Graft Group Research Articles

The best position of bone grafts in the medial open-wedge high tibial osteotomy: A finite element analysis

Background and objectiveThe application of wedge-shaped bone grafts can increase the biomechanical stability of knee during the medial open-wedge high tibial osteotomy (MOWHTO) by reducing the von Mises stress of the medial plate and lateral cortical hinge area. However, the optimal position of bone grafts it remains unclear, so we aimed to determine search for the optimal position of the bone grafts in MOWHTO by using finite element analysis. MethodsIn the finite element analysis, MOWHTO models were established with three different osteotomy distraction heights and assembled into four groups according to different conditions, including the no bone grafts (NBG) group, the anterior bone grafts (ABG) group, the middle bone grafts (MBG) group, and the posterior bone grafts (PBG) group. Based on previous studies, 600 N and 1800 N loads were applied to the knee joint to simulate the static forces during a double and single leg stance to measure the von Mises stress of the medial implant area and lateral hinge area, the maximum displacement of different models, the relative displacement of the osteotomy area and the stress distribution in the bone grafts. ResultsCompared to the NBG and ABG groups, the stress of the lateral cortical hinge area and the medial implate area was significantly lower in the PBG group. For example, under the 600N force load, when the height of the osteotomy area was 10 mm, 15 mm, and 20 mm, the maximum von Mises stress of the medial implate area and lateral cortical hinge area in the NBG group were 140, 141, 172, and 53, 57, 60 MPa, respectively. Compared with the NBG group, the maximum von Mises stress of the medial implate area and lateral cortical hinge area in the PBG group were reduced by 45%, 56%, 63% and 14%, 39%, 68% at distraction height of 10 mm, 15 mm, and 20 mm, respectively. The bone grafts in the posterior parts provide the best stability,with the stress of the middle and posterior bone grafts are mainly concentrated in the edge. ConclusionsThe posterior part of the osteotomy area is the best position for bone graft placement since it provides optimal stability and reduces von Mises stress in the medial plate and lateral cortex hinge area, with the stress of the posterior bone grafts mainly concentrated in the edge. These findings guide bone graft placement sites in clinical surgery and are a basis for future research on bone graft materials and structures in MOWHTO.

Comparison of Hematopoietic Stem Cell Transplantation and Immunosuppressive Therapy for Patients with Severe Hepatitis-Associated Aplastic Anemia

Background：Hepatitis-associated aplastic anemia (HAAA) is known as a rare variant of acquired aplastic anemia, characterized by a syndrome of bone marrow failure following the development of hepatitis. Immunosuppressive therapy (IST) or hematopoietic stem cell transplantation (HSCT) could provide lifesaving opportunities for severe HAAA patients. However, to date, no cohort has characterized treatment outcome and long-term survival between those patients receiving IST and HSCT. In this study, we aim to retrospectively evaluate the outcome of these two therapies for severe HAAA in China. Methods: Patients consecutively diagnosed as severe HAAA between August 2008 and Jan 2021 were enrolled in this study. The definition of severe HAAA is that severe aplastic anemia developed within three months after documented hepatitis. The enrollments were patients who received HSCT or IST as a first-line treatment. Patients with HSCT were conditioned as described previously with cyclophosphamide (Cy, 120-150 mg/kg, divided doses on days -6 to -2), and rabbit ATG (Thymoglobulin®, Genzyme, Cambridge, MA) (2.5mg/kg once i.v. daily on days -6 to -2) or p-ALG (Anti-lymphocyte Immunoglobulin®, Wuhan Institute of Biological Products Co., Ltd., China) (20mg/kg once i.v. daily on days -6 to -2), Fludarabine 150 mg/m2 i.v.in divided doses on days -6 to -2, with or without Busulfan (Bu, 0.8 mg/kg four times i.v. daily on days -7 and -6). IST consisted of both rabbit ATG (rATG) (3~3.75mg/kg once i.v. daily on 5 days), porcine antilymphocyte globulin (pALG)(20mg/kg once i.v. daily on 5 days), combined with a six-month course of cyclosporine (3mg per kilogram per day orally, with adjustment of the dose to maintain a blood level between 200 and 400 ng per milliliter). Probabilities of overall survival (OS), failure-free survival (FFS), and treatment-related-mortality (TRM) were calculated by Kaplan-Meier method. Results and Discussion: This study retrospectively included 94 consecutive HAAA patients, including 68 patients underwent HSCT and 26 patients receiving IST. The IST and HSCT groups were similar with respect to age and gender ratio. The median follow up were 1752 (±153.62, 95%CI 1450.90~2053.10) days, and 2648 (±321.41, 95%CI 2018.05-3277.96) days among alive patients in the IST and HSCT group, respectively. In HSCT group, all patients achieved neutrophil engraftment. No primary or secondary graft failures (GF) was documented. Compared with patients receiving alternative donor HSCT (n=11), patients in matched sibling donor HSCT (MSD-HSCT) group (n=15) had a significant lower cumulative incidence of acute graft versus host disease (aGVHD) (20±10.33% vs 56.4±15.47%, p=0.048), and lower incidence of cytomegalovirus (CMV) reactivation group (72.73% vs 13.33%, p=0.004). No clinical significance of chronic graft versus host disease (cGVHD) incidence group (43.4±18.85% vs 50±35.4%, p=0.78) and bacterial/fungus infection (26.67% vs 36.36%, p=0.683) was found between MSD-HSCT group and alternative donor-HSCT. Attributable causes of death were pneumonias and severe infection in patients receiving HSCT. In IST group, the hematology response rate to treatment evaluated at 3m, 6m and 12m was 27.68%, 52.94%, and 60.23%, respectively. There were thirteen patients were non-evaluable, including six patients transferred to perform HSCT, two patients were diagnosed MDS/AML transformation and one patient relapsed. The 5-year overall survival (OS) and failure-free survival (FFS) rate was 85.5±4.44% (95% CI, 0.772, 0.946) and 69.6± 5.35% (95% CI, 0.599,0.809) of all enrolled HAAA patients, respectively (Figure 1). For patients receiving different therapy, the 5-year OS rates were 92.86 ± 6.88% in MSD-HSCT group, 72.7± 13.43% in alternative donor-HSCT, and 84.1 ± 7.28% in the IST group (P = 0.56). Otherwise, the 5-year estimated FFS rate was 56.0± 11.51% in the IST group, compared with 92.86 ± 6.88% in the MSD-HSCT group and 72.7± 13.43% in alternative donor-HSCT group (P = 0.10). The cumulative incidence of treatment-related-mortality (TRM) of MSD-HSCT, alternative-HSCT and IST was 7.1±6.9% (95% CI, 80.30-100), 27.3±13.4% (95% CI, 50.60-100), 14±5.54% % (95% CI, 7.58-97.6) (p=0.22), respectively. Even there was no difference between the HSCT and IST groups in OS, MSD-HSCT group still showed superior FFS. Patients receiving alternative donor HSCT, and IST showed comparable OS and FFS. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Haploidentical Stem Cell Transplantation Had a Lower Incidence of Bronchiolitis Obliterans Syndrome Compared with HLA-Matched Sibling Transplantation for Patients with Hematologic Malignancies: Benefit from ATG?

Background: Haploidenticalstem cell transplantation(HID-SCT) based on antithymocyte globulin (ATG) GVHD prophylaxis had achieved similar incidence of cGVHD with HLA-matched sibling transplantation (MSD-SCT). However, bronchiolitis obliterans syndrome (BOS) serve as pulmonary cGVDH, was rarely compared between HID and MSD transplantation. Methods: One thousand four hundred and five patients with hematologic malignancies underwent SCT were enrolled in this retrospective study. Based on donor type, we divided the patients into three groups: HID, MSD and MUD (match unrelated donor) groups. All patients in HID and MUD group received ATG for GVHD prophylaxis, and the minority of patients in MSD group because of clinical trials. The vast majority of HID-SCT recipients transplanted with mixed grafts (bone marrow plus peripheral blood stem cell), whereas most MSD-SCT and all MUD-SCT recipients received PBSC (peripheral blood stem cell) grafts. The cumulative incidences and risk factors of BOS were analyzed. Results: The 5-year cumulative incidence of BOS was 7.2% in the whole population. HID transplantation had lower 5-year cumulative incidence of BOS than MSD transplantation (4.1% vs 10.0%; p<0.001), and the similar incidence with MUD transplantation (4.1% vs 6.2%; p=0.224). The 5-year cumulative incidence of BOS was lower in ATG group than that in non-ATG group in the whole and MSD population both (4.6% vs 11.2%; p<0.001; and 4.1% vs 11.2%; p=0.042, respectively). The 5-year incidence of BOS in mixed grafts group was also lower than that in PBSC group (4.2% vs 9.1; p=0.001). Multivariate analysis showed that HID, ATG and mixed grafts were protective factors for BOS (OR 0.3; 95%CI, 0.2 to 0.6; p<0.001; OR 0.3; 95%CI, 0.2 to 0.7; p=0.001; OR 0.3; 95%CI, 0.1 to 0.8; p=0.013), and aGVHD and cGVHD were independent risk factors for BOS (OR 2.1; 95%, 1.1 to 4.3; p= 0.035; OR 10.1; 95%CI, 4.0 to 25.0; p<0.001). Conclusions: HID transplantation had a lower incidence of BOS than MSD transplantation, which might be associated with ATG and mixed grafts. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Comparison of Graft Materials in Multilayer Reconstruction with Nasoseptal Flap for High-Flow CSF Leak during Endoscopic Skull Base Surgery.

Cerebrospinal fluid (CSF) leak is a crucial complication after endoscopic skull base surgery. Therefore, multilayer reconstruction with grafts is as essential as a reconstruction with pedicled flaps. Although widely used, the multilayer technique with autologous fascia lata has drawbacks, such as additional wound and donor site complications. We compared acellular dermal graft and banked homologous fascia lata graft (alternative grafts) with autologous fascia lata graft for high-flow CSF leak repair. We retrospectively enrolled 193 subjects who underwent endoscopic skull base reconstruction with multilayer fascial grafts and nasoseptal flap for high-flow CSF leaks from November 2014 to February 2020 at a single institution. Acellular dermal matrix (ADM), banked homologous fascia lata, and autologous fascia lata were used in 48 (24.9%), 102 (52.8%), and 43 (22.3%) patients, respectively. Postoperative CSF leaks occurred in 23 (11.9%) patients and meningitis in 8 (4.1%). There was no significant difference in postoperative CSF leak (p = 0.36) and meningitis (p = 0.17) across the graft groups. Additionally, we could not find out contributing risk factors for postoperative CSF leak and meningitis. ADM and banked homologous fascia lata are non-inferior to autologous fascia lata for endoscopic skull base reconstruction in water-tight reconstruction or safety without additional donor site morbidities.

Enhanced osteogenesis by addition of cancellous bone chips at xenogenic bone augmentation: In vitro and in vivo experiments.

To investigate and compare the influence of deproteinized bovine bone mineral (DBBM) combined with autologous cortical (CorBC) or cancellous bone chips (CanBC) as bone grafts on guided bone regeneration (GBR) in vivo and in vitro. Defects were created in the mandibular buccal alveolar ridges in dogs and randomly filled with 3 groups of bone grafts: DBBM, DBBM + CorBC, or DBBM + CanBC. Osteogenesis was evaluated by sequential fluorescent labeling and histological analysis. Moreover, rat bilateral calvaria defects were randomly grafted with DBBM, DBBM + CorBC, or DBBM + CanBC. A blank group was included as control. Defect healing was assessed by histological staining, micro-CT, and quantitative polymerase chain reaction. In vitro migration, proliferation, and osteogenic differentiation assays were performed by stimulating rat bone marrow mesenchymal stem cells (rBMSCs) with cortical (CorBCM) or cancellous bone conditioned medium (CanBCM) to unveil the cellular mechanism. In the canine model, the augmented sites of DBBM + CanBC exhibited higher mineralized tissue proportion than the other two groups (DBBM: 0.61 ± 0.03 versus DBBM + CorBC: 0.69 ± 0.07 versus DBBM + CanBC: 0.86 ± 0.06; p < .05). In the rat model, the BV/TV value of DBBM + CanBC (0.51 ± 0.01) was higher than those of DBBM + CorBC (0.41 ± 0.02), DBBM (0.31 ± 0.01), and Control (0.10 ± 0.01; p < .01). Further radiological, histological and transcriptional results showed similar trends. In vitro experiments revealed that CorBCM and especially CanBCM could enhance rBMSCs migration, proliferation, and osteogenic differentiation. In vivo and in vitro experiments verified favorable synergistic effect of mixing autologous bone chips with DBBM on osteogenesis. Furthermore, CanBC presented more powerful osteogenic effect than CorBC.

Evaluation of Omega-3 piscine acellular dermal matrix membrane as a soft tissue alternative for the treatment of mucogingival defects.

The natural Omega-3 lipids in the OADM serve to reduce inflammation. Preliminary results in a human model reported no adverse events and favorable healing and esthetic outcomes. The primary objective of this animal model study was to histologically evaluate the use of Omega-3 piscine acellular dermal matrix (OADM) as a soft tissue alternative in surgically created mucogingival defects. Bilateral maxillary canines in 6 adult beagle dogs were randomly assigned to the test (OADM) and control sub-epithelial connective tissue graft (SCTG) groups. Dehiscence defects 4 × 6 mm were created surgically on the buccal surfaces. The OADM/SCTG were placed to completely cover the root surface to the level of the cemento-enamel junction and sutured with resorbable sling sutures. The gingival flap was repositioned to cover the grafts. At two months follow-up, the dogs were sacrificed, and block samples were retrieved, including the whole canine and periodontium. The histological outcomes were evaluated using qualitative analysis. The qualitative histological analysis revealed the oral, sulcular and junctional epithelium had healed with normal appearance on both test and control sites. None of the test (OADM) samples presented with any foreign body reaction. The use of this new piscine xenograft resulted in minimal complications and the attachment apparatus healed normally.

Dual Dural Patch Graft With AlloDerm and DuraGen Underlay for Duraplasty in Chiari Malformation Results in Significantly Decreased Cerebrospinal Fluid Leak Complications.

Grafts available for posterior fossa dural reconstruction after Chiari decompression surgery include synthetic, xenograft, allograft, and autograft materials. The reported rates of postoperative pseudomeningocele and cerebrospinal fluid leak vary, but so far, no dural patch material or technique has sufficiently eliminated these problems. To compare the incidence of graft-related complications after posterior fossa surgery using AlloDerm alone vs AlloDerm with a DuraGen underlay. We performed a retrospective single-center study of a cohort of 106 patients who underwent Chiari decompression surgery by a single surgeon from 2014 through 2021. Age, sex, body mass index, tonsillar descent, syrinx formation, type of dural graft, and follow-up data were analyzed using univariate and χ2 statistical tests. The AlloDerm-only group had a percutaneous cerebrospinal fluid (CSF) leak rate of 8.6% vs a 0% rate in the dual graft group (P = .037). At initial follow-up, there was a 15.5% combined rate of pseudomeningocele formation plus CSF leak in the AlloDerm-only group vs 18.8% in the AlloDerm + DuraGen group (P = .659). However, the pseudomeningoceles were larger in the AlloDerm-only cohort (45.5 vs 22.4 mm anteroposterior plane, P = .004), and 5 patients in this group required operative repair (56%). All pseudomeningoceles resolved without reoperation in the AlloDerm + DuraGen group (P = .003). The use of a DuraGen underlay with a sutured AlloDerm dural patch resulted in significantly fewer CSF-related complications and eliminated the need for reoperation compared with AlloDerm alone. This single-center study provides evidence that buttressing posterior fossa dural grafts with a DuraGen underlay may decrease the risk of postoperative complications.

Condensing of Low-Density Fat by Mechanical Process Improves Fat Retention and Reduces Oil Cyst Formation in Breast Reconstruction.

Although autologous fat grafting is a useful adjunct for breast reconstruction, its indications remain limited as large-volume fat grafting results in high absorption and complication rates. Low-density fat includes small numbers of viable cells and considerable oil, resulting in nodules and oil cysts. This study evaluated the volumization effect and complications with combined fat grafting of condense low-density fat and high-density fat. This retrospective, single-center study included 25 patients who underwent combined grafting of condensed low-density fat and high-density fat (CLDF + HDF) and 20 patients who underwent conventional Coleman fat grafting for breast reconstruction from December 2017 to January 2022. Retention rates and complications were evaluated by magnetic resonance imaging and ultrasound rates. Patient satisfaction was evaluated using a typical Likert scale. Photographs were taken and imageological examinations were performed before and after treatment. Graft retention rate was higher in patients who underwent CLDF + HDF than Coleman fat grafting for breast reconstruction (38.40 ± 4.41% vs. 31.43 ± 5.43%, p <0.05). One patient in the CLDF + HDF grafting group, compared with twelve in the Coleman fat grafting group, developed oil cysts exceeding 1 cm. Patient satisfaction rate was higher in the CLDF + HDF grafting group. Mechanical processes can concentrate the cellular content of LDF and remove oil, condensing LDF to the level of HDF. Combined grafting of CLDF optimized by mechanical processing and HDF is effective for breast reconstruction, with a higher retention rate and a lower incidence of complications than conventional Coleman fat grafting. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Duraplasty with autologous nuchal ligament fascia to reduce postoperative complications in pediatric patients undergoing neoplasia resection with a suboccipital midline approach.

The authors sought to explore the safety and efficacy of an autologous nuchal ligament for dural repair in pediatric patients undergoing tumor resection through a suboccipital midline approach. Pediatric patients diagnosed with posterior fossa neoplasia who underwent surgery through a suboccipital midline approach were retrospectively reviewed. The patients were divided into artificial graft and autograft groups according to whether artificial duraplasty material or autologous nuchal ligament was used to repair the dura. Postoperative complications were reviewed and analyzed, including CSF leak, pseudomeningocele, and meningitis, during hospitalization and follow-up. Univariate and multivariate logistic regression analyses were used to investigate the relationship between duraplasty material and postoperative complications, as well as other risk factors for postoperative complications. Furthermore, multinomial logistic regression analysis was used to clarify which postoperative complications the autologous nuchal ligament tended to reduce. This retrospective study included 66 pediatric patients who underwent tumor resection through a suboccipital midline approach. The clinical baseline characteristics were comparable between the two groups. The results showed that the autograft group had significantly fewer postoperative complications, especially pseudomeningocele, compared with the artificial graft group. Moreover, the time required to repair the dura in the autograft group was significantly less than that in the artificial graft group. Further results revealed that the duraplasty material, ependymoma, preoperative severe hydrocephalus requiring an external ventricular drain (EVD), and postoperative hydrocephalus exacerbation were independent risk factors for postoperative complications. In particular, the autologous fascia of the nuchal ligament tended to reduce pseudomeningocele more than CSF leak and meningitis. However, compared with pseudomeningocele and CSF leak, both ependymoma and postoperative hydrocephalus exacerbation were more likely to increase the occurrence of meningitis. In contrast, preoperative severe hydrocephalus requiring EVD led to increased rates of postoperative complications. For pediatric patients with intracranial tumors who need to undergo resection through a suboccipital midline approach, dural repair using the nuchal ligament is safe, cost-effective, and time saving and significantly reduces postoperative complications.

Preparation of isoelectric point-switchable polymer brush-grafted mesoporous silica using RAFT polymerization with high performance for Ni(II) adsorption

A series of polymer brushes were formed on the surface of mesoporous silica microspheres by copolymerizing 1-vinyl imidazole and acrylic acid through reversible-addition fragmentation chain transfer (RAFT) polymerization, with pI-switchable property and high grafting groups content. The resulting materials (SiO 2 @poly(VI- co -AA)) were then applied for removing Ni(II) from aqueous solution with a fast adsorption rate, and the maximum adsorption capacity was 62.81 mg/g. Significantly, the removal rate of 30 mg/L of Ni(II) could reach up to 99.40%, and the adsorbent also exhibited a good reusability, with the desorption efficiency of over 99%. Furthermore, the adsorption mechanism was supposed to be electrostatic interaction and complexation characterized by Zeta potentials and XPS. It implied that the SiO 2 @poly(VI- co -AA) microspheres could be considered as a potential adsorbent for removing Ni(II) from wastewater, and was expected to expand its application to remove other heavy metals and dyes. • The polymer brush-grafted mesoporous silica was first used for Ni(II) removal. • The SiO 2 @poly(VI-co-AA) microspheres were prepared and characterized. • The adsorbent has good pI-switchable property and high grafting groups content. • The adsorbent shows comparable adsorption capacity and rapid rate. • The adsorbent exhibits a good reusability.

Localized Surface Hydrophilicity Tailoring of Polyimide Film for Flexible Electronics Manufacturing Using an Atmospheric Pressure Ar/H2O Microplasma Jet.

The poor hydrophilicity of polyimide (PI) films limits their applications in flexible electronics, such as in wearable and implantable bio-MEMS devices. In this paper, an atmospheric pressure Ar/H2O microplasma jet (μAPPJ) with a nozzle diameter of 100 μm was utilized to site-selectively tune the surface hydrophilicity of a PI film. The electrical and optical characteristics of the μAPPJ were firstly investigated, and the results showed that multi-spikes occurred during the plasma discharge and that diverse reactive species, such as O atoms and OH radicals, were generated in the plasma plume. The physical and chemical properties of pristine and microplasma-modified PI surfaces were characterized by the water contact angle (WCA), atomic force microscopy (AFM) and X-ray photoelectron spectroscopy (XPS). The wettability of the PI surface was significantly enhanced after microplasma modification, and the WCA could be adjusted by varying the applied voltage, water vapor content, plasma treatment time and storage time. The AFM images indicated that the surface roughness increased after the plasma treatment, which partially contributed to an improvement in the surface hydrophilicity. The XPS results showed a reduction in the C content and an increase in the O content, and abundant hydrophilic polar oxygen-containing functional groups were also grafted onto the PI film surface. Finally, the interaction mechanism between the PI molecular chains and the microplasma is discussed. The breaking of C-N and C-O bonds and the grafting of OH radicals were the key pathways to dominate the reaction process.

Autologous wound margin point columnar full-thickness skin grafting combined with negative pressure wound therapy improves wound healing in refractory diabetic foot ulcers.

Diabetic lower extremity ulcers (DLEUs) are a severe complication of diabetes mellitus (DM) and are difficult to heal. This study aimed to explore the efficacy of autologous point columnar full-thickness skin graft taken from the ulcer wound margin combined with negative pressure wound therapy (NPWT) in refractory DLEUs. This is a prospective cohort study. A total of 40 inpatients with refractory DLEUs were recruited in the Diabetes Foot Center of Guangxi Zhuang Autonomous Region People's Hospital from October 2019 to November 2021. According to the doctors' professional suggestions and the patients' personal wishes, these enrolled patients were divided into two groups based on different topical wound management: the graft group (n=18) and the conventional wound therapeutic (CWT) group (n=22). The efficacy evaluations included the time to complete re-epithelialization of the wound and healing speed within 14 days of graft treatment or after 14 days of graft treatment in the two groups. Before the treatment, the graft group had a significantly larger ulcer area than the CWT group [27.22 (15.28, 46.59) versus 10.92 (7.00, 24.93) cm2 , P < .01]. However, the time to complete wound re-epithelialization in the graft group was shorter than in the CWT group [58.22 ± 30.60 versus 86.09 ± 49.54 d, P < .05]. Meanwhile, the healing speed in graft group was markedly faster than in CWT group, whether within 14 days [0.60 (0.40, 0.92) versus 0.16 (0.07, 0.34) cm2 /d, P < .01] or after 14 days of graft treatment [0.57 (0.45, 0.91) versus 0.13 (0.08, 0.27) cm2 /d, P < .01]. However, the total treatment cost in the graft group was lower than in the CWT group [419.59 ± 137.20 versus 663.97 ± 497.02 $, P < .05]. The novel treatment modality of autologous full-thickness skin graft taken from the ulcer wound margin combined with NPWT has hereby proposed for the first time, and is a safe, effective, and reliable method with a good performance-to-cost ratio to promote wound healing and shorten the healing time for DLEUs.

Orthognathic surgery and fat injection for corrective liposculpture: a systematic review

Introduction: Orthognathic Surgery (OS) aims to correct deformities of the bones of the maxilla and mandible. In this scenario, fat grafting is a powerful tool for corrections and also for facial aesthetic improvement together or after OS. The benefits of fat grafting during orthognathic surgery; to maximize aesthetic results, minimize swelling and optimize wound healing. Objective: To analyze the main clinical studies on the benefits and risks of facial fat grafting in orthognathic surgery, to know the current state of the art. Methods: It followed a systematic literature review model on the main clinical findings of orthognathic surgery and fat grafting, according to the rules of PRISMA. The research was carried out from July to September 2022 and developed based on Google Scholar, Scopus, PubMed, Ovid, Scielo, and Cochrane Library, using scientific articles from 1986 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: 123 studies were analyzed, with only 32 medium and high-quality studies selected, according to GRADE rules, and with risks of bias that do not compromise scientific development, based on the Cochrane instrument. Studies have shown that OS aims to establish harmonious facial esthetics, excellent functional occlusion, and improved airway conditions. As an important adjunct to OS, fat grafting is becoming more and more common due to its antiinflammatory role and effects on facial swelling. High patient satisfaction with the results. Postoperative swelling resolved at week 12 in the fat graft group and persistent edema. The edema decrease over time, with almost complete resolution within 1 year, improvement in facial morphology, function, quality, and skin texture in most of their patients. The use of assisted lipo transfers containing mesenchymal stem cells derived from adipose tissue, enables improvement in skin quality, smoothing of wrinkles, pore size, and attenuation of pigmentation and resolution of scars. Furthermore, enrichment of the lipoaspirate with stem cells derived from adipose tissue increases graft retention. Conclusion: Most of the studies analyzed in this review study showed that fat grafting in orthognathic surgery is a safe and effective tool to improve wound healing, improve aesthetic results, present an anti-inflammatory effect and reduce edema.

Effect of the surface coverage of an alkyl carboxylic acid monolayer on waterborne and cellular uptake behaviors for silicon quantum dots

This article reports the development of highly waterborne silicon quantum dots (Si QDs) terminated with a reactive group for grafting of biomolecules. Hydrogen-terminated QDs were prepared by thermal disproportionation of amorphous hydrogen silsesquioxane derived from triethoxysilane followed by hydrofluoric etching. Next, the hydrogenated Si surfaces were exposed to 10-undecenoic acid at different temperatures in Ar atmosphere, yielding the termination of the QDs with a carboxyl group. The thermal hydrosilylation of 10-undecenoic acid yielded the termination of the QDs with a carboxyl group. An increase in molecular coverage of an undecanoic acid (UA) monolayer resulted in both the enhanced increase of zeta-potential in a negative direction for a greater water-dispersity and the increase of absolute quantum yield (QY) of photoluminescence (PL). PLQY improved for ~ 1% to 26% with increasing UA coverage. We assessed the molecular interaction between the UA-SiQDs and HeLa cells by means of cellular uptake experiments using the QDs with different UA coverages. Results showed that the QDs with the highest dispersity in water were not internalized in the cells under confocal fluorescence microscopic observation. In contrast, the QDs with lower coverage of UA monolayer were internalized by endocytosis when incubated with HeLa cells. This contrasting observation opens the possibility of successfully preparing carboxy-capped SiQDs that do not allow cellular uptake but are targeted to specific cells by appropriate conjugation with biomolecules.

Repair of cerebrospinal fluid leak during posterior thoracolumbar surgery using paraspinal muscle flap combined with fat graft.

ObjectiveThis study aimed to propose a novel surgical method via combination of fat graft and paraspinal muscle flap, in order to treat cerebrospinal fluid (CSF) leak during posterior thoracolumbar surgery. The clinical outcomes were also evaluated.MethodsData of a total of 71 patients who were diagnosed with intraoperative incidental durotomy and CSF leak after posterior thoracolumbar surgery in our hospital form January 2019 to January 2021 were retrospectively collected and analyzed. Among them, 34 and 37 patients were assigned into conventional suturing (CS) group and fat graft and paraspinal muscle flap (FPM) group, respectively. Patients’ demographic and clinical data were compared between the two groups.ResultsThe average drainage tube time in the FPM group was 3.89 ± 1.17 days, which was shorter than that in the CS group (5.12 ± 1.56, P < 0.001). The drainage volume in the FPM group (281.08 ± 284.76 ml) was also smaller than that in the CS group (859.70 ± 553.11 ml, P < 0.001). Besides, 15 (44.11%) patients in the CS group complained of postural headache, which was more than that in the FPM group (7 patients, 18.91%). There was a statistically significant difference in postoperative visual analogue scale (VAS) score between the two groups (P = 0.013). Two patients underwent revision surgery resulting from incision nonunion and delayed meningeal cyst.ConclusionFat graft combined with paraspinal muscle flap showed to be an effective method to repair CSF leak during posterior thoracolumbar surgery. The proposed method significantly reduced postoperative drainage tube time and postoperative drainage volume. It also decreased the incidence and the degree of postural headache. The proposed method showed satisfactory clinical outcomes, and it is worthy of promotion.

Reconstruction of Facial Skin Defects with Flap and Graft Techniques: A Comparative Study

Background: Reconstruction of facial skin defects is challenging. Skin flaps and grafts are well-known techniques for reconstructing these defects. The outcomes of the surgeries can vary depending on the surgical procedures and the patient's characteristics. Objectives: This study aimed to compare the results of reconstructing facial skin defects using skin grafts and flaps in patients referred to Imam Reza Hospital, Birjand, Iran. Methods: This quasi-experimental study was performed on 100 patients with tumors and traumatic lesions in the facial area referred to the plastic surgery service of Imam Reza Hospital, Birjand, Iran. For comparison, the data of 50 patients with skin grafts and 50 patients with flaps who underwent facial skin defect repair surgery were collected. Patients' demographic characteristics were extracted from their hospital records. The final reconstruction results were evaluated based on the presence or absence of aesthetic or functional complications three months after surgery. Results: The mean ages of participants were 64.6±14.0 and 58.3±19.1 in the flap and graft groups, respectively. Women comprised 26 (52%) of the flap and 22 (44%) of the graft groups. The mean size of lesions in the graft group was 21.3±17.3 cm and 4.7±3.9 cm in the flap group (P=0.001). The frequency of aesthetic and functional complications in the flap group was 13 (26%) and 9 (18%), and in the graft group was 24 (48%) and 15 (30%), respectively. The frequency of aesthetic complications in the flap group was significantly lower than that in the graft group (P=0.023). There was no significant difference between the two groups in terms of the frequency of functional complications (P=0.160). The frequency of disease recurrence was not significantly related to surgical technique (P=0.749). Furthermore, the lesion location had a significant association with the surgical technique (P=0.009); however, the number of surgeries had no significant association with the surgical technique (P=0.389). Conclusion: In general, except for when there is an indication for using a method, the reconstruction of facial skin defects using a skin flap will have better results than a skin graft.

The Effectiveness of injectable platelet-rich fibrin and bone graft addition to open flap debridement for infrabony pocket therapy

Various biomaterials have been utilized as additional material to help tissue regeneration in the open flap debridement (OFD) procedure. Platelet-rich fibrin (PRF) is an autologous platelet concentrate that contains many growth factors (GFs) and generally used as an additional biomaterial in OFD. However, PRF has several weaknesses, such as its consistency, which is hard to mix with another biomaterial, and its abundant sediment of regenerative cells resulted from high-speed centrifugation. Injectable Platelet Rich Fibrin (I-PRF) is one of the PRF derivatives that contain more regenerative cells. Due to the low-speed centrifugation, I-PRF has a liquid form. Certain GFs were also found in I-PRF, such as PDGF, TGF-β1, VEGF, IGF, EGF dan COL-Ia. In this study, we measured probing depth (PD), relative attachment level (RAL), and bone height as the healing parameter, to see the effectiveness of I-PRF addition and bone graft in the OFD for infrabony pocket as the aim of this study. Twenty (20) periodontal pockets were chosen (PD= 5-7 mm) and divided into OFD+I-PRF+bone graft (bg) group (group I) and OFD+PRF+bg group (group II) equally. The clinical evaluation was measured at the baseline, day-30, and day-90. Results showed that PD (p= 0.022) and RAL (p= 0.008) significantly increased in group I (PD 2.80 ± 0.42; RAL 2.50 ± 0.52) compared to group II (PD 2.10 ± 0.73; RAL 2.00 ± 0.67); however, there was no significant difference in the bone height (p= 0.194). Taken together, our data revealed that I-PRF+bg induces soft tissue regeneration in infrabony pocket treatment.

Comparison of Iliac Bone Transplantation with Bone Transport in the Treatment of Femur Fracture and Bone Defect.

Objective To compare the curative effect of iliac bone transplantation with the bone transport in the treatment of femur fracture complicated with a bone defect. Methods Patients with femur fractures and defects who were admitted to our hospital from January 1, 2020, to January 31, 2022, and met the inclusion criteria were retrospectively selected and allocated into an iliac bone transplantation group or a bone transport group. The treatment effect and quality of life of the two groups were compared. Results A total of 98 patients who met the inclusion standards were enrolled, including 50 cases in the iliac bone transplantation group and 48 cases in the bone transport group. There were no significant differences in IL-6, IL-8, TNF-α, visual analog scale (VAS) score, or Japanese Orthopedic Association (JOA) score between the two groups on postsurgical day 1 (p=0.051, 0.150, 0.102, 0.564, and 0.826 respectively), but there were significant differences in the above index on postsurgical day 7 (all p < 0.01). There were no significant differences in social function, physical function, role function, and cognitive function between the two groups one week after the operation (p=0.245, 0.051, 0.102, and 0.067, respectively), but there were significant differences in the above parameters at one month after operation (p=0.001, 0.005, 0.005, and 0.001, respectively). The total effective rate of the bone transplantation group was significantly better than that of the iliac bone transplantation group (p=0.026). The number of postoperative complications in the bone removal group was significantly fewer than that of the iliac bone graft group (p=0.001). Conclusion Bone transport is effective in treating femur fractures complicated with bone defects, with fewer postoperative complications.

Ninety-seven cases of experiences with the left thoracotomy approach for off-pump conventional revascularization: a retrospective cohort study.

Minimally invasive coronary surgery-coronary artery bypass grafting (MICS CABG) is well adopted in clinical practice. However, this procedure did not really achieve conventional complete revascularization. The present study aimed to explore the feasibility and safety of conventional revascularization via the left thoracotomy (8-10 cm) approach. From January 2020 to March 2022, a total of 97 consecutive patients who needed coronary artery revascularization were operated on using this technique. The patients' preoperative, intraoperative, postoperative, and follow-up data were collected. Perioperative variables were compared between the single graft and non-single graft groups. All patients received dual-source computerized tomographic angiography at 1-week postoperatively to evaluate the graft patency and detect pulmonary embolism and aortic dissection. The patients were followed up for 3-27 months. The mean age of the entire cohort was 61.5±8.8 years, there were 16 (16.5%) female patients, and 1-4 grafts were performed per patient. There were no conversions to median sternotomy or on-pump CABG. The average number of grafts was 1.9±0.9, and that of the non-single graft group was 2.5±0.6. Among the 97 included patients, one patient in the single graft group suffered from aspiration pneumonia after a stroke and died. The 30-day mortality was 1.0% (one patient), one patient required re-exploration for bleeding (1.1%), and a total of 191 grafts were performed. All grafts were unobstructed except for one graft to the obtuse marginal branch (OM) (0.5%). Follow-up was performed by phone or via outpatient visits and was available for 92 patients (95%). During the follow-up period, 1 (1.1%) patient suffered an acute myocardial infarction and received percutaneous coronary intervention with no redo-surgery. All patients are alive and angina-free. Left thoracotomy for conventional revascularization is a safe procedure for appropriately selected patients, with few early complications and good early and mid-term results. More cases are ongoing and long-term results are in observation.

Long-Term Follow-Up of Hindfoot and Ankle Arthrodesis Procedures Supplemented with an Autologous Bone Graft Alternative (rhPDGF)

Category: Hindfoot; Ankle Introduction/Purpose: Recombinant human platelet-derived growth factor (rhPDGF) is commonly used in hindfoot and ankle arthrodesis as an alternative to autologous bone graft, the current gold standard grafting material. The largest randomized controlled trial ever conducted in foot and ankle arthrodesis showed that rhPDGF was associated with similar successful radiographic and clinical outcomes to those of autologous bone graft at 24 months. The objective of this study was to determine if outcomes remained similar for these two grafting materials at long-term follow-up. Methods: All 37 sites (414 subjects) from the previously conducted randomized controlled trial examining outcomes for hindfoot and ankle arthrodesis supplemented with either rhPDGF or autologous bone graft (randomized 2:1) were invited to return for a single visit occurring at a minimum follow-up of 60 months. All returning subjects who provided consent were evaluated with computed tomography (CT) scans, American Orthopaedic Foot &amp; Ankle Society (AOFAS) Scores, Foot Pain and Disability (FFI) Scores, and visual analog scores (VAS) assessing fusion site, weight bearing, and graft harvest site pain. Because final fusion status was dependent upon the status exiting the original trial, maintenance or improvement of fusion status was the key focus of the study. The change in baseline from all other outcomes measures were also compared between the two groups. Results: A total of 169 subjects (109 rhPDGF, 60 autologous) from 26 sites completed a follow-up visit at a mean 9.1 years (7.7- 10.9).The rate of maintenance or improvement of CT fusion status was statistically noninferior for subjects in the rhPDGF group compared to the autologous bone graft group (92.7% vs. 95.0%,p=0.021), Total AOFAS Scores (74.9+16.7 vs. 77.2+13.9, p&lt;0.001), FFI Scores (22.7+21.7 vs. 16.5+12.0, p&lt;0.001), weight bearing pain change from baseline (-46.0+33.4 vs. -51.0+33.1, p=0.002), and fusion site pain change from baseline (-34.0+33.6 vs. -34.0+32.4, p&lt;0.001). There were no differences in secondary surgical interventions with the most common reasons being hardware complications (7.3% vs. 8.3%) and non-union (4.6% vs. 1.7%). There were no significant differences in the rates of medically relevant adverse events. In the autologous bone graft group, 3 (5%) subjects continued to experience clinically relevant pain (VAS&gt;20) at their graft harvest site. Conclusion: The outcomes of rhPDGF in hindfoot or ankle arthrodesis were statistically noninferior to those of autologous bone graft at a mean follow-up of 9.1 years. Over 92% of rhPDGF subjects maintained or improved their fusion status. Similarly, the baseline change for all VAS and functional outcomes were non-inferior for the two groups. The exception was clinically significant graft harvest site pain, which only existed in the autologous bone graft group. The results of this study demonstrate that rhPDGF used in hindfoot and ankle arthrodesis is associated with similar long-term radiographic, functional, and clinical outcomes as autologous bone.