Iliac Graft Research Articles

Innovations in the comprehensive management of orofacial defects - Combined strategies of maxillofacial surgery, endodontics, orthodontics and Implants for the optimization of clinical results: A Narrative Review

Orofacial defects caused by congenital anomalies, trauma, or surgical procedures present complex challenges that affect physical function and psychological well-being. Maxillofacial rehabilitation, incorporating surgery, endodontics, orthodontics, and implants, aims to restore form, function, and aesthetics. This review evaluates innovative multidisciplinary strategies for orofacial defect management. A narrative review was conducted using PubMed and Google Scholar databases. Search terms included "management of orofacial defects," "maxillofacial surgery," "endodontics in complex cases," "orthodontics in facial surgery," and "dental implants." Articles published between 2014 and 2024 were reviewed, focusing on human studies demonstrating integrated treatment strategies. The interdisciplinary approach to managing orofacial defects, integrating maxillofacial surgery, endodontics, orthodontics, and implants, has demonstrated significant improvements in both functional and aesthetic outcomes. Combined surgical techniques, such as the use of iliac and fibula grafts, offer enhanced graft success through improved vascularization. Technological advancements in endodontics, including CBCT and regenerative procedures, optimize treatment precision. Orthodontic innovations, like clear aligners and mini-implants, enhance patient comfort and treatment efficiency, while digital implant planning reduces complications. The incorporation of growth factors, bioactive materials, and AI further boosts clinical success in treating complex orofacial defects.

ThP2.17 - Efficacy of Mesenchymal Stem Cells in the Treatment of Osteonecrosis of Femoral Head

Abstract Introduction Osteonecrosis of the femoral head (ONFH) has substantial morbidity and impacts patient populations worldwide. Mesenchymal stem cells (MSCs) are implicated for their potential in ONFH treatment. The objective of this study is to examine the effectiveness of MSC when compared to existing surgical options in the treatment of ONFH. Method A literature search is conducted through Pubmed, MedlineOvid, and Cochrane. The studies were selected using PRISMA and ROBVIS. Four randomised controlled trials and two preliminary studies with a total of 599 participants were included in the study. Results Progression to advanced stages of ONFH was reduced in bone marrow mesenchymal stem cells (BMMSC) applied in conjunction with core decompression (CD) when compared to CD alone (3.77% vs. 22.7%, p<0.05) and reduced femoral head collapse (28% vs. 72%). Improvement in Hip Harris Score (HHS) when compared to CD alone (31.85 vs. 19.72 control, p = 0.03) was also observed. The joint preservation rate of applying BMMSC in tantalum rod insertion with vascularized iliac grafting in end-stage ONFH patients was greater than that of vascularized iliac grafting alone (83.33% vs. 57% in stage IV patients) and associated with a better outcome (HHS 6.29±6.11 to 77.23±14.75). Improvement in WOMAC, VAS and Lequesne index was also observed when comparing CD with bone grafts and CD, bone grafts and BMMSC. Conclusion The use of MSC applications along with current surgeries has been shown to improve post-operative outcomes and progression to advanced ONFH stages in the treatment of ONFH compared to surgeries done alone.

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.

Osteosynthesis and Reconstruction in Neglected Neck of Femur Fracture: A single-center Study and literature review.

Purpose : Our study evaluates the effectiveness of our innovative treatment for neglected femoral neck fractures. Methods : This retrospective study included 23 patients from January 2016 to March 2023, treated with our new innovative technique. Data has been extracted from the respective department, and informed consent has been obtained prior to any intervention. Radiographs, including AP and lateral radiographs and range of motion at the hip joint, were evaluated in follow-ups at different intervals. Post-operative complications and total hip arthroplasty conversions were also noted. The SPSS software version 26 was used to analyze data for this study. Results : With a mean follow-up of 4.5 ± 1 years, the participants’ ages ranged from 14 to 60 years old, with a mean age of 29.74 ± 11.47 years. The database record indicates that 20 subjects had the radiological and clinical union observed. The non-union was reported in 3 (14.2%) patients; however, only one was symptomatic. Almost 41.7% of the patients reported feeling pain occasionally after exertion. At the operated hip, all patients had excellent range of motion (ROM), primarily in the areas of hip flexion, abduction, adduction, and external rotation. Following reconstruction, the average hip Haris score was 83.46 ± 10.40 at one year. As a post-operative complication, 4 individuals (16.7%) had an infection. Conclusion : Our unique technique has dramatically improved neglected femur neck fractures, even in young patients. It involves ORIF using three cancellous screws, non-vascularized fibular and iliac crest cancellous grafts for reconstruction, and vascularized Tensor fascia lata pedicle graft osteosynthesis.

Conversion Total Hip Arthroplasty After Pedicled Peri-Hip Bone Flap Grafting: The Chinese Experience

BackgroundThis study investigated the perioperative outcomes of patients undergoing conversion total hip arthroplasty (THA) after failed peri-hip bone flap grafting (PBFG) and compared them with those patients undergoing primary THA for osteonecrosis of the femoral head (ONFH). MethodsFrom January 2010 to December 2021, 163 Chinese patients (163 hips) were treated by conversion THA after failed PBFG (containing 94 patients who had pedicled vascularized iliac bone flap grafting and 69 patients who had pedicled vascularized greater trochanter bone flap grafting), and 178 Chinese patients were treated by primary THA. The preoperative baseline data and perioperative indicators in both groups were compared. ResultsIn the conversion group, patients had significantly greater blood loss, a longer length of stay, and greater changes in serum hemoglobin than those in the primary THA group (P < 0.05). The operative room time, transfusion volume, calculated blood loss, changes in serum hematocrit, and increased superficial infection (P > 0.05) in the conversion group were greater compared with the primary cohort; however, the difference was not statistically significant. The mean postoperative Harris Hip Scoring system (HHS) of the PBFG group at the 1-month follow-up was 81, and the control group had a score of 82. Importantly, subgroup analysis of the PBFG group indicated that there was no significant difference between patients who had prior pedicled vascularized iliac bone flap grafting and pedicled vascularized greater trochanter bone flap grafting (P > 0.05), except for the operative room time (P = 0.032). ConclusionsHip-sparing surgery of ONFH did not make THA more difficult or lead to more perioperative complications, but increased blood loss and extended hospital stay from a prior PBFG are still notable problems in clinical practice. Thus, it is necessary for surgeons to focus attention on the improvement of the preoperative condition and prepare for any specific intraoperative challenges.

Comparative Study Between Latarjet Procedure Versus Free Iliac Graft in the Management of Recurrent Shoulder Dislocation

Abstract Background: The most common form of shoulder dislocation is the recurrent anterior traumatic type. Latarjet and Eden Hybinette are the two competing techniques in reconstructing significant bone loss accompanying this type. Aim of the Work: The aim is to evaluate the functional results in the management of recurrent shoulder dislocation with bone loss by comparing Latarjet and Eden Hybinette techniques. Patients and Methods: A prospective, randomized controlled trial was performed on forty adult patients suffering from recurrent shoulder dislocations. Two groups (a total of forty patients; twenty iliac graft cases and twenty Latarjet controls) were performed in a randomized method. We compared the two groups; clinical evaluation was completed before surgery and at least 1 year postoperatively, by using the modified Rowe score which consists of pain level, stability, motion loss, and limitation of function. Satisfactory results included excellent and good results, while unsatisfactory results included fair and poor results. Adverse events were prospectively recorded. CT studies were performed to assess the radiographic result preoperatively, immediately-postoperatively, and at final follow-up visits. Results: Both groups did not differ significantly in either the clinical or the radiological aspects (P &gt; 0.05) except for more limited range of motion (ROM) (external and internal rotation) in the Latarjet group at the final follow-up (P &lt; 0.05). One case in the Latarjet group had recurrent dislocation due to tramadol fits. Two cases in each group had anterior apprehension only. Donor-site sensory disturbances were reported in 10% of the iliac group patients. Computed tomography revealed a larger graft size in the iliac group. Conclusion: Both Latarjet and Eden Hybinette can be used as reconstructive surgeries in restoring critical bone loss accompanying shoulder dislocations; they did not show significant differences except for the more limited external and internal rotation motions in the Latarjet group.

Periprosthetic Transpatellar Fracture Replacement With Autogenous Iliac Graft: A Technical Note.

Periprosthetic fractures involving total knee arthroplasty (TKA) components, particularly involving the patella, can present a significant challenge regarding orthopedic surgery. This technical note outlines an approach for the reconstruction of complicated periprosthetic transpatellar fractures, with poor bone stock, utilizing autogenous iliac graft. This kind of procedure requires careful preoperative evaluation of imaging, precise intraoperative planning, and strict postoperative management to achieve adequate postoperative results. The inventive option of utilizing an autogenous iliac graft for reconstructionsuggests its potential benefits in addressing the unique biomechanical demands of patellar fractures in TKA patients with poor bone stock. Key technical aspects of this approach are highlighted and include graft harvest, graft preparation, and fixation techniques. Overall, this technique can provide a golden standard bailout for periprosthetic transpatellar fracture reconstruction and potentially offer orthopedic surgeons a comprehensive framework for addressing this challenging clinical scenario.

Three-dimensional comprehensive evaluation of unilateral alveolar cleft bone grafting with iliac bone and chin bone blocks

In this study, we aimed to provide guidance for selecting bone grafting materials in cases of alveolar clefts. Twenty-nine patients with unilateral complete alveolar clefts were categorized into three groups based on the bone grafting material used: Group A (iliac bone block grafts), Group B (iliac cancellous bone grafts), and Group C (chin bone block grafts). Cone-beam computed tomography (CBCT) data were analyzed using Mimics 19.0 software. Results showed that Group A had the highest bone formation rate, with significant differences observed between Groups A and B, as well as between Groups B and C. Group A and Group C had the highest proportion of Type I in volume assessment, while Group B had the highest proportion of Type III, Significant differences were observed in the distribution of volume assessment scores among the three groups. Bone height measurement results indicated that buccal-side measurement points had a higher proportion of Type I bone height than palatal-side measurement points. Bone width measurement results showed that Type I bone width was highest in Group C, while Type IV bone width was highest in Group B. Significant differences were observed in the distribution of implanted bone width among the three groups. Total grafting scores indicated that Types A and D were predominant in Groups A and C, while Group B had the highest proportion of Type D. Significant differences were observed in the distribution of total grafting scores among the three groups. The comprehensive evaluation method provides accurate assessment of alveolar cleft bone grafting outcomes and is applicable in clinical settings. Based on the results, we consider both iliac bone blocks and chin bone blocks as suitable materials for alveolar cleft bone grafting. Grafting material selection should consider preoperative gap volume measured using CBCT, required bone quantity, donor site complications, and overall clinical needs.

Endovascular repair of bilateral isolated common iliac artery aneurysms with unsuitable anatomy utilizing an aortic bifurcated unibody endograft and modified sandwich technique to preserve pelvic blood flow: a case series

Bilateral isolated common iliac artery aneurysms (CIAAs) are rare, and endovascular repair of CIAAs has emerged as an alternative to traditional open surgical repair. The primary goal of therapy is to exclude the aneurysm sac while maintaining perfusion of at least one internal iliac artery (IIA) to prevent pelvic ischemia. Although the iliac branch device (IBD) has improved the feasibility of preserving the IIA, its applicability is limited to a specific subset of aneurysm anatomy. We present a case series of three patients with bilateral isolated CIAAs in whom preoperative CT scans revealed an absence of a landing zone, the diameter of proximal CIA diameter was less than 13.0 mm, and normal diameter of the nonaneurysmal infrarenal aorta, making it challenging to use an IBD alone or a standard bifurcated aortic endograft to provide a proximal landing zone for iliac artery stenting. To overcome the small diameter of the infrarenal aorta, we implanted an aortic bifurcated unibody endograft. Then, we utilized a balloon-expandable covered stent-graft with overdilation as a modified sandwich technique to create an “eye of the tiger” configuration to prevent gutter leakage. The final angiography performed during the procedure revealed successful exclusion of the aneurysms, with blood flow to the right IIA and no type III endoleak. During the postoperative follow-up period, no patients exhibited symptoms associated with pelvic ischemia. There were no endoleaks or sac expansions on the two-year follow-up CT scans, and all external and internal iliac graft limbs were patent. This study demonstrated that a combination of an aortic bifurcated unibody endograft and a modified sandwich technique can effectively treat bilateral isolated CIAAs with certain anatomical constraints.

Long-term survival and success rate of dental implants placed in reconstructed areas with extraoral autogenous bone grafts: A systematic review and meta-analysis.

To evaluate the long-term survival and success rates of implants placed in reconstructed areas using microvascularized or non-microvascularized extraoral bone grafts. An electronic search was performed in five databases and in gray literature for articles published until June, 2023. The eligibility criteria comprised observational studies (prospective or retrospective) and clinical trials, reporting survival and success rates of implants placed in extraoral bone grafts. A meta-analysis (implant failure) was categorized into subgroups based on the type of bone graft used. The risk of bias within studies was assessed using the Newcastle-Ottawa Scale. Thirty-one studies met the inclusion criteria. The mean follow-up time was 92 months. The summary estimate of survival rate at the implant level were 94.9% (CI: 90.1%-97.4%) for non-vascularized iliac graft, 96.5% (CI: 91.4%-98.6%) for non-vascularized calvaria graft, and 92.3% (CI: 89.1%-94.6%) for vascularized fibula graft. The mean success rate and marginal bone loss (MBL) were 83.2%; 2.25 mm, 92.2%; 0.93 mm, and 87.6%; 1.49 mm, respectively. Implants placed in areas reconstructed using extraoral autogenous bone graft have high long-term survival rates and low long-term MBLs. The data did not demonstrate clinically relevant differences in the survival, success, or MBL of grafts from different donor areas or with different vascularization. This systematic review was registered in INPLASY under number INPLASY202390004.

Deep Circumflex Iliac Artery-vascularized Iliac Bone Graft for Femoral Head Osteonecrosis: Computed Tomography Anatomical Study.

Deep circumflex iliac artery (DCIA)-vascularized iliac graft transposition is a method for treating femoral head osteonecrosis but with inconsistent efficacy. We aim to improve the method of this surgery by recommending the optimal location of the iliac pedicle to satisfy the vascular length for transposition and the blood supply of the vascularized iliac graft. The DCIA and its surrounding tissues were assessed on computed tomography angiography images for 100 sides (left and right) of 50 patients. The length of the vascular pedicle required for transposition and the length of the pedicle at different iliac spine positions were compared. The diameter and cross-sectional area of the DCIA and the distance between the DCIA and iliac spine were measured at different points to assess blood supply. We also compared differences in sex and left-right position. The diameter and cross-sectional area of the DCIA gradually decreased after crossing the anterior superior iliac spine (ASIS), and it approached the iliac bone. However, when the DCIA was 4 cm behind the ASIS (54 sides, 54%), it coursed posteriorly and superiorly away from the iliac spine. The vascular length of the pedicle was insufficient to transpose the vascularized iliac graft to the desired position when it was within 1 cm of the ASIS. The vascular length requirement was satisfied, and the blood supply was sufficient when the pedicle was positioned at 2 or 3 cm. To obtain a satisfactory pedicle length and sufficient blood supply, the DCIA pedicle of the vascularized iliac graft should be placed 2 to 3 cm behind the ASIS. The dissection of DCIA has slight differences in sex and left-right position due to anatomical differences.

Using iliac arterial graft to bridge hepatic artery and L aorta during liver transplantation

Using iliac arterial graft to bridge hepatic artery and L aorta during liver transplantation

Alveolar cleft reconstruction using bone marrow aspirate concentrate and iliac cancellous bone: A 12-month randomized clinical study

ObjectiveThis study aimed to compare the bone density and volume in patients with alveolar cleft reconstructions utilizing bone marrow aspirate concentrate with iliac graft versus iliac graft alone.Material and methodsThirty-six patients with unilateral alveolar cleft were randomly allocated into either an intervention group receiving an iliac bone graft mixed with bone marrow concentrate or a control group receiving an iliac bone graft. Cone beam CT was obtained preoperative, 6 and 12 months postoperatively to assess the bone density of the graft and bone volume of the alveolar defect, and then, the bone loss ratio was calculated.ResultsBone volume and bone density demonstrated a statistically significant increase in the intervention group at 6 and 12 months. In contrast, the bone loss ratio decreased significantly in the intervention group throughout the follow-up period.ConclusionA combination of bone marrow concentrate and iliac cancellous bone in alveolar cleft reconstruction may improve bone densities and volume in addition to decreasing graft loss rate.Clinical significanceUsing of bone marrow aspirate concentrate will decrease the amount of the graft needed and decrease the ratio of bone loss at the grafted site by the time.Trial registration ClinicalTrials.org (NCT04414423) 4/6/2020

Bone regeneration after maxillary sinus floor augmentation with different ratios of autogenous bone and deproteinized bovine bone mineral an in vivo experimental study.

Test the hypothesis of no difference in bone regeneration after maxillary sinus floor augmentation (MSFA) with different ratios of iliac or mandibular autogenous bone (AB) graft and deproteinized bovine bone mineral (DBBM). Forty minipigs were randomly allocated to bilateral MSFA using: (A) 100% AB, (B) 75% AB and 25% DBBM, (C) 50% AB and 50% DBBM, (D) 25% AB and 75% DBBM, or (E) 100% DBBM. The animals were euthanized 12 weeks after surgery. Percentage of bone, non-mineralized tissue, and residual DBBM were estimated by histomorphometric analysis in a randomly selected region of interest and summarized as mean percentage with 95% confidence interval (CI). Mean percentage of bone following MSFA with iliac or mandibular AB graft was: (A) 55.5% and 64.2%, (B) 60.3% and 61.6%, (C) 54.4% and 52.1%, (D) 51.8% and 53.1%, and (E) 47.6%, respectively. There was a significant trend toward a higher percentage of bone, with a higher ratio of AB within the graft (p < .01), regardless of the origin of AB graft (iliac or mandible). The hypothesis was rejected since percentage of bone was significantly increased with larger proportions of AB within the graft. Consequently, AB or a mixture of AB and diminutive quantities of DBBM seem to be the preferred graft for MSFA based solely on histomorphometric assessment. However, it should be emphasized that newly formed bone and residual AB graft particles could not be distinguished by the applied histologic procedure.

Medium term donor-site morbidity after tricortical iliac crest graft harvesting for foot and ankle indications

Purpose of the studyThe retrospective study aimed at assessment of donor site morbidity of tricortical iliac crest graft harvest for foot and ankle indications in a single-surgeon, single-technique group of patients. Materials and methodsConsecutive patients undergoing procedures in foot and ankle requiring grafting from iliac crest were contacted with telephoned questionnaire within a second year post surgery. ResultsAmong the group of 37 patients, 100% follow-up has been achieved. One patient reported continued pain at the donor site, one case of hyperesthesia around the approach and one case of hypoesthesia of lateral cutaneous nerve of the thigh were reported. DiscussionData regarding complications of tricortical bone graft harvest from iliac crest is varied. Long term pain has been reported in up to 29% of cases. Variability of information negatively influences informed consent process. We report the results of homogeneous cohort of patients operated for foot and ankle indications. ConclusionHarvesting of tricortical anterior iliac graft for foot and ankle indications carries minimal risk of long term pain at the donor site.

Comparative analysis of cancellous graft and cortico-cancellous graft in osteosynthesis of scaphoid pseudoarthrosis with plate.

Scaphoid is the most fractured carpal bone, with a 5-10% nonunion rate. Treatment challenges include choosing the implant and graft that best corrects humpback deformity and carpal malalignment with higher chances of bony healing. Compare cortico-cancellous and cancellous grafts between two groups of patients treating scaphoid nonunion with locking plates using autologous bone graft and evaluate bone healing rates and radiographic, tomographic, and functional parameters before and after surgery. Non-randomized prospective study including 20 cases of scaphoid nonunion. Groups were divided into Group A (ten patients treated with cortico-cancellous iliac graft) and Group B (ten patients treated with cancellous iliac graft). Patients underwent pre- and postoperative radiographs, computed tomography, and functional evaluation. In postoperative analysis, Group A showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle (p = 0.011) correction when comparing the pre- and postoperative periods. Group B showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle correction (p = 0.0018), grip strength (p = 0.002), and tip pinch strength (p = 0.001) when comparing the pre- and postoperative periods. By comparing both groups, Group B showed a statistically significant difference in intrascaphoid angle correction (p = 0.002), grip strength (p = 0.002), tip pinch strength (p = 0.002), and radial deviation (p = 0.0003). There was no statistical difference when comparing bony healing between groups. Scaphoid nonunion treatment with a locking plate was effective, showing a high bony healing rate and improved carpal alignment in imaging tests for both graft types. However, results for intrascaphoid angle correction, grip strength, tip pinch strength, and radial deviation were better in Group B. IV, case series.

Management of advanced metacarpal aneurysmal cysts: Surgical technique

The hand is a rare site for aneurysmal bone cysts (ABCs). Depending on their degree of invasiveness, treatment of ABCs ranges from medical therapy to surgical curettage and bone filling. In the most advanced cases, bone resection and reconstruction, with or without adjuvant or neoadjuvant treatment, are indicated.We describe a technique involving segmental bone resection and structural iliac graft reconstruction with carpo-metacarpal plate arthrodesis, for the management of advanced ABC involving the base of the metacarpals. The radio-clinical results of two patients operated on using this technique are presented, at 18 and 36 months.At the last follow-up, the results showed a QDASH of 15 and 10, and a PRWE of 9 and 11. Satisfaction was 10/10 in both cases. Grasp strength was 25 kg and 42 kg versus 28 kg and 40 kg on the opposite side. Pinch strength was 6 kg and 11 kg versus 7 kg and 10 kg. Metacarpophalangeal flexion was 80° and 90°. Extension was complete in both cases. Radiographs showed good graft fusion, with no lysis or signs of ABC recurrence at the last follow-up.Segmental bone resection and iliac autograft reconstruction with carpo-metacarpal plate arthrodesis represents a therapeutic option in the management of advanced ABCs of the metacarpal base.

Pectoralis major pedicle bone grafting vs. tricortical iliac grafting for Neer 4-part proximal humerus fractures: a randomized controlled trial

The risk of avascular necrosis, nonunion, or malunion is high in osteoporosis-related 4-part fractures. We tried to evaluate the results of patients who underwent plate osteosynthesis with vascularized pectoralis major graft comparing with tricortical iliac grafting to treat 4-part proximal humerus fractures. Thirty-four patients aged 50-75 with Neer 4-part proximal humerus fractures were studied. Group A (n=17) underwent osteotomy of a 2.5cm±1cm pectoralis major pedicle bone graft and plate application, while Group B (n=17) underwent plate osteosynthesis using iliac autogenous grafts. Final follow-up assessments included evaluation using Constant and American Shoulder and Elbow Surgeons scoring systems, Humeral Neck-Shaft Angle (HNSA), humeral head height (Humeral Head Height) and humeral head avascular necrosis. Although reduction loss was observed in 3 patients (17.6%) in Group A patients, reduction loss was observed in 10 patients (58.8%) in Group B., p= 0.013. Humeral head avascular necrosis was 1 (5.8%) in Group A, while it was 5 (29.4%) in the other group (p= 0.071). The HNSA was normal in 12 (70.5%) of Group A patients, while it was normal in 6 (35.2%) of Group B patients. The HNSA was weak or bad (<1200) in 29.4% of Group A patients, while this rate was 64.7% in Group B patients. HHH was 2.64±1.45 mm in Group A and 3.66±1.65 mm in Group B. There were no statistically significant differences between the two groups in terms of Constant and American Shoulder and Elbow Surgeons scoring systems. Pectoralis major bone pedicle graft in Neer 4-part proximal humerus fractures reduces the risk of avascular necrosis and nonunion rates. Our technique yielded excellent clinical and radiological results. We achieved recovery without creating additional donor site morbidity.

Cryopreserved arterial allografts vs rifampin-soaked Dacron for the treatment of infected aortic and iliac grafts

ObjectiveAortic and iliac graft infections remain complex clinical problems with high mortality and morbidity. Cryopreserved arterial allografts (CAAs) and rifampin-soaked Dacron (RSD) are options for in situ reconstruction. This study aimed to compare the safety and effectiveness of CAA vs RSD in this setting. MethodsData from patients with aortic and iliac graft infections undergoing in situ reconstruction with either CAA or RSD from January 2002 through August 2022 were retrospectively analyzed. Our primary outcomes were freedom from graft-related reintervention and freedom from reinfection. Secondary outcomes included comparing trends in the use of CAA and RSD at our institution, overall survival, perioperative mortality, and major morbidity. ResultsA total of 149 patients (80 RSD, 69 CAA) with a mean age of 68.9 and 69.1 years, respectively, were included. Endovascular stent grafts were infected in 60 patients (41 CAA group and 19 RSD group; P ≤ .01). Graft-enteric fistulas were more common in the RSD group (48.8% RSD vs 29.0% CAA; P ≤ .01). Management included complete resection of the infected graft (85.5% CAA vs 57.5% RSD; P ≤ .01) and aortic reconstructions were covered in omentum in 57 (87.7%) and 63 (84.0%) patients in the CAA and RSD group, respectively (P = .55). Thirty-day/in-hospital mortality was similar between the groups (7.5% RSD vs 7.2% CAA; P = 1.00). One early graft-related death occurred on postoperative day 4 due to CAA rupture and hemorrhagic shock. Median follow-up was 20.5 and 21.5 months in the CAA and RSD groups, respectively. Overall post-discharge survival at 5 years was similar, at 59.2% in the RSD group and 59.0% in the CAA group (P = .80). Freedom from graft-related reintervention at 1 and 5 years was 81.3% and 66.2% (CAA) vs 95.6% and 92.5% (RSD; P = .02). Indications for reintervention in the CAA group included stenosis (n = 5), pseudoaneurysm (n = 2), reinfection (n = 2), occlusion (n = 2), rupture (n = 1), and graft-limb kinking (n = 1). In the RSD group, indications included reinfection (n = 3), occlusion (n = 1), endoleak (n = 1), omental coverage (n = 1), and rupture (n = 1). Freedom from reinfection at 1 and 5 years was 98.3% and 94.9% (CAA) vs 92.5% and 87.2% (RSD; P = .11). Two (2.9%) and three patients (3.8%) in the CAA and RSD group, respectively, required graft explantation due to reinfection. ConclusionsAorto-iliac graft infections can be managed safely with either CAA or RSD in selected patients for in situ reconstruction. However, reintervention was more common with CAA use. Freedom from reinfection rates in the RSD group was lower, but this was not statistically significant. Conduit choice is associated with long-term surveillance needs and reinterventions.

Cryopreserved Arterial Allografts vs Rifampin-Soaked Dacron for the Treatment of Infected Aortic and Iliac Grafts

Cryopreserved Arterial Allografts vs Rifampin-Soaked Dacron for the Treatment of Infected Aortic and Iliac Grafts