short bulbar or posterior urethral strictures with vsEPA. The main objective of this manuscript is to outline the surgical technique and to report the representative surgical outcome. A total of 117 patients were managed according to the described protocol. The analysis was performed on the entire patient cohort and on the bulbar (n = 91) and posterior (n = 26) vsEPA group separately. Success rates were 93.4% and 88.5% for the bulbar and posterior vsEPA, respectively. To conclude, vsEPA, as outlined in the protocol, provides excellent success rates with low complication rates for isolated short bulbar and posterior urethral strictures.

Evaluation of autologous composite colo-peritoneal grafts in the repair of experimental urinary bladder defects in dogs

Background: Urinary bladder (UB) defects are most often associated with embryologic development and pelvic trauma. The cause of the defects could be congenital abnormalities or various aetiologies connected with modern life, including road traffic accidents, assault (gunshot injuries) and occupational hazards (neoplasia). industrial, and criminal activities. Medical treatment for these defects is mostly limited thereby necessitating surgical intervention. This study was aimed at finding alternative reconstruction tissue for restoring bladder storage and voiding capability. Materials and Methods: The surgical procedure was aseptically performed under general anesthesia. The dorsal aspect of the urinary bladder served as the recipient site, while sero-muscular colonic pedicle flap of the descending colon along with free peritoneal sheath formed a composite tissue (donor), colo-peritoneal pedicle graft. The surgical procedure included preparation of the colonic pedicle flap, preparation of free peritoneal flap, formation of composite colo-peritoneal graft, preparation of urinary bladder graft bed, and colo-peritoneo-cystoplasty. The dogs were evaluated in the post-operative period by physical examination, urinalysis, and cystography within the duration of 14 weeks. Results: Cystographic evaluations performed on the 2nd, 10th, and 14th weeks post surgery revealed gradual transition of the urinary bladder architecture at the point of graft with clear delineation and minimal blurring at initial assessment, which gradually disappeared later. Complications observed were straining and constipation, which responded positively following appropriate interventions. Post surgical urinalysis showed transient changes in specific gravity and urine pH values, but returned to pre surgical level after day 18 post surgery. Post surgical proteinuria was observed for the first 7 days, but disappeared on day 12. Hematuria occurred within the first 16 days post surgery. Conclusion: It was concluded that autologous composite colo-peritoneal tissue graft was successfully formed and effectively used in the repair of urinary bladder defects in the dogs. This surgical management intervention could be evaluated in human subjects with similar urinary bladder defects.

PDGF-BB Induces Formation of Bridging Callus After Reconstructive Surgery of Large Bone Defect

Background:Reconstructive surgery by using allografts often conducted to manage large bone defects, either due to traumatic or non-traumatic causes. However, poor vascularization of the graft bed is still problematic. To overcome this, bone tissue engineering method has been developed that uses growth factor as an angiogenic stimulator, such as platelet derived growth factor BB (PDGF BB).Objective:This study aimed to evaluate the administration of recombinant rat Platelet Derived Growth Factor BB (rrPDGF BB) on bone healing process, showed by formation of bridging callus, Vascular Endothelial Growth Factor (VEGF), Bone Morphogenetic Protein-2 (BMP-2) and osteocalcin inmassivefresh frozen allograft post reconstructive surgery.Methods:This was a Post Test Only Control Group Design study involved 32 Wistar rats divided into two groups,i.e.treatment group (defect on right femoral bone and received fresh frozen allograft with the addition of rrPDGF BB) and control group (without addition of rrPDGF BB). Expression of VEGF, BMP-2 and osteocalcin was identified through immunohistochemistry.Results:A significantly higher expression of VEGF, BMP-2 and osteocalcin was observed in the treatment group as compared to the control group (p< 0.05). The presence of bridging callus on the fresh frozen allograft also showed to be significant (p= 0.003). Path analysis showed formation of bridging callus after administration of PDGF on allograft occur through three pathways, in which VEGF holds the most important role.Conclusion:The application of rrPDGF BB significantly enhances the formation of new bone through increased expression of VEGF, BMP-2 and osteocalcin.

Urethroplasty for urethral injuries and trauma-related strictures in children and adolescents: a single-institution experience

Urethral injuries and trauma-related strictures (UITSs) in children are rare. The treatment is challenging but crucial to avoid life-long urinary complications such as recurrent stricture formation, urinary incontinence, and impotence. The aim was to report on the surgical and functional outcome of urethroplasty for UITSs and to provide data on patient-reported outcome measures (PROMs). Between November 2001 and October 2017, 18 male children (≤18 years; median: 13 years) underwent urethroplasty for UITSs at a single tertiary referral center. Etiology was iatrogenic in five (27.8%), perineal straddle injury in six (33.3%) and pelvic fracture urethral injury (PFUI) in seven (38.8%) patients. PFUIs and short (≤3cm) bulbar strictures were treated by transperineal anastomotic repair (n=15; 83.3%), whereas a long bulbar stricture and a penile stricture were treated by, respectively, a preputial skin graft and flap urethroplasty. A penetrating penile urethral injury during circumcision underwent early exploration with primary repair of the laceration. Failure was defined as need for additional urethral instrumentation. PROMs were sent to patients ≥16yearsat the latest evaluation. Median follow-up was 57 (range: 8-198) months. No complications and grade 1, 2, and 3 were present in, respectively, 13 (72.2%), two (11.1%), one (5.6%), and two (11.1%) patients. The success rate in a tertiary referral center was 94.4%. An immediate failure was observed in a patient with a PFUI and concomitant bladder neck injury. PROMs were available in 12 patients. Four patients (33.3%) reported erectile dysfunction. Post-void dribbling (25%) and urgency (50%) were the most frequently reported complaints. All patients were satisfied after urethroplasty and stated that they would undergo the surgery again. This series corroborates the recent trend in favor of transperineal anastomotic repair for PFUI, with combined abdominoperineal approach reserved for complex situations (e.g. bladder neck injury). For anterior UITSs, adaption of the technique to the characteristics of UITSs (etiology, location, length, and quality of graft bed) yielded excellent outcomes. Future systematic use of PROMs is also needed in children to elucidate the impact of urethroplasty on the urinary and sexual function. External trauma is the most important etiology of UITSs, but iatrogenic causes should not be neglected. Urethroplasty, mainly by anastomotic repair (AR) but with the technique adapted to local stricture characteristics if necessary, has an excellent long-term success rate in experienced hands. Functional disturbances are frequent, but despite this, patient satisfaction is high after urethroplasty.

Analysis on the efficacy of different exsection range in pterygium

Objective To analyse the efficacy of different exsection range in pterygium excision combined with conjunctival limbal autograft transplantation. Methods The clinical data of 86 eyes of 86 patients with ptergium, from Jan. 2016 to Jan. 2017 were analyzed retrospectively.Among them 2 cases were recurrent pterygium. All cases were divided into 2 groups randomly.Group A, 44 cases, treated with pterygium extended excision combined with Tenon’s capsule excision.Group B, 42 cases, received obvious hyperplasia pterygium excision only.The follow-up time was 1 year.Postoperative recurrence rates, efficacy and complications between both groups were compared and analyzed. Results The difference of length, width of pterygium invaded the cornea and the age of onset were not statistically significant between the two groups (P=0.247, 0.185, 0.125). In group A, the conjunctival of grafting bed occurred persistent congestion in 3 eyes after surgery. At the end of follow up, no recurrent or scar exposure occured.In group B, there were 10 cases with repeated conjunctival congestion in grafting bed. The conjunctival fibrovascular tissue proliferation and significant scar tissue exposure occured in 5 eyes(11.9%). Conclusion Pterygium extended excision combined with Tenon’s capsule excision is an efficient method for pterygium.It may reduce recurrence and improve postoperative conjunctival congestion. Key words: Surgery; Pterygium; Exsection range; Recurrence

Improved Bone Graft Method for Upper Cervical Surgery with Posterior Approach: Technical Description and Report of 52 Cases.

We sought to report a minimum 12 months' follow-up results of our improved bone graft method for upper cervical surgery with the posterior approach. Among 52 consecutive cases, odontoid nonunion occurred in 33 patients, atlantoaxial instability in 11 patients, and occipitocervical deformity in 8 patients who underwent posterior C1-C2 transarticular screw/screw-rod internal fixation (41 cases) and occipitocervical fusion (11 cases) with the improved bone graft technique. Each surgical procedure was performed by the same senior spine surgeon. We took lateral cervical standing roentgenograms before surgery and immediately after surgery. Then we conducted craniocerebral computed tomography examination with reconstruction at 3, 6, 12, and 24 months and annually thereafter. The postoperative follow-up times are about 12-38 months. All cases showed satisfactory screw fixation by radiographic examination, and there were no postoperative neurologic complications. One case had postoperative retropharyngeal infection after the transoral release and posterior reduction by pedicle screw instrumentation. All patients got solid fusions, and no pseudarthrosis occurred. All cases had solid fusions at the 3-month follow-up. Good bone graft bed, enough bone graft material, solid local fixation, and effective bone graft method are prerequisites for a successful bone graft. By analyzing postoperative follow-up in the consecutive cases in this study, our bone graft method describing a new bone graft structure is a reliable posterior fusion technique. It is worth considering, and further research is needed.

Allogeneic sclera graft combined autologous conjunctival flap for repairing the emergent corneal perforation

To report a palliative and alternative surgical procedure, allogeneic sclera graft combined with autologous conjunctival flap (ASGACF), employing to repair the large emergent corneal perforation. The detail protocol of the surgical procedure was characterized and four representative cases were reviewed. An allogeneic sclera graft and recipient bed were prepared as the traditional penetrating keratoplasty (PK). And then sutured the sclera graft to the bed with 10-0 nylon suture and covered with a pedicled autologous conjunctival flap in half size. In the follow-up, the ASGACF repaired all of the corneal perforations and restored the integral walls of eyeballs, in spite of one who underwent a second surgery. This surgical procedure provided a palliative method to repair the large emergent corneal perforation while there is the lack of a corneal graft.

A 2- to 16-Year Clinical Follow-Up of Revision Total Hip Arthroplasty Using a New Acetabular Implant Combined With Impacted Bone Allografts and a Cemented Cup

BackgroundTreatment of acetabular bone loss with impaction bone grafting (IBG) at revision total hip arthroplasty is highly dependent on mechanical stability and graft compression for clinical success. Here, we describe a new technique to further compress and stabilize the acetabular graft bed with a thin, perforated titanium shell. MethodsWe retrospectively analyzed 170 cases of acetabular revision arthroplasty 7 years (standard deviation 2.8) after IBG combined with a graft-compressing titanium shell implant. The patients were reviewed by clinical score and radiography. Three patients were lost to follow-up. The medical journals of the 33 deceased cases were reviewed for any reoperation. Of the 170 cases, 74 had a cavitary acetabular bone defect, 93 had combined segmental and cavitary bone defects, and 3 had a pelvic dissociation. Bone graft incorporation was assessed and correction of the hip center of rotation was calculated. ResultsFive cases (3%) were reoperated for mechanical loosening. One more was assessed as loose but asymptomatic and was not planned for revision. There were 3 reoperations for recurrent dislocation, 2 for deep infection and 1 for technical error. Reoperation for any reason, as the end point of survivorship, showed a survival rate of 92% after 10 years. Hip score according to Merle, d'Aubigne, and Postel increased from 10.8 (preoperatively) to 16.4 at follow-up. The clinical and radiological results were excellent. ConclusionIBG combined with the compressing shell results in excellent results for this challenging condition.

Posttransplant oxygen inhalation improves the outcome of subcutaneous islet transplantation: A promising clinical alternative to the conventional intrahepatic site.

Subcutaneous tissue is a promising site for islet transplantation, due to its large area and accessibility, which allows minimally invasive procedures for transplantation, graft monitoring, and removal of malignancies as needed. However, relative to the conventional intrahepatic transplantation site, the subcutaneous site requires a large number of islets to achieve engraftment success and diabetes reversal, due to hypoxia and low vascularity. We report that the efficiency of subcutaneous islet transplantation in a Lewis rat model is significantly improved by treating recipients with inhaled 50% oxygen, in conjunction with prevascularization of the graft bed by agarose-basic fibroblast growth factor. Administration of 50% oxygen increased oxygen tension in the subcutaneous site to 140mmHg, compared to 45mmHg under ambient air. In vitro, islets cultured under 140mmHg oxygen showed reduced central necrosis and increased insulin release, compared to those maintained in 45mmHg oxygen. Six hundred syngeneic islets subcutaneously transplanted into the prevascularized graft bed reversed diabetes when combined with postoperative 50% oxygen inhalation for 3days, a number comparable to that required for intrahepatic transplantation; in the absence of oxygen treatment, diabetes was not reversed. Thus, we show oxygen inhalation to be a simple and promising approach to successfully establishing subcutaneous islet transplantation.

A pilot study to evaluate the efficacy of fibrin glue in attaching full thickness skin graft in repair of cicatricial ectropion

Background: Traditionally, sutures are used to attach skin graft. Periocular skin reconstruction is peculiar in respect of constant movement of the graft bed due to lid movements. This study was aimed at evaluating the use of fibrin glue in skin graft for cicatricial ectropion.Methods: This was prospective, non-randomized, interventional study. Total 10 patients with cicatricial ectropion were recruited. After dissection of scar, skin defect was covered with full thickness post auricular graft. Fibrin glue used to attach the graft over host bed. Bolster tied and bandage applied. Patients were evaluated for graft stability, opposition of graft host junction and graft uptake.Results: The mean age was 30.9 years. Patients were divided into three groups i.e. 20-30 years, 30-40 years and 40-50 years. There were 05 patients (50%) in first group, 03 patients (30%) in second group and 02 patients (20%) in third group. Majority (90%) were male. Following injury 70% patients reported between 1-3 years. Grade 3 ectropion was most common (60%). Average duration of surgery was 79.3 min (standard deviation of 14.15 min). Horizontal dimensions of graft, 32 mm maximum and 26 mm minimum (average 29 mm). Vertical dimensions of graft, 18 mm maximum and 12 mm minimum (average 15 mm). Graft uptake was complete in all cases. No cases of graft infection or necrosis. However, 03 patients had residual ectropion.Conclusions: Use of fibrin glue in attaching full thickness skin graft is an effective and safe technique with good uptake and stable graft host junction.

Treatment of donor corneal tissue with immunomodulatory cytokines: a novel strategy to promote graft survival in high-risk corneal transplantation

Antigen-presenting cells (APCs) play an important role in transplant rejection and tolerance. In high-risk corneal transplantation, where the graft bed is inflamed and vascularized, immature APCs in the donor corneal stroma quickly mature and migrate to lymphoid tissues to sensitize host T cells. In this study, using a mouse model of corneal transplantation, we investigated whether enrichment of tolerogenic APCs (tolAPCs) in donor corneas can enhance graft survival in corneal allograft recipients with inflamed graft beds. Treatment of donor corneas with interleukin-10 (IL-10) and transforming growth factor-β1 (TGFβ1) altered the phenotype and function of tissue-residing APCs. Transplantation of these tolAPC-enriched corneas decreased frequencies of interferon gamma (IFNγ)+ effector T cells (Teffs), as well as allosensitization in the hosts, diminished graft infiltration of CD45+ and CD4+ cells, and significantly improved corneal allograft survival compared to saline-injected controls. These data provide a novel approach for tolAPC-based immunotherapy in transplantation by direct cytokine conditioning of the donor tissue.

Early application of the antibiotic-laden bone cement (ALBC) combined with the external fixation support in treating the open fractures of lower limbs complicated with bone defect

To discuss the curative effect of the early application of the antibiotic-laden bone cement (ALBC) combined with the external fixation support in treating the open fractures of lower limbs complicated with bone defect. From December 2013 to January 2015, 36 cases of lower limb open comminuted fractures complicated with bone defects were treated by the vancomycin ALBC combined with the external fixation support, including 26 males and 10 females with an average age of 38.0 years old ranging from 19 to 65 years old. The included cases were all open fractures of lower limbs complicated with bone defects with different degree of soft tissue injuries. Among them, 25 cases were tibial fractures, 11 cases were femoral fractures. The radiographs indicated a presence of bone defects, which ranged from 3.0 to 6.1 cm with an average of 4.0 cm. The Gustilo classification of open fractures:24 cases were type IIIA, 12 cases were typr IIIB. The percentage of wound infection, bone grafting time, fracture healing time and postoperative joint function of lower limb were observed. The function of injured limbs was evaluated at 1 month after the clinical healing of fracture based on Paley evaluation criterion. All cases were followed up for 3 to 24 months with an average of (6.0±3.0) months. The wound surface was healed well, neither bone infections nor unhealed bone defects were presented. The reoperation of bone grafting was done at 6 weeks after the patients received an early treatment with ALBC, some of them were postponed to 8 weeks till the approximate healing of fractures, the treatment course lasted for 4 to 8 months with an average of(5.5±1.5) months. According to Paley and other grading evaluations of bone and function, there were 27 cases as excellent, 5 cases as good, 3 cases as ordinary. The ALBC combined with external fixation support was an effective method for early treatment to treat the traumatic lower limb open fractures complicated with bone defects. This method was typified with the advantages such as easy operation, short operation time, overwhelming superiority in controlling infection and provision of good bone grafting bed, a good bone healing can be realized by the use of membrane induction technology for bone grafting.

Murine Full-thickness Skin Transplantation.

Murine full-thickness skin transplantation is a well-established in vivo model to study alloimmune response and graft rejection. Despite its limited application to humans, skin transplantation in mice has been widely employed for transplantation research. The procedure is easy to learn and perform, and it does not require delicate microsurgical techniques nor extensive training. Moreover, graft rejection in this model occurs in a very reproducible immunological reaction and is easily monitored by direct inspection and palpation. In addition, secondary skin transplantation with donor-matched or third-party skin grafts can be performed on more complex transplant models as an alternative and uncomplicated method to assess donor-specific tolerance. The complications are low and are in general limited to anesthesia overdose or respiratory distress after the procedure. Graft failure, on the other hand, occurs commonly as a result of poor preparation of the graft, incorrect positioning in the graft bed, or inappropriate placement of the bandage. In this article, we present a protocol for full-thickness skin transplantation in mice and describe the important steps necessary for a successful procedure.

Cut-and-place technique of pterygium excision with autograft without using sutures or glue: Our experience.

BACKGROUND:Conjunctival sutures used in pterygium surgery are not only time-consuming process but also may lead to local complications such as discomfort, scarring, granuloma, or infection. Plasma-derived products such as fibrin glue may produce possible hypersensitivity reactions whereas the risk of viral transmission remains theoretically possible. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures.MATERIALS AND METHODS:After pterygium excision and fashioning of the autologous conjunctival graft, the recipient bed is encouraged to achieve natural hemostasis and relative desiccation before graft placement. Excessive hemorrhage in the graft bed is tamponed. Graft adherence and positioning is examined 12–15 min after surgery.RESULTS:A total of 205 cases of pterygium underwent excision with conjunctival autograft without using sutures or glue. Mean follow-up time was 14.6 months. Cosmesis achieved was excellent in all cases. There were no intraoperative complications seen. Recurrence was seen in 6.8% of cases (14 cases). Nasal gaping was seen in 36% of cases (74 cases), which healed spontaneously without any surgical intervention.CONCLUSION:This simple technique for pterygium surgery is not only cost effective and quick but also may prevent potential adverse reactions encountered with the use of foreign materials and in this large series provided safe and comparable results to current methods.

Conservative Surgery for Subungual Melanoma <i>In Situ</i> Using Matriderm<sup>&reg</sup>

Background: Standard treatment for subungual melanoma is wide local excision including digit amputation in order to obtain safety margins. Level of amputation has been discussed in order to achieve appropriate oncological results along with preservation of limb function wherein local excision of subungual melanoma in situ without amputation is an option. Methods: We report two cases of subungual melanoma in situ treated by using a conservative approach. Both cases were treated with local excision with the resected tumor defect covered with an artificial dermis, Matriderm?. One case was of a 65-year-old male with a left thumb subungual melanoma in situ and another of a 41-year-old female with the same type of melanoma in the left hallux. Full-thickness skin graft was used for reconstruction after 7 weeks from the first surgery in the latter, and in the former case re-epithelization occurred within 90 days after surgery. To date, no clinical signs of recurrence have been found, and finger/toe functions were completely preserved with a minimized scar and little graft bed sensitivity. Follow-up time is two years and ten months for the left thumb case, and one year and six months for the left hallux subungual melanoma in situ. Conclusion: We present two cases of subungual melanoma in situ treated with digit sparing surgery including excision of the periosteum followed by the use of an artificial dermal template to guarantee coverage of the tumor bed defect, providing good functional and cosmetic outcome.

DONOR SITE MORBIDITY AFTER HARVESTING OF BONE FROM ANTERIOR ILIAC CREST FOR MAXILLOFACIAL RECONSTRUCTION

Aim of the study: The aim of the current study was to assess the vitality of autogenous bone grafts harvested from rabbits` calvaria following decontamination of the grafts using three different antimicrobial agents.Materials and Methods: Autogenous bone grafts were harvested from the calvaria of twenty four white New Zealand male rabbits. The grafts were allowed a five minutes contact time with normal saline (Group I), 2% chlorhexidine (Group II), Clindamycine (Group III) and Oleozone gel (Group IV). The grafts were then reinserted into the previously created graft beds. Animals were sacrificed at 10 and 21 days post surgery, dual energy x-ray absorptiometry (DEXA) scans were performed for the skull of the rabbits and bone specimens were collected for histological examination.Results: Histomorphometric analysis showed a superior results in favor of the ozone treated group represented as a significantly higher percentage of normal osteocytes and marked increase in area percentage of new bone formation. Additionally, DEXA scan revealed a significant increase in bone mineral density and bone mineral concentration of the ozone treated group compared to the other studied groups. Conclusion: The ozone treated grafts showed a distinguished preservation of osteoblastic vitality, which may indicate a superior biocompatibility compared to chlorhexidine and clindamycin.