Patch Graft Research Articles

Pericardium Patch Graft (Tutoplast) for Bleb Repair and Bleb Remodelling After Nonpenetrating Filtering Surgery: 6-Month Outcomes.

The purpose of this study was to evaluate the outcome of pericardium patch graft (Tutoplast) as an adjuvant to either bleb repair or bleb reduction after nonpenetrating filtering surgery. Retrospective study, at a tertiary glaucoma center. Bleb revision with Tutoplast positioning was performed either for bleb repair to treat early leaks or hypotony with maculopathy, either for bleb reduction to improve ocular pain, discomfort, burning, foreign body sensation, tearing, and fluctuations of visual acuity. Intraocular pressure (IOP), best corrected visual acuity, number of antiglaucoma medications, and postoperative complications were analyzed postoperatively at 1 week, 1, 3, 6 months, and compared with the preoperative baseline. Surgical success was defined as achieving an IOP between 8 and 16 mm Hg. Six-month data were available from 15 eyes of 15 patients; mean patient age was 69.6±11.7 (66.7% male). Bleb revision was necessary for 10 patients due to bleb dysesthesia (bleb reduction), and in 5 patients due to leaking filtering bleb (bleb repair). The success rate was 73.3% at 6 months, with a significant IOP increase from 4.9±2.2 mm Hg preoperatively to 12.7±3.5 mm Hg at 6 months (P=0.0001), and a concomitant rise of best corrected visual acuity from 0.5±0.3 to 0.6±0.3 (P=0.2871). To control IOP, antiglaucoma medications were needed for 3 patients (20%) at 6 months. Overall, 3 patients (20%) required additional bleb revision for persistent hypotony, and 1 patient underwent a subsequent glaucoma surgery (transscleral cyclodestruction). Pericardium patch graft (Tutoplast) is a safe and effective adjuvant for bleb revision due to bleb dysesthesia of leaking filtering bleb after nonpenetrating filtering surgery.

Amniotic Membrane as a Main Component in Treatments Supporting Healing and Patch Grafts in Corneal Melting and Perforations.

Purpose To report on surgical approaches using amniotic membrane applications and patch grafts in corneal melting and perforations. Anatomical and functional results, including advantages and disadvantages of the interventions, will also be explored. Methods A five-year retrospective analysis of 189 surgical treatments involving corneal melting with perforation was performed. In one evaluated treatment type, a graft of amniotic membrane, often folded one to three times, was sutured with the epithelial side facing the previously mechanically debrided corneal tissue. A larger monolayer amniotic patch was then sutured, with the epithelial side facing the top of the first membrane, to the perilimbal conjunctiva. For corneal patch grafts, the size-fitting technique of graft trephination was applied, and the donor-recipient junctions were sewn with interrupted sutures. All the procedures were evaluated, noting outcomes and complications of surgery, preoperative and postoperative visual acuities, postoperative intraocular pressures, graft rejection, and other late comorbidities and complications. Results We performed 119 amniotic membrane applications (63%) and 70 corneal patch grafts (37%). Anatomical reconstruction of the anterior chamber was achieved in 157 eyes, of which 102 eyes (86%) received an amniotic membrane and 55 eyes (79%) were treated with the patch graft technique. In 63 eyes (33%), more than one amnion or graft treatment was necessary to close the corneal perforation. Conclusions The success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; nevertheless, patch grafts deliver better tectonic reconstruction than amniotic membrane alone.

Uso de sustituto semisintético de duramadre como injerto tras extrusión de prótesis en una cavidad anoftálmica

We present a case report of a three-year old patient diagnosed with retinoblastoma in her left eye. The course of the disease made enucleation of the latter eye and a prosthesis implant necessary. Two years after surgery, partial prosthesis extrusion occurred and a semisynthetic dura mater substitute was used as a patch graft to cover the defect. To our knowledge, semisynthetic dura mater substitutes’ use in this scenario has not been previously reported.

Duodenojejunostomy, an Old Technique but Novel Solution for Giant Duodenal Perforations - A Report of Four Cases and Review of Literature

Background: Despite advances in the medical management of peptic ulcer disease, duodenal ulcer (DU) perforation remains a common surgical emergency. Most DU perforations are small and can be managed with omental patch repair. However, occasionally the surgeon may encounter a giant perforation not amenable to this. Giant DU perforations are defined as > 2cm. They are associated with high leak rates and mortality. Prognosis in elderly patients are particularly poor because of advanced age and comorbidities. Furthermore, there are no specific recommendations for their management despite a variety of repair techniques being described. Here, we aim to describe a novel technique used to treat such patients, especially those of advanced age, in our institution and to review the current literature. Case presentation: Four patients with giant DU perforation underwent emergency laparotomy and repair with our duodenojejunostomy technique at our hospital. Post-operatively, patients were monitored clinically and radiologically and discharged when well and tolerating diet. The mean age of the patients was 67 years with an equal gender distribution. The average Charlson Comorbidity Index (CCI) score was 3 (moderately severe). All presented with peritonitis and two had concomitant bleeding. There were two anterior and two posterior ulcers. One was a revision repair after a leak post laparoscopic omental patch repair for the initial perforation. In all cases, the duodenojejunostomy repair technique was used. Post-operative recovery was uneventful for all except one who developed pneumonia. In particular; there were no anastomotic leaks, intra-abdominal collections, gastric outlet obstructions or mortalities. Conclusion: Giant DU perforation remains a challenge to the general surgeon, particularly so in elderly patients with multiple comorbids. A review of the current literature suggests a myriad of surgical techniques but no perfect solution. Some suggested techniques include omental patch with pyloric exclusion, controlled tube duodenostomy, jejunal pedicled graft or serosal patch, gastric disconnection and partial gastrectomy. Here, we propose that isolated duodenojejunostomy can be a quick, safe and novel solution that ensures definitive repair of giant ulcer perforation in a single setting in the high-risk patient.

Biomechanical Response to Distraction of Hip Capsular Reconstruction With Human Acellular Dermal Patch Graft

To quantify the biomechanical properties of the hip capsule with human dermal allograft reconstruction to determine whether a dermal patch restored capsular resistance to distraction. Nine cadaveric hip specimens were dissected until capsule and bony structures remained and were then mounted in a testing fixture in neutral flexion and abduction. Four states of the hip capsule were sequentially tested under axial distraction of 5 mm measured with video analysis and with resultant force measurement: (1) intact hip capsule, (2) interportal capsulotomy, (3) capsulectomy to the zona orbicularis, and (4) capsular reconstruction with human dermal allograft using acetabular anchors and capsule-to-patch sutures. Capsulectomy was different from intact (P= .036), capsulotomy differed from capsulectomy (P= .012), and the repair was statistically significantly different from capsulectomy (P= .042); intact and reconstructed cases were not statistically significantly different. The force required for 5 mm of distraction decreased after interportal capsulotomy by an average of 9% compared with the intact state and further decreased after capsulectomy by 30% compared with the intact state. After capsular reconstruction using dermal allograft, force requirements increased by an average of 36% from the capsulectomy state, only 5% below the intact state. Human dermal allograft tissue graft provides restoration of distractive strength for use during hip capsule reconstruction with acetabular anchor fixation and distal soft-tissue fixation after capsulectomy in a cadaveric model. Capsular repair or reconstruction with a dermal patch offers time-zero restoration of function; intact and reconstructed cases showed no difference, and reconstruction restored a capsulectomy to a biomechanical equivalent of the intact case when distraction was applied.

Outcomes of corneal transplantation using donor corneas retrieved from patients with chronic kidney disease

Purpose:To report the outcomes of corneal transplantation utilizing corneas retrieved from donors with chronic kidney disease (CKD).Methods:Outcomes of corneal transplantation (optical PK and EK) performed from Jan 2018 to Dec 2018 utilizing donor corneas retrieved from CKD patients was performed retrospectively.Results:Of the total of 233 donor corneas retrieved from CKD, 135 (57.9%) were utilized for transplantation after the routine screening protocol of the eye bank. Mean age of the donors was 56.2 ± 13.5 years. The mean endothelial cell density on specular microscopy of the donor corneas used for optical PK was 2685.7 ± 377.6 cells/mm2 (range, 2028–3448 cells/mm2) and for EK was 2731.7 ± 189.1 cells/mm2 (range, 2380–3194 cells/mm2). The overall primary graft failure rate was 5.1%. All grafts except 1, cleared in the PK group. In the EK group (6 DMEK and 16 DSAEK), 1 patient had a complete graft detachment and another 1 had a primary graft failure after DMEK.Conclusion:The donor corneas retrieved from chronic kidney disease patients are safe and suitable for optical keratoplasty provided they meet the criteria for transplantation.

Long-term clinical outcomes of submacular blood removal with isolated autologous retinal pigment epithelium-choroid patch graft transplantation in long-standing large-sized submacular hematomas: An Indian experience.

Purpose:To study the outcomes of submacular blood removal with isolated autologous full-thickness retinal pigment epithelial (RPE)-choroid patch graft transplantation in long-standing large-sized submacular hematomas in Indian population.Methods:A retrospective study was done on eight consecutive patients of long-standing large-sized submacular hematoma from east India. In all cases, 23G vitrectomy was performed with the induction of retinal detachment (performed with or without 38G or 41G subretinal cannula) and a temporal 180° retinectomy was done. Submacular blood along with choroidal neovascular tissue was removed. A full-thickness RPE-choroid autologous patch graft was taken from a relatively healthy quadrant at the mid periphery and then the graft transferred under perfluorocarbon liquid (PFCL) to place it in the subfoveal area. Then, retina was re-attached using PFCL and laser completed. Silicone oil (5000 cst) was used as a tamponade. Post-operatively, wide-field fundus photographs (Optos), serial optical coherence tomography (OCT), indocyanine green angiography (ICGA), and multifocal electroretinography (ERG) were done.Results:The mean age of the patients at presentation was 67.88 ± 10.03 years. Mean pre-operative best corrected visual acquity (BCVA) was 2.64 ± 0.3 log MAR and mean postoperative BCVA was 1.095 ± 0.27 log MAR (P < 0.05). The mean follow-up was 20 ± 16.57 months. ICG showed re-vascularization of translocated graft in all at 2 months. Multifocal ERG (after 6 months) showed some waveform in all. None of the cases developed re-bleed.Conclusion:Removal of submacular blood and neovascular membrane with autologous RPE-choroid graft is a viable option in cases with long-standing large submacular hematomas.

P260 Left ventricular pseudoaneurysm manifesting as syncope

Abstract Introduction Left ventricular (LV) pseudoaneurysms form when cardiac rupture is contained by adherent pericardium or scar tissue. LV pseudoaneurysm is one of the mechanical complications of myocardial infarctions (MI), particularly inferior wall MI. Although LV pseudoaneurysms are not common, the diagnosis is difficult and they are prone to rupture. Transthoracic echocardiography is commonly used in clinical practice and is usually sufficient to make the diagnosis of LV pseudoaneurysm. Regardless of treatment, patients with LV pseudoaneurysms had a high mortality rate, especially those who did not undergo surgery. Description of the clinical case 74 years-old woman, with previous history of hypertension, dyslipidaemia and type 2 diabetes and stable coronary disease. In June 2018 the patient underwent coronary angiography that revealed left main and 3 vessels coronary disease, Cardiac revascularization surgery was proposed that the patient refused. The patient was stable during 6 months. Four days before presenting to emergency department the patient mentioned intermittent pre-cordial pain associated with exertion. At admission day she felt intense pre-cordial pain, accompanied by sudoresis and nausea, relieving with sublingual nitrate. The patient was hemodynamically stable at admission. Electrocardiogram showed sinus rhythm 65 bpm with 2mm ST-elevation of inferior leads. Troponin I was positive 30 ng/dL. Echocardiogram revealed marked hypokinesia of inferior and lateral wall with moderate depression of global systolic function ans presence of slight circumferential pericardial effusion (6mm in diastole on lateral wall) Emergent coronariography was performed and revealed progression of coronary disease of the right coronary artery with sub-occlusion of the mid segment. Cardiac revascularization surgery was proposed and the patient accepted this time. Echocardiogram was repeated during hospitalization revealed a stable pericardial effusion with reduced dimension comparing to admission. After 3 weeks, while waiting surgery in the ward, the patient was a syncope that resulted in fracture of the distal peroneum. Ecocardiogram was performed and revealed a LV posterior wall pseudoaneurysm through a narrow neck in parasternal long axis view and the presence of large pericardial effusion (Fig 1). The patient was submitted to definitive reparative cardiac surgery with pericardium patch and coronary artery bypass graft from left internal mammary to anterior descending coronary artery. The patient recovered well from the cardiac surgery and at 2 months follow up is alive and without signs of heart failure. This case illustrates the complexity in the management of patients with LV pseudoaneurysm. These patients require substantial critical care, imaging and surgical expertise. A high clinical index of suspicion is needed to avoid missing the diagnosis LV pseudoaneurysm and transthoracic echocardiography is essential to establish the diagnosis. Abstract P260 Figure. Fig 1 - LV pseudoaneurysm

Patch Grafting of Cells into Solid Organs Such as Liver and Pancreas

Patch Grafting of Cells into Solid Organs Such as Liver and Pancreas

Scleral patch graft as a rescue for infectious scleritis

We report a case of a 68-year-old male who presented with redness and pain in the right eye with a previous history of pterygium surgery with mitomycin-C in the same eye 2 weeks before onset of symptoms. On examination, visual acuity in the right eye was counting fingers at 2 m improving to 6/24 with pinhole and the left eye was 6/18 improving to 6/12 with pinhole. Right eye showed signs of melting in the nasal sclera with avascularity and perilimbal corneal infiltrate. Scraping was done and culture showed growth of Fusarium species. The patient was started on antifungal drops, and a scleral patch graft was done with multilayered amniotic membrane graft with fibrin glue. On follow-up, the patient showed symptomatic improvement with vascularization of scleral graft and vision improved following cataract surgery.

Commentary: Retinal pigment epithelium-choroid patch graft for large submacular hemorrhage.

Commentary: Retinal pigment epithelium-choroid patch graft for large submacular hemorrhage.

Arthroscopic Superior Capsular Reconstruction for Treatment of Massive Irreparable Rotator Cuff Tears: An Update of the Technique for 2020.

The treatment of massive, irreparable rotator cuff tears presents a substantial challenge to health-care professionals. Treatment options range from nonoperative to operative, including debridement, partial repair, biceps tenotomy, bridging patch grafts, muscle transfers, and reverse total shoulder arthroplasty. However, the results of such treatments are often mixed, and many carry a substantial risk of complications. Superior capsular reconstruction has been described as a surgical alternative to the aforementioned procedures. Superior capsular reconstruction is a technique that provides an anatomic reconstruction of the superior capsule of the glenohumeral joint, with the goal of restoring the normal restraint to superior translation that is lost with a deficient superior rotator cuff. The technique described in the present article highlights the pearls and pitfalls learned over the last several years of performing arthroscopic reconstruction of the superior capsule with dermal allograft.

Adipose-derived stem cells improve grafted burn wound healing by promoting wound bed blood flow.

BackgroundResearchers have explored the use of adipose-derived stem cells (ASCs) as a cell-based therapy to cover wounds in burn patients; however, underlying mechanistic aspects are not completely understood. We hypothesized that ASCs would improve post-burn wound healing after eschar excision and grafting by increasing wound blood flow via induction of angiogenesis-related pathways.MethodsTo test the hypothesis, we used an ovine burn model. A 5 cm2 full thickness burn wound was induced on each side of the dorsum. After 24 hours, the burned skin was excised and a 2 cm2 patch of autologous donor skin was grafted. The wound sites were randomly allocated to either topical application of 7 million allogeneic ASCs or placebo treatment (phosphate-buffered saline [PBS]). Effects of ASCs culture media was also compared to those of PBS. Wound healing was assessed at one and two weeks following the application of ASCs. Allogeneic ASCs were isolated, cultured and characterized from non-injured healthy sheep. The identity of the ASCs was confirmed by flow cytometry analysis, differentiation into multiple lineages and gene expression via real-time polymerase chain reaction. Wound blood flow, epithelialization, graft size and take and the expression of vascular endothelial growth factor (VEGF) were determined via enzyme-linked immunosorbent assay and Western blot.ResultsTreatment with ASCs accelerated the patch graft growth compared to the control (p < 0.05). Topical application of ASCs significantly increased wound blood flow (p < 0.05). Expression of VEGF was significantly higher in the wounds treated with ASCs compared to control (p < 0.05).ConclusionsASCs accelerated grafted skin growth possibly by increasing the blood flow via angiogenesis induced by a VEGF-dependent pathway.

Application of the SMILE-derived lenticule in therapeutic keratoplasty.

To observe the clinical efficacy of the small incision lenticule extraction (SMILE)-derived lenticule patch graft in therapeutic keratoplasty, especially for the treatment of corneal microperforation or partial-thickness corneal defects. Corneal lenticule obtained from SMILE surgery with diameter greater than 6.5mm and thickness greater than 100μm was preserved in a balanced salt solution (Alcon Laboratories, Fort Worth, TX) containing 50mg/mL penicillin, 50mg/mL streptomycin, 100mg/mL neomycin, and 2.5mg/mL amphotericin for at least 3months. Preoperatively, anterior segment optical coherence tomography was used to assess the depth of the ulcer and to decide the thickness of the lenticule. Patients were followed up on day 1 and then at 1, 3, and 6months postoperatively. Corneal perforation or defects were successfully patched in all 17 eyes; 8 eyes (47%) exhibited improvement postoperative corrected distance visual acuity. During the follow-up period of 6months, there was no evidence of infection, relapse, or perforation detected in all eyes. Lenticule grafts were attached by graft beds very well and remain clear through to the last follow-up checkup in all eyes treated. The lenticule patch graft seems to serve as a safe, feasible, and inexpensive surgical option for the treatment of keratohelcosis or partial-thickness corneal defects, especially in small perforation and defects. There are hopeful signs that SMILE-derived lenticule becomes a potential graft for therapeutic keratoplasty.

Surgical treatment of corneal dermoid by using intrastromal lenticule obtained from small-incision lenticule extraction.

To report a novel technique to treat superficial limbal dermoid by using the corneal intrastromal lenticules obtained from SMILE and to evaluate the initial clinical outcomes of lenticule patch graft for treatment of limbal dermoid. In this single-center case series, lenticules were obtained from patients undergoing SMILE for the correction of myopia and the lenticule patch graft was performed in three patients with limbal dermoid. Patients were postoperatively followed at first, second weeks and first, third months after surgery. The main measured outcome parameters were included the best-corrected visual acuity, transparency of graft, tectonic integrity and restoration of optical transparency. All surgeries were successful, and all patients recovered well. Obviously, improving tendency in visual acuity and astigmatism was seen at the final follow-up in all eyes. No statistically significant difference has found in the thickness of the cornea between the surgical field and the corresponding normal field. Globe integrity was achieved in all cases, and no immune rejection or perforation was detected until the last follow-up visit in all eyes treated. Lenticule keratoplasty may be a safe, feasible and inexpensive surgical option for the treatment of corneal dermoid. It retains globe integrity and decreases the risk of complications such as postoperative limbal ectasia and visible corneal scarring and should be widely promoted in the areas with shortage of donor corneas.

Multifacet of Cornea Patch Graft in Anterior Segment Diseases

Incidence of cornea melting or perforation is commonly seen in variety of cornea conditions. It can cause debilitating vision loss and impair patient's daily activity. Several techniques have been described to surgically treat cornea perforation and melting. In this article, a series of corneal diseases treated with corneal patch graft are highlighted to relate different approach of cornea patch graft surgery. Post-operative management and complications are discussed.

Long-term clinical outcomes of keratoplasty using gamma-irradiated corneal lenticules

ObjectiveTo report long-term clinical outcomes of gamma-irradiated corneal lenticules in partial and full-thickness keratoplasty.Methods and AnalysisThis multicentre, retrospective case series includes 23 patients who underwent surgery at three centres (India,...

Irreparable Massive Rotator Cuff Tear: How do I address

Despite advances in arthroscopic techniques and devices, symptomatic massive contracted rotator cuff tear is still a challenging to most shoulder surgeons. This rotator cuff tissue has all of the f...

Irreparable rotator cuff tears: Current treatment options.

Rotator cuff disease is one of the most common causes of shoulder pain, yet controversy still exists regarding treatment of “irreparable” tears. Nonoperative management, including physical therapy and steroid injections, should be reserved for those without significant pain or functional impairment. Debridement may be used for low-demand patients, and should be performed with partial cuff repair, subacromial decompression, and/or acromioplasty to maximize outcomes. Biceps tenotomy and/or tenodesis have been shown to reduce postoperative pain and improve satisfaction when performed in conjunction with rotator cuff repairs, with no difference in functional outcome comparatively. Tendon transfers have been advocated with the potential benefit to improve function and decrease pain. More recently, extracellular matrix and human-derived dermal allografts have been used off-label as patch grafts in irreparable tears. Superior capsular reconstructive techniques and subacromial balloon spacers serve a similar function by acting to depress the humeral head in a cuff-deficient shoulder, however long-term data is needed before widespread adoption of these procedures. Finally, reverse shoulder arthroplasty serves as a salvage option for low demand elderly patients.

Effects of Right Atrioventricular Expanded Polytetrafluoroethylene Path Graft Reconstruction on Arrhythmogenicity and Ventricular Function in Dogs.

Right atrioventricular pericardial autografts, including the coronary groove, may cause myocardial ischemia. Our aim was to explore the effects of this procedure using an expanded polytetrafluoroethylene (ePTFE) patch on arrhythmogenicity and right ventricular function. Four healthy beagles and one client-owned golden retriever with recurrent cardiac tamponade as a result of hemangiosarcoma were included. The four healthy dogs underwent right atrioventricular ePTFE patch graft reconstruction after complete resection of the right auricle. Right ventricular function and arrhythmia were evaluated using tricuspid annular plane systolic excursion and tissue Doppler imaging on echocardiography and Holter electrocardiography, respectively, before and after surgery. The golden retriever underwent right atrioventricular ePTFE patch graft reconstruction followed by resection of the cardiac mass. None of the echocardiographic values, not involving systolic function, changed after surgery in the four healthy dogs. Transient arrhythmias tended to increase 1 day after surgery. The dog with recurrent cardiac tamponade exhibited more severe arrhythmia and required transient antiarrhythmic treatment for 3 days and survived the cardiac tamponade for 434 days after surgery. We showed that an ePTFE patch can serve as a suitable alternative material for right atrioventricular patch graft reconstruction, although transient arrhythmias may occur following surgery.