Graft Site Research Articles

First Report of Cladosporium scabrellum Causing Stipe Spot Disease of Morchella importuna in China.

Morchella is a genus of edible and medicinal fungi with a global distribution and economic value. Artificial cultivation of Morchella has risen to 8,000 hectares in China in last 5 years (Zhao et al. 2020). In the early March of 2021, a peculiar stipe spot disease was first detected on Morchella importuna at a manufacturing base in Yangxian county (33°02' N, 108°11' E), Shaanxi, China. Several dark brown patches were observed on the surface of M. importuna fruiting bodies, with approximately 40% of the fruiting bodies infected at a late stage of production. This symptom typically manifests in March to May each year during the growing season of M. importuna. Following infection of the fruiting body, a light brown spot (2 to 4 mm) appears at the base of the stipe when the fruiting body is about 3 cm long. The spot progressively darkens and proceeds to cover the large stipe of the fruiting body. At 5 to 7 days after the appearance of the first spot, infected young fruiting bodies soften and decay. Temperature (>20℃) or humidity (80 to 90%) increases the likelihood of disease. To isolate the causal agent, the edge of a lesion was carefully scraped, inoculated into potato dextrose agar (PDA), and then incubated in the dark at 24±2°C (Bensch et al. 2010). The colonies were grayish-green in front, green to black on the reverse, and grew as concentric rings after 14 days of culture. The conidiophore was thin, branched with warty ramoconidia, and 2.5 to 4.7 µm long by 1.5 to 2.0 µm wide (length×width, mean=0.72, n=150). The ramoconidia were cylindrical and long at 14.3 to 28.7 µm by 6.4 to 10.7 µm (length×width, mean=2.52, n=150); the secondary ramoconidia were narrower and rod-shaped at 3.8 to 4.9 µm by 2.4 to 3.6 µm (length×width, mean=0.19, n=150). These morphological features were consistent with Cladosporium scabrellum (Bensch et al. 2012). Genomic DNA was extracted from mycelia of the pathogen using an Ezup column fungal genomic DNA extraction kit (Sangon Biotech, Shanghai, China). To confirm the identity of the pathogen (C. scabrellum), the genomic fragments for the internal transcribed spacer (ITS), translation elongation factor 1 alpha (EF-1α) and actin (ACT) gene of the isolate were amplified by PCR (Carbone et al. 1999; Walker et al. 2016; Xu et al. 2021). The resultant sequence was uploaded to the GenBank database with accession number (GeneBank ID of gene ITS, EF-1α, ACT are MZ736660, OQ982380, OQ982381, respectively). BLAST results showed >99% identity with those of C. scabrellum(GeneBank ID of gene ITS, EF-1α, ACT are HM148195, HM148440, HM148685, respectively). Phylogenetic analysis was performed using the maximum-likelihood (ML) method and Bayesian phylogenetic inference (BI) analyses in MEGA7 software (Kumar et al., 2018). For pathogenicity testing, 20 naturally occurring M. importuna fruiting bodies in an artificial climate chamber were randomly selected, inoculated by spraying with a conidial suspension of the pathogen (1×106 conidia/ml sterile water), and incubated at 20°C and 90 to 95% humidity. On the third day after inoculation, a yellow-brown spot appeared around the grafting sites, the spot gradually darkened and began to cover the stipe; the infection rate was 80 to 85%. Ten control fruiting bodies of M. importuna sprayed with sterile water grew normally and were symptomless. The pathogen was reisolated from infected fruiting bodies and confirmed as C. scabrellum by morphology and ITS, EF-1α, ACT sequence. To our knowledge, this is the first report of M. importuna stipe spot disease caused by C. scabrellum. According to a farmer in Yangxian, these spots rapidly spread every year, drastically reducing the production and market value of Morchella. This is a major problem for producers of this edible mushroom.

Three cases of pseudoepitheliomatous hyperplasia mimicking squamous cell carcinoma of the foot: A case series

Abstract Pseudoepitheliomatous hyperplasia (PEH) is a benign condition characterized by hyperplasia and proliferation of the epidermis and adnexal epithelium which can mimic squamous cell carcinoma (SCC). In our first case, a 55-year-old female with a prior history of split skin graft presented with dark verrucous growth over the graft site with a nonhealing ulcer of 3 cm × 2 cm seen over the ventral aspect of the left foot. Our second case, a 59-year-old male with a prior history of split skin grafting presented with dark verrucous growth and pain over the right forefoot for 3 months. The third case, a 58-year-old man with diabetic foot ulcer with verrucous growth over the toes. In all the cases, the biopsy was done and diagnosed to be PEH. We report this case series of PEH for the proper distinction from the SCC of the skin.

Biopolymeric membrane - a new concept in guided bone regeneration. Series of cases

Introduction. Different types of resorbable and non-resorbable membranes, cortical autogenous and allogenic bone plates, and prefabricated and perforated titanium meshes are currently used as guidance and support materials. All these devices present a series of advantages, but also disadvantages, such as gingival dehiscence with exposure and superinfection, additional trauma, and complete resorption of the bone graft. The objective of the study. This study emphasizes the importance of resorbable biopolymeric membranes in GBR. The retrospectively and descriptive analyses of the technique at 6 months postoperative time on a series of cases were performed. Materials and methods. GBR with resorbable biopolymer mesh was performed in 15 patients in 18 graft sites. Was analyzed just graft sites without any complication. The density of the newly formed bone under the augmentation membrane was evaluated postoperatively at 6 months using computed tomography (CBCT) according to the Hounsfield scale. Results. Results were interpreted in 18 graft sites and were evaluated at 6 months by paraclinical CBCT examination. After the polymer mesh GBR procedure, the mean radiodensity of the new bone obtained in the 18 sites was 1805 HU and the radiodensity of the native cortical bone next to the bone graft was 1793.4 HU

Our experience with the love handle and its surroundings as a donor area of autologous fat grafting at the radiothreapy demaged breast

Objective Patients who had prior breast reconstruction using implants, subsequently underwent radiotherapy resulting in breast damage, and had received at least one session of fat injection were included in the study. This aim of this study was to determine the rationale behind selecting the “love handle” and its adjacent regions as the primary donor site for fat grafting in this patient group. Materials and Methods This retrospective study included 86 patients who had undergone either nipple sparing or skin-sparing mastectomy between January 2019 - December 2023. The fat from each side was removed equally. The depressed areas within the fat removal site and patient satisfaction were assessed. The evaluation was performed at least 6 months after the last session. Results The mean body mass index was 28.9 kg/m2. Of these patients, 26 (30%) underwent a single session, while 60 patients (70 %) received two or more sessions of fat injection. An average of 120 cc of pure fat graft was extracted from the “love handle” and its adjacent areas during the initial session. Except for one patient, all other patients reported that they were satisfied with the procedure. Conclusion The ‘love handle’ and its surroundings is ideal for these patients due to its proximity to the breast, distance from vital vessels and nerves, ability to yield a sufficient amount of fat in the initial session, the ability for successive sessions as BMI increases, and low complication.

Autologous nanofat harvested from donor site of full-thickness skin or skin flap grafting for the treatment of early postburn scarring: a case series.

Postburn scarring often presents a specific reconstructive challenge from both functional and cosmetic perspectives. The purpose of this study was to investigate whether autologous nanofat harvested from the donor site of full skin or a skin flap can be reused for the treatment of early postburn scaring. From July 2018 to April 2022, patients with early postburn scarring underwent scar reconstruction surgery with full-thickness skin or a skin flap for a contour deformity and/or scar contracture, and autologous nanofat grafting was performed during the same operation. The Vancouver Scar Score (VSS) and the itch and pain scores were evaluated at the preoperation time point as well as at 2-3 weeks and 3-months postoperation. A comparison was made among the same patients at different time points. A total of 17 patients, aged from 18 months to 62 years old were included in this analysis. The VSS was reduced from 10.00 ± 2.12 to 7.41 ± 1.277 at the 2-3-week postoperation time point, and to 5.53 ± 1.37 at the 3-month postoperation time point. The pain and itch score were reduced from 4.65 ± 1.37 and 6.35 ± 1.27, to 3.70 ± 1.10 and 4.94 ± 1.30 at the 2-3-week postoperation time point, and to 3.00 ± 1.28 and 3.94 ± 0.97 at the 3-month postoperation time point respectively. The VSS and pain and itch scores showed a statistically significant reduction (P < 0.05) at the 2-3-week and 3-month postoperative follow-ups compared with the preoperation time point. Autologous nanofat grafting from donor sites of full thickness skin or skin flap may be a promising treatment for an early postburn scaring as it promotes scar softening, improves itching and pain within the scar. However, this is a small case series with only 17 patients. Further conclusions need to be drawn through expanded samples for randomized controlled clinical trials. Hypertrophic scarring is the most common complication after partial thickness burn injury, and the complex pathogenesis and prolonged dynamic process render treatments only marginally effective. In the past few decades, with the technological advances of liposuction and fat grafting, nanofat grafting has been used in a variety of surgical fields, including wound healing, scleroderma, facial rejuvenation, and neuralgia. However, the role of nanofat grafting is not well documented in the prevention and treatment of early postburn scarring. Full-thickness skin grafting or skin flap transplantation is the most common method for the reconstruction of a hypertrophic scaring until now. In the current study, we harvested subcutaneous fat during the preparation of the full-thickness skin or skin flap, prepared nanofat and injected it in the scar located at a nonsurgical site. Comparison of the pre- and postoperation scores for scar color, scar thickness, scar stiffness, and scar regularity showed that the postoperation scores were decreased significantly and that there was a significant improvement in scar pigmentation and thickness as well astheaesthetic outcome after treatment. Most importantly, reductions in the scores for pain and itching could be assessed objectively. It seems that the nanofat grafting is a potential method for prevention and treatment for early postburn scaring.

Outcomes of Osteochondral Autologous Transplantation with Ipsilateral Lateral Talar Autograft for Medial Osteochondral Lesions of the Talus.

Osteochondral autologous transplantation (OAT) has been widely used in the treatment of osteochondral lesion of the talus (OLT). Previous studies have reported successful outcomes following the use of osteochondral autogenous grafts from the intercondylar notch of the knee or a non-weight-bearing region of the femoral condyle. However, donor-site morbidity of the knee joint has been observed in several cases. This study aimed to investigate the outcomes and safety of OAT with autografts from the ipsilateral lateral talar articular facet as an alternative donor site for medial OLT. Among 40 patients who underwent OAT, 29 patients were excluded. Eleven patients who underwent OAT with an osteochondral graft harvested from the ipsilateral lateral talar articular facet from 2011 to 2022 were retrospectively analyzed. The size of OLT was measured on ankle magnetic resonance imaging, including coronal length, sagittal length, depth, and area. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and a visual analog scale (VAS). Weight-bearing ankle radiographs were obtained postoperatively and at 1 year after surgery. The average follow-up time after surgery was 64.7 months (range, 14-137 months). The average diameter of lesions was 8.8 mm (range, 8-9.9 mm). The average size of lesions was 51.2 mm2 (range, 33.6-71.3 mm2) , and all lesions included subchondral cysts. The average depth of lesions was 7.3 mm (range, 6.2-9.1 mm). Graft sizes ranged from 8 to 10 mm in diameter (8 mm, n = 1; 10 mm, n = 10) All measured clinical outcomes improved postoperatively, including the AOFAS scores (preoperative, 55.4 ± 9.0; 1-year follow-up, 92.1 ± 7.6; p = 0.001) and VAS scores (preoperative, 5.5 ± 0.7; 1-year follow-up, 1.9 ± 0.8; p = 0.001). All weight-bearing ankle radiographs of the graft and donor sites did not reveal arthritic change in the ankle joint, lateral talar dome collapse, and graft-site delayed union or nonunion at 1 year after surgery. For a single medial OLT, harvesting autografts from the ipsilateral lateral talar articular facet without knee donor-site morbidities can be a good alternative in OAT for OLT.

Biomaterial-assisted strategies to improve islet graft revascularization and transplant outcomes.

Islet transplantation holds significant promise as a curative approach for type 1 diabetes (T1D). However, the transition of islet transplantation from the experimental phase to widespread clinical implementation has not occurred yet. One major hurdle in this field is the challenge of insufficient vascularization and subsequent early loss of transplanted islets, especially in non-intraportal transplantation sites. The establishment of a fully functional vascular system following transplantation is crucial for the survival and secretion function of islet grafts. This vascular network not only ensures the delivery of oxygen and nutrients, but also plays a critical role in insulin release and the timely removal of metabolic waste from the grafts. This review summarizes recent advances in effective strategies to improve graft revascularization and enhance islet survival. These advancements include the local release and regulation of angiogenic factors (e.g., vascular endothelial growth factor, VEGF), co-transplantation of vascular fragments, and pre-vascularization of the graft site. These innovative approaches pave the way for the development of effective islet transplantation therapies for individuals with T1D.

MACI Sandwich Technique With Autologous Bone Graft

Background: Osteochondral lesions of the knee are difficult to manage. Such lesions can be effectively treated with the matrix-induced autologous chondrocyte implantation (MACI) “sandwich” technique using autologous chondrocytes on porcine collagen membrane in conjuction with autologous cancellous bone grafting (ABG). Few studies have examined this technique to restore the osteochondral unit. Indications: The MACI “Sandwich” procedure is indicated when osteochondral lesions are larger than 2 cm2 in size and deeper than 8 to 10 mm, with symptoms consistent with the location of the lesion. Technique Description: The chondral defect is radically debrided back to healthy bone and cartilage tissue. The base of the bony cavity is drilled to enhance the vascular supply and promote healing. Next, the bony cavity is prepared to slightly undermine the subchondral bone surface around the articular margins, with the depth of the cavity wider than the opening, similar to a dental amalgam. The autologous cancellous bone is subsequently morselized and impacted up to the level of the native subchondral bone plate. The first MACI membrane with the cells facing up is placed directly onto the bone graft site and compressed with a neural patty. The neural patty is removed, and the second MACI membrane is then placed with the cells facing down. The edges are then micro-sutured to ensure stability. Results: The “sandwich” technique has superior survival rates compared with autologous bone grafting alone, with patients reporting decreased pain, improved function, and high satisfaction scores over a mid-term to long-term follow-up. Discussion/Conclusion: The MACI “sandwich” technique is an effective surgical intervention to restore the osteochondral unit and preserve the patient's native knee joint. 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.

Pleiotropic effect of intramucosal injection of FTY720 on angiogenesis and tissue healing after free gingival graft surgery: a comparative experimental study in rabbits.

Free gingival graft surgery is the gold standard for increasing the size of keratinized tissue. Blood supply in the recipient site is critical for healing. Therefore, in this study, the effect of FTY720 on angiogenesis, healing, and scar tissue presence following free gingival graft surgery is investigated. Surgeries were performed on 10 New Zealand white rabbits. Rabbits were randomly assigned to two groups. In the experimental group, immediately after surgery, 2 and 4days later, FTY-720 was injected into the tissue surrounding the recipient site. In the control group, the same frequency of placebo vehicle was injected. After 30days, tissue samples were assessed histologically and histomorphometrically. The blood vessel count (P < 0.000) and rete ridge formation (P < 0.05) in the experimental group were significantly higher, while the epithelial thickness was lower in this group (P < 0.000). There was no significant difference in the percentage of regions occupied by collagen fibres between the groups (P = 0.987). Furthermore, a significant and negative relationship between epithelial thickness and blood vessel count was shown (Pearson correlation coefficient = - 0.917). The findings indicate that the angiogenic effects of FTY-720 in the recipient site of free gingival graft can be employed to promote tissue healing and reduce scar tissue presence. A significant decrease in epithelial thickness and increase in angiogenesis as well as rete ridge formation score in the FTY-720 group were shown, which can be translated into improved tissue healing and less presence of scar tissue.

Anterior Wall of Maxillary Sinus as a New Autogenic Graft Source: A Case Report

This study introduces the anterior wall of the maxillary sinus as a viable and accessible graft site for small to moderate bone defects in the maxilla that pose challenges for implantation. A healthy 40-year-old woman was referred by a prosthodontist due to malpositioned implants. Following a comprehensive assessment, the decision was made to remove the implants. Upon executing this treatment plan, a medium-sized defect was revealed. The flap was elevated to expose the anterior wall of the maxillary antrum, from which an osseous graft was obtained. This graft was then fixed as a buccal wall of the defect and supported by a membrane. After a healing period of 6 months, two implants were successfully inserted. The anterior wall of the maxillary sinus can serve as a beneficial graft source. However, more extensive studies with appropriate design are required to reach a definitive conclusion.

Comparative Study of Immunodeficient Rat Strains in Engraftment of Human-Induced Pluripotent Stem Cell-Derived Airway Epithelia.

The airway epithelia (AE) play a role in the clearance of foreign substances through ciliary motility and mucus secreted. We developed an artificial trachea that is made of collagen sponges and polypropylene mesh for the regeneration of the tracheal defect, and it was used for a clinical study. Then, a model in which the luminal surface of an artificial trachea was covered with a human-induced pluripotent stem cell-derived AE (hiPSC-AE) was transplanted into the tracheal defect of nude rats to promote epithelialization. In the future, this model was expected to be applied to research on infectious diseases and drug discovery as a trachea-humanized rat model. However, at present, sufficient engraftment has not been achieved to evaluate functional recovery in transplanted cells. Therefore, this study focused on immunosuppression in recipient rats. Nude rats lack T cell function and are widely used for transplantation experiments; however, more severe immunosuppressed recipients are preferred for xenotransplantation. Several strains of immunodeficient rats were created as rats that exhibit more severe immunodeficiency until now. In this study, to establish a trachea-humanized rat model in which human AE function can be analyzed to improve engraftment efficiency, engraftment efficiency in nude rats and X-linked severe combined immunodeficiency (X-SCID) rats following hiPSC-AE transplantation was compared. In the analysis of the proportion of engrafted cells in total cells at the graft site, the engraftment efficiency of epithelial cells tended to be high in X-SCID rats, although no statistical difference was found between the two groups, whereas the engraftment efficiency of mesenchymal cells was higher in X-SCID rats. Furthermore, the number of immune cells that accumulated in the grafts showed that a pan T cell marker, that is, CD3-positive cells, did not differ between the two strains; however, CD45-positive cells and major histocompatibility complex (MHC) class II-positive cells significantly decreased in X-SCID rats. These results indicate that X-SCID rats are more useful for the transplantation of hiPSC-AE into the tracheae to generate trachea-humanized rat models.

Ultra‐low Mn(salen) supported on lignin and selective epoxidation of olefins

AbstractPrecise design of highly efficient, low metal load and eco‐friendly catalysts is the key to sustainable catalysis and green chemistry. In this work, we develop an ultra‐low loading of Mn(salen) complexes covalent grafted with lignin and applied in the selective epoxidation of olefins using O2 as an oxidant. Lignin not only provides the Mn(salen) graft sites but also promotes substrate enrichment via the π‐stacking interaction between substrate and supports. In particular, high turnover frequencies (TOF) of 1833 h−1 can be obtained for styrene epoxidation under mild conditions, which can be superior to most reported Mn(salen) supported catalysts. Compared with cellulose, the lignin‐based catalysts exhibit a higher selectivity toward styrene oxide during the epoxidation of styrene under mild conditions. Controlled experiments indicate that the synergistic effect between phenolic hydroxyl groups and the Mn(salen) complex can improve the conversion rate and selectivity during the selective epoxidation of styrene. This work designs a series of lignin‐based catalysts with ultra‐low Mn(salen) loading, which broadens the utilization of lignin and gives enlightenment for the rational design of lignin‐based catalysts.

Comparison of hamate versus second or third toe osteochondral graft using magnetic resonance imaging for reconstruction of proximal interphalangeal fracture-dislocations.

Hemi-hamate arthroplasty is a method used to reconstruct complex fracture-dislocations of the proximal interphalangeal joint of the fingers. Other graft sites, including the toe second and third phalanges, have been proposed as alternatives to hemi-hamate arthroplasty due to variable clinical outcomes and anatomy. Through a prospective magnetic resonance imaging (MRI)-based study in asymptomatic individuals, we aimed to characterize the anatomy of the proximal interphalangeal joint and compare this with the hamate, second and third toes to determine the closest anatomical match using pre-determined measurements. Our results show that the second and third toes have greater anatomical similarity to the proximal interphalangeal joint of the fingers compared to the hamate. High-resolution MRI is a reliable method of characterizing the anatomy of these structures and could be a useful clinical tool in determining reconstructive options in the management of this challenging injury.Level of evidence: II.

Palmar reconstruction using full-thickness skin grafts from the groin and lateral malleolus regions: A comparison of long-term outcomes.

Using the skin of the lateral malleolus region for reconstruction of smaller areas of the palm may yield better outcomes than using the skin of the groin region. However, no previous study has provided long-term data comparing the groin and lateral malleolus regions as donor sites for full-thickness skin grafts (FTSGs) in palmar reconstruction. Therefore, this study aimed to compare the groin and lateral malleolus regions as donor sites for FTSGs in palmar reconstruction over a long-term follow-up period. The patients were classified into groin and lateral malleolus region groups (n = 15 each). Measurements were obtained at the graft site, the contralateral site corresponding to the graft site, and the donor site. A chromameter was used to measure skin color, and the Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate the scar at the skin graft site. Compared to the groin region group, the lateral malleolus region group showed skin colors that were closer to the original color of the palm in terms of lightness and red/green values. Additionally, the lateral malleolus region group received better esthetic ratings in the POSAS. Our results revealed that using the lateral malleolus region for FTSGs in palmar reconstruction resulted in better outcomes than using the groin region, even over a long period.

Quantitative Volumetric Measurements of Bone Grafting Sites Within the Lower Extremity on Computed Tomography Scans

The anterior iliac crest is one of the most used options; however, pain and other complications have been reported. Other options for bone harvest in the lower extremity, such as the proximal tibia and calcaneus, can be useful sites for bone grafting. Computed tomography angiography images of the lower extremity were analyzed using 3-D Slicer™ medical imaging software, creating an advanced 3-dimensional model. Bone volume (cm3) and bone mineral density (Hounsfield units) were measured from the cancellous bone in the anterior iliac crest, posterior iliac crest, proximal tibia, and the calcaneus. Fifteen studies were included. The total volume measured it was of 61.88 ± 14.15 cm3, 19.35 ± 4.16 cm3, 32.48 ± 7.49 cm3, 26.40 ± 7.18 cm3, for the proximal tibia, anterior and posterior iliac crest, and calcaneus, respectively. Regarding Hounsfield units, the densities were 116 ± 58.77, 232.4 ± 68.65, 214.4 ± 74.45, 170.5 ± 52.32, for proximal tibia, anterior and posterior iliac crest, and calcaneus. The intraclass correlation coefficients were in average >0.94. In conclusion, the proximal tibia has more cancellous bone than the anterior and posterior iliac crest. The calcaneus has more cancellous bone than the anterior iliac crest. Bone mineral density was highest in the anterior iliac crest and in proximal tibia was the lowest value.

Optimising oral cancer reconstruction: a retrospective cohort study on the modified radial forearm free flap technique to eliminate the need for a secondary donor site

The radial forearm free flap (RFFF) is commonly used in the reconstruction of oral cancer patients. Traditional RFFF (TRFFF) techniques, which often require a secondary donor site to repair the forearm defect, may result in a scar extending to the dorsal hand. This can lead to significant functional and aesthetic concerns in the forearm. We designed a modified RFFF (MRFFF) that incorporates a glasses-shaped flap and features deep venous drainage. To evaluate its effectiveness we conducted a retrospective chart review of 105 patients with oral squamous cell carcinoma who underwent reconstructive surgery between 2018 and 2022. These patients were treated either with a TRFFF (n = 60) or the newly developed MRFFF (n = 45). Our inclusion criteria, guided by preliminary surgical experience prior to initiating the study, stipulated that single oral defects should be no larger than 6 × 6 cm2, and adjacent double defects no larger than 3 × 6 cm2. Flap size, pedicle length, harvesting duration, and anastomosis during the surgical procedure were compared between the two techniques. Preoperative and postoperative oral function, recurrence, mortality, and dorsal scarring were recorded. One-week, one-month, and six-month postoperative subjective aesthetics assessments, and self-reported postoperative donor hand function, were measured using the Michigan hand questionnaire (MHQ). There were no significant differences between the groups in terms of flap size, pedicle length, harvesting time, anastomosis time, postoperative oral function, recurrence, and mortality. However, patients with a MRFFF did not require a second donor graft site and did not have scars extending to the dorsal forearm. They also had significantly improved postoperative aesthetic outcomes (1 week: 70.6%, 1 month: 62.2%) and donor hand function (1 week: 54.6%, 1 month: 40.4%) compared with the TRFFF group (p < 0.001). The MRFFF eliminates the need for secondary donor sites and improves primary donor site outcomes. It is versatile and can be employed for either single or composite oral defects. Through extensive case studies, we have defined its specific scope: it is suitable for single defects measuring no more than 6 × 6 cm2, or for composite defects no larger than 3 × 6 cm2. Furthermore, it does not compromise the functional recovery of the recipient site, and should be widely adopted for all qualifying patients.

Development of sulfhydryl grafted hierarchical porous geopolymer for highly effective removal of Pb (II) from water

Geopolymers have captured increasing attention in the adsorption of lead ions due to their zeolite-like three-dimensional network structure, and several advantages such as low cost and environmental friendliness. However, their adsorption performance is limited by a small specific surface area and fewer adsorption sites. In this study, a metakaolin-based geopolymer was first pretreated with different concentrations of nitric acid to increase the porosity and surface area. Subsequently, the sulfhydryl functional group was grafted onto the above hierarchical porous geopolymer, which is a inorganic material with multistage pore structure. The result of N2 adsorption and desorption results demonstrated that an increase in specific surface area and number of grafting sites for sulfhydryl groups with increasing acid concentration when the highest nitric acid concentration used is 5 mol/L and acid treatment time is for 5 h. The specific surface area of the fabricated geopolymers was as high as 343.87 m2/g and the concentration of silanol groups reached 4.46 mmol/g at 3 mol/L acid concentration. The maximum Pb2+ adsorption quantities for SH-1HGeo, SH-2HGeo, and SH-3HGeo samples were 173.2 mg/g, 239.8 mg/g, and 386.3 mg/g, respectively. The adsorption processes were in accordance with the pseudo-second-order kinetic model and the Langmuir models, indicating that the Pb2+ adsorption on the sulfhydryl grafted hierarchical porous geopolymer was mainly chemisorption and monolayer adsorption. The contribution of different Pb2+ adsorption mechanism on geopolymer was ion-exchange, while that on SH-3HGeo was functional group complexation.

360-degree Arthroscopic Management of Scaphoid Pseudarthrosis: Description of Technique and Indications.

Nonunion remains one of the main complications of scaphoid fractures, with no consensus being reached as to the best surgical technique for scaphoid pseudoarthrosis. Thus, different types of procedures for bone stability and biological stimulus for consolidation have been described. The use of arthroscopy for scaphoid pseudoarthrosis has advantages as it allows for treating associated injuries, preserving wrist proprioception by minimizing damage to the joint capsule and ligaments and not deteriorating the already fragile scaphoid vasculature, leading to a quick recovery. Arthroscopy was initially indicated for stable scaphoid pseudoarthroses, being used in all patterns of this condition, including unstable ones and those with flexion collapse. However, most scientific articles describe the use of arthroscopy only through the dorsal portals, creating technical difficulty in complete debridement of the site of pseudarthrosis and in placing bone graft. This study describes the 360-degree technique, which standardizes arthroscopy in scaphoid pseudoarthrosis treatment, allowing, with the use of dorsal, volar, and radial portals, direct approach to the entire circumference of the nonunion site, facilitating the debridement of the injury site, the correction of the scaphoid deformity, and the placement of a graft directly on the site of the defect, mainly in its volar region after correction of the flexion deformity. The 360-degree technique aims to help and standardize the arthroscopic procedure for scaphoid pseudarthrosis, creating a routine with defined surgery stages. Additional portals allow complete access to the entire nonunion site and better positioning of the bone graft under direct view.

Split-thickness Plantar Skin Graft for Foot Syndactyly.

For the treatment of syndactyly, the submalleolar or inguinal area is the common donor site for skin grafts. However, high skin tension of the submalleolar area could potentially delay wound healing or cause scarring. Skin grafts from the inguinal area cause pigmentation. In this study, we have harvested split-thickness skin grafts from the plantar area to treat syndactyly and evaluated the healing course and aesthetic outcome. We analyzed 13 recipient and nine donor sites in eight patients, aged 13-68 months (average 25 months), with syndactyly of the foot. The minimum follow-up was 14 months, and average follow-up period was 22.3 months. Aesthetic outcomes including color and texture match, wound healing of donor site using Vancouver Scar Scale, and complications of both sites were assessed in all patients. At the recipient sites, the graft survived well, and the lack of pigmentation of the graft led to good color match. At the donor sites, hypertrophic scar and high scar scale were seen around postoperative month 3, but were momentary, as all donor sites matured to a flat and soft scar. Morbidity of split-thickness skin graft from the plantar region is limited. It causes minimum scarring of the nonexposed area. Moreover, because it does not cause pigmentation, the split-thickness skin graft technique is a reasonable option for the treatment of syndactyly.

Bone Grafting Options for Single-Level TLIF: So Many Options, What Is the Evidence?

This review seeks to investigate the clinically relevant bone graft materials in single-level transforaminal lumbar interbody fusion (TLIF) procedures as defined by (1) primary outcomes (ie, fusion rates and complication rates) and (2) patient-reported outcomes (ie, visual analog scale [VAS] and Oswestry disability index [ODI]). Because of the advantages in stimulating bone growth, autologous bone grafts such as the iliac crest bone graft (ICBG) have been the gold standard. Numerous alternatives to ICBG have been introduced. Understanding the risks and benefits of bone graft options is vital to optimizing patient care. A PubMed search was performed for all clinical studies published between January 2008 and March 2023 that referenced the single-level TLIF procedure as well as one of the following grafts: autograft, allograft, bone morphogenetic protein (BMP), demineralized bone matrix, or mesenchymal stem cells (MSCs). Case studies and reports were excluded. Twenty-eight studies met the inclusion criteria. Studies from the PubMed search demonstrated similarly high fusion rates across nearly all graft materials, the lone exception being MSCs, which showed lower fusion rates. ICBG grafts experienced higher rates of postoperative graft site pain. The BMP graft material had high rates of radiculitis, heterogeneous ossification, and vertebral osteolysis. Patients saw an overall improvement in VAS and ODI scores with all graft materials. Local autografts and ICBG have been the most studied. Fusion rates during single-level TLIF were similar across all graft materials except MSCs. Patient-reported pain levels improved after TLIF surgery regardless of the type of grafts used. While BMP implants have shown promising benefits, they have introduced a new array of complications not normally seen in ICBG implants. The study is limited by the lack of evidence of certain graft materials as well as nonuniformity in metrics evaluating the efficacy of graft materials.