Graft Length Research Articles

Chlorine-resistant positively charged polyamide nanofiltration membranes for heavy metal ions removal

Heavy metal pollution is one of the most serious environmental problems. Nanofiltration (NF) is an effective and potential membrane separation technology for removal of heavy metal ions from water. However, the separation performance and chlorine resistance of NF membranes should be further improved in industry. Herein, to obtain exceptional water permeability and chlorine resistance, novel positively charged polyamide (PA-PDMC) NF membranes were fabricated by surface-initiated atom transfer radical polymerization (SI-ATRP), through which methacryloxyethyltrimethyl ammonium chloride (DMC) was grafted to the 2-bromoisobutyryl bromide (BIBB) exposed on the surface of polyamide (PA-Br1) membrane. The graft length of positively charged polymer chains were controlled by ATRP time, which furtherly exerted influences on the surface structures and properties of PA-PDMC membranes. At the optimal graft content, the retentions to MgCl2, CaCl2, CuCl2, ZnCl2 of the as-prepared PA-PDMC membrane were 92.8%, 90.8%, 93.5% and 96.8% respectively with the flux of 82.5 L m−2 h−1, which maintained stability during the long-term operation process of 168 h. Moreover, the PA-PDMC membrane exhibited exceptional chlorine resistance at the chlorination condition of 12,000 ppm h.

Dynamic Reconstruction for Facial Nerve Paralysis

Dynamic and static reconstruction procedures are employed for facial reanimation in patients suffering from facial nerve paralysis. Denervation and paralysis of the facial nerves causes considerable psychological and functional damage. Facial paralysis can affect facial expressiveness, communication, smile symmetry, eye protection, and speech competence. Due to their presumed poor prognosis, patients requiring facial nerve repair in a head and neck cancer practice are historically the least likely to receive a nerve graft. Dynamic reconstruction, on the other hand, is the gold standard in neurotology since patients are unlikely to die from their underlying condition. Even with malignant pathology, extended preoperative palsy, proximal nerve injury location, radiation, or long graft length, the current series supports the use of dynamic reconstruction. Dynamic facial reconstruction should be preformed in most cases unless there’s health risk of the method.

Risk factors and outcomes for failure of biological reconstruction after resection of primary malignant bone tumors in the extremities

Biological reconstruction is widely used to reconstruct bone defects after resection of bone tumors in the extremities. This study aimed to identify risk factors for failure and to compare outcomes of the allograft, nonvascularized autograft, and recycled frozen autograft reconstruction after resection of primary malignant bone tumors in the extremities. A retrospective study was performed at a single center between January 1994 and December 2017. Ninety patients with primary malignant bone tumors of the extremities were treated with tumor resection and reconstruction using one of three bone graft methods: nonvascularized autograft (n = 27), allograft (n = 34), and recycled frozen autograft (n = 29). The median time for follow-up was 59.2 months (range 24–240.6 months). Overall failure of biological reconstruction occurred in 53 of 90 patients (58.9%). The allograft group had the highest complication rates (n = 21, 61.8%), followed by the recycled frozen autograft (n = 17, 58.6%) and nonvascularized autograft (n = 15, 55. 6%) groups. There was no statistically significant difference among these three groups (p = 0.89). The mean MSTS score was 22.6 ± 3.4 in the nonvascularized autograft group, 23.4 ± 2.6 in the allograft group, and 24.1 ± 3.3 in the recycled frozen autograft group. There was no significant difference among the groups (p = 0.24). After bivariate and multivariable analyses, patient age, sex, tumor location, graft length, methods, and type of reconstruction had no effects on the failure of biological reconstruction. Biological reconstruction using allograft, nonvascularized autograft, and recycled frozen autograft provide favorable functional outcomes despite high complication rates. This comparative study found no significant difference in functional outcomes or complication rates among the different types of reconstruction.

174 Semi-Skeletonized Versus Pedicled Internal Mammary Artery Harvesting: A Systematic Review

Abstract Objectives To compare semi-skeletonized with pedicled harvesting technique of the internal mammary artery for coronary artery bypass surgery. Method A comprehensive literature search was performed on PubMed, Cochrane database, Embase, Google Scholar and Ovid identifying articles that compared semi-skeletonised to pedicled internal mammary artery in the use of coronary artery bypass surgery. Databases were evaluated and assessed from inception to July 2020. Results Only five studies fulfilled the criteria for this review. There was no reported incidence of sternal wound infection, myocardial infarction, or mortality. The length of the IMA graft was longer in the semi-skeletonized group compared to the pedicled group, 16.06cm versus 14.63cm respectively (p < 0.001). The intraoperative diastolic flow was significantly greater in the semi-skeletonized grafts than in the pedicled grafts during (p = 0.003) and after (p = 0.005) cardiopulmonary bypass. The incidence of pleural effusion (pedicled, 52.6%; semi-skeletonized, 23.6%; p = 0.002) and atelectasis (pedicled, 42.1%; semi-skeletonized, 20.0%, p = 0.015) were significantly higher in pedicled group. Post-operative chest tube drainage was significantly higher in the pedicled group (608 ± 58 mL compared to 470 ± 48 mL; p = 0.027). Additionally, FEV1 was significantly decreased in the pedicled group 6 days after surgery (pedicled:76.0% ± 1.6%; semi-skeletonized: 83.2% ± 1.6%; p = 0.020). Conclusions These results demonstrate that the semi-skeletonized preparation technique is associated with satisfactory outcomes during harvesting the internal mammary artery. Yet, due to limited numbers of studies, there is need for larger comparative studies to assess post-operative outcomes with a longer period of follow up.

Long-term results of total endovascular repair of arch-involving aortic pathologies using parallel grafts for supra-aortic debranching

ObjectiveWe evaluated the long-term morphologic and clinical outcomes after thoracic endovascular aortic repair combined with parallel grafts (PG-TEVAR) for arch-involving aortic pathologies. MethodsWe performed a retrospective analysis of perioperative and follow-up data of patients who had undergone PG-TEVAR at a single vascular surgery center from November 2010 to April 2018. Patients with prior or simultaneous open chest or cervical debranching procedures or arch repair were excluded. The primary endpoint was freedom from overall PG-TEVAR–related reintervention. The secondary endpoints were parallel graft sealing zone failure (presence of gutter-related type I or Ic endoleak), PG failure (occlusion or reintervention), stroke, and 30-day and overall PG-TEVAR–related and all-cause mortality. Kaplan-Meier curves were used to estimate the freedom from reintervention and survival. Receiver operating characteristics curves were used to find the optimal cutoff to prevent type Ia endoleak-related reintervention. ResultsA total of 33 patients, including 8 women, with a median age of 74 years (interquartile range, 67-79 years) had undergone PG-TEVAR (chimney, periscope, and sandwich in 20, 15, and 13 patients, respectively) with proximal landing in Ishimaru zone 0, 1, or 2 in 4, 5, and 24 patients, respectively. The aortic pathologies included type B aortic dissection (acute and chronic, eight and six, respectively), degenerative aneurysm (n = 10), type Ia endoleak (n = 3), para-anastomotic/patch aneurysm (n = 4), left subclavian artery aneurysm (n = 1), and traumatic rupture (n = 1). The perioperative stroke rate and 30-day mortality was 6% and 9%, respectively. Direct postoperative computed tomography revealed 28 endoleaks (gutter-related type Ia, 12; gutter-related type Ib, 9; type Ia, 2; type Ic, 2; type III, 1; undetermined, 2) in 27 patients. The technical and clinical success rate was 37% and 30%, respectively. The mean follow-up for survival was 48 ± 31 months. The latest radiologic follow-up demonstrated 12 remaining and 1 new endoleak. The early and overall PG sealing zone failure and PG failure was 73% and 36% and 9% and 18%, respectively. The overall PG-TEVAR–related reintervention rate was 33% (n = 11). The estimated freedom from overall PG-TEVAR–related reintervention was 68% at 60 months. The main graft oversizing and length oversizing rates were not significantly associated statistically with the type Ia endoleak-related reintervention rate. The PG-TEVAR–related and all-cause mortality were 18% and 34%, respectively. ConclusionsPG-TEVAR for total endovascular repair of arch-involving aortic pathologies resulted in a high rate of type I endoleaks and the need for long-term reintervention. Gutter-related endoleaks might be more frequent than reported and should not be underestimated because they can lead to sac enlargement and reintervention. Frequent radiologic surveillance is mandatory. Further studies comparing PG-TEVAR to other total endovascular alternatives are required to confirm these findings.

Outcomes of Endovascular Therapy for Stanford Type B Aortic Dissection in Patients With Marfan Syndrome

A single-center, retrospective review was performed between January 2009 and December 2019. A total of 26 patients with Marfan syndrome (MFS) underwent thoracic endovascular aorta repair (TEVAR) for Stanford type B aortic dissection (TBAD). The mean age was 38 years (range, 24-64 years). In-hospital mortality was 0%. The cumulative survival rate was 88% at 5 years and 83% at 10 years. Freedom from reintervention was 83% at 5 years and 50% at 10 years. Patients with a thrombosed false lumen (FL) along the length of the stent graft had a significantly higher cumulative survival rate and freedom from reintervention than patients with patent FL. TEVAR can be performed safely and effectively for TBAD in patients with MFS. Perioperative mortality and morbidity were low. Lifelong follow-up is mandatory to prevent aortic rupture. Patients with a patent FL were at high risk of late death.

Grafting of poly(ε‐caprolactone) from Abaca cellulose fibers via ring‐opening polymerization resulting in facile one‐pot biocomposites

AbstractAs efforts to replace nonsustainable plastics increase, biocomposites from cellulose fibers and biodegradable polymers like poly(ε‐caprolactone) (PCL) are promising candidates. The necessary adhesion between fibers and matrix can be achieved by grafting polymeric chains onto the fibers. Herein, we report grafting of PCL onto Abaca fibers (AFs), a one‐pot method to obtain a composite containing grafted fiber and free PCL, and the characterization of prepared composite films. Three parameters for pretreatment (disintegration, drying, and solvent exchange) of AF were compared. Short and long PCL chains with molecular weights below and close to the chain entanglement weight of PCL were grafted from AFs. Using benzyl alcohol as an additional initiator, free PCL was simultaneously prepared. The unreacted monomer was removed by precipitation in water, resulting in ready‐made one‐pot composites. The biocomposites containing the free PCL and PCL‐grafted AFs were further processed by a combination of compounding and hot‐pressing. The analyzed mechanical (tensile) and rheological properties show a large dependence on the lengths of the PCL grafts. The herein‐reported composites pave the way for interesting bio‐based alternatives to plastic, especially looking at the tailoring of material properties.

Amylopectin graft copolymers for oil sands tailings treatment

AbstractThe oil sands industry has contributed to the Canadian economy for over 50 years. Challenges have arisen, however, due to worldwide concerns regarding the long‐term environmental impact of waste by‐products generated in the bitumen extraction process from oil sands. Reclaiming legacy tailings and reducing the number of ponds are two of these challenges. This article describes the synthesis and characterization of amylopectin‐graft‐hydrolyzed‐poly(methyl acrylate) copolymers with different graft lengths and densities, and how they can be used to treat oil sands tailings. Flocculation and dewatering results depend strongly on how the hydrophobic amylopectin backbones are combined with the hydrophilic hydrolyzed poly(methyl acrylate) grafts. These hybrid polymers, combining a natural backbone with synthetic grafts, seem to be an attractive alternative to treat oil sands and probably other mineral ore tailings.

Indirect markers for length adjustment in distal biceps tendon allograft reconstruction.

Chronic musculotendinous retraction, shortening and fibrosis after distal biceps tendon tears makes a primary reconstruction often difficult or even impossible. Interposition reconstruction with allograft provides a solution, however there is no consensus about appropriate intraoperative graft length adjustment. Therefore, the purpose of this study was to find a practical reference value for distal biceps tendon length adjustment. Three-dimensional surface models of healthy distal biceps tendons were created based on 85 MRI scans. The tendon length was measured from the myotendinous junction to the insertion on the bicipital tuberosity. Inter-epicondylar distance (IED) and radial head diameter (RHD) were measured on antero-posterior radiographs as a surrogate for patient size. Correlations between the tendon length and IED, RHD and patient’s height (PH) were calculated. Mean length of the external part of the distal biceps tendon was 69mm (female 64mm, male 71mm). The tendon length in mm was on average 1.1 times of the IED (mm), 3 times of the RHD (mm) and 0.4 times of PH (cm). Herewith, the tendon length could be predicted within a narrow range of +/-1cm in 84% by using IED, 82% by using RHD and 80% by using PH. Intra- and inter-reader reliabililty of IED and RHD was excellent (R2 = 0.938–0.981). The distal biceps tendon length can be best predicted within 1cm with an accuracy of 82–84% using the IED and RHD with an excellent intra- and inter-reader reliability.

MP56-20 LONG-TERM OUTCOMES AND COMPLICATIONS OF MODIFIED LINGUAL MUCOSA GRAFT RECONSTRUCTIVE TECHNIQUE FOR ANTERIOR URETHRAL STRICTURE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-20 LONG-TERM OUTCOMES AND COMPLICATIONS OF MODIFIED LINGUAL MUCOSA GRAFT RECONSTRUCTIVE TECHNIQUE FOR ANTERIOR URETHRAL STRICTURE Chao Feng, Yue-min Xu, Ying-long Sa, Jiong Zhang, Hong xie, Chong-rui Jin, Jie-min Si, Lu-jie Song, Kai-le Zhang, and Qiang Fu Chao FengChao Feng More articles by this author , Yue-min XuYue-min Xu More articles by this author , Ying-long SaYing-long Sa More articles by this author , Jiong ZhangJiong Zhang More articles by this author , Hong xieHong xie More articles by this author , Chong-rui JinChong-rui Jin More articles by this author , Jie-min SiJie-min Si More articles by this author , Lu-jie SongLu-jie Song More articles by this author , Kai-le ZhangKai-le Zhang More articles by this author , and Qiang FuQiang Fu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The feasibility and reliability of lingual mucosa graft (LMG) for urethroplasty has been confirmed. In this study, we tried to evaluate the long term results of LMG urethroplasty and to analyze the impact factors for the surgical outcome of LMG reconstruction. METHODS: This retrospective study conclude 105 male patients with anterial urethral strictures. The etiology of strictures included lichen sclerosis, trauma, inflammatory, iatrogenic and idiopathic. Modified lingual mucosa graft harvesting technique was used in all cases. One side dissection dorsal onlay technique (Kulkarni technique) was used for reconstruction. The cases were followed up 6 months, 2 years and 5 years after discharge. RESULTS: The mean follow-up duration was 33.77±19.43 months. The average length of stricture was 7.45±4.22 cm. The average length and width of lingual mucosa graft were 7.13±3.95 cm and 1.50±0.45 cm, respectively. By the 6 months after operation, 77.17% cases were recorded a good result. At the end of 2 years, 80.95% cases still maintained an idea outcome. Within 5 years follow-up, only 7 cases complained about the oral complications since 6 months after the operation. The width and length of graft was not related with surgical outcome and complication. However, age showed the relationship with short term surgical outcome. CONCLUSIONS: The modified lingual mucosa graft reconstructive technique has been proved to be used for various anterior urethral stricture feasibly. For the long-term results, it showed the good outcome and few complications. The age might be the independent impact factors for the short term surgical ooutcome. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e976-e977 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chao Feng More articles by this author Yue-min Xu More articles by this author Ying-long Sa More articles by this author Jiong Zhang More articles by this author Hong xie More articles by this author Chong-rui Jin More articles by this author Jie-min Si More articles by this author Lu-jie Song More articles by this author Kai-le Zhang More articles by this author Qiang Fu More articles by this author Expand All Advertisement Loading ...

PD22-06 A MODIFIED APPROACH TO MEDIUM-LENGTH OBLITERATIVE BULBAR STRICTURES: TECHNIQUE AND OUTCOMES OF THE MUCOMUCOSAL ANASTOMOTIC NON-TRANSECTING AUGMENTATION (MANTA) URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (PD22)1 Sep 2021PD22-06 A MODIFIED APPROACH TO MEDIUM-LENGTH OBLITERATIVE BULBAR STRICTURES: TECHNIQUE AND OUTCOMES OF THE MUCOMUCOSAL ANASTOMOTIC NON-TRANSECTING AUGMENTATION (MANTA) URETHROPLASTY Phillip Marks, Roland Dahlem, Maryam Khonsari, Lennart Kühnke, Frederik König, Margit Fisch, and Malte W. Vetterlein Phillip MarksPhillip Marks More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Maryam KhonsariMaryam Khonsari More articles by this author , Lennart KühnkeLennart Kühnke More articles by this author , Frederik KönigFrederik König More articles by this author , Margit FischMargit Fisch More articles by this author , and Malte W. VetterleinMalte W. Vetterlein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002011.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For short and obliterative bulbar strictures, non-transecting excision and primary anastomosis (EPA) has come of age to avoid disrupting spongiosal blood flow. Longer obliterative strictures may be treated by a combined "double" ventral + dorsal graft (Palminteri et al. 2008) or an augmented anastomotic approach, which was recently refined by a non-transecting technique combining EPA and a dorsal graft (Welk et al. 2012; Bugeja et al. 2016). We here present the initial experience with our ventral modification of this technique, the mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty. METHODS: We included patients with an obliterative bulbar segment (≤2 cm) and mild to moderate spongiofibrosis undergoing MANTA between 2016-2019. The stricture is approached by ventral stricturotomy to avoid extensive urethral dissection and mobilization from the corpora cavernosa. Dorsally, the scar is superficially excised and the spongiosum is left intact. Dorsal mucomucosal anastomosis (excluding sponge tissue) is performed, which is complemented by a ventral onlay buccal mucosal graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated PROMs (6-item LUTS score of the USS PROM). We evaluated the postoperative improvement of objective (uroflowmetry at three weeks postoperatively) and functional follow-up, which incorporated patient-reported parameters (LUTS score) and functional success, whereas recurrence was defined as the symptomatic need of any re-intervention. RESULTS: Median age in 54 men undergoing MANTA was 51 yr, 83% and 26% had a history of ≥1 urethrotomy and urethroplasty, respectively. Stricture location was bulbar in 70% and penobulbar in 30%. Median operative time and graft length was 55 min and 4 cm, respectively. In 35 patients with measurable uroflowmetry data, median Qmax significantly improved (7.7 ml/s preoperatively to 31 ml/s three weeks postoperatively; p<0.001). Cross-sectional functional follow-up was performed at a median of 40 mo (range 5-57) postoperatively and was available in 50/54 patients (93% response rate). Preoperative median 6-item LUTS score was 12 (IQR 8–14) and improved significantly after surgery to a postoperative median of 1 (IQR 0-3; p<0.001). Overall success was 93% with 4/54 patients suffering from functional stricture recurrence and the need of a re-intervention. CONCLUSIONS: MANTA urethroplasty using a ventral onlay provides excellent mid-term results in patients with bulbar strictures with an obliterative segment ≤2 cm and adds to the surgical armamentarium of non-transecting techniques by minimizing extensive mobilization. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e382-e382 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phillip Marks More articles by this author Roland Dahlem More articles by this author Maryam Khonsari More articles by this author Lennart Kühnke More articles by this author Frederik König More articles by this author Margit Fisch More articles by this author Malte W. Vetterlein More articles by this author Expand All Advertisement Loading ...

Is reimplantation surgery an option in resource constrained countries?

Re-implantation of a severed body part is a demanding procedure that requires consolidated surgical efforts. Many factors influence the outcome, amongst them being availability of re-implantation team and necessary support structure. There is paucity of data on the management and outcome of the severed extremities in many resource constrained settings especially in Africa. To determine clinical presentation and outcomes of patients offered re-implantation after cut extremities. We carried out a prospective cohort study of patients presenting with cut extremities managed by re-implantation in our center between January2018 and December 2019. Variables determined included anatomical locations, ischemic time, length of surgery, grafts utilized and outcome. A total of 11 patients with 12 cut extremities requiring re-implantation were managed at Kenyatta National Hospital during the period of our study. The age range was six to forty five years. Majority were male [11] with only one female. Most injuries involved the upper limb (11 patients) with one the lower limb. The mean ischemia time was 13.3 h. Ten patients required venous or arterial grafts during the surgery. The overall success rate was 71% for the re-implantations. The functional recovery varied from fair to good in all the patients whose limbs were saved. Re-implantation surgery is a viable option in many countries with limited resources. Determinants of success rate include multidisciplinary team approach as well as motivation and necessary experience in microsurgery. Post-operative follow up is critical for functional outcome. • Male patients more affected that female. • Mean ischemic time of more than 12 h. • More than 80% required vascular grafts. • Overall reimplantations success of greater than 70%. • -multidisciplinary approach with plastic and orthopaedic surgeons is critical.

Myosteatosis, the More Significant Predictor of Outcome: An Analysis of the Impact of Myosteatosis, Sarcopenia, and Sarcopenic Obesity on Liver Transplant Outcomes in Johannesburg, South Africa.

In high-income countries, myosteatosis, sarcopenia, and obesity with sarcopenia (sarcopenic obesity) are associated with adverse outcomes after liver transplantation. In South Africa, an upper-middleincome country, we investigated the prevalence and impact of these muscle abnormalities on posttransplant outcomes in adult liver transplant recipients. We reviewed 106 liver transplant recipients and measured muscle abnormalities on computed tomography using segmentation software. The parameters evaluated were myosteatosis by mean muscle attenuation, sarcopenia by skeletal muscle index at the third lumbar vertebra using validated cutoffs, and sarcopenic obesity as sarcopenia and a body mass index of ≥25 kg/m². The effects of these abnormalities on 1-year patient and graft survival (primary endpoint) and length of hospital and intensive care unit stay, costs, and 90-day and overall postoperative complications (secondary endpoints) were assessed. Most liver transplant recipients were male (n = 64, 60%). Alcoholic and/or nonalcoholic steatohepatitis were the most frequent indications for transplant (n = 38, 36%). Myosteatosis occurred in 76 patients (72%), 69 patients (65%) had sarcopenia, and 36 patients (34%) had sarcopenic obesity. One year after transplant, myosteatosis was associated with higher mortality (hazard ratio of 3.3; 95% confidence interval, 1.00-11.13; P = .049), greater risk of allograft failure (hazard ratio of 4.1; 95% confidence interval, 1.2-13.5; P = .021), and longer hospital and intensive care unit stays compared with those without myosteatosis. All patients with no body composition abnormalities were alive at 1 year compared with 69% with coexisting myosteatosis and sarcopenia. In our setting, liver transplant recipients with myosteatosis had a higher risk of death and allograft failure at 1 year compared with patients without body composition abnormalities.

Extensive Aortic Stent Graft Coverage for Thoracoabdominal Aortic Aneurysm is Associated With Hemorrhagic Complications Induced by Disseminated Intravascular Coagulation

Hybrid endovascular repair for thoracoabdominal aortic aneurysm (TAAA) is a less invasive alternative treatment than conventional open repair. However, disseminated intravascular coagulation (DIC) and hemorrhagic complications can occur postoperatively. We investigated risk factors for hemorrhagic complications after hybrid endovascular TAAA repair. Sixty-one patients who underwent elective hybrid endovascular TAAA repair between 2007 and 2020 were included. Laboratory data before and after placing stent graft were collected, and DIC was diagnosed using a scoring system established by the Japanese Association for Acute Medicine. The length of the stent graft used to cover the aorta was defined as the aortic coverage length, which was measured using the first postoperative computed tomography image. Predictors of unexpected hemorrhagic complications were evaluated. Postoperative thrombocytopenia was observed in 57 (93%) patients, and their platelet count decreased significantly after stent graft placement (14.3 [9.5-18.0] vs. 8.2 [5.4-10.9]×104/µL, P < 0.001). Fifteen (25%) and 45 patients (74%) were diagnosed with DIC before and after stent graft placement, respectively. Hemorrhagic complications were observed in 21 patients (34%). Multivariate logistic regression analysis revealed that aortic coverage length was an independent risk factor for hemorrhagic complications (odds ratio 1.441/50 mm increase; 95% confidence interval, 1.041-1.994, P=0.027). The cutoff value for aortic coverage length obtained from the receiver operating characteristic curve (area under the curve=0.72) was 304.4 mm (sensitivity 0.76, specificity 0.70). Aortic coverage length is a risk factor for hemorrhagic complications. Patients undergoing extensive aortic coverage greater than 304 mm should be closely monitored.

Achilles Tendon Allograft Preparation Technique for Anterior Cruciate Ligament Reconstruction: A Technical Note

Several factors associated with graft preparation for the surgery of the anterior cruciate ligament (ACL) like the wrong thawed, prophylaxis, bone cuts, excessive bone removal as well as positioning problems like a tunnels-graft mismatch, insufficient harvesting of the donor's tendon, size graft limitations (length and diameter), uncontrolled rotation of graft in their longitudinal axis, over or under tensioned graft, fixation mistakes, bone defects, secondary arthrofibrosis or morbidity of the donor site, and others factors importantly affect the outcomes of the ACL surgery. In this sense, the Achilles tendon Allograft is an advantageous technique where many of the previous limitation factors described can be controlled during an appropriate preparation. However, to obtain the maximum potentialities of the graft a detailed knowledge of the preparation is required. Hence, we aimed to describe how to prepare the Achilles tendon Allograft to control the graft's length and diameter, bone removal, and fixation requirements.

Transepicondylar Distance Can Predict Graft and Tunnel Length for Different Pediatric Anterior Cruciate Ligament Reconstruction Techniques: A Magnetic Resonance Imaging Study

To find a correlation and mathematical formulas between a linear 2-dimensional (2D) magnetic resonance imaging (MRI) measurement around the knee and the length of the grafts and tunnels required for both all-inside-all-epiphyseal and Kocher-Micheli pediatric anterior cruciate ligament (ACL) reconstruction techniques. At time 0 and 30 days after, 2 observers measured: (1) on standard 2D knee MRI, 7 linear distances, representing morphologic measurements, such as transepicondylar distance (TD), and (2) on 3-dimensional (3D) MRI, 5 curved distances, corresponding to Kocher-Micheli and all-epiphyseal ACL reconstruction techniques. Intra- and interobserver reliability was tested for all measurements. The correlation between 2D and 3D measurements was tested. The 2D measurement with highest repeatability and reproducibility and with strongest correlation with 3D measurements was used to extract formulas to calculate the tunnel and graft length for the 2 techniques. Seventy-six MRIs were used. The intra- and interobserver reliability of 2D measurement was high, with TD showing the highest reproducibility and repeatability. 3D measurements also showed good intra and inter-observer reliability. A linear correlation was found between 2D and 3D measurements, with TD showing the strongest correlation. TD was used to extract formulas to calculate graft or tunnel length for Kocher-Micheli and all-epiphyseal ACL reconstruction. All formulas were proven to be accurate. A reference chart was also created to be used in the surgical setting. With specific formulas, TD can be used to calculate the length of the tunnels, intra-articular portion and graft length for an all-inside all-epiphyseal pediatric ACL reconstruction and the length of the iliotibial band required for the Kocher-Micheli technique. The surgeon can use these formulas in pediatric ACL reconstruction preoperative planning, graft harvesting and tunnel drilling.

Comparison of free vascularized fibular flaps and allograft fibular strut grafts to supplement spinopelvic reconstruction for sacral malignancies

Orthopaedic and reconstructive surgeons are faced with large defects after the resection of malignant tumours of the sacrum. Spinopelvic reconstruction is advocated for resections above the level of the S1 neural foramina or involving the sacroiliac joint. Fixation may be augmented with either free vascularized fibular flaps (FVFs) or allograft fibular struts (AFSs) in a cathedral style. However, there are no studies comparing these reconstructive techniques. We reviewed 44 patients (23 female, 21 male) with a mean age of 40 years (SD 17), who underwent en bloc sacrectomy for a malignant tumour of the sacrum with a reconstruction using a total (n = 20), subtotal (n = 2), or hemicathedral (n = 25) technique. The reconstructions were supplemented with a FVF in 25 patients (57%) and an AFS in 19 patients (43%). The mean length of the strut graft was 13 cm (SD 4). The mean follow-up was seven years (SD 5). There was no difference in the mean age, sex, length of graft, size of the tumour, or the proportion of patients with a history of treatment with radiotherapy in the two groups. Reconstruction using an AFS was associated with nonunion (odds ratio 7.464 (95% confidence interval (CI) 1.77 to 31.36); p = 0.007) and a significantly longer mean time to union (12 months (SD 3) vs eight (SD 3); p = 0.001) compared with a reconstruction using a FVF. Revision for a pseudoarthrosis was more likely to occur in the AFS group compared with the FVF group (hazard ratio 3.84 (95% CI 0.74 to 19.80); p = 0.109); however, this was not significant. Following the procedure, 32 patients (78%) were mobile with a mean Musculoskeletal Tumor Society Score 93 of 52% (SD 24%). There was a significantly higher mean score in patients reconstructed with a FVF compared with an AFS (62% vs 42%; p = 0.003). Supplementation of spinopelvic reconstruction with a FVF was associated with a shorter time to union and a trend towards a reduced risk of hardware failure secondary to nonunion compared with reconstruction using an AFS. Spinopelvic fixation supplemented with a FVF is our preferred technique for reconstruction following resection of a sacral tumour. Cite this article: Bone Joint J2021;103-B(8):1414-1420.

Bilateral ileal ureter substitution for patients with ureteral strictures secondary to gynecological tumors radiotherapy: a multi-center retrospective study.

BackgroundThe selection of treatment for bilateral ureteral strictures caused by radiotherapy in patients with gynecological tumors often brings great challenges to urologists. This study was designed to analyze the characteristics of radiation-induced ureteral strictures and summarize the surgical experience of bilateral ileal ureter substitution.MethodsWe retrospectively collected the medical records of 18 patients between June 2010 and June 2019 who had a radiation-induced bilateral ureteral strictures. Time interval from radiotherapy to the discovery of ureteral stricture was categorized into short-term (less than 12 months) and long-term (over 12 months) groups. All patients received reverse “7” bilateral ileal ureteral substitution. Surgical success was defined as no restenosis, relief of symptoms, and improved/stabilized hydronephrosis.ResultsThe patients had been suffered from ureteral stricture for a median of 12 [2–106] months. The mean length of the left and right ureteral stricture was 9.6±2.6 and 8.8±3.2 cm, respectively. The mean length of the ileal graft was 29.1±7.4 cm. The mean operative time was 308.4±70.2 min, and the mean estimated blood loss was 254.7±166.2 mL. The postoperative hospital stays in the short-term group was significantly shorter than that in the long-term group (14.0 vs. 20.6 days, P=0.049). During a median follow-up time of 24.1 (4.5–71.9) months, the success rate was 94.4%. Eight minor complications and two major complications occurred in 7 patients.ConclusionsBilateral ileal ureter substitution can be an effective strategy for radiation-induced ureteral stricture in patients with gynecological tumors.

QS1: Pre-implanted Nerve Grafts (PING) to Improve Functional Outcomes in VCA

Purpose:Improved graft reinnervation and functional recovery would greatly enhance the utility of vascularized composite allotransplantation (VCA). Pre-implantation of nerve grafts in a limb transplant recipient prior to transplantation to increase the length of the severed nerves in the amputation stump offers a novel, readily translatable approach to this problem. At the time of transplantation a pre-implanted nerve graft (PING) would be elevated from its wound bed in the amputated stump and unfurled distally into the transplanted limb, allowing for a more distal nerve coaptation.Methods:We used a reversed sciatic-tibial nerve isograft coapted end-to-end to a median nerve in a rat to: (1) determine viability of distal axons after elevating PINGs; and (2) assess for ischemic injury to axons in the distal PING following elevation from the wound bed. For axonal viability, grafts of varying lengths (2cm,3cm,4cm, n≥5/group) were left to regenerate for 8 weeks. The distal ends were then biopsied prior to elevation, and again one week after elevation. For ischemia assessment, blood flow along 4cm long PINGs was measured with laser doppler at multiple timepoints: baseline (at time of grafting), 8 weeks after grafting (before elevation), immediately after elevation, and 3 and 7 days post-elevation (n=8/timepoint). Means were compared with t-tests and ANOVA. A pig forelimb model was used to assess the functional impact of PINGs. A 6cm long reversed ulnar-PING was coapted to the proximally transected ulnar nerve. After 12 weeks of regeneration, the distal PING was transferred end-to-end to the median nerve just proximal to the elbow. A control group underwent ulnar-to-median nerve transfer 6cm proximal to the elbow (n=4 limbs/group). Hoof flexion force was measured every three weeks.Results Axonal viability:after 8 weeks, axons had regenerated into the distal grafts in all lengths: mean myelinated axon counts (±SD): 7043 (±790), 6066 (±1838), 6491 (±983) in 2cm,3cm,4cm grafts, with no differences between graft lengths (p=0.48). One week after elevation and unfurling, the number of myelinated axons was significantly decreased in all groups (p<0.006): 3821 (±567), 2953 (±1107), 2894 (±1761) in 2cm,3cm,4cm grafts, with no differences between lengths (p=0.91). Ischemic injury: immediately after elevating a PING, blood flow within the distal half of the graft fell to baseline levels (i.e. no blood flow). 3 days after elevation, blood flow throughout the graft was significantly above baseline (p≤0.04) and matched/exceeded flow measured immediately prior to elevation. Functional impact: preliminary results suggest PINGs can deliver rapid functional recovery.Conclusions:Axons remain present in clinically relevant numbers at the distal ends of PINGs after elevation and unfurling. A decrease in axon counts after elevation may relate to ischemia in the distal PING immediately after elevation. Preliminary functional results show PINGs are capable of delivering early functional recovery.

Long-term sensibility outcomes of secondary digital nerve reconstruction with sural nerve autografts: a retrospective study

BackgroundRecovery of sensibility after digital nerve injury is crucial for restoring normal hand function. We evaluated long-term outcomes of digital nerve reconstruction with autografts.MethodsThis retrospective study included patients who underwent secondary reconstruction of digital nerves with nerve autografting. Recovery of sensibility was evaluated based on the following: patient self-assessment, two-point discrimination (2PD), and a total sensation score (sum of proprioception, temperature sensation, and sharp/dull discrimination). Mixed models regression was used to study predictors of sensibility outcomes. The predictors analyzed were age, sex, smoking status, number of fingers involved in a patient (as a measure of injury severity), time to reconstruction, and time to follow-up.ResultsIn 61 patients, 174 digital nerves in 126 fingers were reconstructed after an average of 33.1 weeks from injury. The mean follow-up was 6.4 years from reconstruction. The mean graft length was 3.6 cm. Self-rated sensibility in the affected area was very good in 13% of patients, good in 33%, satisfactory in 40%, and poor in 24%. 2PD at 6 mm was present in 17% of patients, at 10 mm in 12%, and at 15 mm in 18% (mean 2PD was 10.8). Proprioception was preserved in 107 (85%) fingers, sensation of temperature was preserved in 99 (75%) of fingers, and sharp/dull discrimination in 88 (70%) fingers. Time from injury to reconstruction was the only significant predictor of the total sensation score.ConclusionOur data indicate that earlier reconstruction is associated with a favorable outcome.