Graft Harvesting Research Articles

Regional Patellar Tendon Strain in the Short- and Long-term After ACL Reconstruction Using Bone-Patellar Tendon-Bone Autograft.

Anterior cruciate ligament reconstruction (ACLR) often involves harvesting a bone-patellar tendon-bone (BPTB) autograft. How graft harvest affects tendon strain across the 3 distinct regions (medial, lateral, and central) is not known. To (1) quantify strain in the 3 regions of the patellar tendon during 60% of maximum voluntary isometric contraction (MVIC) in 90° of knee flexion and (2) assess how effort level in 2 different knee joint angles (60° and 90°) impacts strain in the medial and lateral regions of the patellar tendon, in 2 cohorts of patients after ACLR using a BPTB autograft (one group <24 months after surgery and another group ≥24 months after surgery). Descriptive laboratory study. Effort levels ranging from 20% to 100% of MVIC were performed at 90° and 60° of knee flexion on an isokinetic dynamometer, with simultaneous ultrasound imaging of tendon length to calculate regional strain. Linear mixed-effects models were used to evaluate regional strain at 60% of MVIC in 90° of knee flexion. The fixed effects of percentage of MVIC, joint angles, and time from surgery groups on patellar tendon strain were evaluated using separate models for the medial and lateral regions. Fourteen participants in the short-term group (7.5 ± 1.9 months from surgery) and 15 participants in the long-term group (71.5 ± 16.5 months from surgery) were included. At 60% of MVIC in 90° of knee flexion, the short-term group demonstrated lower patellar tendon strain than the long-term group regardless of region (P < .01). The central region also had lower strain than the medial and lateral regions regardless of group (both P < .01). Finally, the rate at which strain increased with increasing effect levels differed between time from surgery groups in both medial and lateral regions. The short-term group had lower strain in all regions of the patellar tendon after ACLR using BPTB autograft. The medial and lateral regions showed varying strain based on time from surgery and effort level. Varying knee joint angles and effort levels for graft site rehabilitation may have to be considered to target specific regions of the patellar tendon. Clinicians should consider the time elapsed since surgery and the manipulation of knee angle as factors that can exert varying levels of strain on different regions of the patellar tendon after ACLR. Accelerating quadriceps strengthening to enhance strain distribution across the patellar tendon to promote tendon healing may be of benefit for optimizing postsurgery rehabilitation.

Comparison of Postoperative Strength Progression and Outcomes Following Primary Versus Secondary ACL Reconstruction in the Young Athlete.

Return to sport testing after ACL reconstruction (ACLR) is becoming increasingly popular. Anecdotally, some believe that patients who undergo a second ACL surgery on either the ipsilateral or contralateral leg progress through their rehabilitation goals faster the second time through. The purpose of this study was to evaluate the rate of strength progression in return to sport testing after primary and secondary ACLR surgeries in a young, active population. A retrospective review of patients who underwent ACLR between September 2013 and December 2022 was performed. Patients were included if they underwent an ACLR and completed at least 2 postoperative strength tests. Strength testing was commonly performed at 3, 6, and 9 months. Exclusion criteria included age older than 30 and those who had a contralateral graft harvest. Structural equation modeling was performed for each strength assessment by the timepoint it was performed. A linear combination of parameters was performed to compare the path coefficients between the primary and secondary ACL groups for each strength test to assess statistical differences in the rate of change of each strength test over time. Three hundred ninety-six patients in the primary ACLR group and 50 patients in the secondary ACLR group met the inclusion criteria. Patients who received secondary ACL surgery were older, had a higher percentage of BTB grafts, lateral augments, and internal brace augments. Months from surgery had a significant positive correlation with nearly all strength tests in both groups. There was no difference between primary and secondary surgery in the progression of any postoperative strength test. There was no difference in progression of IKDC or RSI scores between groups. This study suggests that patients who undergo a second ACL surgery do not progress their strength faster or slower than after primary ACLR. This implies that these patients do not require different return-to-play protocols from a strength perspective. Retrospective study, level III evidence.

Comparison between Conventional and No Touch Technique Vein Graft Harvesting in Coronary Artery Bypass Surgery

Comparison between Conventional and No Touch Technique Vein Graft Harvesting in Coronary Artery Bypass Surgery

Evaluation of the Palatal Features in Relation to Graft Harvesting in the Saudi Population.

Background and Objectives: The palate's morphological characteristics are of great importance, especially in periodontology, where the palatine tissue represents a source of tissue graft for multiple mucogingival surgeries. This study aimed to estimate the amount of donor tissue available through the average palatal height and average location of the greater palatine artery in the Saudi population according to age and gender. Materials and Methods: Digital casts for adult Saudi patients at the age of 18-60 years old with a mean age of 37.76 ± 12.68 years were collected and analyzed using EXOCAD software. The digital casts were evaluated, and measurements of arch width at molars and canines, palatal vault height (PVH), palatal height index (PHI), and extension of the palatal rugae were registered. Finally, the amount available for soft tissue graft harvesting was calculated. Results: Overall, 109 maxillary casts for Saudi patients, 52 (47.7%) males and 57 (52.3%) females, were analyzed. The maxillary inter-molar arch width, inter-canine width, and palatal vault height significantly differed between males and females (p < 0.05). The mean PHI was 45.51% ± 8.12%, and 27.5% were classified as orthostaphyline, while 72.5% were categorized as hypsistaphyline, with no significant difference between the genders. The mean maximum graft width was 11.45 mm, and the graft width was significantly different between males and females (p < 0.005), while the mean maximum graft length was 17.78 mm, and the graft length showed no significant difference. Conclusions: The results of this study provide specific clinical guidelines for periodontal procedures by emphasizing the importance of gender-specific anatomical considerations. Data on graft dimensions and palatal measurements will enable the exact planning of soft tissue harvesting to minimize surgical risks and optimize mucogingival surgery outcomes in the Saudi population.

Effect of inferior alveolar plus buccal nerve block on donor site morbidity at buccal mucosal graft harvest site: A double-blinded, randomized placebo-controlled trial

ABSTRACT Introduction: Pain at the buccal mucosal graft (BMG) harvest site in the immediate postoperative period is common and delays resumption of oral intake. This study compares the time for resumption of pain-free solid and liquid diets and postoperative pain scores at harvest site following the administration of inferior-alveolar nerve-block plus buccal-nerve block (IANB + BNB) versus placebo. We hypothesize that the intervention could decrease pain and aid in early food intake. Methods: A single-center, placebo-controlled, double-blinded randomized-control trial was conducted from September 2022 to August 2023 (CTRI). All individuals &gt; 18 years undergoing BMG harvest were included. Patients with contraindications for BMG harvest and diabetes were excluded. Furthermore, patients requiring additional lingual/labial graft, bilateral BMG, or a history of prior BMG harvest were also excluded. IANB + BNB was performed with a 10 ml mixture comprising lignocaine, bupivacaine, and dexamethasone, while normal saline was administered in the control group. Both groups received submucosal local anesthetic infiltration. Results: After randomization (n = 28 in each group), patients who received IANB + BNB had an early return to pain-free liquid (median 1 vs. 2 days; P ≤ 0.001) and solid diet (median 2 vs. 3 days; P = 0.001) 1 day quicker than those who received placebo. In the intervention arm, Visual Analog Scale scores at harvest site were lower from 2 to 48 h postoperatively, had reduced paracetamol requirement (median 7 g vs. 9 g; P = 0.001), and fewer necessitated opioids for breakthrough pain (14.4% vs. 53.3%; P = 0.002). Conclusion: Patients who received IANB + BNB resumed a pain-free diet in the postoperative period quicker, reported lower pain scores, and there were lesser postoperative analgesic requirements.

Revisiting Fat Graft Harvesting and Processing Technique to Optimize Its Regenerative Potential.

The use of fat grafting has expanded to include cell and tissue regeneration, necessitating investigations to ensure the viability of stromal and adipose-derived mesenchymal stem cells (ASCs) within the transferred fat parcels. This study explored the impact of harvesting technique and centrifugation on the viability of stromal cells and ASCs in lipoaspirate. Fat was harvested from patients undergoing fat grafting using 2 types of liposuction cannula: (A) a 3-mm blunt tip cannula with 3 smooth holes and (B) a 2.4-mm, sharp point port, multihole blunt tip cannula. Fat from cannula B underwent different processing methods: no centrifugation, 300g, 600g, and 900g centrifugation. Stromal cells were isolated, quantified, and evaluated for viability. ASCs were cultured from these samples to confirm survival. Lipoaspirates from 21 patients were analyzed. The mean stromal cell counts were 0.937 × 109 ± 0.346 × 109/mL for cannula A and 0.734 × 109 ± 0.266 × 109/mL for cannula B (P = 0.684), with viabilities of 98.79% and 98.22% (P = 0.631), respectively. ASCs isolated and after 2-passage culture were also higher for cannula A. Stromal cell quantification and viability were lowest in the noncentrifuged group (P < 0.05) and highest in the 600g centrifugation group. Fat harvesting using cannulas A and B showed no significant difference in stromal cell yield or viability. Handheld syringe liposuction preserved stromal vascular fraction cell and ASC viability. Centrifugation at different speeds did not significantly affect stromal cell viability.

Esthetic and Colorimetric Assessment of Peri-implant Soft Tissue Augmented with the Strip Gingival Graft Harvested Either from the Buccal Soft Tissue or the Palate: A Retrospective Study.

It is well known that keratinized mucosa (KM) plays a crucial role for maintaining peri implant health and esthetic outcomes. The Strip Gingival Graft (SGG) technique, which involved an apically positioned flap (APF), in combination with an autogenous SGG and a xenogeneic collagen matrix (XCM), demonstrated its efficacy in re-establishing an adequate amount of KM width at implant sites. Nevertheless, it is still unclear whether harvesting the SGG from the palate (pSGG) or from the buccal aspect of natural dentition (bSGG) affects the esthetic outcomes at the augmented implant sites. Therefore, the objective of the present study was to compare the esthetic outcomes of dental implants augmented with either bSGG &#43; XCM or pSGG &#43; XCM. The present study was designed as a single-center retrospective study, assessing the esthetic and colorimetric outcomes of peri-implant KM augmentation with either pSGG &#43; XCM or bSGG &#43; XCM in cohort of 49 subjects. The two groups were compared in terms of colorimetric outcomes, assessed on clinical photograph using specific software able to identify and quantify the predominant color within the peri implant soft tissue. Colorimetric comparisons with adjacent untreated sites were also investigated. In addition, the Pink Esthetic Score (PES) and the Subjective Esthetic Score (SEE) were performed to further assess the esthetic outcomes of pSGG &#43; XCM and bSGG &#43; XCM. The colorimetric analysis did not show statistically significant differences among sites augmented with pSGG &#43; XCM, sites augmented with bSGG &#43; XCM, and untreated sites. Implants treated with bSGG &#43; XCM showed significantly greater PES (in terms of shape of the mesial and distal papilla, level of the soft tissue margin, soft tissue contour, anatomy of the alveolar process, and final PES) and SEE compared to implants augmented with pSGG &#43; XCM. The present study demonstrated that implant sites augmented with APF with either pSGG &#43; XCM or bSGG &#43; XCM did not show different colorimetric outcomes compared to adjacent untreated sites, while bSGG &#43; XCM obtained superior professional and subjective esthetic scores compared to pSGG &#43; XCM.

Modern methods of preparing autologous vein for bypass surgery (non-systematic review)

INTRODUCTION: The use of an autologous vein conduit in bypass operations is the leading trend in vascular and cardiac surgery. In the context of a high risk of repeated interventions and of limited availability of high-quality venous resources, it is important that the autovenous conduit remain functional as long as possible. AIM: To study the dynamics of conclusions from the modern research works on harvesting, preservation and quality assessment of autovein grafts in the postoperative period. The graft patency after open and endoscopic harvesting is comparable. Unsatisfactory results in terms of the long-term patency of an endoscopically harvested autovein may be associated with a long period of training in endoscopic techniques. They facilitate fast healing of postoperative wounds on the leg and reduce pain syndrome. The no touch open harvest technique, the use of low pressure when distending an autovenous graft, and ligation of the tributaries are factors that reduce the risk of postoperative hyperplasia of intima, thus contributing to a long-term functioning of the shunt and reducing the number of reinterventions. The preferable method of harvesting an autovenous graft for bypass surgeries in the lower limbs is an open bridging method. Keeping the autovenous graft in the whole autologous blood before the bypass surgery is also believed to reduce the risk of autograft injury, but randomized studies with a greater number of observations are required. Control of the graft quality before and after application of anastomosis and initiation of blood flow helps to improve the immediate and long-term bypass patency, and is performed using ultrasound imaging, measurement of blood flow transit time, angiographic examination, introduction of indocyanine green, and thermal imaging. CONCLUSION: This review presents a modern multicomponent analysis of the role of mechanical, thermal, environmental and organic factors in the formation of the properties of an autovein conduit, essential for maintaining its maximal patency as of an arterial bypass, and the methods of intraoperative patency control.

Сhanges in the donor site following bone-patellar tendon-bone graft harvesting with open or closed defects

Background. The patellar tendon is frequently used as a graft source for anterior cruciate ligament reconstruction. The search of the factors that enhance the healing process of the donor site may contribute to improved anatomical and functional outcomes. The aim of the study — to determine the features of the harvesting techniques for better donor site healing by examining postoperative changes in the patellar tendon following two different graft harvesting methods. Methods. This study examined the condition of the patellar tendon after two methods of graft harvesting under the same early mobilization protocols. Group 1 (retrospective) enrolled 30 patients who underwent follow-up MRI at different times after surgery, during which ligamentous and bony defects were not closed. Group 2 (prospective) included 30 patients who received full-layer suturing of the patellar tendon and patellar and tibial bone defects plasty. Postoperatively, all patients underwent radiography and the Insall-Salvati ratio of their patellar position was evaluated. In Group 2, MRI was performed preoperatively and 12 months post-surgery, while CT scans were taken 1 day and 6 months post-surgery. MRI was utilized to measure the size and qualitatively assess the condition of the tendon, whereas bone defects were evaluated on CT scans. Results. The Insall-Salvati ratio of patellar position was within the physiological norm and did not differ between the groups (M1 = 1.11; SD1 = 0.13 and M2 = 1.12; SD2 = 0.15; p = 0.955). In Group 2, after 12 months, the length of the tendon was 3.1% shorter (M = -1.4 mm; SD = 2.4 mm; p = 0.003). The width of the tendon in the upper third and middle third was slightly increased (M = 0.3 mm; SD = 2.4 mm; p = 0.502 and M = 0.5 mm; SD = 2.1 mm; p = 0.205), while in the lower third it was 2.7% larger (M = 0.7 mm; SD = 1.7 mm; p = 0.034). The thickness of the tendon increased by 55% (M = 2.4 mm; SD = 1.6 mm; p = 0.001). All patients in Group 1 exhibited persistent bony and ligamentous defects. In Group 2, six months after surgery, cancellous bone filled the defects and integrated with the bone bed; 12 months later, the tendon was healed, and its shape and size approximated preoperative parameters. Conclusion. Full-layer suturing of the patellar tendon, reconstruction of defects using cancellous bone autograft, and early mobilization promote the healing of bone defects and restore the integrity, shape, and size of the tendon.

A comprehensive review of evolution of advanced follicular unit excision systems

Initially, the application of the follicular unit excision (FUE) technique for hair transplantation faced a challenge due to a significant occurrence of hair follicle damage. However, advancements in techniques, punch designs, and tools have successfully addressed this issue. The integration of motorized equipment featuring rotation, roto-oscillation, oscillation, vibration, suction, and hydration has significantly improved the successful harvesting of grafts. More recently, the adoption of robotic technology for both graft extraction and incision is becoming increasingly common in FUE procedure. Given the wide range of available devices and technologies, hair transplant surgeons may find it challenging to select the most suitable option for their specific practices. The advancements in techniques, punch shapes, and motorized devices have played a key role in reducing the rate of follicle damage and increasing the speed of FUE procedures. It is crucial for hair restoration surgeons to stay informed about the various accessible devices and understand how these tools can be customized to suit the unique hair and skin characteristics of each patient.

Complications in anterior cruciate ligament reconstruction.

Anterior cruciate ligament reconstruction (ACLR), despite its effectiveness in restoring knee stability and function, can have associated morbidity. The most frequent complications are technical errors, which have been described during graft harvesting, tunnel placement or graft fixation. The most serious complications are neurovascular injuries, arthrofibrosis and infections. Recently, several high-quality studies have been published to help surgeons improve their performance in this surgery. Each stage of the surgical process carries potential complications, even when safe techniques are followed. When complications arise, it is crucial to promptly recognize them and adhere to established guidelines to effectively correct, minimize, or resolve the issues. In this review article, we have attempted to summarise the best available evidence addressing ACLR complications, following our primary goal of improving the outcomes for patients who suffer an ACL injury.

Evaluation of the results of reconstruction of large bony defects of humerus using vascularized bone grafts.

Vascularized bone grafts (VBGs) are currently the main surgical option for the restoration of humeral bone defects particularly when defects are larger than 6cm. Because it offers a strong, rapid blood supply, VBGs easily integrate into the recipient sites and undergo active resorption and remodeling into healthy bone through primary bone healing. Additionally, they support the recipient site's immune system in preventing and reducing infection.The Aim was to assess the outcomes of utilizing vascularized bone grafts to reconstruct large humeral bony defects (greater than 6cm). This study comprised twenty patients with major humeral bony defects treated by vascularized bone grafts. Under general anesthesia, the procedure was carried out with the patient in the supine position for free fibula harvesting or in the lateral or prone position for pedicled scapular graft harvesting. The union rate was 90% and the mean healing time was 7.78±3.04 months. Complications were present in 40% of cases, with non-union being the most common, followed by infection and wound dehiscence. The study suggests that the reconstruction of large bony defects of humerus using vascularized bone grafts is effective, with a predictable healing time and a manageable complication rate.

Rib and Sternum Nonunions: Diagnosis and Treatment and Awareness of Other Potential Posttraumatic Pathology.

As the operative management of acute, chest wall, skeletal injury escalates throughout the world, it has become commonplace for patients with posttraumatic conditions to present with clinical reconstructive challenges as well. In addition, it is becoming clear that rib nonunions are not rare, likely more than 5% of rib fractures. No subspecialty is better equipped to address such painful conditions than orthopaedic surgery. Likewise, there are a plethora of other posttraumatic problems that patients face, from intercostal neuralgia, pleural herniation, rib synostosis, and costal margin and sternal injuries that do not heal properly, which require treatment solutions. This emerging new field of surgery is optimized by an interdisciplinary approach, between general and orthopaedic trauma surgeons, and between thoracic, anesthesia, and rehabilitation specialists. This article emphasizes the workup and operative treatment of painful rib and sternal nonunions, in particular, and familiarizes the orthopaedist with other cold skeletal trauma in general. From the distinctive history and physical examination of the patient with a rib psuedoarthrosis to proper diagnostic studies, the surgeon is led through a principled approach to nonunion surgery, inclusive of autogenous graft harvest to provide both biologic and mechanical variables to bear in the successful treatment of this condition.

Digital workflow for graft harvest and positioning in deficient anterior mandibles versus conventional technique: Randomized controlled trial.

The cortical shell technique is frequently associated with technical drawbacks, such as the lack of anatomical guidance during shell harvest and graft. This study aims to assess the horizontal bone gain and accuracy of a digitalized protocol that incorporates two interlocking patient-specific stackable guides (PSSGs) to control the shell harvest, positioning, and fixation. Twenty patients with deficient anterior mandibles were randomly allocated; 10 patients received freehand symphyseal shell harvest and fixation (the control group), whereas the other 10 received fully guided harvest and graft (study group) using (PSSGs), the first aided an accurate shell harvest, whereas the second conveyed shell fixation. The interposition gap among both groups was loaded with an equal mix of xenogeneic and autogenous particulates. The mean radiographic bone gain among both groups was calibrated 6 months postoperatively, and the accuracy of the digital plan was assessed by superimposing and comparing the virtually planned horizontal bone dimensions with the immediate postoperative actual bone dimensions. The mean 6-month postoperative horizontal bone gain value of the study group was recorded as (4.97 ± 0.73) mm versus (4.45 ± 0.61) mm for the control group, with a statistically insignificant mean gain difference of (0.52) mm, (p = 0.101). The mean virtual preplanned horizontal bone gain was recorded (5.4 ± 0.6) versus (5.4 ± 0.6) for the immediate postoperative actual bone gain, which was also statistically insignificant (p = 0.9). The (PSSGs) provided a precise method for graft harvest, position, and fixation, resulting in satisfactory alveolar ridge dimensions with intimate accuracy.

Retrospective evaluation of postoperative analgesia efficacy of a new technique in anterior iliac crest bone graft harvesting: anterior iliac block

BackgroundIn reconstructive surgeries, iliac crest bone graft harvesting is commonly preferred. The pain experienced after surgery at the anterior iliac crest (AIC) donor site might be more intense compared to the pain at the primary surgical area where the graft is placed. To address this issue, we defined a novel technique called the anterior iliac block (AIB), which can provide analgesia with lower volumes. In this study, the effect of this technique for AIC bone greft harvesting was evaluated.MethodsPatients who were operated on and had AIC bone graft harvested included in this retrospective study. The study collected age, height, weight, ASA classification, and duration of surgery, information on the regional anesthesia technique, block performance, postoperative pain severity, opioid consumption, rescue analgesics used in the first postoperative 24 h.ResultsData from 16 patients were analyzed. The popliteal sciatic block was performed in eight patients, infraclavicular brachial plexus block in four patients, supraclavicular brachial plexus block in one patient, PENG block in one patient, and proximal adductor canal block in two patients two provide analgesia for primary surgery. The median morphine consumption at postoperative 24th hour was 3.5 mg, median NRS score was 1 at postoperative 1st hour, and 0 at postoperative 6th, 12th and 24th hours.ConclusionsThe study findings indicate that the AIB provides adequate analgesia for AIC graft harvesting in the first postoperative 24-hour period. It can be used as an adjuvant to the peripheric nerve block for the primary surgical site.Trial registrationNCT06295224.

Patient Experience and Wound Healing Outcomes Using Different Palatal Protection Methods After Free Gingival Grafts: A Systematic Review.

(1) Background: A free gingival graft (FGG) is a common technique used to reconstruct or enhance the area of keratinized mucosa, while a connective tissue graft (CTG) is utilized to boost soft tissue thickness, thereby promoting stability in interproximal marginal bone levels. Most reported complications following FGG procedure are associated with the donor site. In addition to a painful, open wound in the palate, the most frequent complications linked to FGG harvesting include excessive bleeding, postoperative bone exposure, and recurrent herpes lesions. Numerous methods for securing the donor site after a free gingival graft surgery have been documented in research publications. The main objective of this systematic review was to assess various techniques for protecting the palate after graft harvesting and their impact on patient experience, with a focus on pain management. The secondary objective was to evaluate these techniques in relation to donor site wound healing. (2) Methods: The search was performed across four databases: Medline (PubMed Central), Scopus, Web of Science, and Embase, in accordance with PRISMA guidelines and the recommendations set forth in the Cochrane Handbook for Systematic Reviews of Interventions. The initial search took place on 9 October 2023, followed by an update on 28 June 2024. The search utilized the following keywords: ("wound" OR "injury") AND ("graft" OR "free gingival graft" OR "graft harvesting") AND ("healing" OR "recovery") AND "palate". (3) Results: After conducting the follow-up search, a total of 958 papers were identified: 193 from PubMed, 314 from Scopus, 101 from Web of Science, and 350 from Embase. Ultimately, of the 49 papers that remained, 11 were excluded due to not fulfilling the inclusion criteria, leaving 38 full-text papers on free gingival grafts (FGG) for qualitative analysis. (4) Conclusions: Various methods for palatal protection after free gingival grafts (FGG) are described in the literature, stemming from biological, physical, or chemical sources. Most studies in this review examined platelet-rich fibrin and suggested that it provides no benefits for patients' subjective experiences or wound healing outcomes. While photobiomodulation appears to support wound epithelialization, it does not influence pain perception. Alternatives such as propolis, hyaluronic acid, and medicinal plant extracts show potential for palatal protection; however, further research is needed to thoroughly evaluate their effectiveness.

Clinical and Patient-Reported Outcome Measures of Palatal Donor Site Healing Using Polyvinylpyrrolidone-Sodium Hyaluronate Gel as a Dressing Material Following Free Gingival Graft Harvesting: A Randomized Controlled Clinical Trial.

This study evaluates the efficacy of polyvinylpyrrolidone-sodium hyaluronate (PVP-SH) gel as a dressing material in enhancing both clinical and patient-reported outcomes post-free gingival graft (FGG) harvesting from the hard palate. This randomized clinical trial included 18 patients and spanned from June 2022 to August 2023. Patients received an FGG procedure to manage a lack of attached gingiva. Following graft harvesting, patients were divided into two groups: the control group, which received Coe-Pak, and the test group, which was treated with PVP-SH gel. The primary outcome measured was complete epithelialization. Secondary outcomes included the Landry healing scale, post-operative pain level, and patient willingness to receive the same treatment again. The test group reported significantly lower analgesic use (p < 0.001) and reduced pain severity (p < 0.001) compared to the control group. Furthermore, test group patients indicated a higher level of satisfaction regarding the prospect of retreatment. In contrast, the control group showed significantly slower progress in wound healing and epithelization (p < 0.05) compared to the test group. The findings of this study suggest that PVP-SH gel is a superior dressing material post-FGG harvesting, yielding improved clinical and patient-reported outcomes relative to Coe-Pak.

Zero incidence of culture-positive septic arthritis and low infection rate following ACLR with all-soft tissue quadriceps tendon autograft: An analysis of 1053 cases.

To evaluate the infection rate following anterior cruciate ligament reconstruction (ACLR) using all-soft tissue quadriceps tendon (ASTQT) autograft. All primary ASTQT autograft ACLRs within a single surgeon's prospectively collected database from 2011 to 2021 were retrospectively reviewed. No topical antibiotics were administered and no graft-soaking with antibiotics was performed during the study period. Patients who underwent multiligament knee reconstruction or a cartilage restoration procedure were excluded. Patients who underwent a subsequent procedure, including irrigation and debridement (I&D) of the knee joint, were included. Case-specific data, including fluid culture analysis, antibiotics (type, route of administration and duration), time to debridement and method of debridement, were collected. Descriptive statistics were utilized to analyze demographics, incidence and possible association between the need for I&D and concomitant meniscus surgery. Out of 1053 cases (mean age: 20.2 ± 6.3, 44.6% female), four patients (0.38%) (mean age: 18.5 ± 4.0, 25% female) underwent subsequent I&D (arthroscopic I&D only [n = 1], graft harvest site I&D only [n = 1], combined graft harvest site and arthroscopic I&D [n = 1] and tibia wound and arthroscopic I&D [n = 1]). There was no significant difference with regard to demographics. No joint fluid cultures returned positive; one wound culture returned positive for Methicillin-susceptible Staphylococcus aureus from their graft harvest site. The time to I&D ranged from 18 to 23 days. Concomitant meniscectomy or meniscal repair was not associated with requiring surgical I&D. All patients who underwent I&D were prescribed antibiotics for a minimum of 10 days and a maximum of 31 days (mean: 16.25 days). Three patients (75%) who underwent I&D ultimately returned to sport. One patient was lost to follow-up. ACL grafts were retained in all patients. The incidence of culture-positive septic arthritis following ASTQT autograft ACLR is 0%, while the overall need for I&D of 0.38% is low and not related to concomitant meniscal procedures or patient-specific factors. Level IV.

A safe, novel and ingenious method for autogenous bone graft storage in spine surgery with constrained resources - operative site as the bone bank.

The aim of our study is to establish whether the bone graft harvested and stored in the surgical wound by our novel technique is safe, reproducible and preserves the viability of the graft. In doing so, it promises successful bony fusion in spine and orthopaedic surgeries. A prospective clinical case series was conducted for autogenous bone graft storage in complex spine surgeries requiring staged procedures, in resource constrained settings. The bone graft harvested was morselized, wrapped in moist sterile gauze and stored in the paraspinal gutter within the operative site. Thereafter, the surgical wound was easily closed without tension. During the second stage surgery, the stored bone was retrieved and mixed with more autologous/allogenic bone (if necessary) and appropriately laid at fusion sites. Bacterial samples were sent before implantation. 16 complex spinal deformity patients who underwent surgery in a resource constrained hospital over a period of 5 years were included. Duration between both stages was within 2 weeks. All patients showed successful fusion, with mean follow-up of 2.6 years. There were no cases of deep or systemic infection in our series. Surgeons found harvesting, storing and retrieval of graft to be straightforward. The operative site provides an ideal, safe and reproducible location for bone graft storage for staged surgeries conducted in resource constrained situations. The osteogenic potential of the autogenous bone graft is retained. This technique can be extrapolated to other orthopaedic surgeries conducted under resource limited environments like in surgical camps or combat medical facilities.

Open Reconstruction of Fibular Collateral Ligament Rupture Using a Partial-Thickness Biceps Femoris Tendon Autograft

Background: Fibular collateral ligament (FCL) injuries are uncommon incidents, with less favorable healing rates compared to medial collateral ligament injuries, often necessitating repair or reconstruction as the predominant treatment approach. Indications: Using a partial-thickness biceps femoris tendon (PTBFT) autograft for FCL reconstruction or augmentation is a viable option for both acute and chronic FCL injuries, especially in patients unwilling to accept allograft tissue and in settings with limited access to allografts. Technique: The fibular head attachments of the biceps femoris tendon (BFT), FCL, and popliteofibular ligament are inspected for injury. The biceps–iliotibial band (ITB) interval is opened, and the native FCL is assessed at its midsubstance for injury. The mid-aspect of the ITB was incised in line with its fibers, and the femoral insertion of FCL is localized. A 10-mm × 70-mm graft is harvested from the middle third of the BFT, preserving the distal insertion on the fibular head. Locking Krackow sutures are placed into the proximal end of the graft, which is passed under the ITB. A femoral tunnel is created at the FCL attachment site, and the graft is placed into the femoral tunnel and secured to the femur using an interference screw. Results: Postoperatively, the patient is instructed on foot-flat touch weightbearing with 2 crutches, on a knee immobilizer, for the first 2 weeks. Increasing weightbearing status and range of motion are expected in a stepwise manner. Return to sports is permitted after 6 to 9 months and depends on the presence of any additional injuries, strength, and functional recovery. There no studies available yet on clinical outcomes. Discussion/Conclusion: FCL reconstruction or augmentation utilizing a PTBFT autograft is an underused treatment option for patients with isolated FCL insufficiency or as part of multiligamentous injuries. This procedure offers advantages such as an anatomic reconstruction; single incision for both graft harvest and FCL reconstruction; shorter, cost-effective surgery with fewer implants used; and a safer approach with reduced risk of neurovascular structures due to lack of a fibular head tunnel. This is a valuable option in the limited source setting or in a patient not accepting of allografts. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.