Graft Healing Research Articles

Analyzing the temporal response mechanisms of the vascular bundles formation of grafted cucumber to different light intensity modes: A joint transcriptomic and metabolomic approach

In plant grafting, the reconnection of vascular bundles between the rootstock and scion not only establishes functional xylem and phloem connections, but also signifies the completion of graft healing. In our previous studies focused on early-stage morphology and physiology of grafted seedlings, we have demonstrated that utilizing light intensities of 50-100-150 μmol/(m2·s) during days 1-3, 4-6, and 7-9 optimizes cucumber/pumpkin graft healing. To further explore the underlying mechanisms, we investigate light intensity regimes: 50-100-100 μmol/(m2·s) and 50-100-150 μmol/(m2·s) during the same time frames (days 1-3, 4-6, and 7-9 after grafting), denoted as CK and T treatments. Initially, we observe histological characteristics of vascular bundle formation under these conditions, followed by the analyses of superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), glutathione peroxidase (GSH-Px) enzyme activities, ascorbic acid (AsA) content in the antioxidant system, and the sequencing of transcriptome and metabolome. It is found that grafted seedlings under the T treatment achieve faster vascular bundle reconnection and shorter healing process compared to those under the CK treatment. Enzyme activities (POD, SOD, GSH-Px) increase over time under both light regimes, while CAT activity and AsA content decrease. Notably, by the 9th day, the T treatment (T9d) exhibits higher SOD, POD and CAT activities than the CK treatment (CK9d). Our findings indicate that increasing light intensity during the days 7-9 after grafting can mitigate oxidative damage at the grafting site and benefit vascular bundle reconnection. Transcriptome and metabolome analyses show the up-regulations of Cinnamaldehyde in the phenylpropanoid biosynthesis pathway, the PHGDH gene and L-Homocysteine in the cysteine and methionine metabolism pathway under T treatment in the days 7-9 after grafting. These enhance the antioxidant enzyme activities and reduce the oxidative damage to the grafting site. Additionally, GAE-related genes, and metabolites D-Xylose and Undecaprenyl phosphatealpha-L-Ara4FN in the amino sugar and nucleotide sugar metabolism pathways are also up-regulated under T treatment. The ethylene responsive factor (ERF) transcription factor CsaRAP2.3 positively regulates Undecaprenyl phosphatealpha-L-Ara4FN expression, promoting cell wall synthesis and therefore accelerating vascular bundle reconnection. In summary, during the vascular bundle formation period of cucumber graft healing, both light intensity modes coordinate regulation of phenylpropanoid biosynthesis, cysteine and methionine metabolism, amino sugar and nucleoside sugar metabolism, and ERF transcription factors, promoting graft healing from both stress resistance and cell wall synthesis. Furthermore, building upon the light intensity applied during the callus formation phase, increasing the light intensity during the vascular bundle formation period can significantly enhance cell wall synthesis, thus expediting the graft healing process. Nonetheless, the generalizability of these research findings to other grafting techniques and species requires further investigation.

Superior Biological Healing of Hamstring Autografts Compared with Tibialis Allografts after Anterior Cruciate Ligament Reconstruction: A Propensity Score Matching Analysis Based on Second-Look Arthroscopy.

Background and Objectives: Remodeling and healing of the graft are crucial processes for long-term graft survival after anterior cruciate ligament reconstruction (ACLR). However, few studies have objectively evaluated the differences in graft healing between autografts and allografts. This study aimed to compare the status of the anterior cruciate ligament (ACL) grafts between hamstring tendon (HT) autografts and tibialis anterior tendon (TAT) allografts using second-look arthroscopy. Materials and Methods: The outcomes of 193 consecutive patients (153 males and 40 females, with an average age of 30.38 and BMI of 25.43 kg/m2) who underwent second-look arthroscopy following primary ACLR were retrospectively reviewed. Prior to participating in this study, all patients provided written informed consent. The patients were divided into two groups: those with HT autografts and those with TAT allografts. Confounding factors were matched between the two groups using propensity score matching (PSM). ACL graft status was assessed during second-look arthroscopy using a numeric scale system based on the degree of four parameters: graft tension, continuity, synovium coverage, and vascular marking. Clinical outcomes were assessed using the Lysholm and International Knee Documentation Committee (IKDC) scores. Graft status and clinical outcomes were compared between the two groups. Additionally, a subgroup analysis based on the timing of the second-look arthroscopy (12-24 months vs. >24 months after the initial ACLR) was conducted. Results: After PSM, 62 patients were included in each group. The second-look arthroscopy was conducted at 23.6 ± 6.6 months for the HT group and at 24.0 ± 7.9 months for the TAT group (p = 0.749). The continuity and tension of the ACL graft were not significantly different between the two groups (p = 0.146 and 0.075, respectively). However, the TAT group exhibited significantly inferior synovial coverage and vascular marking of the ACL graft compared with the HT group (p = 0.021 and 0.007, respectively). These findings were consistent regardless of the timing of the second-look arthroscopy. Clinical outcomes, according to the Lysholm and IKDC scores, significantly improved in both groups with no significant differences (p = 0.386 and 0.733, respectively). Conclusions: Although there were no differences in graft tension and continuity between HT autografts and TAT allografts, the biological healing of ACL grafts, in terms of synovialization and vascularization, was superior in HT autografts compared to TAT allografts.

Hoxc10-mediated 'positional memory' regulates cartilage formation subsequent to femoral heterotopic grafting.

The Hox gene plays a crucial role in the bone development, determining their structure and morphology. Limb bone grafts expressing Hox positive genes are commonly used for free transplantation to repair Hox negative mandibular critical bone defects. However, the specific role of original Hox genes in newly formed bone during the cross-layer bone grafting healing process remains unexplored. Our findings demonstrate that femurs ectopically grafted into the mandibular environment retained a significant ability to differentiate into cartilage and form cartilaginous callus, which may be a key factor contributing to differences in bone graft healing. Hoxc10, an embryonic layer-specific genes, regulates cartilage formation during bone healing. Mechanistically, we observed Hoxc10 retention in co-cultured femoral BMSCs. Knocking out Hoxc10 narrows the bone gap and reduces cartilage formation. In summary, we reveal Hoxc10's 'positional memory' after adult cross-layer bone graft, influencing the outcomes of autologous bone graft.

Patients With Graft Tears Leaving the Tuberosity Covered Have Similar Functional Outcomes to Those With an Intact Graft After Superior Capsular Reconstruction.

Studies to date of superior capsular reconstruction (SCR) comparing outcomes of healed grafts versus torn grafts do not separate graft tears based on location of the tear, rather they combine and report all tears as a single group. The purpose of this study was to correlate functional outcome with graft integrity and graft tear location after SCR with a dermal allograft. It was hypothesized that the functional outcomes of patients with an intact graft would be equivalent to those with graft tears leaving the tuberosity covered. Cohort study; Level of evidence, 3. Patients who underwent SCR with an acellular dermal allograft at a single institution were included. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score, visual analog scale (VAS) for pain, and postoperative Single Assessment Numeric Evaluation (SANE) scores were recorded. A magnetic resonance imaging scan was performed postoperatively to assess graft integrity. A total of 39 patients met inclusion criteria. Mean age of patients was 60.4 ± 8.7 years; mean follow-up was 53.3 ± 25 months (range, 14-98 months). Magnetic resonance imaging performed at a mean of 17.5 months (range, 6-66 months) demonstrated an intact graft in 14 (36%); tear from the glenoid in 11 (28%), from midsubstance in 4 (10%), and from the tuberosity in 8 (21%); and complete graft absence in 2 (5%). Patients were divided into group 1 (intact graft), group 2 (tuberosity covered: tears from glenoid and midsubstance tears), and group 3 (tuberosity bare: tears from the tuberosity and dissolved or absent grafts). In group 1, there was significant improvement in ASES (37.9 to 88.5; P < .001), Oxford (25.2 to 46.2; P < .001), and VAS (6.8 to 0.9; P < .001). In group 2, there was significant improvement in ASES (32.2 to 86.1; P < .001), Oxford (23.4 to 44.2; P < .001), and VAS (7.3 to 1.3; P < .001). In group 3, there was no significant improvement in ASES (40.3 to 45.8; P = .50) or Oxford (33.5 to 31.4; P = .81), but there was a significant reduction in VAS (7.1 to 5.4; P = .03). There was no significant difference between group 1 and 2 in postoperative ASES (88.5 vs 86.1; P = .59), Oxford (46.2 vs 44.2; P = .07), VAS (0.9 vs 1.3, P = .42) and SANE (85.4 vs 83.2; P = .92) scores. However, group 3 had significantly lower ASES (45.8; P < .001), lower Oxford (31.4; P < .001), lower SANE (45.4; P < .001), and higher VAS (5.4; P < .001) scores than groups 1 and 2. There were no differences in outcomes based on sex (P = .72), previous surgery (P = .06), preoperative acromiohumeral distance (P = .57), and preoperative Goutallier stage of the supraspinatus (P = .16). Patients who underwent SCR with a dermal allograft and developed a graft tear leaving the tuberosity covered had equivalent functional outcomes to those with an intact graft.

High Rate of Return to Sport in Contact and Collision Athletes After Arthroscopic Latarjet With Cortical Button Fixation

Background: Contact and collision athletes face a higher risk of recurrent anterior shoulder instability after surgical stabilization. The Latarjet procedure is often preferred given the high incidence of bony lesions. However, this stabilizing procedure, performed either open or arthroscopically, is met with concerns regarding complications and revision surgery rates. Purpose: To evaluate the return to sport (RTS) and assess complication and instability recurrence rates in contact/collision athletes undergoing the arthroscopic Latarjet procedure using a guided technique with suture buttons for coracoid fixations. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was conducted on contact/collision athletes who underwent the arthroscopic Latarjet procedure for recurrent anterior shoulder instability between January 2011 and March 2018. All patients were operated on arthroscopically using glenoid and coracoid guides and suture button fixation of the transferred coracoid. RTS was defined as the patient being able to participate in his or her activity without any restriction postoperatively. Two independent observers assessed patients using postoperative computed tomography (CT) scans to evaluate coracoid positioning and healing. A multivariate analysis was performed to identify predictive factors associated with persistent apprehension. A group comparison was performed to assess RTS failure risk factors. Results: In 136 contact/collision athletes (mean age, 25 ± 7 years), 93% were satisfied, and 98% achieved shoulder stability at a mean follow-up of 60 months (range, 24-117 months). No suture button–related complications or neurovascular issues were reported. Overall, 82% (112/136) returned to contact/collision sports. The mean time to RTS was 5.3 ± 1.2 months (range, 3-7.3 months). In a CT study performed 2 weeks after surgery, 87% (118/136) of bone grafts were positioned below the equator and 93% (126/136) were flush to the glenoid surface. At the 6-month postoperative CT examination, complete bone block healing was achieved in 84% (114/136). On clinical examination at the latest follow-up, 36 patients (26%) reported some anterior apprehension on testing. On multivariate analysis, patients with severe humeral bone defects (medium to large Hill-Sachs lesions, Calandra grade 2 or 3) had a higher risk of postoperative persistent apprehension. On group comparison, a visual analog scale score >3 and persistent anterior apprehension were found to be associated with failure of RTS. Conclusion: The arthroscopic Latarjet procedure with suture button fixation allowed 82% of athletes with recurrent anterior shoulder instability to return to contact or collision sports. Patients with severe humeral bone defects have a higher risk of persistent anterior apprehension and decreased RTS. The arthroscopic-guided procedure with suture button fixation is safe; accurate, with a high rate of anatomic graft positioning and healing; and reliable, with a low recurrence rate.

Promising clinical effect of arthroscopic autologous iliac bone grafting with suture anchor binding fixation for recurrent anterior shoulder instability.

To evaluate the clinical efficacy of arthroscopic autologous iliac bone grafting with suture anchor binding fixation combined with a Bankart repair for recurrent anterior shoulder dislocation with a significant anterior glenoid defect. Patients with recurrent anterior shoulder dislocation with an anterior glenoid defect area greater than 20% admitted to our department from March 2019 to March 2022 were prospectively enrolled. Arthroscopic autologous iliac bone grafting with suture anchor binding fixation combined with a Bankart repair was performed. Computed tomography (CT) images were captured preoperatively, immediately after surgery, and at 3, 6, and 12 months postoperatively to evaluate the glenoid defect area, graft area, and graft healing. Shoulder function was assessed using the Instability Severity Index, Oxford Shoulder Instability, and Rowe scores recorded preoperatively and at the final follow-up. The shoulder range of motion, shoulder stability test, surgery-related complications, subluxation/dislocation, and revision surgery were also evaluated. A total of 32 patients were included in the study, with an average follow-up time of 18.3 ± 6.3 months, when the graft healing rate was shown to be 100%. The area ratio of the graft to the glenoid was 37.6% ± 10.5% (range, 23.5%-44.1%) determined by an enface-view three-dimensional CT performed immediately after surgery, and 29.2 ± 8.2% (range, 19.6%-38.7%) at 12 months postoperatively. At the final follow-up, the glenoid defect had improved from 28.7 ± 6.4% (range, 20.5%-40.6%) before surgery to -10.2 ± 4.7% (range, -13.8% to 6.1%). The preoperative Rowe and Oxford scores were 56.4 ± 8.5 and 34.7 ± 7.1 respectively, which improved to 94.3 ± 6.7 and 15.3 ± 3.2 at the final follow-up (p < .001). All patients had no limited shoulder joint activity, no re-dislocation or revision surgery, and no neurovascular injury. For recurrent anterior shoulder dislocation with an anterior glenoid defect area greater than 20%, arthroscopic autologous iliac bone grafting with suture anchor fixation combined with a Bankart repair produced a promising clinical effect. A significant shoulder function score was achieved, as was a 100% bone healing rate and ideal glenoid reconstruction without major complications. Thus, this technique may be considered an alternative to the classic Latarjet approach to treat recurrent anterior shoulder dislocation with an anterior glenoid defect area greater than 20%. IV.

Risk Factors for Postoperative Donor Site Complications in Radial Forearm Free Flaps.

Background and Objectives: The radial forearm free flap (RFFF) is the most commonly used flap for head and neck reconstruction. However, complications at the donor site are its major drawbacks. We aimed to identify the patient comorbidities and factors that predict donor site complications after RFFF. Materials and Methods: A retrospective chart review of consecutive patients who underwent RFFF reconstruction for head and neck cancer between 2015 and 2022 was performed. Demographic variables, clinical processes, and postoperative complications were assessed. All variables were analyzed using univariate and multivariate analyses. Results: Sixty-seven patients underwent RFFF reconstruction, and all received a split-thickness skin graft at the donor site. Twenty-five patients experienced delayed skin graft healing, whereas nine experienced sensory changes at the donor site. Hypertension and age had statistically significant negative effects on wound healing. The incidence of hand swelling was related to graft size, and the occurrence of paresthesia was significantly higher in diabetic patients and significantly lower in those with acellular dermal matrix (ADM). Conclusions: Patients with hypertension had a higher risk of prolonged wound healing after RFFF than their normotensive patients. Clinicians should pay particular attention to wound healing strategies in patients with hypertension. Additionally, better neuropathy care is recommended to achieve sensory recovery after RFFF in patients with diabetes. Using a skin graft with ADM could be a method to alleviate neurological symptoms.

A bone graft from the tibial resection or patella that rectified a tibial over-resection reliably healed and improved clinical outcome scores: A retrospective study of kinematically aligned TKA.

During kinematically aligned (KA) total knee arthroplasty (TKA), the surgeon may need to rectify an over-resection of the medial, lateral or posterior tibia. This study tested the hypothesis that a bone graft taken from the tibial resection or patella and impacted beneath a tibial baseplate would heal, regardless of whether the tibial component and knee were in outlier ranges according to mechanical alignment (MA) criteria. The study also tested the hypothesis that the Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) would improve beyond the substantial clinical benefit and that the source and thickness of the bone graft would not influence their improvement. This retrospective study radiographically assessed the healing of a bone graft from the tibial resection (n = 19) or patella (n = 10) in 29 KA TKAs (18 females, mean age 65 years). The tibial component and knee alignment were categorized as in-range or outliers based on reported MA criteria for bone graft healing and implant survival. The one-sample t test identified differences in the improvement of the OKS and KOOS JR from their reported substantial clinical benefit of 16 and 20 points, respectively. At an average follow-up of 37 months, all bone grafts healed even though ≥55% of tibial components and 34% of knees were varus outliers according to MA criteria for bone healing and implant survival. Amongst the 29 patients, the mean OKS and KOOS JR improvements of 25 ± 11 and 47 ± 21 points, respectively, surpassed the threshold of their respective substantial clinical benefit (p < 0.01) and were not influenced by the bone graft's source and thickness (p ≥ 0.51). During cemented KA TKA, the surgeon can use a bone graft from the tibial resection or patella to rectify a tibial over-resection. This technique led to consistent bone healing and improved outcome scores. Level IV.

Comparative analysis of one-step and two-step full thickness skin grafting and secondary intention healing for skin defects after surgical management of plantar malignant melanoma.

Plantar malignant melanoma is largely managed surgically, particularly in its early stages. However, the plantar region has a lower survival rate of skin grafts than other regions. Furthermore, complete wound healing occurs over a long period of time, postoperatively. Thus, in this study, we retrospectively analyzed the use of skin grafts to reconstruct skin defects, as postoperative complications of plantar malignant melanoma. Forty-nine patients, (23 males, 26 females; mean age 70.4-years) underwent excisional surgery for plantar malignant melanoma at our hospital, between March 2018 and December 2022. The time from initial surgery to wound healing was analyzed, using a multivariate Cox proportional hazards model, to identify related factors. We excluded cases with lesions in non-weight-bearing areas and cases with segmental layer grafts, based on multivariate analysis, to eliminate bias when comparing a one-step resection and reconstruction technique to resection followed by waiting for granulation to occur before reconstruction. Patients were categorized into three cohorts. The first and second cohorts had undergone one-step and two-step skin grafting, respectively. Patients in the third cohort underwent secondary intention healing without skin grafting. The results revealed that the factors associated with wound-healing time included a defect size of >1800 mm2, in addition to two-step and split-thickness skin grafting. Therefore, Kaplan-Meier curves were constructed across the three cohorts, based on the data of 37 patients. Nine cases of non-weight-bearing areas and three cases of split-thickness skin grafts were excluded from the original total of 49 patients. The median times from the initial surgery to wound healing were 14.6, 12.0, and 21.9 weeks for the one- and two-step skin grafting and secondary intention healing cohorts, respectively. A statistically significant difference in the treatment time between the skin grafting and secondary intention healing cohorts was observed (p < 0.001) Moreover, a statistically significant difference in the treatment time between the one- and two-step skin grafting cohorts was noted (p = 0.046). Thus, two-step skin grafting after surgical treatment for plantar malignant melanoma may shorten the overall treatment duration by allowing granulation to occur.

The Efficacy of Modified Ilizarov Distraction-Tension Device on Limb Wound Difficult to Cover with Skin Flaps.

Closure of complex limb wounds poses challenges and requires innovative approaches. This research aimed to evaluate the effectiveness of a modified distraction-tension device using Ilizarov external fixation for wound closure in challenging cases. A retrospective analysis was conducted on 43 patients with extremity wounds that were difficult to cover with skin flaps between January 2019 and December 2022. Tension-relieving traction was applied using the Ilizarovexternal fixator apparatus, tailored to individual wound characteristics. Three types of wire-pin connections were used in this study. The distraction begins on the third postoperative day, with a speed of 0.5mm/d. Clinical wound healing scores were evaluated at 5 and 30 days postoperatively. Complications were documented following the Paley classification system. Traction using modified Ilizarovexternal fixation promoted a significant reduction in wound size. The mean traction period was 11.2 ± 7.3 days, and the mean healing duration was 17.0 ± 3.7 days. The clinical wound healing score improved from 3.7 ± 2.9 at 5 days to 1.7 ± 0.7 at 30 days postoperatively (p < 0.05). Complications were minimal, with no significant obstacles or sequelae observed. Direct closure healing was achieved in 21 cases, skin graft healing in 13 cases, and suture healing in 9 cases. No recurrences were reported. Using Paley's classified complications, there were 17 problems, 9 obstacles, and 0 sequelae. The Ilizarov tension-relieving traction shows promise in facilitating wound closure that is challenging to manage with skin flaps. The modified three types of pin-skin connection configuration could satisfy various types of wound closure.

Clinical and radiographic outcomes using standard length of cannulated screws for traditional Latarjet procedure

PurposeThe purpose of this study was to evaluate the clinical and radiographic outcomes of open traditional Latarjet stabilization using 32mm and 30mm long cannulated screws in males and females respectively with a minimum of 2 years’ follow-up. MethodsWe retrospectively reviewed open Latarjet procedures using cannulated screws of standard length with a minimum of 2 years follow-up. Functional evaluation was performed with postoperative Rowe and Walch score, visual analogue scale for pain (VAS) and return to sport. Graft healing was assessed with CT scans at 4 to 6 months postoperatively. Patients were divided into 2 groups according to postoperative radiographic measurements: a bicortical or unicortical screw groups. The α angle between the shaft of the screw and the glenoid subchondral bone was measured for superior and inferior screws. Level of significance was 0.05. The post hoc power analysis was 0.89. ResultsA total of 69 patients met the criteria for inclusion. Of these patients, 60 (87%) were available for final follow-up (n =62 shoulders), with a mean age of 28.4 ±9.5 years (range, 16-55 years) at time of surgery. 56 males (93.3%) and 4 females (6.7%) were included. The mean final follow-up period was a mean of 38 months after the procedure (range, 25-48 months). 8 out 60 patients (13.3%) had persistent apprehension in abduction–external rotation position. One patient (1.7%) had a recurrence of shoulder subluxation. The mean Walch-Duplay score was 90±11.6 points (range, 40-100 points), and the mean Rowe score was 93.4±11 points (range, 50-100 points). The mean VAS score for the evaluation of pain was 0.9±1.3 (range, 0-4). The coracoid healed the glenoid neck in 87.1% (54/62) of the shoulders on the postoperative CT scan. Lower alpha angle for inferior and superior screws had more rate of unicortical fixation (P=0.05 and P=0.04, respectively). 14 out 62 (22.6%) shoulders were found unicortical screws. Six bicortical cases and 2 cases unicortical screws (25%) showed nonunion (p=0.86). There were 2 complications, one patient had hematoma that required drainage, one case had transient axillary nerve palsy which resolved spontaneously. No complications associated with the hardware were found. ConclusionOpen traditional Latarjet procedure using 32 mm and 30mm long cannulated screws in male and females respectively, provided good outcomes with acceptable complication rates. Unicortical screws fixation does not have a higher rate of non-union than bicortical screws.

Exploring the efficacy of negative pressure wound therapy in the management of mycobacterium ulcerans wounds: a comprehensive literature review

Mycobacterium ulcerans (M Ulcerans) infection leads to the debilitating Buruli ulcer (BU), characterized by necrotizing skin and soft tissue lesions. Conventional treatment primarily focuses on an antibiotic regimen, but wound management remains paramount to patient recovery. This literature review aims to evaluate the efficacy and benefits of Vacuum Assisted Dressing (VAC) in the treatment and management of BU wounds. A systematic literature search was undertaken using databases such as PubMed, Cinahl, Cochrane database, Joanna Briggs Institute, Medline, Internurse, Nursing &amp; Allied Health database, and Scopus search from January 1995 to December 2023. The key search terms included “Mycobacterium ulcerans”, OR “Buruli ulcer”, AND “vacuum assisted dressing”, “vacuum assisted therapy”, “Vacuum Assisted Dressing”, “negative pressure wound therapy”, and “Negative Pressure Wound Therapy (NPWT)”. The exclusion criteria were animal studies and studies not in the English language. The current literature emphasizes the importance of antibiotic treatment for BU and highlights the skin and soft tissue damage that results in open, infected wounds. However, there is a notable lack of quantitative data on the efficacy of NPWT for treating BU wounds. Early evidence indicates that NPWT might accelerate wound healing, decrease secondary infections, and enhance wound bed readiness for grafting or secondary healing. While more comprehensive quantitative studies are warranted, NPWT emerges as a promising adjunctive therapy in the holistic management of BU wounds, offering benefits that may improve patient outcomes and reduce morbidity.

Management of patellar and trochlear cartilage lesions with matrix-induced autologous chondrocyte implantation in conjunction with patellofemoral realignment procedures improves patient-reported outcomes and magnetic resonance image appearance

ObjectivesThe aim of this study is to evaluate the relationship between the achievement of clinically significant improvement in patient-reported outcome measures (PROMs) and the postoperative magnetic resonance image (MRI) appearance of matrix-associated chondrocyte implantation (MACI), in conjunction with patellofemoral realignment procedures, for the treatment of grade-IV chondral defects about the patellofemoral joint. MethodsA retrospective review of patients undergoing MACI for grade-IV chondral defects of the patella or trochlea by a single sports-medicine-fellowship-trained surgeon from 2017 to 2020 was performed. Concomitant realignment procedures, including tibial tubercle osteotomy and medial patellofemoral ligament reconstruction, were also performed as needed. Patients with preoperative and minimum 1-year postoperative PROMs and postoperative knee MRI were included. MRI scans were obtained at 6.3 (interquartile range: 5.8, 7.5) months postoperatively. A fellowship-trained musculoskeletal radiologist assigned a Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score (range: 0–100, with 100 equating to complete graft healing) to each MRI. Achievement of the minimal clinically important difference (MCID) for International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Score—Quality of Life, and Kujala scores were determined for each patient. Paired t-tests or Wilcoxon rank-sum tests were used to evaluate for an association between achievement of the MCID for each PROM and MOCART score. The average follow-up time and time from surgery to PROMs were 2.7 ​± ​1.5 years and 1.7 ​± ​0.66 years, respectively. ResultsThirty patients were included. There was a significant improvement in all PROMs from preoperative to postoperative (p ​< ​0.001). More than two-thirds of patients achieved the MCID for each PROM. Patients who achieved the MCID for IKDC had significantly higher MOCART scores (66.5 ​± ​16.2) than those who did not meet the MCID for IKDC (50.6 ​± ​23.6, p ​= ​0.043). ConclusionMACI for the treatment of patellofemoral chondral injuries is associated with clinically significant improvement in PROMs at short-term follow-up. Clinically significant improvements in IKDC scores are associated with a more mature MRI appearance of the autologous chondrocyte implantation graft on postoperative MRI, as indicated by higher MOCART scores. Level of evidenceIV—Case Series.

Optimization of cassava (Manihot esculenta Crantz) grafting technique to enhance its adoption in cassava cultivation

Grafting techniques have been successfully adopted to improve resistance to biotic and abiotic stresses, increase yields, fruit quality and study systemic signaling in plants. This technique has not been fully explored in cassava and there is currently no standardized grafting method for this species published especially in Africa. This is the first report on cassava grafting protocol in Africa with valuable advantages including utilizing a cost-effective and environmentally friendly wooden healing chamber. In this study, we describe an optimized cleft grafting protocol for cassava utilizing a wooden healing chamber and outline the step-by-step procedure with optimum conditions to generate a high grafting success rate. Using a top wedge grafting technique with high reproducibility and success rates, we developed a straightforward and robust grafting protocol for cassava (M. esculenta) cultivars. Grafting success was recorded and this protocol produced a high grafting success of 90 % and its reproducibility makes it suitable for mass production thereby addressing the need for efficient cassava propagation. This grafting protocol requires less specialized equipment and expertise making it more accessible to farmers and researchers with limited resources to promote the use of grafting for cassava growth, yield improvement and advanced studies such as systemic long-distance signaling in plants.•Optimization of cleft grafting method obtains a high success grafting rate of cassava.•A wooden healing chamber provides a controlled environment for graft healing.•Promoting cassava grafting; a priority to produce new cultivars and explore breeding research prospects.

Iliac crest vertical block grafts -placing outside or inside the bone contour: A cohort study.

Challenging defect configurations and dimensions arise from severe, localized vertical alveolar ridge defects caused by trauma or prior surgery. This study aims to analyze three-dimensional bone gain, assess marginal bone stability in such defect configurations, and evaluate the impact of grafting outside the bone contour on the overall outcome, with a focus on iliac crest block grafts as a valid treatment option. The prospective cohort study evaluated patients who required vertical block grafting due to localized bone defects in the maxilla or mandible and who had received iliac grafts. Three-dimensional bone gain was analyzed using cone beam computed tomography (CBCT) after 3 months of bone healing for each treated site and implant position. A comparison between bone grafts inside and outside the bone contour was conducted. Marginal bone stability was measured using intraoral radiographs during routine annual follow-up visits. Seventy patients with 89 treated sites were evaluated. After 3 months of graft healing, the mean vertical bone gain was 11.03 ± 3.54 mm, the mean horizontal bone gain was 7.18 ± 2.00 mm, and the mean graft length was 28.19 ± 11.01 mm. A total of 217 implants were placed in the augmented regions. On implant level, a mean vertical bone gain of 10.44 ± 3.44 mm and a mean horizontal bone gain of 6.54 ± 1.86 mm were measured. Over a 43-month observation period, mesial and distal marginal bone loss averaged 0.44 ± 0.92 mm and 0.49 ± 1.05 mm, respectively. Eight implants were diagnosed with periimplantitis, resulting in the loss of four implants, while no early implant losses were reported. Within the limitations of this study, vertical bone grafts with iliac crest block grafts were found to be a dependable treatment option for dental implant placement, and placing block grafts outside the bone contour did not lead to inferior outcomes.

A Comparative Analysis of the Advances in Stem Cell Therapy in Plastic Surgery: A Systematic Review of Current Applications and Future Directions.

Stem cell (SC) therapy is revolutionizing the field of plastic surgery by harnessing the regenerative abilities of SCs derived from adipose tissue and bone marrow to boost tissue repair and enhance aesthetic outcomes. This groundbreaking method enhances results in procedures such as fat grafting, facial rejuvenation, and wound healing. As studies advance, SC therapy shows potential for more sophisticated uses in both reconstructive and cosmetic surgery. The objective of this review is to comprehensively examine the advances in SC therapy within the field of plastic surgery, highlighting its current applications and exploring future directions. The systematic review was conducted on SC therapy in plastic surgery adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and specific search criteria. This systematic review highlights these main outcomes, and SC therapy in plastic surgery enhances tissue repair and aesthetic outcomes by utilizing mesenchymal SCs such as adipose-derived SCs (ADSCs) and bone marrow-derived SCs (BMSCs), with platelet-rich plasma (PRP) providing additional support. Techniques such as scaffolds and cellular reprogramming are employed to guide SC growth, enabling tailored tissue engineering for complex regenerative procedures. This innovative approach accelerates healing, reduces scarring in reconstructive surgeries, improves skin texture, and ensures the natural integration of treated areas, ultimately yielding enhanced aesthetic results and transforming facial rejuvenation processes. SC therapy in plastic surgery holds great promise, but challenges such as protocol standardization, cost, and regulations still need to be addressed. SC therapy is leading innovative advancements in plastic surgery, offering superior outcomes and improved quality of life for patients. Interestingly, the future of plastic surgery is focused on integrating SC therapy for personalized and transformative treatments. Furthermore, interdisciplinary collaboration among bioengineers, clinicians, and regulatory bodies is essential for overcoming challenges and advancing SC research into clinical practice.

Wound healing induced by new synthetic peptide, A7-1, in C57BL/6 mouse model

The effects of the novel synthetic peptide, A7-1, on wound healing and skin grafts were evaluated in a C57BL/6 mouse model. Two 15-mm wide circular skin excisions were made on the backs of mice and to each excision, 100 µM A7-1 or normal saline was applied daily. The treatments were applied and sutured for skin graft analysis. Digital photos were acquired on days 4, 7, 11, and 14 and fluorescein angiography was conducted. Wound sizes were verified using stereoscopic microscopy. Histological analysis was performed via hematoxylin and eosin staining and Masson’s trichrome staining. Western blotting was performed using vascular endothelial growth factor. Using a stereoscopic microscope, significantly faster wound healing (17.3%) and skin graft healing (16.5%) were observed in the A7-1 treatment group in comparison to that of the control. The angiogenesis was significantly faster in fluorescein angiography examination in wound healing (11%) and skin grafts (15%). However, the average completion of epithelization (overall time for wound healing), did not show any significant differences. In comparison to the control, the new protein, A7-1, led to significantly faster wound healing in the initial angiogenesis.

A New Tissue Engineering Strategy to Promote Tendon-bone Healing: Regulation of Osteogenic and Chondrogenic Differentiation of Tendon-derived Stem Cells.

In the field of sports medicine, repair surgery for anterior cruciate ligament (ACL) and rotator cuff (RC) injuries are remarkably common. Despite the availability of relatively effective treatment modalities, outcomes often fall short of expectations. This comprehensive review aims to thoroughly examine current strategies employed to promote tendon-bone healing and analyze pertinent preclinical and clinical research. Amidst ongoing investigations, tendon-derived stem cells (TDSCs), which have comparatively limited prior exploration, have garnered increasing attention in the context of tendon-bone healing, emerging as a promising cell type for regenerative therapies. This review article delves into the potential of combining TDSCs with tissue engineering methods, with ACL reconstruction as the main focus. It comprehensively reviews relevant research on ACL and RC healing to address the issues of graft healing and bone tunnel integration. To optimize tendon-bone healing outcomes, our emphasis lies in not only reconstructing the original microstructure of the tendon-bone interface but also achieving proper bone tunnel integration, encompassing both cartilage and bone formation. In this endeavor, we thoroughly analyze the transcriptional and molecular regulatory variables governing TDSCs differentiation, incorporating a retrospective analysis utilizing single-cell sequencing, with the aim of unearthing relevant signaling pathways and processes. By presenting a novel strategy rooted in TDSCs-driven osteogenic and chondrogenic differentiation for tendon-bone healing, this study paves the way for potential future research avenues and promising therapeutic applications. It is anticipated that the findings herein will contribute to advancing the field of tendon-bone healing and foster the exploration of TDSCs as a viable option for regenerative therapies in the future.

Poster 327: Postoperative Physical Activity in the Setting of Delayed ACL Reconstruction is Associated with Increased Local and Systemic Immune Responses in Mice

Objectives: The local and systemic immune responses to anterior cruciate ligament (ACL) injury and ACL reconstruction likely have substantial effects on graft-to-bone healing and patient recovery; however, the immune cell profile following ACL injury and reconstruction has not been well-characterized. The primary aim of the study was to evaluate the local and systemic immune response to ACL injury and reconstruction using a murine ACL reconstruction model. The secondary aim of the study was to evaluate the impact of postoperative physical activity on the immune cell profile. Methods: Following IACUC approval (IACUC approval number: 2019-0034), fifty-five 11-week-old male C57BL/6 mice were randomized to one of 3 groups: (1) closed ACL rupture only (“closed” group, n = 15), (2) closed ACL rupture followed by immediate ACL reconstruction (“immediate” group, n = 19), or (3) closed ACL rupture followed by delayed ACL reconstruction at 7-days post-injury (“delayed” group, n = 15). Thirty-three of the mice were sacrificed at 10 days post-injury or post-surgery, 16 of the mice were sacrificed at 3 days, and 6 mice were sacrificed as uninjured controls. For the group of mice sacrificed at 10 days, half of the mice underwent 1 week of daily treadmill running for 40 minutes (n = 6 in the immediate group, n = 6 in the delayed group, and n = 6 in the closed group), with the other half remaining as a free cage activity group (n = 6 in the immediate group, n = 6 in the delayed group, and n = 3 in the closed group). Draining ipsilateral iliac lymph nodes (iLN) to assess local immune responses and spleens to assess systemic responses were harvested and processed for flow cytometry. Unpaired, two-tailed t-tests were used to evaluate for differences in total lymph node cellularity between groups. In addition, the OsteoArthritis Research Society International (OARSI) scoring system was used to evaluate the degree of articular cartilage degeneration in each mouse. Results: Compared to uninjured normal mice, mice undergoing closed ACL rupture with or without ACL reconstruction had increased total iLN cellularity. The greatest increase in cellularity (over 8-fold) was observed in the 10-day immediate ACL reconstruction group with postoperative physical activity having little effect. There was a similarly large increase in cellularity in the 10-day delayed group only observed in mice that underwent daily treadmill running (Figure 1, p &lt; 0.001). These differences were reflected in the absolute B cell and CD4+, CD8+, and T regulatory cell counts. Monocyte, macrophage, resident dendritic cell (DC), migratory DC, and neutrophil counts also mirrored this trend. In contrast, differentiated plasma cells (PCs) were increased only in the treadmill running groups regardless of surgical timing. Compared to normal uninjured mice, total spleen cellularity was increased only in 10-day immediate, and 10-day delayed running groups. Splenic monocyte and neutrophil counts were increased in these groups as well. The B/T cell ratio was elevated in only the 3-day groups. Conclusions: Postoperative physical activity in the setting of delayed ACL reconstruction is associated with increased local and systemic immune responses, reflecting either increased inflammation to clear the site of injury or an aberrant, prolonged inflammatory response. Postoperative physical activity played a smaller role in the setting of immediate ACL reconstruction. We hypothesize that excessive physical activity may delay or prevent resolution of the post-injury inflammatory process. The greater increase in immune response in the delayed ACL reconstruction group may be due to further stimulation of inflammation secondary to knee instability following the ACL injury. While inflammation is part of the normal response to injury, unresolved or excessive inflammation may impair graft healing due to stimulation of fibrosis and may also contribute to the development of PTOA. Our ongoing histologic, gene expression, and biomechanical studies will provide further insight into the biological relevance of such immune responses.

Topical Application of Robusta Coffee Extract Gel Enhances Angiogenesis, Fibroblast, Collagen Density, and Epithelial Thickness on Wound Healing of Skin Graft in Rats

Topical Application of Robusta Coffee Extract Gel Enhances Angiogenesis, Fibroblast, Collagen Density, and Epithelial Thickness on Wound Healing of Skin Graft in Rats