Graft Exposure Research Articles

Pre-transplantation 31P-magnetic resonance spectroscopy for quality assessment of human pancreatic grafts – A feasibility study

ObjectiveTo investigate the feasibility of using 31P-MRS for objective non-invasive quality assessment of human pancreas grafts prior to transplantation or islet isolation. Materials and methodsPancreata from 5 human donors, 3 males and 2 females, aged 49–78years, with body mass index (BMI) 22–31kg/m2, were included. Pancreata were perfused with histidine-tryptophan-ketoglutarate solution during procurement and stored in hypothermic condition (4°C) for 21–44h. During the period of hypothermic storage repeated spectra were obtained for each graft by 31P-MRS (1.5Tesla) to measure the cold ischemia time (CIT) dependent changes of the phosphorous metabolites adenosine triphosphate (ATP), phosphomonoesters (PME), phosphodiesters (PDE) and inorganic phosphate (Pi), in the grafts. Graft temperature was measured immediately before and after MR-examination. Reference spectrum for non-viable tissue was obtained after graft exposure to room temperature. ResultsPME/Pi, PDE/Pi and ATP/Pi spectral intensities ratios decreased with increasing CIT, reflecting the decreased viability of the grafts. PME/Pi ratio was the most discriminatory variable at prolonged CIT. 31P-MRS could be performed without significantly increasing graft temperature. Conclusions31P-MRS may provide quantitative parameters for evaluating graft viability ex vivo, and is a promising tool for objective non-invasive assessment of the quality of human pancreas grafts prior to transplantation or islet isolation.

Vacuum-assisted closure of an exposed prosthetic femoral graft

The multiple comorbidities present in vascular surgery patients predispose them to surgical site infections, poor wound healing, and prosthetic graft exposure. We report our experience with a patient who underwent an emergent femoral-to-femoral bypass and developed an infection at bilateral groin incisions, resulting in wound separation and prosthetic vascular graft exposure. This was successfully treated with negative pressure wound therapy (NPWT) using the vacuum-assisted closure system (V.A.C., Kinetic Concepts Inc., San Antonio, Texas, USA). This is a case in which NPWT was used to treat a groin wound with an exposed vascular prosthetic graft, thereby eliminating the need for additional surgical flap coverage procedures and ultimately resulting in a completely healed wound. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice based learning and improvement. Republished with permission from: Delaney KO, Smead W, Gordillo G. Vacuum assisted closure of an exposed prosthetic femoral graft. OPUS 12 Scientist 2008;2(4):1-3.

Distraction Osteogenesis in Implantology for Ridge Augmentation - A Systematic Review

The purpose of this systematic review was to evaluate distraction osteogenesis for ridge augmentation in implant dentistry and also to present the associated advantages and limitations. A Medline and manual search was conducted to identify clinical studies concerning distraction osteogenesis in implant dentistry published between 1998 to 2012. 52 articles were assessed. The articles included evaluated the type of distractor used, augmentation achieved and the success and survival rate of implant placed in the augmented site. It was seen that when comparing methods of regeneration, a decreased treatment time is seen in cases of distraction osteogenesis. The reason for this lies in the fact that within 12 weeks the distraction segments are formed and there is a increase noted in the height of the alveolar bone, from 5 to 15 mm as well as an implant survival rate of 95.7%. It can be concluded that distraction osteogenesis is a relatively simple, effective and reliable technique for alveolar ridge reconstruction in contemporary implant dentistry. It can be considered versatile owing to its simplicity, possibility of avoiding bone grafts, infections and blood transfusions. The fact that graft and membrane exposure or inadequate tissue coverage do not pose complications, makes this an effective method of bone augmentation in implantology

ASSESSMENT OF SOFT TISSUE EXPANSION USING OSMED SELF INFLATING HYDROGEL PRIOR TO MANDIBULAR RIDGE AUGMENTATION

Objectives: This study was conducted to assess the ability of self-inflating tissue expander to produce proper amount and quality of mucosa prior to bone grafting and implants insertion and degree of bone graft survival in severely atrophied alveolar ridges. Material and Methods: All patients included in this study were referred to the Department of Oral and Maxillofacial Surgery, Faculty of Oral & dental Medicine, Cairo University for rehabilitation with dental implants. Inclusion criteria comprised: Missing mandibular premolar or molar area with a buccal osseous and soft tissue defect. The adjacent teeth had to be uncompromised with healthy gingival conditions. The exclusion criteria were patients who did not need bone grafting before implant placement. There were 10 patients (6 men and 4 women), with a mean age of 32 years (range, 18-60 years), who fulfilled the inclusion criteria and were consecutively included in the study. All patients were healthy and had no systemic contraindications to implant placement. They received standard treatment planning and diagnosis and gave signed informed consent. All 10 patients had an osmotic soft tissue expander implanted in the area with osseous and soft tissue defect, prior to bone grafting using bovine bone graft. Linear and volumetric measurements of the bone grafts were recorded immediately following bone graft and 6 months post grafting using cone beam CT scans.Results: 10 sites in 10 patients were treated with soft tissue expansion using self inflating hydrogels. Complications of soft tissue expansion were only perforation (two sites), and no infection was noted. Primary wound closure was easily attained during bone augmentation procedure with no incidence of graft exposure, infection, or loss. It also allowed for good vertical bone height gain for implant placement. Volumetric measurements showed that an average mean of 1.36 cm3 mandibular ridge augmentation was established immediately Post bone grafting and 1.19 cm3 6 months after bone grafting. These measurements concluded that only 15.7% bone resorption occurred 6 months after bone grafting indicating good survival of the xenogenic bone graft.Conclusion: The use of Osmed self-inflating tissue expander prior to bone augmentation and implants insertion allowed sufficient amount of mucosa that can cover the grafts and implants without tension or compromise to the periosteum and ensued minimal bone graft resorption in severely atrophied alveolar ridges.

Esthetic and Functional Treatment of Gingival Recessions in the Mandible: A Micro-Surgical and Mini-Invasive Concept Based on Tunneling Procedure and Controlled Connective Tissue Graft Exposure: Case Reports

Esthetic and Functional Treatment of Gingival Recessions in the Mandible: A Micro-Surgical and Mini-Invasive Concept Based on Tunneling Procedure and Controlled Connective Tissue Graft Exposure: Case Reports

A new pedicled periosteal flap for alveolar bone graft surgery: a technical note

Achieving a good bone volume is an important aspect of secondary alveolar bone grafting in patients with alveolar clefts. Wound breakdown is a major cause of bone graft exposure and graft failure. We describe a new technique using a pedicled periosteal flap to achieve a double layered wound closure during secondary alveolar bone graft surgery. We report the first use on a unilateral alveolar cleft. Good wound healing and bone volumes were noted on 6 months review. Bone formation by the grafted periosteum was expected in addition to wound protection.

Endophthalmitis Associated With Glaucoma Drainage Implants.

To identify the clinical features, organisms, and treatment outcomes in patients with endophthalmitis associated with glaucoma drainage implants. A retrospective noncomparative case series. Of the 13 patients, exposure occurred in eight eyes, including exposure of the tube in four eyes, exposure of the patch graft in three eyes, and exposure of the plate in one eye. In the remaining five eyes, either recent implant placement or conjunctival revision occurred. The most common organism was Staphylococcus epidermidis (five eyes). Intravitreal antibiotics were administered in all eyes, with the exception of one eye (primary evisceration). Removal of the implant was performed in six eyes and evisceration or enucleation was performed in three eyes. Median pre-infection visual acuity was 20/80 (range: 20/30 to hand motion). Visual acuity at last follow-up was no light perception (five eyes), light perception (two eyes), hand motion (one eye), and better than or equal to 20/200 (five eyes). Clinical features associated with endophthalmitis include implant exposure and a history of recent surgery. Staphylococcus epidermidis was the most common isolate. Although removal of the implant was performed in many patients, successful treatment was accomplished in some patients without removal. Visual outcomes were generally poor. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:563-569.].

Pre-augmentation soft tissue expansion improves scaffold-based vertical bone regeneration - a randomized study in dogs.

ObjectiveSoft tissue (ST) dehiscence with graft exposure is a frequent complication of vertical augmentation. Flap dehiscence is caused by failure to achieve tension‐free primary wound closure and by the impairment of flap microcirculation due to surgical trauma.Soft tissue expansion (STE) increases ST quality and quantity prior to reconstructive surgery. We hypothesized that flap preconditioning using STE would reduce the incidence of ST complications after bone augmentation and that optimized ST healing would improve the outcome of bone regeneration.Materials and methodsSelf‐filling tissue expanders were implanted in mandibular bone defects in ten beagle dogs. After expansion, alloplastic scaffolds were placed for vertical bone augmentation in STE sites and in control sites without STE pre‐treatment. ST flap microcirculation was analysed using laser Doppler flowmetry. The incidence of graft exposures was evaluated after 2 weeks. Bone formation was assessed after 2 months, using histomorphometry and immunohistochemistry.ResultsTest sites showed significantly less impairment of perfusion and faster recovery of microcirculation after bone augmentation. Furthermore, no flap dehiscences occurred in STE sites. Bone regeneration was found in both groups; however, significantly greater formation of new bone was detected in test sites with preceding STE.ConclusionsPreconditioning using STE improved ST healing and bone formation after vertical augmentation. The combination of STE and the subsequent placement of alloplastic scaffolds may facilitate the reconstruction of severe bone defects.

EACMFS Prizes and Awards

The aim of this study was to evaluate the possibility of using the zygomatic buttress as an intraoral bone harvesting donor site and determine the safety of this harvesting procedure for later optimal positioning of dental implants in accordance with prosthodontic and functional principles.A consecutive retrospective study was conducted on patients who had been treated at the Department of Oral and Maxillofacial Surgery of Ulm military and academic hospital, over a 3-year period (January 2008 to December 2010). Medical history, smoking status, area of surgery, and complications were recorded. The need for bone grafting was defined by the impossibility of installing implants of adequate length or diameter to fulfill prosthetic requirements, or for esthetic reasons. The patients were treated using a 2-stage technique. During the first operation, bone blocks harvested from the zygomatic buttress region were placed as lateral onlay grafts and fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After 3–6 months of healing, the flap was reopened, the screws removed and the implants placed.A total of 113 zygomatic buttress bone block grafts in 112 patients were performed. Graft loss and graft removal were defined as failure; swelling, wound dehiscence, infection with pus, temporary paresthesia, and perforations of the maxillary sinus membrane were defined as complications. According to our criteria, 4 (3.5%) of the patients presented postoperative complications of the donor site and 20 (17.8%) of the recipient site. Throughout, 93 (82.3%) of the bone grafts were successful and 20 (17.6%) had complications, regardless of the final success of the implant procedure. Smoking was associated with a high rate of complications and graft failure. Early graft exposure appeared to compromise the results, whereas pain and swelling were comparable to usual dentoalveolar procedures. However, in 1.7% of all cases, concerning 2 patients, the final rehabilitation with dental implants was not possible.The zygomatic buttress block bone graft is a safe intraoral donor site for the reconstruction of small- to medium-sized alveolar defects, providing the greatest surgical access with minimal postoperative complications.

Effects of Recombinant Human Bone Morphogenetic Protein-2 Dose and Ceramic Composition on New Bone Formation and Space Maintenance in a Canine Mandibular Ridge Saddle Defect Model.

Treatment of mandibular osseous defects is a significant clinical challenge. Maintenance of the height and width of the mandibular ridge is essential for placement of dental implants and restoration of normal dentition. While guided bone regeneration using protective membranes is an effective strategy for maintaining the anatomic contour of the ridge and promoting new bone formation, complications have been reported, including wound failure, seroma, and graft exposure leading to infection. In this study, we investigated injectable low-viscosity (LV) polyurethane/ceramic composites augmented with 100 μg/mL (low) or 400 μg/mL (high) recombinant human bone morphogenetic protein-2 (rhBMP-2) as space-maintaining bone grafts in a canine mandibular ridge saddle defect model. LV grafts were injected as a reactive paste that set in 5-10 min to form a solid porous composite with bulk modulus exceeding 1 MPa. We hypothesized that compression-resistant LV grafts would enhance new bone formation and maintain the anatomic contour of the mandibular ridge without the use of protective membranes. At the rhBMP-2 dose recommended for the absorbable collagen sponge carrier in dogs (400 μg/mL), LV grafts maintained the width and height of the host mandibular ridge and supported new bone formation, while at suboptimal (100 μg/mL) doses, the anatomic contour of the ridge was not maintained. These findings indicate that compression-resistant bone grafts with bulk moduli exceeding 1 MPa and rhBMP-2 doses comparable to that recommended for the collagen sponge carrier support new bone formation and maintain ridge height and width in mandibular ridge defects without protective membranes.

Synthetic Graft Augmentation in Vaginal Prolapse Surgery: Long-Term Objective and Subjective Outcomes

ObjectiveTo report long-term objectives and subjective outcomes in women who underwent prolapse surgery with a synthetic graft augmentation. DesignRetrospective analysis (Canadian Task Force classification II-3). SettingUniversity hospital in the southeastern United States. PatientsWomen with symptomatic pelvic organ prolapse who underwent transvaginal graft augmentation using the Prolift mesh system between July 2006 and December 2008 for a minimum 5-year follow-up. InterventionsSubjects completed the Pelvic Floor Distress Inventory (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ), and the Patient Satisfaction Questionnaire. Subjects also underwent postoperative physical examination with Pelvic Organ Prolapse Quantification (POP-Q) and vaginal pain/stricture assessment. Long-term postoperative findings were compared with preoperative baseline data. Measurements and Main ResultsOf 208 eligible subjects, 70 completed the questionnaires only, and 48 of these 70 provided both postoperative examination and questionnaire data. The mean duration of follow-up was 7.0 ± 0.7 years (range, 5.8–8.1 years). POP-Q measurements of Ba (point B anterior), Bp (B posterior), C (cervix), GH (genital hiatus), PB (perineal body), and overall pelvic organ prolapse stage were significantly improved (all p < .001 except for PB, p = .006). PFIQ-7 (total, Urinary Impact Questionnaire, and Pelvic Organ Prolapse Impact Questionnaire) and PFDI-20 (total, Urinary Distress Inventory, and Pelvic Organ Prolapse Distress Inventory) scores significantly improved (all p < .001). No differences were noted in the colorectal-anal subscales (Colorectal-Anal Impact Questionnaire and Colorectal-Anal Distress Inventory) and PISQ scores at >5-year follow-up (all p > .05). Satisfaction rates were 15.7% for not at all, 35.7% for somewhat, and 48.6% for completely satisfied. Complications included graft exposure (n = 3; 6%) and dyspareunia (n = 25; 36%). ConclusionWomen undergoing transvaginal prolapse surgery using a synthetic graft continue to have positive objective and subjective outcomes, leading to significantly improved quality of life at a minimum 5-year follow-up.

Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver Transplantation.

Background. Exogenous bilirubin may reduce experimental ischemia-reperfusion injury (IRI) due to its antioxidant properties. We studied if early graft exposure to high bilirubin levels in the recipient affects the early IRI and outcomes after liver transplantation (LTx). Methods. In 427 LTx patients, the AUROC curve based on bilirubin and AST at day 1 identified a cutoff of 2.04 mg/dL for the recipient pretransplant bilirubin. Recipients were grouped as having low (group L, n = 152) or high (group H, n = 275) bilirubin. Both groups had similar donor-related variables (age, preservation time, donor BMI > 28, and donor risk index (DRI)). Results. Alanine (ALT) and aspartate (AST) aminotransferase levels were higher in group L at day 1; ALT levels remained higher at day 2 in group L. LTx from high risk donors (DRI > 2) revealed a trend towards lower transaminases during the first two days after transplantation in group H. One month and 1-year patient survival were similar in groups L and H. High preoperative bilirubin did not affect the risk for early graft dysfunction (EGD), death, or graft loss during the first year after transplantation nor the incidence of acute rejection. LTx using donors with DRI > 2 resulted in similar rates of EGD in both groups. Conclusion. Increased bilirubin appears to reduce the early IRI after LTx yet this improvement was insufficient to improve the clinical outcome.

A clinical study of the outcomes and complications associated with zygomatic buttress block bone graft for limited preimplant augmentation procedures

The aim of this study was to evaluate the possibility of using the zygomatic buttress as an intraoral bone harvesting donor site and determine the safety of this harvesting procedure for later optimal positioning of dental implants in accordance with prosthodontic and functional principles. A consecutive retrospective study was conducted on patients who had been treated at the Department of Oral and Maxillofacial Surgery of Ulm military and academic hospital, over a 3-year period (January 2008 to December 2010). Medical history, smoking status, area of surgery, and complications were recorded. The need for bone grafting was defined by the impossibility of installing implants of adequate length or diameter to fulfill prosthetic requirements, or for esthetic reasons. The patients were treated using a 2-stage technique. During the first operation, bone blocks harvested from the zygomatic buttress region were placed as lateral onlay grafts and fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After 3-6 months of healing, the flap was reopened, the screws removed and the implants placed. A total of 113 zygomatic buttress bone block grafts in 112 patients were performed. Graft loss and graft removal were defined as failure; swelling, wound dehiscence, infection with pus, temporary paresthesia, and perforations of the maxillary sinus membrane were defined as complications. According to our criteria, 4 (3.5%) of the patients presented postoperative complications of the donor site and 20 (17.8%) of the recipient site. Throughout, 93 (82.3%) of the bone grafts were successful and 20 (17.6%) had complications, regardless of the final success of the implant procedure. Smoking was associated with a high rate of complications and graft failure. Early graft exposure appeared to compromise the results, whereas pain and swelling were comparable to usual dentoalveolar procedures. However, in 1.7% of all cases, concerning 2 patients, the final rehabilitation with dental implants was not possible. The zygomatic buttress block bone graft is a safe intraoral donor site for the reconstruction of small- to medium-sized alveolar defects, providing the greatest surgical access with minimal postoperative complications.

Ex Vivo Expansion or Manipulation of Stem Cells to Improve Outcome of Umbilical Cord Blood Transplantation.

The outcome of umbilical cord blood transplantation for adult patients with hematologic malignancies now rivals that of matched unrelated donor transplantation. However, delayed hematopoietic and immunologic recovery remains a source of significant morbidity and mortality. Multiple strategies are now being studied to overcome these limitations. One strategy involves ex vivo expansion of the umbilical cord blood unit prior to transplantation. A second strategy involves exposure of the umbilical cord blood graft to compounds aimed at improving homing and engraftment following transplantation. Such a strategy may also address the problem of slow hematopoietic recovery as well as the increased risk of graft failure. Many of these strategies are now being tested in late phase multi-center clinical trials. If proven cost-effective and efficacious, they may alter the landscape of donor options for allogeneic stem cell transplantation.

Pain Scores and Exposure Rates after Polypropylene Mesh for Pelvic Organ Prolapse.

To characterize pain and exposure after Prolift placement and identify risk factors. A case series of women who underwent Prolift vaginal mesh were surveyed. Pain was assessed using a visual analog scale. Exposure was evaluated clinically. Of 183 eligible patients, 160 completed the survey, and 45 returned for examination. Mean preoperative pain score was 0.97 and postoperative was 1.35 (P = 0.12). Pre- and postoperative pain scores by compartment were: anterior (1.34 vs 1.25, mean change -0.09, P = 0.84), posterior (1.30 vs 1.56, mean change 0.26, P = 0.72), and total (0.63 vs 1.34, mean change 0.71, P = 0.05). Graft exposure was confirmed in 23 of 183 patients (12.6%); however, because asymptomatic patients were not examined, the true exposure rate may be underestimated. Hematoma formation is independently associated with mesh exposure, adjusted odds ratio 18.4 (95% confidence interval 3.4-147.4, P = 0.01). Although pain scores did not increase overall, there was a trend toward increased pain score in the patients with total (anterior and posterior) Prolift. Hematoma formation was significantly associated with mesh exposure.

First Comparison of Hypothermic Oxygenated PErfusion Versus Static Cold Storage of Human Donation After Cardiac Death Liver Transplants: An International-matched Case Analysis.

Exposure of donor liver grafts to prolonged periods of warm ischemia before procurement causes injuries including intrahepatic cholangiopathy, which may lead to graft loss. Due to unavoidable prolonged ischemic time before procurement in donation after cardiac death (DCD) donation in 1 participating center, each liver graft of this center was pretreated with the new machine perfusion "Hypothermic Oxygenated PErfusion" (HOPE) in an attempt to improve graft quality before implantation. HOPE-treated DCD livers (n = 25) were matched and compared with normally preserved (static cold preservation) DCD liver grafts (n = 50) from 2 well-established European programs. Criteria for matching included duration of warm ischemia and key confounders summarized in the balance of risk score. In a second step, perfused and unperfused DCD livers were compared with liver grafts from standard brain dead donors (n = 50), also matched to the balance of risk score, serving as baseline controls. HOPE treatment of DCD livers significantly decreased graft injury compared with matched cold-stored DCD livers regarding peak alanine-aminotransferase (1239 vs 2065 U/L, P = 0.02), intrahepatic cholangiopathy (0% vs 22%, P = 0.015), biliary complications (20% vs 46%, P = 0.042), and 1-year graft survival (90% vs 69%, P = 0.035). No graft failure due to intrahepatic cholangiopathy or nonfunction occurred in HOPE-treated livers, whereas 18% of unperfused DCD livers needed retransplantation. In addition, HOPE-perfused DCD livers achieved similar results as control donation after brain death livers in all investigated endpoints. HOPE seems to offer important benefits in preserving higher-risk DCD liver grafts.

Salvage of Exposed Groin Vascular Grafts with Early Intervention Using Local Muscle Flaps.

Background:Peripheral vascular surgery may be complicated by wound infection and potential graft exposure in the groin area. Muscle flap coverage of the graft has been promoted to address these wound complications. The authors present their findings regarding graft salvage rates and patient outcomes using local muscle flaps to address vascular graft complications of the groin.Methods:Data were obtained by retrospective cohort study of patients who underwent a local muscle flap procedure by a single surgeon following vascular graft complication in the groin.Results:Seventeen patients undergoing local muscle flap coverage of a vascular graft were reviewed. Six men and 9 women, 51–80 years old, were included in the study. Wound complications in the groin occurred anywhere from 3 days to 3.5 years following graft placement. Graft exposure was the most common presenting complication (14 of 17 patients). Muscle flap coverage occurred within 15 days of complication presentation in all patients (average, 6.4 days). Seven of the 15 patients experienced postoperative complications within 6 months of the procedure, most commonly wound dehiscence. However, analysis demonstrated that vascular grafts were successfully salvaged in 10 of the 17 patients (59%) over the course of follow-up (range, 104–1748 days). Average time to muscle flap coverage was 4.2 days in patients who retained the graft and 9.6 days in patients who ultimately lost their vascular graft.Conclusion:The authors demonstrate improved vascular graft salvage rate when local muscle flap procedure is performed early after initial wound complication presentation.

The effect of a hydrogen sulfide releasing molecule (Na2S) on the cold storage of livers from cardiac dead donor rats. A study in an ex vivo model

Liver transplantation is currently the preferred treatment option for end-stage liver disease. Donation after cardiac death was a common practice in the early years of organ donation before brain death criteria were established. Those organs were subjected to variable periods of warm ischemia that might intensify cold ischemia/reperfusion injuries. In the present, shortage of brain dead donors has led to the reassessment of organ donation after cardiac death.Since many cytoprotective roles have been describe for H2S during ischemia/reperfusion on a variety of tissues, we hypothesized that graft exposure to this bioactive gas might improve preservation of non-heart beating donated organs.Therefore, to establish a rat model of donation post-cardiac arrest and using this approach to judge H2S delivery effects on graft hypothermic preservation, were the main objectives of this investigation.Cardiopulmonary arrest was induced in sedated rats by overload of potassium (K+). Livers were surgically removed and subsequently stored in HTK Solution (Histidine–tryptophan–ketoglutarate) at 0–4°C. After 24h of hypothermic preservation, livers were rewarmed in an ex vivo model. Three experimental groups were established as follows: I – Livers procured before cardiac death and cold stored 24h in HTK (BCD); II – Livers procured after cardiac death (45min) and cold stored 24h in HTK (ACD); III – Livers procured after cardiac death (45min) and cold stored 24h in HTK+10μM Sodium Sulfide (Na2S) (ACD-SS). Data suggest that after 45min of warm ischemia, viability parameters assessed during reperfusion in the ex vivo model were significantly impaired. Real time PCR revealed that after ex vivo reperfusion there is an increased expression of HO-1 and TNF-α and a modest drop in Bcl-2 mRNA, which could be interpreted as the cellular response to the hypoxic insult sustained during warm ischemia.On the other hand, warm ischemic livers exposed to H2S during cold storage, improved microcirculation, morphology and viability parameters during ex vivo reperfusion and showed significant modulation of HO-1 mRNA expression.In conclusion, HTK supplementation with Na2S arose as a potential treatment to recover non-heart beating harvested organs. Furthermore, an appropriate model of cardiac dead liver donors was successfully developed.

Bone augmentation of the osteo-odonto alveolar lamina in MOOKP--will it delay laminar resorption?

We aimed to describe a new technique and analyse the early outcomes of augmenting the canine tooth using a mandibular bone graft in an attempt to delay or retard the process of laminar resorption following the modified osteo odonto keratoprosthesis (MOOKP) procedure. This was a retrospective case series. Eyes that underwent the bone augmentation procedure between December 2012 and February 2014 were retrospectively analysed. The procedure, performed by the oromaxillofacial surgeon, involved securing a mandibular bone graft beneath the periosteum on the labial aspect of the canine tooth chosen to be harvested for the MOOKP procedure. This procedure was performed simultaneously with the Stage 1 A of the MOOKP. Three months later, the tooth was harvested and fashioned into the osteo-odonto alveolar lamina similar to the method described in the Rome-Vienna Protocol. The bone augmentation procedure was performed in 11 eyes (five SJS/ six chemical injuries). The mean follow-up after Stage 2 of MOOKP procedure in these eyes was 7.45 months (2 to 20 months). Complications noted were peripheral laminar exposure (three eyes-SJS) and bone graft exposure and necrosis in the mouth (nine-SJS). No evidence of clinical laminar resorption was noted in any of the eyes. Laminar resorption in MOOKP can lead to vision and globe threatening complications due to the consequent cylinder instability and chances of extrusion. Augmenting the bone on the labial aspect of the canine tooth might have a role to play in delaying or preventing laminar resorption.

Modified auricular cartilage sling for paralytic ectropion

To evaluate the outcomes of a modified auricular cartilage sling for paralytic ectropion. We treated 17 eyelids of 17 patients (average 67 years old) with an auricular cartilage sling between 2004 and 2012. All patients had paralytic ectropion with lower eyelid ptosis. Cartilage was harvested via an incision just inside the anterior rim of the helix. Skin incisions were made at the subciliary, medial and lateral canthal regions. The auricular cartilage graft was sutured to the medial canthal tendon medially, lateral orbital rim laterally, inferior tarsus superiorly, and lower eyelid retractors inferiorly. Average follow-up period was 40 months (range 16-60months). The median L-MRD (mm) was improved from 8.4 preoperatively (interquartile range 7.5-8.9) to 5.2 postoperatively (4.8-5.3). The median lagophthalmos (mm) was improved from 5.8 preoperatively (4.7-7.0) to 2.2 postoperatively (1.6-2.6). 16 patients had corneal exposure preoperatively and this resolved completely in 12 patients. All patients experienced good anatomical and functional results with relief of their preoperative pain/discomfort symptoms without complications. No patients required reoperation and none experienced infection, exposure of the cartilage graft, or recurrence of lower eyelid malpositions. Postoperatively, all lower eyelids moved downward with down-gaze. The auricular scar left no significant cosmetic deformity. The modified auricular cartilage sling with 4 point fixation for paralytic ectropion appears to maintain normal eyelid mobility with down-gaze and avoids the problem of lower eyelid fixation.