Graft Recipient Sites Research Articles

Midterm Donor Site Morbidity After Vascularized Free Fibula Flap Harvesting.

Vascularized fibula grafts (VFGs) have become one of the most preferred grafts for the reconstruction of bone defects. However, despite the many advantages over other graft options, recipient and donor site morbidities are also common. Donor site morbidity has been reported at rates ranging from 5% to 67%. The aim of this study was to present a single-center series examining the clinical, functional, and radiologic aspects of donor site morbidity following VFG harvesting. The study included 69 patients who underwent biological reconstruction with VFG for bone tumors, avascular necrosis of the femoral head, or bone defects after trauma. Patients were evaluated functionally, clinically, and radiologically for donor site morbidity. Donor site morbidity was observed in 33 of 69 patients (48%). The most complications were sensation deficits around the feet and ankles (20 of 69; 29%). Knee laxity was more common in patients who underwent osteoarticular fibular resection (P = .006). We found VFG to be an effective method for the reconstruction of large bone defects, but associated with a relatively high rate of complications. Complications requiring surgical intervention were rare and the majority of patients did not have long-term functional limitations. Level IV, retrospective case series.

Enhanced Fat Graft Viability and Remodeling Using a Helium-based Radiofrequency Device to Prepare the Recipient Site

BackgroundImprovements to autologous fat grafting for soft tissue augmentation are needed to overcome the unpredictable volume retention. Approaches such as fat harvesting and processing, injection technique, preparation of the recipient site, and supplemental biologics are topics of ongoing research. Here, an energy-based device was investigated as a stimulatory tool for recipient site preparation for improving fat graft retention.ObjectiveThe objective was to measure the stimulatory responses in fat grafts after 4 weeks when using a helium-based radiofrequency device to pretreat the recipient tissue.MethodsUsing an autologous fat grafting mouse model, the inguinal fat pad was grafted in a small cranial pocket after either a saline injection alone (control) or a saline injection followed by pretreatment (treated). The fat pad was resected after 4 weeks, sectioned and stained with immunofluorescence markers to investigate tissue remodeling.ResultsPretreatment resulted in higher viability of adipocytes, a higher concentration of viable ASCs in areas of adipose tissue regeneration, and localized macrophages in the areas of regeneration when compared to the control. There was no observable difference in vascularity or angiogenesis. The staining for ASCs was higher in the pretreated group in comparison with the control group (5.0% vs. 3.3%, p=0.36) when using a pixel classifier in QuPath in the viable adipose tissue regions.ConclusionsThe use of a helium-based radiofrequency device as a pretreatment tool appears to increase the viability of the adipose tissue likely due to higher concentration of ASCs. The apparent increase in viable ASCs may be due to enhanced proliferation or paracrine recruitment of these cells in response to the helium-based radiofrequency treatment.No Level AssignedThis journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.Bullet List of Important Points:Pretreatment of the fat graft recipient site increases the viability of the adipose tissue after 4 weeks in comparison with the control grafts.The increased viability is likely due to the observed increase in adipose-derived stem cells in the pretreated group.Pretreatment enhanced the adipose tissue remodeling as colocalization of adipose-derived stem cells and macrophages showed an active remodeling, whereas the control group exhibited more necrotic and fibrotic tissue.

Comparison of morbidity at the donor site and clinical efficacy at the recipient site between two different connective tissue graft harvesting techniques from the palate: A randomized clinical trial.

This study was conducted to compare the pain levels in patients and the clinical efficacy of grafts obtained using two techniques, namely de-epithelialized gingival graft (DGG) and subepithelial connective tissue graft (SCTG), in combination with coronally advanced flap (CAF) for the treatment of multiple adjacent gingival recessions. Twelve patients were treated using DGG+CAF on one side and SCTG+CAF on the other. The patients' pain levels at the surgical site, the number of analgesics taken on days 3 and 7, the mean root coverage (MRC), the percentage of complete root coverage (CRC), color match, and gingival thickness (GT) at the graft recipient site were evaluated 6 months after surgery. The total number of analgesics taken during the 7-day period after surgery and pain levels at the surgical site from day 3 to day 7 were significantly higher in the DGG+CAF group compared to the SCTG+CAF group (P=0.001). In the 6-month follow-up, color match and CRC were significantly higher in the SCTG+CAF group, while GT was significantly higher in the DGG+CAF group. There was no significant difference in MRC between the two groups. The pain and analgesic consumption levels were higher in the DGG+CAF group compared to the SCTG+CAF group, and the recipient site had a weaker color match. However, this technique can lead to a greater increase in the thickness of the grafted area.

Solitary Keratoacanthoma at the Recipient Site of a Full-Thickness Skin Graft: A Case Report and Review of the Literature.

A 57-year-old man presented with a pigmented papule, 0.4 cm in diameter, on the left lower eyelid. Skin biopsy revealed a basal cell carcinoma, which was excised through a wide excision followed by a full-thickness skin graft (FTSG). Two weeks after the surgery, an erythematous nodule developed in the lower margin of the graft recipient site. The nodule size increased rapidly over 2 weeks, becoming dome-shaped with a central hyperkeratotic plug. A diagnosis of keratoacanthoma (KA) was made, and surgical excision was performed. Histological findings revealed a large, well-differentiated squamous tumor with a central keratin-filled crater and buttress. The human papilloma virus (HPV) genotyping results were negative. Risk factors for KA include trauma, old age, exposure to ultraviolet (UV) radiation, immunosuppression, and HPV infection. KA has most often been reported to develop at the donor site. Although the pathogenesis of KA is unclear, trauma is believed to act as a second insult to a preceding oncogenic insult, such as exposure to UV radiation, resulting in a koebnerization. Herein, we report a case of solitary KA at a FTSG recipient site. This report presents information that may provide guidance during dermatologic surgeries.

Eruptive Non-melanoma Skin Cancers/Squamous Atypia Following Skin Surgery. Report of Two New Cases, Concise Review of the Literature With Special Emphasis on Treatment Options.

Eruptive cutaneous squamous cell carcinomas (ESCC), eruptive squamous atypia (ESA) and eruptive keratoacanthomas (EKA) are different terms used to describe the occurrence of multiple cutaneous squamous neoplasms after skin surgery, laser treatment, traumas, such as tattoos, and local or systemic medical treatments. ESCC have been reported to arise at the sites of skin surgery, including the area affected by the primary tumor and split thickness skin graft (STSG) donor and recipient sites. The aim of this study is to report 2 additional cases of ESCC after skin surgery and make a critical revision of the literature, analyzing the clinical, histological features and outcomes of ESCC after cutaneous surgery. Up to August 2021, according to our systematic review of the literature, we have collected 19 published articles and a total of 34 patients, including our 2 cases. The results of this review highlight five red flags that clinicians should consider: (i) lower and upper limbs represent the cutaneous site with the highest risk, representing 83,78% of the cases in the literature; (ii) the median time to onset of ESCC is approximately 6 weeks; (iii) primary cutaneous squamous cell carcinomas were completely excised with free margins on histologic examination in the totality of the cases of the literature, and therefore ESCC should not be considered recurrences; (iv) any surgical technique involves a risk to promote ESCC; (v) treatment of ESCC includes medical treatment, surgery or combined surgical and medical treatment. This review highlights 5 red flags which could support clinicians in the diagnosis and management of ESCC after skin surgery.

The Safety of Fat Grafting: An Institutional Retrospective Review.

Autologous fat grafting is a popular technique for volume replacement in the breast and face. The efficacy, safety, and complication rate of this technique at the division of plastic surgery at the University of Alabama at Birmingham will be described in this review. An institutional review board-approved retrospective review of patients undergoing fat grafting procedures from January 2015 to July 2018 was performed. Records were reviewed for fat graft recipient site, donor site, amount grafted, and complications. Continuous variables were compared using either a t test or one-way analysis of variance test. Categorical data were compared using χ2 test. A P value of 0.05 or less was considered statistically significant for all comparisons. A total of 396 patients who underwent fat grafting procedures of the face and body from January 2015 through July 2018 met inclusion criteria. Average amount of fat grafted for all grafts was 124.4 +/- 6.74 grams. Two hundred fifty of the grafts (62.7%) involved the bilateral breasts with an average of 140.6 +/- 93.97 g used, 70 per side. Of the 396 patients, 110 (27.8%) experienced complications. Forty three of the complications (10.9%) were considered to be major, which included hematomas/seromas, fat necrosis, dermatitis/cellulitis, and infection. No statistical differences were seen among recipient site complication rate. Types of minor complications were statistically significant per recipient sites with bilateral breasts more likely to experience asymmetry than the other recipient sites (20% for bilateral breasts vs 16% overall, P < 0.05). Fifty nine of the 110 patients (53.6%) had the complications reported to be resolved. Fat grafting is a reliable method for volumization of the breasts and face. Minor complications were not infrequent in this case series; however, no life-threatening complications were observed. Continued work needs to be done to use fat grafting beyond traditional measures.

Evaluation of topical erythropoietin application on the healing outcome of gingival graft recipient site; a randomized controlled clinical trial

BackgroundFree gingival graft (FGG) is a highly predictable method to increase the width of keratinized gingiva. Various materials have been reported to accelerate the wound healing process. Considering the positive effect of EPO on dermal wound healing this study aimed to investigate the effects of EPO on the rate of healing and degree of inflammation in free gingival grafts.MethodsSeventeen patients with bilateral lack of keratinized gingiva in mandible were selected for this clinical trial. The surgical intervention was performed after phase I periodontal therapy.Recipient site was prepared apical to the mucogingival line, and FGG was harvested from the palate. Before graft placement, the test side and control side were treated with 1 ml of EPO 4000 IU/ml and distilled water, respectively, for 2 min. On days 7, 14, 21, 28, 60, and 90 after surgery, the grafted sites were examined by blinded observers to compare the healing and inflammation of the areas.ResultsAll the 17 patients completed the surgeries and follow-up examinations. Direct examination revealed significantly better healing in EPO group only on the 28th day. Assessment of the photographs showed a significant value in favor of the test group at some other time points as well. The EPO group demonstrated less inflammation, which was statistically significant in many time points. The graft area was 80.88 ± 30.21 mm2 and 71.35 ± 15.62 mm2 in the EPO and control groups, respectively. The difference was not significant, though.ConclusionsTopical application of erythropoietin can accelerate the healing of gingival grafts and reduce the inflammation during healing period. The final graft outcome, nevertheless, does not seem to be influenced by EPO.Trial registration This was a split-mouth randomized controlled clinical trial (IRCT201201278830N1). The first registration date: 2016-10-22

The Effect of Hyaluronidase on the Fat Graft.

Fat grafting has been widely used for facial rejuvenation and soft tissue reconstruction. However, it is associated with a lower retention rate than expected and complications such as fat necrosis or calcification. Several techniques that may increase the survival rate of fat grafts have been proposed. The techniques that promote the recipient sites vascularity to increase the survival rate of fat grafts include administration of growth factors, platelet- rich plasma, and adipose derived-stem cells or preconditioning of the recipient fat graft site. In this study, the authors evaluated the effect of hyaluronidase on autologous fat graft survival by pretreatment with hyaluronidase at the recipient site by using an animal model. In the experimental group, the recipient site of the fat graft was pretreated with hyaluronidase before fat grafting, whereas the control group was pretreated with normal saline. After 8 weeks of fat grafting, the average volume retention was 78.2% in the experimental group and 68.6% in control group. Considerable fibrosis between the fat globules in the control group was confirmed with Masson trichrome staining. CD31 immunofluorescence staining was performed and stained vessels were counted. Counted vessel number was significantly greater in the experimental group than in the control group. Pretreatment of hyaluronidase on the fat graft recipient site is a good option to enhance the outcome of the fat graft in the clinical setting.

Evaluation of the Effect of Hyaluronic Acid Application on the Vascularization of Free Gingival Graft for Both Donor and Recipient Sites with Laser Doppler Flowmetry: A Randomized, Examiner-Blinded, Controlled Clinical Trial.

This study aimed to evaluate with laser Doppler flowmetry (LDF) the effect of topical hyaluronic acid (HA) application on the vascularization of free gingival graft (FGG) donor and recipient sites during the early wound healing period and to investigate the effect of HA application on the dimensional change of the FGG. Forty systemically healthy, nonsmoking patients who required FGG due to insufficient amount of attached gingiva in a partial edentulism were randomly assigned to a study group: test (FGG+HA) or control (FGG alone). The LDF values of the donor and recipient sites were measured in both groups before the operation and at 4, 7, 10, 14, and 30 postoperative days. LDF measurement of the graft was performed as soon as the graft was taken from the palatal site. FGG dimensions (width, height, and thickness) were assessed and recorded at baseline and on day 30, as well as the percentage of the changes in these values. LDF values of the recipient site in the FGG+HA group were found to be statistically higher than those in the control group on days 4 and 7 (P = .013 and P = .020, respectively); however, no differences were found for days 10, 14, and 30. Additionally, no differences were found for the LDF values of the palatal site between the FGG+HA and control groups (P > .05) at all examined time points. The height of the graft measured on day 30 was statistically higher in the FGG+HA than the control group (P < .001). The percentage change in thickness and height of the FGG was statistically lower in the FGG+HA than control group (P = .028 and P < .001, respectively). Application of HA on the recipient bed under the FGG at the first week of healing allows the formation of a well-vascularized layer, which acts as a barrier against tissue tensions by functioning as a scaffold between the recipient bed and FGG, thus reducing the shrinkage of the graft, especially in the vertical direction. This study further showed that the graft taken from the donor site had a remaining blood perfusion value of its own.

Biomechanical assessment of the stability of osteochondral grafts implanted in porcine and bovine femoral condyles.

Osteochondral grafts are used clinically to repair cartilage and bone defects and to restore the congruent articulating surfaces of the knee joint following cartilage damage or injury. The clinical success of such osteochondral grafts is heavily reliant on the biomechanical and tribological properties of the surgical repair; however, a limited number of studies have investigated these factors. The aim of this study was to evaluate the influence of graft harvesting and implantation technique as well as bone properties on the primary stability of press-fit implanted osteochondral grafts using a series of uniaxial experimental push-in and push-out tests. Animal (porcine and bovine) knees were used to deliver models of different bone properties (elastic modulus and yield stress). The study showed the graft harvesting method using either a chisel or drill-aided trephine to have no influence on primary graft stability; however, the preparation technique for the graft recipient site was shown to influence the force required to push the graft into the host tissue. For example, when the length of the graft was equal to the recipient site (bottomed), the graft was more stable and dilation of the recipient site was shown to reduce short-term graft stability especially in immature or less dense bone tissue. The push-out tests which compared tissue of different skeletal maturities demonstrated that the maturity of both the graft and host bone tissue to influence the stability of the graft. A higher force was required to push out more skeletally mature grafts from mature bone tissue. The study demonstrates the importance of surgical technique and bone quality/properties on the primary stability and ultimately, the success of osteochondral grafts in the knee.

LEA 5. Use of Disposable Negative Pressure Wound Therapy on Split-Thickness Skin Graft Recipient Sites for Peripheral Artery Disease Foot Wounds—Two Case Reports

Negative pressure wound therapy (NPWT) is a popular and effective adjunct treatment for a great variety of wounds including split-thickness skin graft (STSG). Studies have concluded that NPWT improves STSG uptake. Recent technologic advancements have led to the advent of a new generation of NPWTs. These are the disposable, ultraportable, and mechanically operated NPWTs designed to treat smaller wounds with low to moderate exudates. We report here a novel use of the disposable NPWT (SNAP Therapy System; KCI, San Antonio, Tex) for STSG recipient sites in two patients with peripheral artery disease foot wounds. In both patients, there was 100% STSG uptake. The lightweight disposable NPWT system made for a more cost-effective and comfortable experience for patients. Disposable NPWT may be a feasible alternative to conventional NPWT to aid with STSG uptake for peripheral artery disease foot wound recipient sites.

Abstract: Implantable Deferoxamine Facilitates Non-Vascularized Grafting in Irradiated Bone

INTRODUCTION: The goal of this proposal is to therapeutically reverse the damaging effects of radiotherapy on bone formation and healing to enable non-vascularized grafting in irradiated bone. Utilizing a rodent model of mandibular bone grafting, we quantified metrics of diminished graft take and bone healing in response to radiation treatment. Subsequently, we utilized implantable deferoxamine (DFO)-an angiogenic stimulant, to reverse these radiation-induced detriments. We hypothesized that the addition of our proposed therapy, would evidence quantifiable degrees of remediation on the process of tissue regeneration, graft incorporation and bone healing. METHODS: Male Lewis rats received a human equivalent dose of radiotherapy (7Gy/d x 5d) to left hemi-mandibles. After recovery, a circular trephine burr (6mm) was utilized to create a critical size defect just posterior to the third molar, and a bone graft was harvested from the right hemi-mandible of the same animal and secured with a custom PLA resorbable plate. Three groups (n=8/group) of animals were investigated: Control, (irradiated) XRT and irradiated + implantable deferoxamine (DFO). Mandibles were imaged at 14, 40 and 60 days with in vivo µCT, and a 60-day healing period was allowed prior to further outcomes testing. Bony union was judged clinically by 3 blinded reviewers on a scale from 0 to 4, representing the approximate percentage of robust union formation along the circular graft-recipient site interface (e.g. 1=25%, 4=100%). Statistical comparisons were conducted with ANOVA (p<0.05). RESULTS: We observed a significant diminution of bone graft healing after radiotherapy. At 60 days, the bone volume fraction (BVF) of the XRT group decreased by 20% (p=0.001), and exhibited lower bony union scores when compared to control (p=0.005). With the addition of DFO, these findings were largely remediated. At 60 days, the BVF improved upon the XRT BVF by 12% (p=0.025), and was not different than control (p=0.282). In addition, the bony union scores of the implanted DFO group significantly improved from XRT levels (p=0.05), and were not different than control (p=0.200). CONCLUSION: Implantable DFO strongly remediates the effects of radiation on non-vascularized bone graft incorporation and healing as measured by micro-densitometry and bony union analysis. These observations are promising with regards to the potential utility of this therapy to enhance bone graft incorporation in the irradiated mandible for head and neck cancer survivors.

Melting graft wound syndrome

Abstract Melting graft wound syndrome is characterized by progressive epidermal loss from a previously well-taken skin graft, healed burn, or donor site. It may result in considerable morbidity and require prolonged treatment. We report a 23-year-old flame-burned patient with second- to third-degree burns involving more than 70% of the total body surface area, whose condition was complicated with septic shock. The patient presented with erosions and ulcers occurring on previously well-taken skin graft recipient sites over both legs and progressive epidermal loss on donor sites over the back. The patient's presentation was compatible with the diagnosis of melting graft wound syndrome, and we successfully treated the patient with debridement and supportive treatment.

A Comparison of Full and Split Thickness Skin Grafts in Radial Forearm Donor Sites

To formally evaluate the functional and aesthetic outcomes between full versus split thickness skin graft coverage of radial forearm free flap donor sites. A retrospective chart review of 47 patients who underwent pedicled or free radial forearm free flap reconstruction from May 1997 to August 2004 was performed. Comparisons were made between patients who had donor site coverage with split thickness skin grafts (STSG) or full thickness skin grafts (FTSG). There was no statistically significant difference between the STSG and FTSG in the number of post-operative dressings, incidence of tendon exposure, time to healing at the skin graft donor site, and time to healing at the skin graft recipient site. The questionnaire data showed there was a trend toward higher scores with the radial forearm scar aesthetics and satisfaction in the FTSG group. Full thickness skin graft coverage of radial forearm free flap donor site is superior to split thickness skin graft coverage in terms of aesthetic outcome, and has no statistically significant difference in terms of tendon exposure, time to healing at the skin graft donor site, time to healing at the skin graft recipient site, or post operative pain.

Single-Stage Bipedicle Local Tissue Transfer and Skin Graft for Achilles Tendon and Posterior Heel Wound Complications

Category: Ankle Introduction/Purpose: Achilles tendon and posterior heel wound complications are difficult to treat. These typically require soft tissue coverage via microvascular free tissue transfer at a tertiary referral center. Here we describe coverage of a series of posterior heel and achilles wounds via simple, local tissue transfer, a bipedicle fasciocutaneous flap. This surgical technique can be performed by an orthopaedic foot and ankle surgeon without resources of tertiary/specialized care or microvascular support. Methods: Three patients with separate pathologies were treated with a single-stage bipedicle fasciocutaneous local tissue transfer. Case 1 was a patient with wound breakdown following midsubstance Achilles tendon repair. Case 2 was a patient with insertional wound breakdown after Achilles debridement and repair to the calcaneus. Case 3 was a heel venous stasis ulcer with calcaneal exposure in a diabetic vasculopath. All three cases were treated with the following technique: an incision was immediately posterior to the lateral malleolus. The length of the incision was approximately 25% greater than the proximal to distal measurement of the wound. The dissection was carried to the flexor retinaculum and carried posteriorly to create a fasciocutaneous flap attached proximally and distally. This flap was then mobilized posteriorly to close the desired defect, leaving an ellipsoid shaped skin defect laterally. A split thickness skin graft was used to cover the defect created by the flap transposition. Results: All three patients demonstrated initial complete healing of the posterior defect, lateral ankle skin graft recipient site, and the skin graft donor site following surgery. Case 3 had a subsequent recurrent ulceration after initial healing. This was superficial and healed with local wound care. All patients regained full preoperative range of motion and were able to ambulate independently without modified footwear. Conclusion: The bipedicled fasciocutaneous flap described offers a simple, predictable single stage procedure that can be accomplished by an orthopaedic foot and ankle surgeon without resources of a tertiary care center for posterior foot and ankle defects. This flap allows for relatively short operative times and can be customized to facilitate defect coverage. Ultimately, the flap is sufficiently durable to withstand the local tissue stresses required for ambulation at an early stage. This provides a reasonable alternative to complicated and time consuming microvascular reconstruction, but does require careful follow-up to manage the patient’s underlying comorbid conditions that may complicate wound healing.

Remote Ischemic Preconditioning Recipient Tissues Improves the Viability of Murine Fat Transfer

Local ischemia before the development of recipient circulation may contribute to the highly variable long-term results of fat grafting. Remote ischemic preconditioning before adipose procurement augments the retention of fat grafts and limits subsequent liposclerosis. However, there is no literature examining what role remote ischemic preconditioning has on the fat graft recipient site. Subcutaneous adipose tissue from transgenic mice expressing green fluorescent protein/luciferase was injected into skin folds of wild-type mice. Donors and recipients experienced intermittent temporary hindlimb tourniquet application before harvest and transfer, respectively. The viability of the transferred tissue was examined over 28 days by luciferin bioluminescence and subsequent histologic analysis. There was a difference in bioluminescence at days 0, 14, and 28. The remote ischemic preconditioning donor or recipient mouse-alone groups demonstrated an approximately 2- to 3-fold increase in bioluminescence. Donor and recipient remote ischemic preconditioning had a 9-fold increase in bioluminescence. Histologic analysis at 28 days confirmed the presence of donor adipocytes, and they were gradually replaced by recipient inflammation and scar tissue. However, the amount of interstitial fibrosis was substantially less in the remote ischemic preconditioning groups. These findings were more pronounced when remote ischemic preconditioning was used for both donor and recipient mice. Remote ischemic preconditioning has the ability to increase the viability of donor adipocytes and limit interstitial fibrosis. More specifically, remote ischemic preconditioning treatment of both donated adipose tissue and recipient wound beds demonstrates the greatest overall adipose cellular viability and native architecture.

Comparing Morbidities of Bone Graft Harvesting from the Olecranon Process and the Distal Radius.

Background:The aim of this study is to compare donor-site morbidities between patients who underwent bone graft harvesting from either the olecranon process (OP) or the distal radius (DR).Methods:We evaluated 44 patients who underwent bone graft harvesting from the OP (25 cases) or the DR (19 cases) for various procedures in the ipsilateral upper extremity. Follow-up averaged 14 (OP group) and 19 months (DR group). Outcome measures included visual analog scales (VAS) for graft harvest-site pain and scar appearance, joint motion, and x-rays of the graft harvest and recipient sites. The VAS scores ranged from 0 to 10 with a low score reflecting no pain and excellent satisfaction and a high score reflecting severe pain and poor satisfaction.Results:The VAS scores for pain averaged 0.4 (OP) and 0.5 (DR), and the VAS scores for scar appearance averaged 0.3 (OP) and 0.7 (DR). These differences were not significant. Within each group, there were no significant differences between the operative and nonoperative limbs for elbow or wrist motion. Early graft harvest-site complications involved 1 superficial wound infection (OP) and 1 wound dehiscence (DR). A graft harvest-site defect was detected by x-ray in 84% of OP cases and in 67% of DR cases. Bone healing at the graft recipient sites was observed in more than 87% of cases in both groups.Conclusions:Bone graft harvesting from either the OP or the DR led to comparable patient- and evaluator-determined outcomes with low risks of complications. Surgeons can safely use either option.

Outcome of full-thickness skin grafts used to close skin defects involving the distal aspects of the limbs in cats and dogs: 52 cases (2005-2012).

To describe the outcome of full-thickness skin grafts used to close skin defects involving the distal aspects of the limbs in cats and dogs and identify factors associated with outcome. Retrospective case series. 20 cats and 32 dogs with a skin defect involving the distal aspect of a limb that received 58 full-thickness skin grafts between 2005 and 2012. Data regarding patient signalment, location and cause of the skin defect, surgical and anesthetic duration, and postoperative bandaging protocol were obtained from the medical records. Graft outcome was assessed by interpreting descriptions in the records; skin viability over ≥ 75% of the graft area between 7 and 14 days after surgery was considered a successful outcome. For 4 of the 58 grafts, graft outcome could not be determined from the medical record. For the remaining grafts, success rate was significantly higher for grafts placed in cats (17/22 [77%]) than in dogs (12/32 [38%]). The overall complication rate was 50%; complications included skin graft failure, donor site dehiscence, and bandage-induced sloughing of skin adjacent to the graft recipient site. In addition to species, anatomic location of the skin defect was identified as a prognostic indicator of graft outcome. Full-thickness skin grafting had a higher success rate in cats than in dogs. Skin grafts applied to the antebrachium, compared with other locations on the distal aspects of the limbs, were associated with a poorer prognosis.

A rabbit model of fat graft recipient site preconditioning using external negative pressure.

BackgroundFat is widely used in soft tissue augmentation. Nevertheless, it has an unpredictably high resorption rate. Clinically, external expansion with negative pressure is used to increase fat graft survival. In this study, fat graft recipient sites were preconditioned by external application of negative pressure in order to test for improvements in vascularity and fat graft survival.MethodsNegative pressure was applied randomly to either the left or right dorsal ear of 20 New Zealand male white rabbits at a pressure of -125 mm Hg. The negative pressure was removed one week after the skin perfusion was measured. The skin flap at each ear was elevated, and 1 g of fat was grafted above the dorsal perichondrium. After one week, the fat weight, microvessel density, mature vessel density of the skin and fat, and amount of glycerol released were measured. Three months after the grafting, the same measurements were performed, with the exception of glycerol release.ResultsThe fat survival rate of the experimental group (75.4%±3.9%) was higher than that of the control group (53.1%±4.3%) (P<0.001). Skin perfusion was higher in the experimental group. The glycerol release in the experimental group was significantly higher than in the control. The microvessel density of the skin and fat was significantly higher in the experimental group. Three months after the grafting, the skin and fat mature vessel density was significantly higher in the experimental groups.ConclusionsNegative pressure prior to fat grafting increased the vascularity of the recipient site, and, accordingly, enhanced fat graft survival.

Reconstruction of mandibular defects using nonvascularized autogenous bone graft in nigerians.

Objectives:The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria.Patients and Methods:A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patients’ records. This information include patients’ demographics (age and sex) as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications.Result:There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ± standard deviation (SD) 12.9 and for females 35.0 ± SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%). Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients) and postoperative wound infection (eight patients) were the most common complications recorded.Conclusion:The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care contributed to the good outcome.