Graft Healing Research Articles

IMPACT OF ADJUVANT FAT GRAFTING ON IMPROVED UPTAKE AND HEALING OF SPLIT THICKNESS SKIN GRAFT AT TERTIARY CARE HOSPITAL.

Since the 1980s, autologous fat grafting has been one of the most widely used methods in plastic surgery to treat volume and contour problems. There are many advantages of autologous fat, i.e., it is cheap, biocompatible, and readily available autologous tissue in large quantities, minimal morbidity. Objective was to compare the outcomes of fat grafting combined with STSGs and STSGs alone in patients with chronic non-healing wounds presenting at a tertiary care hospital. It was a prospective cohort study carried out at the Department of plastic surgery, Civil hospital Karachi, Pakistan from 11th April to 12th October 2023. Patients aged 18-60 years with chronic non-healing wounds due to burn, trauma, or infection lasting at least six weeks were included. Group A received fat grafting followed by STSGs, while Group B received STSGs alone. Follow-up for both groups continued for 4-5 weeks, focusing on graft uptake and healing, with successful graft take defined as wound healing upon clinical examination. Data was analyzed by SPSS version 25. Overall, the mean age of the patients was 36.47±8.57 years. In Group A, the median width was 8.00 cm, and in Group B, it was 7.00 cm, this difference was statistically significant (p=0.005). The proportion of healing in group A was significantly higher as compared to group B (66.7% vs 30%, (p=0.001). The odds of wound healing were 0.21 times lower in group B as compared to group A (95% CI=0.07 to 0.63). After adjusting for duration and width of wound, the odds of wound healing in group B remains significantly lower as compared to odds of wound healing in group A (OR=0.13, 95% CI=0.03 to 0.54). The combination of fat grafting with split-thickness skin grafts holds promising result for improved wound healing in patients with chronic non-healing wounds.

The Impact of Topical Application of Platelet-Rich Fibrin on Graft Survival in Surgeries for Chronic Otitis Media.

This study aims to evaluate the efficacy of platelet-rich fibrin (PRF) application in tympanoplasty procedures for patients with chronic otitis media (COM), assessing its influence on graft survival and healing time. In this prospective interventional study, conducted between January 2022 and June 2023, 80 patients diagnosed with COM were enrolled and divided into two groups. Group A underwent standard tympanic membrane repair using temporal fascia grafts (TFG), while Group B received TFG with adjunctive PRF application. The patients were observed and assessed over a 20-week postoperative period. The study showed a significant enhancement in graft survival rates in Group B (TFG+PRF), with only one residual perforation compared to seven in Group A (TFG alone) at 20 weeks (p=0.02534). Furthermore, Group B patients experienced faster healing, achieving 97.5% graft integrity at 10 and 20 weeks, in contrast to Group A's 87.5%. The application of PRF in tympanoplasty procedures for COM notably enhances graft stability and expedites the healing process. These findings suggest that PRF can be a valuable adjunct in otolaryngological surgeries, offering potential improvements in patient outcomes and surgical efficacy.

Examining Postoperative Posterior Cruciate Ligament Index: A Structural Paradigm in Anterior Cruciate Ligament (ACL) Reconstructions With Hamstring Tendon Autograft.

The current study aimed to compare the posterior cruciate ligament (PCL) index values of patients who underwent hamstring tendon (HT) autograft reconstruction due to an anterior cruciate ligament (ACL) tear. The comparison involved assessing these values in a similar cohort and evaluating the association between the alteration in the PCL index and functional results. Patients who were clinically diagnosed with a complete, unilateral ACL tear and underwent ACL reconstruction (ACLR) using HT autograft between January 2018 and January 2021 constituted the operated group (Group 1) of the study. The control group (Group 2) consisted of patients selected from a convenience sample without ACL rupture, meniscal lesion, or cartilage damage who underwent an MRI during an outpatient orthopaedic consultation for knee pain. The operated group was submitted for an MRI of the knee one year after the operation for any reason such as pain, graft healing, the presence of tunnel widening, or suspicion of re-rupture. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form and the Lysholm Scoring System were applied to the patients in the operated group in the preoperative and postoperative periods to evaluate their complaints, function, and participation in sports and to assess functional ability and functional capacity. A radiologist with five years of experience measured the PCL index in the sagittal section of an MRI. In the operated group, changes in PCL index, IKDC, and Lysholm values during the postoperative period were assessed, along with their correlation. Additionally, a comparison was made between the values of the operated group and the non-operated group. No statistically significant correlation was found between the PCL index alteration and the functional score alteration (IKDC and Lysholm) in the operated group (p>0.05). In comparison to the non-operated group, the preoperative PCL index measures of the operated group were significantly lower (p: 0.000; p<0.05). The increase in the postoperative PCL index measurements of the operated group was similarly statistically significant (p: 0.000; p<0.05). Although the PCL index appears to be a strong anatomical structural parameter in ACLR patients performing HT autograft in the postoperative period, its correlation with functional results is weak.

Hyperbaric oxygen therapy enhances graft healing and mechanical properties after anterior cruciate ligament reconstruction: An experimental study in rabbits.

Hyperbaric oxygen therapy (HBOT) has proven successful in wound healing. However, its potential effects on anterior cruciate ligament (ACL) injuries remain uncertain. This study aimed to investigate the impact of HBOT on graft healing following ACL reconstruction in rabbits. Male New Zealand rabbits underwent ACL reconstruction and were randomly divided into two groups: the HBOT group and the ambient air group. The HBOT group received 100% oxygen at 2.5 atmospheres absolute for 2 h daily for 5 consecutive days, starting from the first day after surgery. The ambient air group was maintained in normal room air throughout the entire period. After 12 weeks following the surgery, animals were euthanized, and their knees were harvested for analysis. The HBOT group demonstrated superior graft maturation and integration in comparison to the ambient air group, as evidenced by lower graft signal intensity on magnetic resonance imaging, decreased femoral and tibial tunnel size, and higher bone mineral density values on high-resolution peripheral quantitative computed tomography scans. Additionally, biomechanical testing indicated that the HBOT group had greater load to failure and stiffness values than the ambient air group. In conclusion, the adjuvant use of HBOT improved ACL graft maturation and integration, reduced tunnel widening, and enhanced the biomechanical properties of the graft. These results may provide important insights into the potential clinical application of HBOT as a therapeutic intervention to enhance graft healing after ACL reconstruction, paving the way for further research in this area.

Physiological and Endophytic Fungi Changes in Grafting Seedlings of Qi-Nan Clones (Aquilaria sinensis)

In recent years, some new Qi-Nan clones of Aquilaria sinensis, which have the characteristics of easily induced and high-quality agarwood, have been selected and propagated by grafting seedlings. To date, research on the grafting of Qi-Nan seedlings is limited. In this study, the effects of grafting on physiological characteristics and endophytic fungi of seedlings within a short period after grafting were studied by means of histochemical observations, physiological index determinations and Illumina sequencing. The results showed that the grafting healing time of ordinary A. sinensis was at least 10 days shorter than that of Qi-Nan, according to the degree of lignification of callus, and the tissue basis for the healing was the interxylary phloem. The MDA content of Qi-Nan peaked earlier than that of ordinary A. sinensis. The contents of JA and ABA peaked earlier in ordinary A. sinensis, and the SA content was significantly higher than that of Qi-Nan at 20–40 days; on average, it was 17.33% higher than that of Qi-Nan. A total of 5 phyla, 28 classes, 84 orders, 197 families, 489 genera and 842 species of endophytic fungi were identified before and after grafting. After grafting, the abundance and diversity of endophytic fungi in ordinary A. sinensis and Qi-Nan decreased, and the endophytic fungi were significantly different before and after grafting. In ordinary A. sinensis, before grafting, Dothideomycetes was the dominant class, and after grafting, Sordariomycetes was the dominant class. The dominant class of Qi-Nan before and after grafting was Dothideomycetes. The dominant genus of ordinary A. sinensis before grafting was Devriesia, and after grafting, it was Fusarium; that of Qi-Nan before grafting was Hyweljonesia and after grafting was Arthopyrenia. Functional genes of the endophytic fungi were mostly related to carbohydrate metabolism and energy metabolism, which may be the reason why endophytic fungi promote agarwood formation in Aquilaria trees. The findings suggest that the healing of the grafting interface in A. sinensis seedlings was the result of multiple factors, and endophytic fungi of Qi-Nan scion changed after grafting.

A Quantitative Analysis of Microcirculation During Healing of Split-Thickness Skin Grafts in Standardized Full-Thickness Wounds

Background. Full-thickness skin defects often are managed with split-thickness skin grafting. The wound healing process, including formation of new vessels during the healing of skin grafts, is complex. Objective. To evaluate the microcirculatory changes in the treated tissue after skin grafting to analyze perfusion dynamics during the wound healing process. Materials and Methods. Fourteen full-thickness skin defects were created on the back of 14 adult male Lewis rats. All wounds were treated with autologous split-thickness skin grafts. The perfusion dynamics were assessed for 84 days with an O2C device that combines a laser light to determine blood flow and white light to determine postcapillary SO2 and the rHb. Results. Blood flow increased for 50 days after grafting. SO2 decreased in superficial skin layers (depth of 2 mm) and increased in deep skin layers (depth of 8 mm) during the entire observation period. The rHb increased until day 10 in superficial layers and until day 20 in deep tissue layers. Conclusion. The microcirculatory changes reflect the different phases of wound healing. Long after the skin transplants were macroscopically healed, alterations in microcirculation were still detected. These alterations were caused by the long-lasting changes in tissue metabolism due to the formation, conversion, and degradation of the dermal matrix and vessels during wound healing and scar formation.

Postoperative healing and complications based on anterior cruciate ligament reconstruction graft type.

Injury to the anterior cruciate ligament (ACL) is a devastating injury to athletes of all ages. The current gold standard treatment following complete rupture of the ACL is reconstruction of the torn ligament with autograft or allograft tendon. Commonly used tendon grafts include patellar tendon, hamstring tendon, and quadriceps tendon. Although ligaments and tendons have similar collagen and proteoglycan compositions, they maintain a unique composition and arrangement of cells to serve their unique biomechanical needs. Therefore, following ACL reconstruction (ACLR), the implanted tendon tissue undergoes a process of remodeling which is termed "ligamentization". The process of ligamentization is divided into three main phases, which include the early healing phase, the proliferative phase, and the maturation phase. Following the process of ligamentization, the graft tissue closely mimics the appearance of ligament tissue on an ultrastructural level. Successful outcome following ACLR is contingent upon adequate remodeling of the tissue as well as healing of the graft within the bone tunnels in the femur and tibia. Choice of graft has individual implications regarding their associated risk of complications, failure, and infection. The purpose of this review is to summarize the process of ligamentization and graft healing and to discuss how graft type influences the rate and types of complications, failures, and infections.

Comparison of two graft procedures in a bilateral sinus lift by MRI and histomorphometric analysis: a case report

Magnetic resonance imaging (MRI) was shown to be a viable method for graft healing evaluation. Platelet-rich fibrin (PRF) was found to speed up bone graft healing process. Sinus lift surgery outcomes after healing period are usually performed with computerized tomography that is not capable to describe graft vascularization and exposes patient to ionizing radiation. The objective of this study is to propose contrast-enhanced magnetic resonance imaging (CE-MRI) as a promising method for the in vivo assessment of sinus lift grafting procedures. A bilateral sinus augmentation surgery was performed. Left sinus was grafted only with bovine deproteinized bone mixed in a 1:1 ratio with autologous bone, in the right sinus, the same biomaterials with the addition of platelet-rich fibrin (PRF) were applied. CE-MRI was performed to evaluate angiogenesis before surgery and at 11, 25, 53, and 104 days after surgery. At 6 months (T0) and after 10 years (T1), before dental implants insertion, bone biopsies were performed and analysed quantitatively. Left sinus graft showed a centripetal pattern of angiogenesis, with the central region remaining unvascularized at 104 days post-surgery. Right side showed a wider and homogeneous vascularization from 25 days after surgery. At T0 new bone formation was only peripheral in the left sinus, whereas it developed both peripherally and through biomaterial in the right sinus. At T1 particles of biomaterial were still present in left sinus, while in right sinus they were not. CE-MRI offers quantitative parameters to evaluate vascularization of biomaterials. The addition of PRF promotes an early development of a widespread vascular system.

Comparação entre as ondas contínua e pulsada do laser de baixa intensidade na cicatrização de enxertos cutâneos aplicados em feridas recém-criadas de coelhos (Oryctolagus cuniculus)

ABSTRACT: Skin grafting is a simple and very useful surgical technique for wound repair, especially where there is difficulty in performing direct synthesis or other reconstructive techniques. low-intensity laser (LIL) has already been used successfully in cases where the graft was applied to wounds shortly after its creation. However, LIL still lacks standardization due to conflicting studies on its results. Thus, this study compared the effectiveness of continuous wave LIL with pulsed wave LIL in stimulating the healing of skin grafts, applied to newly created wounds in rabbits. For this purpose, 31 rabbits were distributed into: control group (CG, n = 10), continuous wave laser group (GLC; n = 10) and pulsed wave laser group (GLP; n = 11). Postoperative management was similar between all groups, with the exception of laser application, as indicated by the group. The GLC and GLP groups showed similar evolution, with a satisfactory healing process of the graft, unlike the GC group. These results were maintained in the microscopic evaluation, as the groups treated with laser showed less inflammation, better integration with the receptor area, greater re-epithelialization and collagenization. There was no difference in vascular density between the treatment groups on immunohistochemical analysis. The newly created wound was not able to provide nutrition for the skin graft in rabbits, but LIL is an efficient adjuvant therapy in stimulating healing between the recipient area and the graft, promoting full integration. However; although, statistically there was no difference in the form of light emission, pulsed or continuous, patients who received continuous wave LIL showed superior microscopic evolution.

A conserved graft formation process in Norway spruce and Arabidopsis identifies the PAT gene family as central regulators of wound healing

The widespread use of plant grafting enables eudicots and gymnosperms to join with closely related species and grow as one. Gymnosperms have dominated forests for over 200 million years, and despite their economic and ecological relevance, we know little about how they graft. Here we developed a micrografting method in conifers using young tissues that allowed efficient grafting with closely related species and between distantly related genera. Conifer graft junctions rapidly connected vasculature and differentially expressed thousands of genes including auxin and cell-wall-related genes. By comparing these genes to those induced during Arabidopsis thaliana graft formation, we found a common activation of cambium, cell division, phloem and xylem-related genes. A gene regulatory network analysis in Norway spruce (Picea abies) predicted that PHYTOCHROME A SIGNAL TRANSDUCTION 1 (PAT1) acted as a core regulator of graft healing. This gene was strongly up-regulated during both spruce and Arabidopsis grafting, and Arabidopsis mutants lacking PAT genes failed to attach tissues or successfully graft. Complementing Arabidopsis PAT mutants with the spruce PAT1 homolog rescued tissue attachment and enhanced callus formation. Together, our data show an ability for young tissues to graft with distantly related species and identifies the PAT gene family as conserved regulators of graft healing and tissue regeneration.

Role of tendon-derived stem cells in tendon and ligament repair: focus on tissue engineer.

This review offered a comprehensive analysis of tendon and ligament injuries, emphasizing the crucial role of tendon-derived stem cells (TDSCs) in tissue engineering as a potential solution for these challenging medical conditions. Tendon and ligament injuries, prevalent among athletes, the elderly, and laborers, often result in long-term disability and reduced quality of life due to the poor intrinsic healing capacity of these avascular structures. The formation of biomechanically inferior scar tissue and a high rate of reinjury underscore the need for innovative approaches to enhance and guide the regenerative process. This review delved into the complexities of tendon and ligament structure and function, types of injuries and their impacts, and the limitations of the natural repair process. It particularly focused on the role of TDSCs within the context of tissue engineering. TDSCs, with their ability to differentiate into tenocytes, are explored in various applications, including biocompatible scaffolds for cell tracking, co-culture systems to optimize tendon-bone healing, and graft healing techniques. The review also addressed the challenges of immunoreactivity post-transplantation, the importance of pre-treating TDSCs, and the potential of hydrogels and decellularized matrices in supporting tendon regeneration. It concluded by highlighting the essential roles of mechanical and molecular stimuli in TDSC differentiation and the current challenges in the field, paving the way for future research directions.

Anterior Cruciate Ligament Reconstruction using Bone-Tendon-Bone Allograft: Surgical Technique Using Augmentation with Bio-Composite Scaffold

Anterior cruciate ligament (ACL) rupture rates remain high; the incidence of isolated ACL ruptures is 68.6 per 100,000. This Technical Note introduces a technique for ACL reconstruction (ACLR) using a bone-tendon-bone (BTB) allograft augmented with BioBrace, a biocomposite scaffold. The BioBrace scaffold is sutured onto the BTB allograft to reinforce the ligament and accelerate healing. Graft preparation with BioBrace, ACLR, and graft passage is described. This technique aims to reduce re-rupture risk, enhance graft healing, and improve patient-reported outcomes. BioBrace offers advantages over other augmentation approaches and synthetic materials, providing improved remodeling, biologic integration, and increased mechanical strength. Feasibility and efficacy have been demonstrated in animal models and human applications. This technique presents a promising approach to enhance ACLR outcomes.

Unexpected Success of Bilateral Robotic-Assisted Ureteral Reconstruction with Buccal Mucosa Graft for Bilateral Ureteral Strictures: A Case of Delayed Graft Healing

Unexpected Success of Bilateral Robotic-Assisted Ureteral Reconstruction with Buccal Mucosa Graft for Bilateral Ureteral Strictures: A Case of Delayed Graft Healing

Arthroscopic Superior Capsular Reconstruction Using Hybrid Autologous Fascia Lata and the Long Head of Biceps Tendon Graft: the Central Beam Concept

Superior capsular reconstruction is a joint salvage treatment option for retracted irreparable rotator cuff tears in relatively young patients. Various graft options have been described in the literature, including autologous fascia lata graft, synthetic graft, and dermal patches. Superior capsular reconstruction using long head of biceps tendon autograft alone has also been described by few authors. In this technical note, we describe a modified technique of performing arthroscopic superior capsular reconstruction using both fascia lata graft and the intra articular portion of the long head of biceps tendon. Our technique resembles central beam concept over which the fascia lata graft is anchored, providing good structural support to the graft and enabling graft healing and improved clinical outcomes.

Effect of systemic atorvastatin on bone regeneration in critical-sized defects in hyperlipidemia: an experimental study

PurposeHypocholesterolemic medications similar to atorvastatin are efficient in lowering blood lipid levels; however, compared to other medications in the statin family, their impact on bone metabolism is claimed to be insufficient. The impact of atorvastatin on bone regeneration in dental implantology in individuals with hyperlipidemia who received atorvastatin in the clinic is doubtful.MethodsIn the study, 16 male New Zealand rabbits of 6 months were used. All rabbits were fed a high-cholesterol diet for 8 weeks, and hyperlipidemia was created. It was confirmed that the total cholesterol level in rabbits was above 105 mg/dl. A critical-sized defect was created in the mandible. The defect was closed with xenograft and membrane. Oral 10 mg/kg atorvastatin was started in the experimental group, and no drug was administered in the control group. At 16th week, animals were sacrificed. For histomorphological examination, the new bone area, osteoclast, and osteoblast activities were evaluated.ResultsWhile new bone area (45,924 µm2, p < 0.001) and AP intensities (105.645 ± 16.727, p = 0.006) were higher in the atorvastatin group than in the control group, TRAP intensities in the control group (82.192 ± 5.346, p = 0.021) were higher than that in the atorvastatin group.ConclusionsIt has been found that high blood lipid levels will adversely affect bone graft healing and the use of systemic atorvastatin contributes to bone healing. Clinicians should pay attention to the selection of surgical materials, considering the importance of questioning drug use in their patients and the risks in cases of non-use.

Hybrid Press-fit and Adjustable Button Femoral Fixation of Anterior Cruciate Ligament Semitendinosus and Bone-patellar Tendon-bone Autografts—A Technical Note

Introduction: Many fixation methods are available for anterior cruciate ligament (ACL) grafts. Adjustable buttons (ABs) are characterized by their high fixation strength but have the disadvantage of potential stretching of their linking suture material. Press-fit bone plugs provide fixation at the joint line and enhance biological graft healing. Using both is thought to result in a higher fixation strength, enhancing graft biology and transferring the fixation point to the joint line. Materials and Methods: It is the aim of this technical note to describe a certain technique of ACL graft hybrid fixation for hamstrings or bone-tendon-bone grafts, using AB combined with bone grafting of the femoral and tibial tunnels with press-fit bone plugs or bone chips. Discussion: ABs are commonly used fixation devices for ACL grafts. AB also allows the surgeon to tighten the ACL graft in full or near full extension. The ultimate load to failure of AB has the potential disadvantage of rendering the ACL graft progressively slack. AB augmented with press-fitting bone plugs enhances biological potentials, adds to fixation strength, and transfers the fixation level of the graft from the outer femoral cortex to the joint line. Conclusion: Hybrid AB and bone plug fixation of ACL autografts, whether hamstrings or bone-tendon bone, optimizes ACL graft fixation by gaining advantages and omitting the disadvantages of both techniques.

Spatio-temporal dynamics of phytohormones in the tomato graft healing process

Graft healing involves a series of cytological and molecular events including wound responses, callus formation and vascular bundle remodelling. Hormones are important signalling molecules regulating plant development and responses to environmental stimuli. However, the detailed dynamics of phytohormones in graft healing remain elusive. In this research, internodes above and below the graft site were harvested from 0 to 168 h after grafting (HAG), and liquid chromatography tandem mass spectrometry (LC-MS/MS) was used to determinate jasmonic acid, auxin, cytokinin, ethylene, salicylic acid, abscisic acid and gibberellin levels during the graft healing process. Uniform manifold approximation and projection (UMAP) and k-means analyses were performed to explore hormone spatio-temporal dynamics. We found the stage-specific and asymmetric accumulation of phytohormones in the tomato graft healing process. At the early healing stage (before vascular bundle reconnection), IAA, cZ, ABA, JA and SA mainly accumulated above the graft site, while tZ and ACC mainly accumulated below the graft site. MEIAA, ICAld and IP mainly accumulated at the later stage. Comminated with the healing process, we suggested that JA is mainly involved in wound responses, IAA is beneficial to the formation of callus and vascular cell development, tZ promotes cell division, and IP is linked to vascular bundle remodelling. In addition, expression of JA-related genes SlMYC2 and SlJAZ2, IAA-related gene SlIAA1, tZ-related genes SlHP2 and SlRR8, and IP-related gene SlRR9 correlated with hormone accumulation. The findings provide important information about the hormones and genes involved in the tomato graft healing process.

Osteoimmunology: Interactions With the Immune System in Spinal Fusion.

Spinal fusion is important for the clinical success of patients undergoing surgery, and the immune system plays an increasingly recognized role. Osteoimmunology is the study of the interactions between the immune system and bone. Inflammation impacts the osteogenic, osteoconductive, and osteoinductive properties of bone grafts and substitutes and ultimately influences the success of spinal fusion. Macrophages have emerged as important cells for coordinating the immune response following spinal fusion surgery, and macrophage-derived cytokines impact each phase of bone graft healing. This review explores the cellular and molecular immune processes that regulate bone homeostasis and healing during spinal fusion.

Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft: Surgical Technique Using Augmentation With a Biocomposite Scaffold

Anterior cruciate ligament (ACL) reconstruction augmentation continues to be widely studied. Both biologic and synthetic augments have been employed to enhance ACL healing and provide early protection. The BioBrace is a biocomposite scaffold that both mechanically reinforces the graft while biologically enhancing graft healing. The purpose of this article is to describe augmentation of an ACL reconstruction with BioBrace.

Minimally Invasive Harvesting of Triple-Fold Superficial Layer Quadriceps Autograft for Knee Ligament Reconstruction

Graft selection plays a critical role in anterior cruciate ligament reconstruction. Autograft options, including hamstrings, bone–patellar tendon–bone, and quadriceps, offer distinct advantages and disadvantages. Soft tissue quadriceps tendon autografts are increasingly favored due to their strength, size compatibility, and potential for enhanced graft healing. This technique offers minimal skin incision, a longer graft, and reduced morbidity, as it specifically targets the superficial band of the quadriceps tendon.