Graft Harvesting Technique Research Articles

Experimental Substantiation of the Study of Fascial Grafts for the Extremity Reconstruction

The results of the anatomic and angiographic study of the radial and anterior serratus muscle fascial grafts on 30 cadavers are presented. Basing on the results of the work it is possible to conclude that potential introduction of this plastic material into clinical practice for the extremity reconstruction is desired, ft is the first time that the technique of the radial fascial graft harvesting is described in details. Angiographic results showed good blood supply of the isolated fascial grafts.

Comparison of traditional and intrafascial iliac crest bone-graft harvesting in lumbar spinal surgery

We studied 117 adult patients undergoing posterior lumbar spinal fusion and instrumentation using bone grafts from the iliac crest between February 1999 and January 2001. All patients had degenerative disease of the lumbar spine, and all were operated upon by the same surgeon. Patients were randomized to have the iliac bone graft harvested either through a separate incision (traditional approach) or utilizing the same midline incision as used for the spinal surgery (intrafascial approach). Total volume of harvested graft, blood loss, pain, complications, and patient satisfaction were evaluated with a minimum of 2-year follow-up. There were no infections. The average volume of harvested bone was 17.2 cc versus 14.7 cc; total blood loss was 168 cc versus 96 cc; total complication rate was 20% versus 8%, and overall satisfaction rate was 81% versus 96%, respectively. The intrafascial graft harvesting technique minimizes morbidity and increases patient satisfaction compared with the traditional bone harvesting technique.

A new technique of graft harvest for anterior cruciate ligament reconstruction with quadruple semitendinosus tendon autograft.

A new technique of graft harvesting was used in 8 cases for arthroscopic anterior cruciate ligament reconstruction with quadruple semitendinosus tendon autograft. The graft is acquired through a small incision on the posteromedial aspect of the knee at the flexor crease instead of the standard anteromedial approach through a paramedian incision. Compared with the standard technique of graft harvesting, this new method of graft harvest facilitates easier identification of the semitendinosus and avoids inadvertent amputation of the semitendinosus tendon during graft harvest, disinsertion of the pes anserinus, or injury to the infrapatellar branch of saphenous nerve. The surgical scars, in addition to the standard portal scars, include a small scar on the posteromedial aspect, which merges into the flexor crease and a 1-cm anteromedial scar. This provides improved cosmesis and better patient compliance for early rehabilitation with less pain in the immediate postoperative period. There is no compromise on the intraoperative ligament reconstruction with good postoperative results. No intraoperative or postoperative complications were encountered. It would be advisable to follow this technique of graft harvesting for all individuals undergoing arthroscopic anterior cruciate ligament reconstruction using quadrupled semitendinosus tendon to avoid the problems encountered with the standard technique, and also to achieve an excellent cosmetic and functional outcome.

A new technique of graft harvest for anterior cruciate ligament reconstruction with quadruple semitendinosus tendon autograft

<h2>Abstract</h2> A new technique of graft harvesting was used in 8 cases for arthroscopic anterior cruciate ligament reconstruction with quadruple semitendinosus tendon autograft. The graft is acquired through a small incision on the posteromedial aspect of the knee at the flexor crease instead of the standard anteromedial approach through a paramedian incision. Compared with the standard technique of graft harvesting, this new method of graft harvest facilitates easier identification of the semitendinosus and avoids inadvertent amputation of the semitendinosus tendon during graft harvest, disinsertion of the pes anserinus, or injury to the infrapatellar branch of saphenous nerve. The surgical scars, in addition to the standard portal scars, include a small scar on the posteromedial aspect, which merges into the flexor crease and a 1-cm anteromedial scar. This provides improved cosmesis and better patient compliance for early rehabilitation with less pain in the immediate postoperative period. There is no compromise on the intraoperative ligament reconstruction with good postoperative results. No intraoperative or postoperative complications were encountered. It would be advisable to follow this technique of graft harvesting for all individuals undergoing arthroscopic anterior cruciate ligament reconstruction using quadrupled semitendinosus tendon to avoid the problems encountered with the standard technique, and also to achieve an excellent cosmetic and functional outcome.

Skeletonized radial artery: New technique for graft harvest with improved angiographic results

Skeletonized radial artery: New technique for graft harvest with improved angiographic results

Preparation of the saphenous vein for coronary artery bypass grafting: a new technique "no touch" that maintains the vein wall integral and provides high immediate patency

BACKGROUND: The technique of harvesting the saphenous vein (SV) for coronary artery bypass grafting (CABG) influences the fate of vein grafts. A new no touch (NT) technique of SV preparation was developed where the vein is harvested with a pedicle of surrounding tissue, which protects the vein from spasms therefore obviating the need for distension. METHOD: A prospective randomized study in 156 patients who underwent CABG was performed comparing three SV harvesting techniques. The techniques were conventional (c) (adventitial stripping of the vein, manual distention and storing in saline solution); Intermediate (I) (after adventitial stripping, the vein was left in situ, covered with a papaverine-soaked compress, and stored in heparinized blood); and no touch (SV dissected with its surrounding tissue was left in situ, covered with a saline-soaked compress and stored in heparinized blood). A morphological study of the endothelium was preformed using scanning electronic microscopy and an angiographic assessment of the vein graft patency was performed at 18 months mean follow-up time. Also an immunohistochemistry assessment was performed to identify the enzyme, nitric oxide synthase (NOS) in the vein wall. RESULTS: The preservation of the endothelial cell integrity was greater with the no touch technique than with the other procedures. At angiographic follow up, the patency for NT was 95.4%, 88.9% for grafts in group C and 86.2% for grafts in group I. The immunohistochemistry assessment revealed NOS in all three layers of the vein wall that was prepared by the no touch technique. However, a great reduction of this enzyme in veins treated by the conventional technique was observed. CONCLUSION: The endothelial integrity and NOS activity were better preserved when using the no touch technique for vein graft harvesting. The vasorelaxation and thrombo-resistant activities of nitric oxide (NO) may be responsible for the reduced of vasospasms and improved patency rate. Furthermore, the mechanical properties provided by the cushion of surrounding tissue in graft harvested by NT technique may contribute to the observed high patency rate.

Use of porcine small intestinal submucosal graft in the surgical management of tunical deficiencies with penile prosthetic surgery

Objectives. To report the use of a new acellular xenographic porcine jejunal submucosal graft as a closure material for tunica albuginea deficiencies (distal erosion, attenuation) after penile prosthesis insertion. Methods. Seventeen patients with at least a 36-month history of having an indwelling three-piece inflatable penile prosthesis developed tunica albuginea deficiencies. Nine patients with unilateral distal erosion of the tunica and eight with attenuation of the tunica underwent penile prosthesis revisionary surgery and tunical reconstruction using lyophilized small intestinal submucosa (Surgisis). The reconstructive techniques used a suprapubic and subcoronal incisional approach and a new three-piece inflatable prosthesis. Results. Reconstructive surgical correction of the tunical defect was achieved in all 17 patients. At a mean follow-up of 21 months (range 6 to 34), no patient had had separation of the graft from the tunica or recurrence of the deficiency. All patients had a satisfactorily functioning prosthesis. Infection, pain, bulging, or evidence of a local inflammatory response at the graft site has not occurred. No patient required any additional surgery. Conclusions. At the initial long-term follow-up, acellular porcine jejunal submucosal grafts for coverage of tunical deficiencies with penile prosthetic surgery allow for satisfactory clinical results. The ease of surgical handling and placement, elimination of nonabsorbable synthetic grafting materials, and no associated comorbidities from graft harvesting techniques, coupled with no adverse reactions, make this graft an anatomic and functional tunical substitute.

Minimal incision technique for sural nerve graft harvest: experience with 61 patients.

Many different methods for harvesting the sural nerve have been described, including a single, long, longitudinal incision, multiple stair-step incisions, or use of a tendon stripper and endoscopic approach. Drawbacks of these methods may include unsightly donor-site scars, inadvertent transection of the nerve, prolonged operative time, and the need for special equipment. A new minimal incision technique of sural nerve harvesting that is simple and quick, causes minimal donor site morbidity, and preserves the integrity of the nerve is described.

Central quadriceps free tendon for anterior cruciate ligament reconstruction

Central quadriceps free tendon provides an outstanding autograft alternative for routine anterior cruciate ligament (ACL) reconstruction, allowing preservation of hamstring tendons and eliminating the morbidity of bone plug harvest from the patella. Correct graft harvest technique, proper tunnel/graft sizing, accurate fixation, and adherence to the methods described will permit excellent ACL reconstruction with low morbidity.

Magnetic Resonance Imaging of the Patellar Tendon After Harvesting Its Central Third: A Comparison Between Traditional and Subcutaneous Harvesting Techniques

Summary: The aim of this study was to compare the 2-year results after anterior cruciate ligament reconstruction using patellar tendon autografts harvested through a paratenon-splitting, traditional technique (group A) with the results of a subcutaneous technique aiming at protecting the infrapatellar nerves and the paratenon (group B). Special emphasis was placed on evaluating the donor site. Magnetic resonance imaging (MRI) of the patellar tendon was performed to evaluate the reconstitution after harvesting its central third. Examinations of knee-walking ability and assessments of anterior knee sensitivity were made in order to evaluate donor-site discomfort and the function of infrapatellar nerves. Seventy-two consecutive patients were included in the study; group A comprised 35 patients and group B, 37 patients. At the 2-year follow-up, the Tegner activity level, the Lysholm score, and the IKDC evaluation system showed no significant differences between groups A and B. The median loss of normal anterior knee sensitivity was 16 cm2 (range, 0 to 200 cm2) in group A and 0 cm2 (range, 0 to 285 cm2) in group B (P =.20). In group A 20% of the patients and in group B 58% had normal sensitivity (P <.01). MRI showed that the donor-site gap (area corresponding to non–tendinous-like tissue signal) was 5 mm (range, 0 to 9 mm) in group A and 2 mm (range, 0 to 5 mm) in group B (P <.0001). At 2-year follow-up, the subcutaneous graft-harvesting technique resulted in less disturbance of anterior knee sensitivity and a smaller donor-site gap than the traditional technique.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 6 (July), 1999: pp 587–593

A comparison of graft implantation techniques for hair transplantation.

Modern hair restoration surgery involves moving hair-bearing grafts from the posterior scalp into areas of hair loss for correction of androgenic alopecia. Over the past decade, this procedure has been refined in multiple ways for the creation of increasingly natural results. The following is a comparison of commonly used graft harvesting, sectioning, and implantation techniques currently in use for hair restoration today. This comparison includes data on total procedure time, graft cutting time, graft insertion time, labor requirements, and cost.

Penile orthoplasty using dermal grafts in the outpatient setting

Objectives. To review and evaluate our extensive outpatient experience in the use of dermal grafts for the correction of significant residual chordee in patients requiring penile orthoplasty. Methods. The medical records of all patients requiring surgical correction for severe penile curvature over the past 5 years were reviewed. Among these, 51 patients were identified in whom dermal grafts were used to correct severe residual chordee. Of these patients, 41 had severe hypospadias, 9 had epispadias, and 1 had urethral atresia. Graft harvest and placement technique, any resulting complications, and parental satisfaction with cosmetic and functional results were all evaluated. Results. The dermal grafts were harvested from the hairless skin of the inguinal area, using one of two techniques. All were used to fill a tunical defect created by incising the tunica at the point of maximal penile curvature. No complications or postoperative hospitalizations resulted from any of the orthoplasty procedures. At a mean follow-up of 27 months, all patients had excellent cosmetic and functional results. Conclusions. In patients with significant residual chordee, a dermal graft is our preferred method of penile orthoplasty. This technique provides a straight phallus with a very minimal complication rate, it can easily and successfully be performed as an outpatient procedure, and it has assured an excellent cosmetic and functional result.

Reduction in peripheral nerve allograft antigenicity with warm and cold temperature preservation.

Lymphocyte migration into fresh and preserved peripheral nerve allografts was assessed to determine the effects of preservation time, preservation temperature, and graft harvest technique on the immunologic response to the peripheral nerve allograft. Peroneal nerve was harvested from either live or cadaveric (tissue) donors and stored as 1.5-cm segments at 5 degrees C or 37 degrees C for 1, 3, 5, or 7 days. Each of nine outbred ewes then received multiple segments of peroneal autograft, fresh allograft, and preserved nerve allograft implants. Lymphocyte migration was studied 7 days after implantation by intravenous injection of autologous 111In-labeled lymphocytes and quantified by gamma counter. Lymphocyte migration into fresh allografts (7212 +/- 1575) increased an average of 4.1 times over fresh autograft tissue (1758 +/- 421; p < 0.05). Short-term preservation (24 hours) at both temperatures enhanced lymphocyte migration into pretreated allograft tissue (12684 +/- 2575 at 5 degrees C, 8751 +/- 1577 at 37 degrees C) as compared with fresh allograft (7212 +/- 1575). Conversely, 7 days of pretreatment at both 5 degrees C (3586 +/- 1421) and 37 degrees C (1570 +/- 414) resulted in migration values not significantly different from autograft. No statistically significant difference was seen between grafts harvested from live (5710 +/- 1651) versus cadaveric (tissue) donors (4013 +/- 832) after 5 days of cold preservation.

A simple fail-safe method for the harvesting of cranial bone.

The technique of cranial bone graft harvesting with the sagittal saw is described. With this technique regular bone grafts of any size can be obtained. Bone-graft size dictates the technique to be used. Small grafts (less than 3.0 cm in shortest dimension) are harvested in situ, while larger grafts are harvested by formal craniectomy.

Nerve Grafting in Head and Neck Reconstruction

Educational objectives: To understand the most current information for all aspects of nerve reconstruction, including graft donor-site options, and graft harvesting and anastomotic techniques and to provide and update on future trends in nerve grafting.

Calvarial Bone Graft Harvest: Techniques, Considerations, and Morbidity

The importance of calvarial bone grafting in craniomaxillofacial trauma and facial reconstructive surgery is now widely recognized. Numerous harvesting techniques have evolved to optimize the desired thickness, size, shape, and curvature for a particular reconstructive need. At the same time, donor site selection and morbidity must be considered. This report includes a discussion of several currently utilized calvarial bone graft harvesting techniques, with emphasis on minimizing complications and morbidity. Choice of optimal harvesting technique and donor site for specific reconstructive situations will likewise be discussed. Finally, the specific morbidity in our multi-institutional calvarial bone graft harvest series of 121 patients and over 350 grafts will be reviewed.

Dermal graft harvest technique for use in temporomandibular joint disc repair

The use of dermis as an interpositional graft material in the temporomandibular joint (TMJ) has been described previously.‘” Dermal grafts have been used for correction of ankylosis’ as well as for replacement and repair of perforated discs.2-5 A frequently used procedure for harvesting derma1 tissue is similar to that described by Meyer for harvesting grafts for TMJ disc perforation repairs.5 This technique involves the use of a dermatome to remove a split-thickness layer of skin over the graft harvest site. The skin flap is left attached at one end. The underlying dermal layer is then harvested using either a free-hand technique or by using the dermatome to remove a layer of tissue. In either case, the split-thickness skin flap is then fenestrated and sutured back in place to cover the graft harvest area. There are several disadvantages to harvesting dermis in this manner. If a dermatome is used, a large area of skin must be elevated in order to allow for a second pass with the dermatome. Moreover, the amount of dermis removed with the dermatome is generally excessive in area but often deficient in thickness. The use of a free-hand technique to remove the dermal tissue frequently results in an indentation in the dermal layer. In both cases, the surgical wound remaining after resuturing of the skin is inconvenient and cumbersome for the patient to maintain in the immediate postoperative period and leaves a significant cosmetic defect after healing. The following technique avoids these problems.

Preface

The objective of this study was to evaluate the safety and efficacy of fat grafting to the facial region for the reconstruction and aesthetic enhancement of facial contour.A systematic literature review of the National Library of Medicine (PubMed), MEDLINE and Cochrane databases was performed. Studies involving the outcomes of autologous fat grafting to correct or enhance contour defects of the face were included. Extracted data included patient demographics, harvest and injection sites, graft harvesting and injection technique, mean injected volume, retained volume percentage and complications.Forty-three articles met the inclusion criteria, resulting in 4577 patients with various facial contour defects treated with autologous fat grafting. Injection sites were categorized by anatomic facial regions as upper (32.5%), middle (53%) and lower face (14.5%). The mean volume of injected fat was 16.9 ml. The mean weighted volume retention of non-enriched grafts was 41.63% at the time of follow up (mean 13.9 months). A total of 104 (2.27%) complications were reported including asymmetry (74), skin irregularities (14), prolonged edema (4), graft hypertrophy (4), fat necrosis (3), infection (2), erythema (1), telangiectasia (1), and activation of acne (1).The present study represents the first systematic review of fat grafting in the facial region, a widely-performed procedure within plastic surgery practice. Importantly, it presents pooled important data such as retained grafting volume and complication rates in this anatomical region, providing clinicians with more accurate information with which to guide their decision-making and patient education.

Functional injury of vein graft endothelium. Role of hypothermia and distention.

The cause of endothelial injury during vein harvesting and preservation is complex. Hypothermia is thought necessary to preserve cell viability but has been implicated in morphologic injury to the endothelium. This study explored the effect of temperature on preserving endothelial function using prostacyclin production as a metabolic marker. Canine veins were atraumatically excised and matched segments were stored at three temperatures using either nutrient medium or heparinized saline. After storage, endogenous production of prostacyclin by the luminal surface of each vein was collected in a closed perfusion system at 37 degrees C and assayed by radioimmunoassay. Optimal prostacyclin production was observed in veins stored in tissue culture medium at normothermia. Preservation of normal endothelial function may require revision of traditional vein graft-harvesting techniques.