Graft Reconstruction Research Articles

Non-vascularized coracoid process autograft for glenoid reconstruction in revision shoulder arthroplasty.

To report the radiological and clinical outcomes of non-vascularized coracoid process autografts used for glenoid reconstruction during revision shoulder arthroplasty. This is a retrospective, monocentric study from January 2016 to October 2022 targeting patients treated with a coracoid bone graft for glenoid reconstruction during revision of shoulder arthroplasty. The primary outcome measures were coracoid graft union rate and graft-implant osseointegration. Secondary outcome measures included clinical and CT-scan identified radiological complications and functional outcomes as measured by the Visual Analog Scale (VAS), Range of Motion (ROM), Subjective Shoulder Value (SSV), Constant score (absolute and ponderate), and ASES score. Fifteen patients (9 males, 6 females; mean age 66.9years, range 38-85) were included. At a mean follow-up of 20.9months (range 12-56months), 93.3% achieved complete graft integration. One case of partial lysis without baseplate loosening was noted. Regarding range of motion, the mean forward elevation was 130° (range 90°-170°), external rotation at the side 25° (range 10°-40°), external rotation in 90° of abduction 45° (range 10°-80°), and internal rotation 52° (range 10-80°). The mean VAS for pain was 1.1 (range 0-8), mean SSV 67.3% (range 40-90%), mean ASES score 85.5 (range 65-98.3), mean Absolute Constant score 58.6 (range 21-83), and mean Ponderate Constant score 77.5% (range 28.8-110.7%). No neurological injuries were reported. Utilizing a non-vascularized coracoid graft during shoulder arthroplasty revision is a safe, reproducible, and time-efficient technique that demonstrated satisfactory osseointegration, implant stability, good functional results, and a low complication rate.

Factors Influencing the Success of Non Vascularized Iliac Bone Graft for Mandibular Reconstruction: A Retrospective Study of 26 Cases

Objective: This study aimed to identify the prognostic factors influencing the success of nonvascularized iliac bone grafts for mandibular reconstruction. Methods: This was a retrospective cohort study conducted at a single center, involving 26 patients who underwent segmental mandibulectomy followed by nonvascularized iliac bone grafts between 2012 and 2022 at the Oral and Maxillofacial Surgery Unit, Buddhachinaraj Phitsanulok Hospital. Data were collected by reviewing electronic medical records and radiographic images. Patients who had received vascularized bone grafts or had a history of head and neck irradiation therapy were excluded from the study. The patients were classified into two groups: successful and failed. Success was defined as clinical and radiographic evidence of bone continuity, a graft resorption rate not exceeding 30% of the initial height, and no evidence of chronic infection for at least 6 months. Results: Successful bone grafting was achieved in 19 patients (73.1%). Multivariable risk difference regression analysis identified that the factors influencing graft incorporation were jaw immobilization using reconstruction plates with maxillomandibular fixation for at least 21 days (RD 63.0; 95% CI 33.1, 93.0; p<0.001) and long segmental block graft design (51.3%; 95% CI 16.9, 85.7; p<0.003). A clinically significant factor, although statistically insignificant, was the duration of plate stabilization, which should ideally range from 172 to 232 days prior to plate removal. The sample size constituted a limitation of this study. Conclusions: Nonvascularized bone grafting remains a viable option for reconstructing mandibular segmental defects. The factors influencing graft stability can help improve clinical outcomes.

Use of polytetrafluoroethylene graft in vascular reconstruction of living donor kidney transplant in a reference center

Use of polytetrafluoroethylene graft in vascular reconstruction of living donor kidney transplant in a reference center

Is fascia lata a viable graft for MPFL reconstruction? An overview of surgical technique and scoping literature review

Lateral patellar dislocation is irrefutably one of the most common knee injuries, while subsequent medial patellofemoral ligament (MPFL) damage requires proper orthopedic care. Treatment of these injuries is regularly associated with the need for MPFL reconstruction surgery. This operation, often in combination with other procedures, can result very fruitful in restoring knee kinematics. There is a considerable variety of options for the orthopedic surgeon to choose from regarding graft selection when performing MPFL reconstruction surgery, including the semitendinosus tendon, the gracilis and others. Notwithstanding, utilizing the fascia lata as an autograft or allograft for MPFL reconstruction has emerged as a promising alternative. Perusing the existing literature, not any review paper could be found examining the efficacy of fascia lata as a MPFL reconstruction graft. As a result, a thorough search was conducted in various databases to investigate and explore the studies analyzing this type of MPFL reconstruction surgery. The number of papers scrutinizing this operation was exceedingly narrow. However, out of these studies it can be concluded that opting for fascia lata grafts when executing MPFL reconstruction surgery features some considerable advantages, involving similar biomechanics to the native MPFL, no hamstrings damage and quicker rehabilitation among others. This paper accentuates the requirement for considering fascia lata as a viable graft option in MPFL reconstruction surgery and the necessity for more pertinent research in order to attain more reliable inferences.

Local Recurrence and Survival in Patients With Melanoma >2 mm in Thickness at Difficult Sites Treated With 1-cm Versus 2-cm Margins.

Melanoma guidelines recommend surgical excision with 2-cm margins for melanomas >2 mm in thickness. However, this procedure may be problematic at critical anatomic sites. We aimed to compare the outcomes of wide (2 cm) versus narrow (1 cm) excision margins in patients with melanoma >2 mm in thickness near critical structures. We retrospectively examined 736 patients undergoing excision with wide versus narrow margins at the National Cancer Institute in Milan, Italy, between 2001 and 2015. A total of 265 (36.0%) patients received a wide local excision-82 (30.9%) with linear repair and 183 (69.1%) with flap or graft reconstruction. A total of 471 (64.0%) patients received a narrow excision-320 (67.9%) with linear repair and 151 (32.1%) with flap or graft reconstruction (P<.001). The 10-year overall survival rate was 69.5% (95% CI, 63.3%-76.2%) in the wide group and 68.7% (95% CI, 63.8%-74.0%) in the narrow group (P=.462); 10-year crude cumulative incidence (CCI) of local recurrence was 5.4% (95% CI, 3.2%-9.2%) in the wide and 8.8% (95% CI, 6.4%-12.1%) in the narrow group (P=.150). Multivariable Fine-Gray modeling of the CCI of local recurrence showed that Breslow thickness (P=.010) was the only statistically significant parameter. Multivariable Cox models for overall survival showed that age (P<.001), Breslow thickness (P<.001), and sentinel lymph node status (P=.019) were statistically significant covariates. Excision margin was not a significant parameter affecting patients' outcome. Wide local excision with 1-cm margins for melanoma >2 mm in thickness was not associated with an increased risk of local recurrence and did not affect overall survival.

Safety and aesthetic evaluation of autologous dermal fat grafts for lateral Skull base defect reconstruction

ObjectiveThe selection of appropriate materials and techniques for reconstructing skull base defects is crucial for restoring function, minimizing complications, and enhancing aesthetics. Dermal fat grafts (DFGs) have been established in many surgeries for contour correction. However, there is little literature describing the application of free dermal fat grafts for reconstruction of lateral skull base surgery defects. Therefore, the aim of this study was to evaluate the clinical effect of using free dermal fat grafts in the reconstruction of lateral skull base defects.MethodsIn this study, 32 patients who underwent primary autologous free dermal fat graft reconstruction for lateral skull base defects were enrolled. Postoperative complications both in the donor and recipient area were evaluated. Three-dimensional (3D) reconstruction techniques were applied to visualize the fat graft shape and volume variations for the assessment of postoperative restoring function. A telephone questionnaire was used for the assessment of postoperative facial aesthetics and patient satisfaction.ResultsA total of 32 patients who met the inclusion criteria were included in the study, showing satisfying results in safety and aesthetics. Participants’ ages averaged at 42.03 years, with the youngest being 18 and the oldest at 75 years old. No patient had postoperative complications of abdominal wounds in the donor area, only two patients had postoperative infections and one patient had a postoperative effusion in the recipient area. The volume of the grafts ranged from a minimum of 24.4 cm³ to a maximum of 131 cm³, with the highest recorded resorption volume being 33.63 cm³. The average resorption rate of the dermal fat graft was 24.36%, ranging from a minimum of 11% to a maximum of 43%. 3D reconstruction based on MRI imaging data indicated that DFGs have a lower resorption rate than traditional free fat grafts. The telephone questionnaire revealed high patient satisfaction with facial aesthetics, with the majority rating their outcomes positively.ConclusionsDermal fat grafts have fewer complication and can provide better resistance to infection and radiation aspect. Based on 3D reconstruction techniques via MRI imaging data, we found that dermal fat grafts have lower resorption rate than traditional free fat grafts, which can be a suitable material for reconstruction of lateral skull base defects.

Plastic Surgery Contributions to the World Wars: Historical Foundations for Modern Craniofacial Techniques.

Plastic surgery played a crucial role during the World Wars. Surgeons dedicated their careers to reconstructing facial injuries and residual deformities incurred during combat. Times of unprecedented trauma led to rapid innovation in plastic surgery, with invaluable impact on practice today. Pioneers such as Harold Gillies are well-known for their work. There are numerous additional contributors who deserve wider recognition. A literature review was performed to identify key surgeons who treated soldiers' craniofacial injuries during World Wars I and II. Biographical information, country of practice, and technical contributions to plastic surgery were compiled. Nineteen plastic surgeons were identified who contributed significantly to craniofacial surgery during the World Wars. These surgeons were: Albéric Pont, Archibald Mcindoe, Arthur Mowlem, Harold Gillies, Hippolyte Morestin, James Barrett Brown, Jaques Joseph, Johannes Esser, John Staige Davis, John Reese, Otto Lanz, Paul Tessier, Robert Ivy, Suzanne Blanche Gros Noël, Thomas Kilner, William Kelsy Fry, Varaztad H. Kazanjian, Vilray P. Blair, and Vladimir Petrovich Filatov. Fourteen were active during WWI. Nine were active during WWII. Notable technical developments were made in maxillofacial fracture fixation, bone grafting, rhinoplasty, dental prosthetics, flap-based coverage, skin grafting, and burn reconstruction. Plastic surgeons played an unheralded role in managing the disfiguring craniofacial injuries of World Wars I and II. By treating tens of thousands of war victims, these surgeons contributed not only to the rehabilitation of soldiers but also to the advancement of craniofacial surgery and the establishment of plastic surgery as a distinct subspecialty.

Extrusion of High-density Porous Polyethylene Implants in the Nose.

Few alloplastic implant materials have been successfully used in nasal reconstruction. The high-density porous polyethylene (HDPE) implant is the most widely accepted alloplastic material for reconstructing the nasal structure. Some authors suggest that the problems associated with using grafts and biocompatible materials are often due to errors on the part of the surgeon or the technique used. This study aims to report several cases of complications related to using HDPEs in the nose. A total of 23 patients who reacted negatively to alloplastic implants were treated. The removal of HDPE is complex due to the formation of connective tissue within it. These complications can cause permanent atrophic changes to the skin of the nose. Most of the patients presented with extrusion of their HDPE implants in the nasal columella region. All patients underwent implant removal, cleaning, disinfection, and secondary rhinoplasty. Surgeons must be able to recognize these possible complications and manage them successfully. Even today, many professionals use alloplastic grafts for reconstruction and esthetics of the nasal region. The potential for permanent damage to the skin and soft tissues, as well as complications such as infection and extrusion of the implant, makes the use of autogenous tissue preferable over alloplastic implants. Early detection and immediate treatment of complications are essential to minimize the severity of the deformity.

Efficacy of Fresh Versus Preserved Amniotic Membrane Grafts for Ocular Surface Reconstruction: META = meta-analysis.

Amniotic membrane transplantation is commonly employed in ophthalmology to mend corneal epithelial and stromal defects. Its effectiveness in restoring the ocular surface has been widely acknowledged in clinical practice. Nevertheless, there is ongoing debate regarding the comparative effectiveness of using fresh amniotic membranes versus preserved ones. The objective of this meta-analysis was to ascertain whether there is a disparity in the effectiveness of fresh versus preserved amniotic membrane in the restoration of the ocular surface in clinical practice. The study utilized the following keywords: "fresh amniotic membrane," "preserved amniotic membrane," "amniotic membrane transplantation," and "ocular surface reconstruction." The study conducted a comprehensive search for relevant studies published until April 18, 2024. Seven different databases, namely PubMed, Web of Science, Embase, Cochrane, China Knowledge, China Science and Technology Journal VIP database, and Wanfang database, were utilized. The search was performed using the keywords "fresh amniotic membrane," "preserved amniotic membrane," "amniotic membrane transplantation," and "ocular surface reconstruction." The process of literature review and data extraction was carried out separately by two researchers, and all statistical analyses were conducted using Review Manager 5.4.1. The final analysis comprised nine cohort studies, encompassing a total of 408 participants. The statistics included six outcome indicators: visual acuity (relative risk [RR] = 1.07, 95% confidence interval [CI] = 0.93-1.24, I2 = 0); amniotic membrane viability (RR = 1.00, 95% CI = 0.93-1.08, I2 = 0); ocular congestion resolution (RR = 1.11, 95% CI = 0.97-1.26, I2 = 0); fluorescent staining of amniotic membranes on the second day after the operation (RR = 1.31, 95% CI = 0.80-2.14, I2 = 11); postoperative recurrence rate (RR = 1.01, 95% CI = 0.50-2.03, I2 = 0); and premature lysis of amniotic membrane implants (RR = 0.96, 95% CI = 0.49-1.88, I2 = 0). The findings indicated that there was no statistically significant disparity between fresh and preserved amniotic membranes across any of the measured variables. There is no substantial disparity in the effectiveness of fresh and preserved amniotic membrane transplants in restoring the ocular surface, and both yield favorable and consistent outcomes.

Nasolabial Transfer Flap with Auricular Cartilage Graft after Fat Grafting for Nasal Ala Reconstruction in Parry-Romberg Syndrome.

Alar atrophy associated with Parry-Romberg syndrome (PRS) can lead to significant nasal contour deformities. The primary objective of this study was to address nasal alar deformities in PRS patients through the application of a nasolabial transfer flap combined with an auricular cartilage graft after sequential fat grafting. All PRS patients with alar deformities who underwent our reconstructive surgery were included in this case series. Sequential fat grafting was performed on the affected nasolabial area, followed by a nasolabial transfer flap combined with an auricular cartilage graft. Surgical outcome and complications were recorded during postoperative follow-up. From September 2021 to November 2023, a total of 14 PRS patients presenting nasal alar defects underwent nasolabial transfer flap combined with an auricular cartilage graft after sequential fat grafting. Complications at 1 month postoperatively included partial flap necrosis (21%), hyperplastic scarring (14%), undercorrection (14%), overcorrection (7%), and pain (7%). The surgery significantly improved the patient's nasal symmetry. FACE-Q questionnaire indicated the overall aesthetic outcome and quality of life were deemed satisfactory for all patients. After sequential fat grafting, the nasolabial fold transfer flap with an auricular cartilage graft is effective to address alar deformities associated with PRS. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Intralimb Coordination Pattern of the Lower Limbs in Male Athletes With Allograft and Autograft Anterior Cruciate Ligament Reconstruction During Landing

Background and Objectives: Two common choices exist for anterior cruciate ligament (ACL) reconstruction, autograft and allograft. Hamstring tendon autografts and soft-tissue allografts are commonly used for ACL reconstruction. The outcomes between these two grafts are controversial. This research aims to quantify and compare lower limb joint coordination between two ACL reconstruction graft options and healthy individuals. Methods: Sixty-one athletes were enrolled after ACL reconstruction surgery (allograft, n=22; autograft, n=18). Furthermore, twenty-one healthy athletes were considered in the control group. The inclusion criteria included unilateral anterior cruciate ligament reconstruction surgery with allograft and autograft methods, male athletes with a minimum of 9 months and a maximum of two years since their surgery, successfully passing a series of quadriceps and hamstring strength tests and distance jumping before entering sports-specific activities under the supervision of a sports physiotherapist, and returning to pre-injury sports activities. Results: Autograft was not statistically different from matched healthy limbs in terms of joint coordination variability and magnitude (P&gt;0.05). However, the magnitude of joint coordination was superior to the allograft group compared to the autograft reconstructed ACL (P&lt;0.05). Conclusion: Although our result reported no significant difference between groups in joint coordination variability, having an insight into coordinative function after ACL reconstruction will help develop postoperative rehabilitation programs as well as minimize the re-injury risk among patients. We also suggest that scholars should conduct more robust trials with valid research designs to control the results of ACL reconstruction comparison with autograft and allograft.

Static Stability of Elbow Interposition Arthroplasty Stabilized With Novel Ligament Reconstruction.

Outcomes of interposition arthroplasty for treatment of elbow arthritis are highly dependent on elbow stability. The purpose of this study was to determine whether interposition arthroplasty with a novel bidirectional ligament reconstruction technique could adequately restore the static stability of the native elbow. Static varus and valgus elbow stability was tested in 7 cadaver elbows with intact ligaments and capsule at 5 flexion angles (0°, 30°, 60°, 90°, and 120°). At each angle, the distance between fixed reference points across the elbow was measured both medially and laterally. The elbows were then destabilized and an interposition arthroplasty with ligament reconstruction was performed. Static elbow stability was reassessed by comparing postoperative deflection measurements with those of the native state. Graft slippage or loosening was visually assessed following testing. Interposition arthroplasty was performed in 7 cadaver specimens. Following ligament reconstruction, specimens reproduced the flexion angle-dependent static stability of native elbows to both varus and valgus stress. The greatest deflection changes between native elbows and elbows after interposition arthroplasty were 2.7% (P = .13) medially and 2.3% (P = .42) laterally, which were not significant. There was no loosening or slippage of either the interposition graft or the ligament reconstruction grafts. Cadaveric elbow specimens underwent interposition arthroplasty with a novel technique for bidirectional ligament reconstruction. Static stability was maintained at varying degrees of elbow flexion, comparable to that of the native elbow. Interposition and ligament reconstruction grafts maintained secure fixation following static biomechanical testing.

Computer-assisted morphometric analysis of the relationship between the coronoid and condylar processes of the mandible

: The mandible is the most durable and only movable bone that constitutes the lower one-third of the face.The mandibular condyle and coronoid processes are two anatomical structures located in the superior portion of the ramus of the mandible. Morphometric understanding of these structures is key to the diagnosis of various disorders associated with the temporomandibular region. It also aids in devising a plan for the management of such disorders.: The purpose of this study is to evaluate the anatomical corelation between the condyle and coronoid of the mandible.: This retrospective study was conducted by obtaining 100 high-resolution computed tomography images from departmental archived records between 2018 and 2024. After acquisition, these images were incorporated into MIMICS Materialize software to create stereolithography models, and morphometric analysis was carried out. Out of 100 HRCT data obtained, 87 were male and 13 were female. There is a statistically significant difference in length and angulation of the coronoid and condyle on both sides. The condyle length for males was (4 ± 5.5 mm) higher than the condyle length of females on both sides. However, the coronoid length of males and females varies in a range of 0.5-2mm on both sides of the mandible. Understanding the morphological variation of mandibular condylar and coronoid processes aids in various fields of medicine like forensics, anthropology, and reconstructive maxillofacial surgery. Our study inference will aid surgeons in planning coronoid grafts for condylar reconstruction as well as other maxillofacial reconstructions. Additionally, it helps in forensic odontology to determine a person's age and gender.

8550 Processing Technique Affects Aromatase Expression in Fat Grafts for Breast Reconstruction

Abstract Disclosure: S. Arbuiso: None. Y. Chen: None. N.A. Vernice: None. A. Zhang: None. I.J. Rhodes: None. C.C. Alston: None. S. Hanif: None. S. Liu: None. P. Bhardwaj: None. D. Janhofer: None. G.G. Black: None. D.M. Otterburn: None. K.A. Brown: None. Introduction: Autologous fat grafting is commonly used in breast reconstruction as it is associated with good cosmetic outcomes, high patient satisfaction, and minimal risks. Adipose tissue is known to support cancer growth via the secretion of adipokines and the modulation of estrogen levels due to aromatase expressed in adipose stromal cells. A higher body mass index (BMI) and postmenopausal status are associated with higher levels of aromatase. With novel processing techniques being developed to increase fat graft retention, there is a need to better understand how these will affect the biology of lipoaspirates for women who have previously had breast cancer. This study aims to assess how different processing techniques used in fat grafting (1) impact aromatase gene expression, (2) affect breast cancer cell proliferation, and (3) affect the cellular composition of the engrafted lipoaspirate. Methods: Patients who underwent breast reconstruction for breast cancer treatment or for prophylactic measures, and were receiving autologous fat grafting, were enrolled in a prospective randomized controlled trial (NCT04891510). Patients were randomized to one of three processing techniques: standard decantation, active filtration, and low-pressure decantation. Conditioned media (CM) was created from each sample. Aromatase mRNA was measured in the lipoaspirate using qRT-PCR for aromatase (CYP19A1) and related to patient BMI or menopausal status. The effect of CM on the proliferation of MCF7 cells (estrogen receptor positive (ER+) breast cancer cell line) was measured using CyQUANT. Formalin-fixed lipoaspirate samples were embedded in HistoGel and paraffin. Adipocyte diameter was measured in hematoxylin and eosin (H&amp;E) stained sections using ImageJ. Results: Aromatase mRNA levels were correlated with BMI and were higher in postmenopausal women (p≤0.05), with the standard decantation group demonstrating a stronger correlation with BMI. Samples processed via active filtration were associated with weaker correlations between aromatase gene expression and BMI and menopausal status. CM induced MCF7 cell proliferation to a similar extent to cells plated in fetal bovine serum-containing media. There was no difference in proliferation patterns between treatment groups. Upon histological assessment, adipocytes were intact, and adipocyte diameter was significantly correlated with patient BMI. Conclusion: Lipoaspirate may contain factors that promote breast cancer cell proliferation, unaffected by processing technique. Caution should be used to ensure local control of the cancer has been achieved prior to reconstruction. Our data suggest that active filtration selects for a lower percentage of adipose stromal cells, which may be beneficial for patients who previously had ER+ breast cancer. Presentation: 6/1/2024

THE EFFECTIVENESS OF THE FUNCTIONING OF RECONSTRUCTED HEPATIC VEINS USING VARIOUS TYPES OF MATERIALS IN TRANSPLANTATION OF THE RIGHT LOBE OF THE LIVER FROM A LIVING DONOR

Background. In adult living donor liver transplantation with the right lobe, the venous outflow of the anterior sector is typically restored during the procedure to form a neo-middle hepatic vein. Restoring the middle hepatic vein for the drainage of the anterior sector is critically important for achieving optimal graft function. Various conduits are used for this reconstruction, such as synthetic and biological grafts (e.g., the recipient's portal vein, vessels from a deceased donor, and modified great saphenous vein). However, the selection of the best option remains a topic of discussion. This study evaluates the effectiveness of using biological and synthetic grafts for MHV reconstruction. Materials and methods. A retrospective analysis of outcomes was conducted in patients who underwent transplantation of a modified right liver lobe due to end-stage liver disease from 2011 to 2024. Results. A transplantation of modified right liver lobes was performed on 80 patients. In 69 cases, the reconstruction of the hepatic veins was carried out using a biological graft, while in 11 cases, a synthetic graft was used. Statistically significant differences were noted in mortality and the postoperative period. No significant differences were found in the frequency of intraoperative complications. Conclusion. Our study demonstrates that the use of a biological graft for the reconstruction of the hepatic veins of segments 5 and 8 is more effective than the application of a vascular prosthesis.

Which tendon graft to choose for anatomical ligament reconstruction in chronic lateral ankle instability? A biomechanical study

BackgroundThe need for anatomic lateral ligament reconstruction of the ankle continues to grow. This procedure usually requires a gracilis autograft or in some cases an allograft. Siegler et al. reported the mechanical characteristics of the collateral lateral ligaments of the human ankle: 231 ± 129 N for the ATFL and 307 ± 142 N for the CFL.The objective of this study was to evaluate the mechanical properties of different tendon grafts available for ATFL and CFL reconstruction. We hypothesized that the properties of the tested grafts are not inferior to the published values of those of the original ligaments on the lateral side of the ankle. MethodsThis was a comparative biomechanical study using 6 cadaver specimens (108 grafts): The biomechanical properties of nine types of grafts were determined using validated tensile testing methods: Gracilis, SemiT, EHL, FHL, Plantaris, Peroneus longus and brevis, TA and TP.The main outcome measure was the comparison of the mechanical properties of each single-stranded tendon with each other and with the known values ​​for the ATFL and CFL, during a uniaxial static rupture test. ResultsThe mean load to failure for the gracilis was 257.5 ± 52.9 N. The groups had similar mean values in terms of the maximum load that they could withstand before failing except for the plantaris (137.9 ± 33.7 N) which was statistically lower than all other tested tendons (p < 0,01).The mean load to failure values of the grafts tested were equal or higher than that of the ATFL and CFL reported by Siegler et al. [14]: 231 ± 129 N for the ATFL and 307 ± 142 N for the CFL, while the grafts tested here had mean failure load between 258 ± 53 N and 464 ± 136 N. ConclusionThe gracilis, peroneus longus/brevis, EHL, FHL, TA, TP and semiT are legitimate grafts for combined ATFL and CFL reconstruction in the ankle. These tendons have mechanical properties (load to failure, maximum strain at failure and stiffness) that are equal to or higher than the native ligaments on the lateral side of the ankle, except the plantaris. Clinical relevanceThis study validates the current use of the gracilis autograft for the anatomical reconstruction of the ATFL and CFL, and even provides proof that other tendons would be suitable for this anatomical reconstruction of the lateral ankle ligament by auto or even allograft under certain conditions. Level of evidenceDescriptive laboratory study.

Skeletal and Soft Tissue Surgeries in the Long-term Management of Patients With Syndromic Craniosynostosis: A 20-Year Review.

Soft tissue procedures are often crucial for normalizing the long-term facial appearance in patients with syndromic craniosynostosis, yet they are underrepresented in the literature and existing treatment algorithms. This study evaluated secondary soft tissue surgeries in relation to skeletal operations in patients with syndromic craniosynostosis. A retrospective review evaluated patients with syndromic craniosynostosis treated at a tertiary children's hospital from 2003 to 2023. Craniofacial skeletal and soft tissue procedures were assessed for timing and frequency. Skeletal surgeries included redo fronto-orbital advancements, monobloc advancement/distraction ± facial bipartition, and LeFort III or III/I advancement/distraction. Soft tissue surgeries encompassed oculoplastic procedures, scalp reconstruction, fat grafting, and septorhinoplasty. Of 106 patients with syndromic craniosynostosis, 57 (57.8%) underwent ≥1 secondary skeletal operation, and 101 (95.3%) underwent ≥1 soft tissue procedures, averaging 3.7 ± 3.3 soft tissue procedures per patient. Patients who underwent secondary forehead advancement had significantly higher rates of subsequent lateral canthopexy (71.4% vs 25.6, P < 0.001), ptosis reconstruction (17.9% vs 7.7%, P = 0.025), and frontotemporal fat grafting (50.0% vs 15.4%, P < 0.001) than those who did not. Patients who underwent midface advancement surgery had significantly higher rates of subsequent lateral canthopexy (65.4% vs 11.1%, P < 0.001), medial canthopexy (7.7% vs 0.0%, P = 0.038), scalp reconstruction (36.5% vs 16.7%, P = 0.020), frontotemporal fat grafting (34.6% vs 14.8%, P = 0.018), malar fat grafting (11.5% vs 0.0%, P = 0.010), and septorhinoplasty (26.9% vs 1.9%, P < 0.001) than those who did not. Specifically, LeFort III or III/I advancement/distractions were significantly associated with higher rates of subsequent septorhinoplasties (33.3% vs 1.6%, P < 0.001). The mean follow-up was 10.2 ± 7.0 years. This study revealed an intricate interplay between skeletal and soft tissue surgery in patients with syndromic craniosynostosis. Exploring techniques to reduce the need for further corrective surgery and anticipating necessary secondary interventions may improve patient counseling and outcomes.

Thrombosis and anticoagulation after portal vein reconstruction during pancreatic surgery – A systematic review

ObjectiveTo comprehensively assess thrombotic events and their clinical impact in patients receiving pancreatic surgery with venous resection and reconstruction. BackgroundPortal vein (PV, including the portal vein and superior mesenteric vein) resection and reconstruction enables surgical removal of borderline-resectable and locally advanced pancreatic cancer. Thrombosis of the reconstructed PV represents a major source of early postoperative and long-term morbidity and mortality. No universally accepted standard for anticoagulation exists. Here, we aimed to assess early and late thrombosis rates after PV reconstruction with special regard to type of PV reconstruction as well as anticoagulation regimen. MethodsPRISMA guidelines were followed. Studies reporting on PV resection and reconstruction providing data on thrombosis rates were included. The following parameters were assessed: Study type, year of publication, number of patients, type/number of PV reconstruction, follow-up period, postoperative mortality, rate of thrombosis of reconstructed PV axis, intraoperative blood loss, and anticoagulation. Results23 studies with 2751 patients were included in the final analysis. 670 patients received tangential resection of the PV with venorrhaphy or patch repair, 1505 patients had segmental resection with end-to-end reconstruction, and 576 patients received reconstruction with an interposition graft/conduit. The pooled overall thrombosis rate was 15%. Reconstruction of tangential defects with either venorrhaphy or patch repair as well as end-to-end repair of segmental defects resulted in a thrombosis rate of 12%. Subgroup analysis according to the type of graft reconstruction revealed the highest occlusion rates of 55% in patients with allogeneic grafts, followed by up to 27% in patients with synthetic PV conduits. Autologous conduits had a thrombosis rate of 10%. Early thrombotic events were detected in 5% of patients after venorrhaphy/patch reconstruction and end-to-end reconstruction. Early events were most common in the allogeneic graft subgroup (22%), followed by synthetic conduits (15%). There were fewer early events in the autologous graft group (7%). Early PV thrombosis was associated with relevant mortality of up to 26%. Anticoagulation regimens varied between studies. ConclusionThe overall rate of thrombosis after portal vein resection is low. However, among different reconstruction techniques, allogeneic interposition grafts/conduits had the highest thrombosis rates among the different types of reconstruction after PV resection. No specific anticoagulation strategy can be considered beneficial on the basis of the existing literature. Mini-AbstractThrombosis of the reconstructed portal vein (PV) after PV resection in pancreatic surgery represents a relevant source of major morbidity and mortality. In this systematic review, while we observed an overall low thrombosis rate following PV resection, reconstruction with allogeneic grafts harbors the highest risk of postoperative thrombosis. Early thrombosis was most common after reconstruction with allogeneic grafts and associated with postoperative mortality. Anticoagulation strategies vary greatly among different studies.

Evaluation of the Regenerative Capacity of Demineralized Bone Matrix vs Fat Graft in Alveolar Cleft Model in Albino Rats.

This study was performed to evaluate the regenerative capacity of demineralized bone matrix vs fat graft, both guided by pericardium membrane in alveolar cleft model in albino rats. A total of 72 rats were required in this study. A surgical bone defect with a 7 mm length × 4 mm width × 3 mm depth was created as a model of an alveolar cleft, then the rats were divided randomly into four equal groups each group contained 18 rats: control group (defect only), the membrane group (the defect was covered by the pericardium membrane), the demineralized bone matrix (DBM) group (the defect was filled with DBM guided by pericardium membrane) and fat group (the defect was filled with a fat graft guided by the pericardium membrane). Around 6 rats from each group were euthanized after 2, 4, and 8 weeks. Skulls were scanned with cone beam computed tomography (CBCT) and harvested for histological evaluation with routine H&E immunohistochemical stains (Anti-osteocalcin and Anti-Wnt5a). The data was recorded and statistically analyzed by a two-way ANOVA. The study showed a notable formation of new bone, and expression of OCN and Wnt5a were notably increased by time in the fat group. However, the density of bone grafts and OCN and Wnt5a expression decreased with time in the DBM group. Control and membrane groups showed negative OCN and Wnt5a immune-reactivity in the cleft site. Fat graft results were superior to DBM results with regard to mucosal closure and accelerated bone regeneration, and may represent an effective treatment for alveolar cleft reconstruction. Finding an inexpensive, accessible, biocompatible and easily manipulated treatment for craniofacial reconstruction and fat graft fulfilled the desired aims. Further investigations with prolonged evaluation periods are needed. How to cite this article: Abdel Raouf E, Elsherbini AM, Abdel Salam Yousef Y, et al. Evaluation of the Regenerative Capacity of Demineralized Bone Matrix vs Fat Graft in Alveolar Cleft Model in Albino Rats. J Contemp Dent Pract 2024;25(6):554-562.

Long-Term Outcomes of Primary Cemented Total Hip Arthroplasty with Acetabular Bone Graft for Protrusio Acetabuli: Minimum 10-Year Follow-Up.

Background: This study reports the long-term survivorship of primary total hip arthroplasty (THA) for protrusio acetabuli. Methods: Patients undergoing THA utilising cement and bone graft acetabular reconstruction for protrusio acetabuli in a university teaching hospital during the period 2003 to 2014 were included. Kaplan-Meier survival estimates were calculated with 95% confidence intervals (CI) up to 15 years following surgery. PROMs were collected pre- and post-operatively for hip-specific function (Oxford Hip Score [OHS]) and health-related quality of life (HRQoL) using the EQ-5D-3L. Results: 129 consecutive THAs (96 patients) performed for protrusio acetabuli were identified (median age 69, IQR 61-75; female 115 [89.1%]; 38 [29.5%] inflammatory arthritis) with a mean follow-up of 15.7 years (range: 10.1-20.1 years). At the final follow-up, fifty-six (43.4%) patients had died and there were eleven (8.5%) reoperations, of which eight (6.2%) involved the revision of the acetabular component. The fifteen-year Kaplan-Meier any-reoperation survival estimate was 91.3% (95% CI 85.9-97.0). When considering all-cause acetabular revision only, the 15-year survival estimate was 93.1% (95% CI 88.2-98.3). The median pre-operative OHS improved significantly from baseline to 1 year post-THA, beyond the minimal important change (mean difference 28, 95% CI 25-30, p < 0.001). Similarly, there were clinically relevant improvements in HRQoL at 1 year post surgery (mean difference 0.10, 95% CI 0.06-0.15, p < 0.001). Conclusions: This study demonstrates that primary cemented THA utilising acetabular bone graft for reconstruction in patients with protrusio acetabuli was associated with 15-year survival rates of 93.1% and clinically relevant improvements in hip-specific function and HRQoL.