Previous Graft Research Articles

Patient experience of autogenous soft tissue grafting has an implication for future treatment: A 10- to 15-year cross-sectional study.

Patient-reported outcomes have received a great deal of interest in periodontal plastic procedures. However, their evaluation has mainly been short-term. Thus, the aim of this study was to evaluate the impact of soft tissue grafting procedures conducted over a decade ago on the willingness of a patients to undergo the surgery again. Subjects that received an autogenous soft tissue graft over 10 years ago were screened and invited for a survey. Their response was only analyzed if they were able to correctly identify the sites of the surgical procedures. Dichotomous questions and visual analogue scales (VASs) were used to assess self-reported pain, willingness to retreat and satisfaction. Fifty-two patients were included in the analyses. Higher pain was reported for mandibular sites, and treated areas including ≥ 3 teeth (P<0.01). Willingness to retreatment was 84.6% and it was negatively associated with self-reported pain measures, the arch location (mandible), and number of treated sites (≥3 teeth) (P<0.01). Mean satisfaction rate was 86.9 ± 13.65 (VAS) and showed a positive correlation with willingness to retreat (P<0.01). Having a complete root coverage at the recall visit was also significantly associated with higher patient satisfaction scores (P<0.01). Patient experience of previous autogenous soft tissue grafting has an influence on their decision to undergo future treatment. Willingness to retreat was negatively affected by mandibular sites, larger treated areas and the perceived pain, while presenting with complete root coverage was significantly associated with patient satisfaction.

Resurrection of Chronically Occluded Prosthetic Bypass Grafts in a Single Stage with Suction Thrombectomy and Intervention

Peripheral arterial occlusive disease (PAOD) continues to be a vexing problem despite the advent of endovascular techniques augmenting traditional open repair. At our institution, we have found there is a growing number of patients with PAOD who are vein-challenged and have undergone prosthetic bypass previously for infrainguinal arterial reconstruction. When occluded, these grafts have been abandoned for a new bypass strategy or amputation. We present a novel technique of reestablishing flow through chronically occluded prosthetic bypass grafts. A retrospective review of a prospectively maintained database compiled at 2 institutions between 2016 and 2019 was performed. Six patients had previous prosthetic bypass grafts with 4 patients having femoral to popliteal grafts, 1 patient with a femoral to femoral graft, and 1 with a femoral to posterior tibial bypass graft. All patients had an attempted single-stage intervention to clear chronically occluded grafts. A total of 6 patients were included in the study. Indications for intervention were chronic, critical limb ischemia with tissue loss (3), severe claudication (2), and acute on chronic limb ischemia (1). Average time from bypass to suction thrombectomy was 29months (6-60months). Mean patency duration is 13months (1-28months). Adjunctive procedures include overnight lysis to improve outflow in 1 patient (16.6%), drug-coated balloon angioplasty (83.3%), or stents (83.3%). There were no embolic complications during these procedures. All (2) wounds healed and all are maintained on full-dose anticoagulation and/or antiplatelet therapy. Often, the timing of bypass graft occlusion is unknown, and the risk of embolism with lysis for chronically occluded bypass grafts is concerning with traditional peripheral intervention techniques. We report a new and unique minimally invasive approach to resurrect chronically occluded prosthetic bypass grafts often successful in just one stage. This tool offers an alternative technique for limb salvage in complex patients and as use increases, requires further interrogation.

Contemporary management and outcomes of complex vascular surgical groin wound infections

ObjectiveVascular surgical groin wound infection (VS-GWI) has multiple causes and frequently is manifested as a limb- or life-threatening problem, resulting in significant morbidity and mortality. For patients undergoing operative extirpation, in situ repair, extra-anatomic bypass, or ligation can be used; however, limited data exist describing comparative results of the different operative choices or conduit subtypes. Therefore, we sought to describe our experience with management of VS-GWI and to detail outcomes of the different strategies. MethodsPatients (2003-2017) undergoing surgical treatment of VS-GWI (Szilagyi grade III) secondary to primary infectious arteritis or infected pseudoaneurysm after percutaneous intervention as well as previous prosthetic graft placement were reviewed. The primary end point was major adverse limb events (MALEs; major amputation, graft occlusion, or unplanned reintervention). Secondary end points included 30-day mortality, wound healing, amputation-free survival (AFS), and all-cause mortality. Cox proportional hazards modeling was used to determine relative risk of end points; Kaplan-Meier methodology was employed to estimate freedom from outcomes. ResultsThere were 149 patients (age, 65 ± 11 years; body mass index, 27 ± 6 kg/m2; 70% male; 32% diabetes) identified, of whom 120 (81%) had unilateral and 29 (19%) had bilateral VS-GWI. Indications included infected prosthetic bypass (88% [n = 131]; infrainguinal, 107; suprainguinal, 24) and primary infectious femoral artery complications (12% [n = 18]). A majority underwent single-stage operations (87% [n = 129]). In situ reconstruction occurred in 87% (n = 129); 9% (n = 13) underwent ligation, and 6% (n = 7) received extra-anatomic revascularization. Autogenous conduit was used most commonly (68% [n = 101/149]; 88% single stage), of which 81% (n = 80) were femoral vein. The remaining patients received cadaveric (15% [n = 23]; 87% single stage) or prosthetic (8% [n=12]; 67% single stage) grafts. Adjunctive myocutaneous flap was used in 37% (n = 54). Length of stay was 19 ± 15 days and 30-day mortality was 7% (n = 10), with no difference between conduit repair types. All femoral wounds healed (mean follow-up, 17 ± 11 months); however, 33% (n = 49) underwent reoperation (unplanned graft reintervention, 33%; graft occlusion, 16%; wound débridement, 15%; major amputation, 11%). Reinfection occurred in 17% (n = 27), with no difference between groups. MALE rate was 22% (n = 33; most were arterial reinterventions, 19%), with no difference in single-stage vs multistage, in situ vs extra-anatomic, or autogenous vs nonautogenous conduit strategies Predictors of MALE included younger age (hazard ratio [HR], 1.6 per decade; 95% confidence interval [CI], 1.1-2.5; P = .02) and lower body mass index (<25 kg/m2; HR, 1.6 per BMI category; 95% CI, 1.1-2.5; P = .02). Overall, 1- and 3-year freedom from MALE, AFS, and survival were as follows: MALE, 74% ± 5% and 63% ± 6%; AFS, 68% ± 4% and 58% ± 5%; survival, 78% ± 3% and 70% ± 4%. Autogenous conduit use was associated with better survival (HR, 0.5; 95% CI, 0.3-0.8; 1-year: 83% ± 4% vs nonautogenous, 78% ± 4%; 3-year: 68% ± 8% vs 53% ± 9%; log-rank, P = .006). ConclusionsAn individualized approach to operative strategy and conduit choice leads to comparable outcomes in this challenging group of patients. VS-GWI can be safely managed with in situ, autogenous reconstruction in a majority of patients with acceptable mortality, excellent wound healing rates, and improved overall survival. However, a significant proportion of patients experience reinfection and MALEs, the preponderance of which are arterial reintervention, mandating need for close follow-up and graft surveillance.

The reversed bell-bottom technique (ReBel-B) for the endovascular treatment of iliac artery aneurysms.

To describe the results of the reversed bell-bottom (ReBel-B) technique for the endovascular treatment of iliac aneurysms (IA) involving the origin of hypogastric artery (HA). The ReBel-B technique is a strategy for the occlusion of HA in selected patients presenting with IA, in whom the HA cannot be spared or safely occluded with coils or vascular plugs. When employing this technique, an iliac flared ("bell-bottom") extension is deployed in a reverse fashion, through a contralateral crossover femoral access that allows the occlusion of the HA at its origin, by exploiting the flared "bell" part of the reversed endograft. A second limb is then deployed to complete the implant, from the common iliac to the external iliac artery, inside the previous graft. Data of all consecutive patients treated with this technique in our experience were then retrospectively reviewed, and outcomes analyzed. The ReBel-B technique was employed in total of six patients who came in an emergent setting for the rupture of a common IA, from January 2014 to December 2018. Endovascular exclusion was performed using a ReBel-B graft plus iliac leg in five out of six cases. In the remaining case, a bifurcated aortic endograft was used to complete the aneurysm exclusion. Technical success was 100%. No complications occurred. In selected cases, the ReBel-B technique can be used for the complete exclusion of IA preventing type II endoleak from the HA, when the embolization with coils or plug or the preservation of the HA is anatomically unfeasible.

Three-Year Outcomes of Tri-Folded Endothelium-In Descemet Membrane Endothelial Keratoplasty With Pull-Through Technique

To assess the 3-year outcomes of tri-folded endothelium-in Descemet membrane endothelial keratoplasty (DMEK) using bimanual pull-through delivery technique. Interventional case series. In this single-center study, we included 153 consecutive eyes that underwent DMEK for various indications (Fuchs endothelial corneal dystrophy [FECD]: n= 111; bullous keratopathy [BK]: n= 24; and failed graft: n= 18). DMEK grafts were loaded into a disposable cartridge in a tri-folded, endothelium-in configuration and delivered using bimanual pull-through technique. Main outcome measures were graft preparation and unfolding times, best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), and graft survival. Mean graft preparation time was 5.9 ± 1.1minutes; and mean graft unfolding time was 2.9 ± 0.9minutes. Excluding eyes with comorbidities, logarithm of minimum angle of resolution BSCVA improved significantly from baseline preoperative values of 0.92 ± 0.58 to 0.02 ± 0.07 at 1 year (P < .001) and remained stable up to 3 years. Mean postoperative ECD decreased significantly (P < .001) from eye bank values to 1,818 ± 362, 1,675 ± 372, and 1,580 ± 423 cells/mm2 at 1, 2, and 3 years, respectively. No significant differences in ECD were observed between eyes with FECD and BK, but ECD was significantly lower in eyes with previous failed graft (P < .05). Three-year cumulative graft survival rate was significantly (P < .001) lower for eyes with previous failed graft (71%) than for FECD (97%) and BK (92%). Tri-folded endothelium-in DMEK requires minimal time for graft unfolding, which is the surgical step considered most challenging by corneal surgeons. Visual outcomes and complication rates are not adversely affected by the modification of the surgical technique.

Outcomes after Haploidentical Stem Cell Transplantation with Post-Transplantation Cyclophosphamide in Patients with Primary Immunodeficiency Diseases.

Allogeneic hematopoietic stem cell transplantation (HCT) can cure primary immunodeficiency diseases (PID). When a HLA-matched donor is not available, a haploidentical family donor may be considered. The use of T cell-replete haploidentical HCT with post-transplantation cyclophosphamide (haplo-PTCy) in children with PID has been reported in few case series. A donor is usually readily available, and haplo-PTCy can be used in urgent cases. We studied the outcomes of 73 patients with PID who underwent haplo-PTCy, including 55 patients who did so as a first transplantation and 18 who did so as a salvage transplantation after graft failure of previous HCT. The median patient age was 1.6 years. Most of the children were male (n=54) and had active infection at the time of transplantation (n=50); 10 children had severe organ damage. The diagnosis was severe combined immunodeficiency (SCID) in 34 patients and non-SCID in 39 (Wiskott-Aldrich syndrome; n=14; chronic granulomatous disease, n=10; other PID, n=15). The median duration of follow-up of survivors was 2 years. The cumulative incidence of neutrophil recovery was 88% in the SCID group and 84% in non-SCID group and was 81% for first transplantations and 83% after a salvage graft. At 100 days, the cumulative incidence of acute GVHD grade II-IV and III-IV was 33% and 14%, respectively. The majority of patients reached 200/μL CD4+ and 1000/μL CD3+ cell counts between 3 and 6 months. The estimated 2-year overall survival was 66%; it was 64% for SCID patients and 65% for non-SCID patients and 63% for first HCT and 77% for salvage transplantations. Twenty-five patients died, most of them due to infection early after transplantation (before 100 days). In conclusion, haplo-PTCy is a feasible procedure, can cure two-thirds of children with PID, and can be used as rescue treatment for previous graft failure. © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

Authors' Comments—Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Authors' Comments—Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Repair of aortoesophageal fistula with homograft aortic replacement and primary esophageal closure

ObjectivesThe presence of a fistula between the thoracic aorta and the esophagus is a rare and highly fatal condition. This study aimed to evaluate the outcomes of the surgical treatment of an aortoesophageal fistula (AEF). MethodsWe retrospectively reviewed patients with AEF who underwent surgery at our institution. ResultsBetween 2007 and 2018, a total of 10 patients who underwent surgery for AEF. The mean age was 63 ± 12 years, and 6 patients were men. Four patients had primary AEFs and 6 patients had secondary AEFs (3 graft replacements and 3 thoracic endovascular aortic repairs). The timing of AEF since graft replacement or thoracic endovascular aortic repairs was 21.6 ± 27 days. We performed aortic replacement with a prosthetic graft (4 patients) or a homograft (5 patients) and extra-anatomical bypass due to a previous aortic graft infection (1 patient). As a treatment of the esophagus, we conducted primary repair in 7 of 10 patients. The median lengths of hospital and intensive care unit stay were 59 days (range, 9-225 days) and 6.3 days (range, 1-87 days), respectively. Seven patients achieved oral feeding after a median 10.3 postoperative days (range, 7-78 postoperative days). Two of the 10 patients died of sepsis at 9 and 74 days postoperatively. ConclusionsThe strategy for patients with AEF should be individualized. Our surgical strategy for AEF, which includes simultaneous aortic graft replacement and primary repair of esophagus in the same operative field, is feasible and promising.

Correction of malocclusion using sliding fibula osteotomy with sagittal split ramus osteotomy after mandible reconstruction

BackgroundFibula free flap mandible reconstruction is the standard procedure after wide resection of the mandible. Establishment and maintenance of normal occlusion are important in mandible reconstruction both intraoperatively and after surgery. However, scar formation on the surgical site can cause severe fibrosis and atrophy of soft tissue in the head and neck region.Case presentationHere, we report a case of severe soft tissue atrophy that appeared along with scar formation after mandibular reconstruction through the fibular free flap procedure. This led to normal occlusion collapse after it was established, and the midline of the mandible became severely deviated to the affected side that was replaced with the fibula free flap, leading to facial asymmetry. We corrected the malocclusion with a secondary operation: a sagittal split ramus osteotomy on the unaffected side and a sliding osteotomy on the previous fibula graft. After a healing time of 3 months, implants were placed on the fibula graft for additional occlusal stability.ConclusionWe report satisfactory results from the correction of malocclusion after fibula reconstruction using sliding fibula osteotomy and sagittal split ramus osteotomy. The midline of the mandible returned to its original position and the degree of facial asymmetry was reduced. The implants reduced difficulties that the patient experienced with masticatory function.

Commentary: Keep working: Current endovascular arch-repair technology still has a way to go

Commentary: Keep working: Current endovascular arch-repair technology still has a way to go

Impact of prior coronary artery bypass grafting in patients undergoing chronic total occlusion-percutaneous coronary intervention: Procedural and clinical outcomes from the REgistry of Crossboss and Hybrid procedures in FrAnce, the NetheRlands, BelGium, and UnitEd Kingdom (RECHARGE).

Chronic total occlusions (CTO) in patients with history of coronary artery bypass graft (CABG) show more advanced and complex atherosclerotic pathology. Aim of our study is to compare outcomes in patients undergoing CTO percutaneous coronary intervention (PCI) with previous CABG versus those without in the REgistry of Crossboss and Hybrid procedures in FrAnce the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE). The RECHARGE cohort (1,252 patients) was divided in two groups according to the presence of previous CABG (217) or not. We also focused, in the post-CABG group, on a comparison between CTO in previously grafted vessels versus non-grafted vessels. The CTO complexity scores were higher and the success rate (71.9% vs. 88.7%, p < .001) was lower in the CABG group, this difference was driven by higher failure rates in high-complexity-score CTO. The rate of in-hospital complications was similar. In the post-CABG group, the procedural success of CTO located in previously grafted vessels versus those in vessels not previously grafted, was comparably suboptimal (73.1% vs. 68%, p = .47). Patients undergoing CTO PCI with prior CABG have a higher prevalence of comorbidities and more complex lesion characteristics. In the post-CABG population the success rate was significantly lower, particularly in high CTO complexity scores, though complication rates were comparable. In the post-CABG population, the CTO success rate was independent of the presence of a previous graft on the CTO vessel.

Obturator bypass using a ringed polytetrafluoroethylene graft for inguinal graft infection.

Inguinal vascular graft infections are high-risk events that cannot be controlled medically but require surgical intervention. This study reviewed the long-term clinical outcomes of obturator bypass using a ringed polytetrafluoroethylene graft for inguinal graft infection. A total of eight consecutive patients who underwent obturator bypass using a ringed polytetrafluoroethylene graft for inguinal prosthetic graft infection at a single medical center between January 2006 and October 2017 were retrospectively analyzed. The demographics, clinical characteristics, surgical procedure, and clinical outcomes were evaluated. There was no perioperative death; however, there were three operative complications. On the 1st and 9th postoperative day, two patients underwent hematoma evacuation in the pelvic cavity, and the other patient underwent suture reinforcement for partial dehiscence of the distal anastomosis on the 49th postoperative day. The median length of hospital stay was 14.5 (range, 7-29) days. Only one graft occlusion was observed at postoperative month 40; however, there were no ischemic symptoms. There were no limb amputations and postoperative deaths during the long-term follow-up period. There were no infections of the previous residual and obturator bypass grafts and inguinal infection during the follow-up period of 49 (range, 7-154) months. Obturator bypass for inguinal graft infection is feasible and durable with excellent long-term outcomes. However, perioperative bleeding should be taken into consideration.

Submental and Anterior Neck Originated Full-Thickness Skin Grafts for Periocular Procedures.

The submental and neck regions share cutaneous features with the face and are suitable donor sites for facial full-thickness skin grafts (FTSGs). Age-related laxity and skin redundancy in the cervicomental region may be an additional motivator to use its skin. We aim to describe, raise awareness, and remind surgeons of the utilization of submental and anterior neck as sources of FTSG for the periocular region, particularly when traditional donor sites are unavailable. Retrospective case series of 5 patients who underwent periocular FTSG from anterior neck and submental regions between January 2017 and January 2019. All patients had contraindications to the usually preferred graft donor sites. Main outcome measures were surgical functional results and cosmesis. Five patients (all female) received FTSGs using anterior neck and submental regions as donor sites. Two patients required skin grafts due to eyelid retraction and anterior lamella shortening; one due to previous multiple basal cell carcinoma excisions with FTSG reconstructions and the other due to chronic Bell's palsy. Three patients required skin grafts for Hughes flap reconstruction after excision of lower eyelid basal cell carcinoma. In all patients, conventional skin donor sites were unavailable or unsuitable due to previous skin grafting, actinic changes, postauricular situated hearing aids or patient's preference. All patients achieved good cosmesis and functional results. None of the patients experienced donor site morbidities. Submental and anterior neck regions are useful FTSG donor sites for periocular procedures, particularly in elderly female patients with submental fullness and neck skin redundancy.

8.5/8.6-mm Excimer Laser-Assisted Penetrating Keratoplasties in a Tertiary Corneal Subspecialty Referral Center: Indications and Outcomes in 107 Eyes.

To report the indications and outcomes of 8.5/8.6-mm excimer laser-assisted penetrating keratoplasties (PKPs) at a tertiary corneal subspecialty referral center. This retrospective, descriptive, observational study included 107 PKPs performed in 96 patients (mean age, 53 ± 12 years). The patients' indications for surgery, best-corrected visual acuity, surface regularity index, surface asymmetry index, topographic astigmatism, central endothelial cell density, central corneal thickness, and graft status were recorded preoperatively, 6 weeks postoperatively, and before (12 ± 2 months) and after (19 ± 4 months) the suture removal. The surgeries included 48 primary PKPs and 59 repeat PKPs. The main indications were corneal ectatic disorders (50%), severe corneal keratitis (21%), and corneal scars (16%) in the primary PKP group and highly irregular astigmatism after PKP (51%) and previous graft decompensation (37%) in the repeat PKP group. From preoperative measurements to the last follow-up visit without sutures, we found significant improvements (P < 0.001 for all) in visual acuity (0.7 ± 0.3 LogMAR to 0.3 ± 0.2 LogMAR), surface regularity index (1.5-1.0), and surface asymmetry index (2.59-1.1). At the last follow-up, the mean outcome measurements did not significantly differ between the primary and repeat PKP groups. Overall, 89 grafts (83%) remained clear at the last follow-up. In cases of ectatic disorders and highly irregular astigmatism after keratoplasty, 8.5/8.6-mm excimer laser-assisted PKP seems to be an excellent treatment option, achieving a significant improvement in visual acuity.

Immobilization of l-alanine into natural kaolinite via amidation catalyzed by boric acid for the development of biohybrid materials

The natural amino acid l-alanine was immobilized on the interlayer space and surface of the natural Brazilian São Simão’s kaolinite using two different routes. In the first 3-aminopropyltriethoxysilane was previously grafted into kaolinite interlayer space resulting into aminofunctionlized kaolinite that was further employed as reactive sites on kaolinite surfaces to bond l-alanine via amidation reaction. In the second route 3-aminopropyltriethoxysilane was first modified by l-alanine via amidation reaction catalyzed by boric acid and the modified alkoxide grafted into kaolinite using kaolinite-dimethylsulfoxide resulting on the biohybrid. In both strategies the amino acid was covalently bounded using the carboxylic acid from the amino acids and amine groups present on the kaolinite surfaces resulting in amide bonds. In both routes, the reaction was catalyzed by boric acid. Results confirms that the nature and loading of immobilized l-alanine changes depending of the route employed. X-ray diffraction confirmed the expansion of the interlayer spaces of the grafted solids resulting in 8.3 ​Å and 10.8 ​Å respectively for grafted materials routes one and two respectively. Reaction effectivity was kinetically evaluated by infrared vibrational spectroscopy that confirms the presence of amide bonds in both products due to the bands at 1560 ​cm−1, due to carbonyl (N–CO) stretching, and 1490 ​cm−1, ascribed to N–H plane vibrations and C–N stretching. The typical vibration of inner surface aluminol groups at 938 ​cm−1 (for purified kaolinite) is absent for both routes employed after grafting reactions confirming the attachment of the modified alkoxide into aluminol groups via covalent bonds resulting in bonds type Al–O–Si. Thermal analysis showed the typical reduction of dehydroxylation temperature from 510 ​°C on pure kaolinite to 480 and 450 ​°C, respectively, on the biohybrid materials and confirmed the functionalization in both routes, the amount of organic content was quantified and was 0.193 and 0.298 ​mol of organic unit per 1 ​mol of kaolinite minimal formulae using route of previous grafting of kaolinite with amine groups and direct grafting of modified alkoxide into kaolinite dimethyl sulfoxide respectively. Specific surface area analysis by N2 adsorption-desorption isotherms (BET method), cationic exchange capacity, and total specific surface area by the methylene blue method also confirmed the reduction of specific surface area from kaolinite grafted derivatives induced by amidation reaction. The solids obtained was tested as matrix to incorporate acetyl salicylic acid and ibuprofen and reveal that grafted clays incorporate a higher amount of both drugs (qt ​= ​210 ​mg/g) The model that explain the adsorption kinetic mechanism was the pseudo-second order that reveal the higher affinity between adsorbent and acetyl salicilSalicylic acid and ibuprofen using the grafted kaolinite with alanine.

MP59-13 KIDNEY TRANSPLANT IN PATIENTS UNDER WARFARIN USE: DOES IT INCREASE THE RISKS? ANALYSIS OF OUTCOMES AND COMPLICATIONS

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery III (MP59)1 Apr 2020MP59-13 KIDNEY TRANSPLANT IN PATIENTS UNDER WARFARIN USE: DOES IT INCREASE THE RISKS? ANALYSIS OF OUTCOMES AND COMPLICATIONS Felipe Bernardes*, Matheus Siqueira, Gustavo Ebaid, Gustavo Messi, Renato Falci, Kleiton Yamacake, Rafael Locali, William Nahas, and Affonso Piovesan Felipe Bernardes*Felipe Bernardes* More articles by this author , Matheus SiqueiraMatheus Siqueira More articles by this author , Gustavo EbaidGustavo Ebaid More articles by this author , Gustavo MessiGustavo Messi More articles by this author , Renato FalciRenato Falci More articles by this author , Kleiton YamacakeKleiton Yamacake More articles by this author , Rafael LocaliRafael Locali More articles by this author , William NahasWilliam Nahas More articles by this author , and Affonso PiovesanAffonso Piovesan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000928.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney disease (CKD) are known to increase the risk of venous thromboembolism. Also, the prevalence of atrial fibrillation (AF) is at least 10-fold higher than in the general population. Warfarin is the most common oral anticoagulant drug used to prophylactic therapy (OAT) in these patients. When CKD patients enter a Kidney transplant (KT) waiting list, they often remain on OAT. This implies the use of reversal agents at the time of Kidney transplant surgery specially with deceased donors. In this study, we aim to determine the outcomes and complications of KT in patients using OAT at the time of surgery. METHODS: From January 2009 to September 2019 2403 kidney transplants were done in our institution. There were 15 patients with current OAT use at the time of the procedure. We reviewed each patient record to determine OAT indication, type of anticoagulant in use, INR based on prothrombin time (PT) test prior to surgery, reversal drugs employed, concomitant use of Antiplatelets drugs, and need to reintroduction of OAT after KT. Surgical complications as well as long term graft function (estimated by MDRD and creatinine) were also investigated. RESULTS: From the 15 patients, 8 were male (53,3%) and 13 (86,7%) received kidney from deceased donors. Mean age was 54,6±11,0 years. Risk factors for thrombosis were the indication for ACO in 9 (60%) including arteriovenous fistula or hemodialysis catheter thrombosis and previous graft loss due to thrombotic event. In the remaining 6 (40%) OAT indication was AF. Eight patients (53,3%) were in concomitant use of Antiplatelets. Median INR in admission test was 2,2±1,0. On 12 patients (80%) the reversion therapy was vitamin K and fresh frozen plasma. The remaining 3 (20%) had INR < 1,5, dismissing treatment. Surgical excessive bleeding requiring transfusion were observed in 7 (46,7%) patients, and there were 02 deaths related to these complications. Re-introduction of OAT was necessary in 8 (53,3%) individuals. There was no statistical difference between long term renal graft function, with a median MDRD of 57,55 and creatinine of 1,6 after 5 years. CONCLUSIONS: Oral anticoagulants use adds surgical risks for bleeding complications and death in kidney transplant recipients, independently of anticoagulant reversal therapy. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e885-e886 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felipe Bernardes* More articles by this author Matheus Siqueira More articles by this author Gustavo Ebaid More articles by this author Gustavo Messi More articles by this author Renato Falci More articles by this author Kleiton Yamacake More articles by this author Rafael Locali More articles by this author William Nahas More articles by this author Affonso Piovesan More articles by this author Expand All Advertisement PDF downloadLoading ...

High-Strength Fiber-Reinforced Composite Hydrogel Scaffolds as Biosynthetic Tendon Graft Material.

The development of suitable synthetic scaffolds for use as human tendon grafts to repair tendon ruptures remains a significant engineering challenge. Previous synthetic tendon grafts have demonstrated suboptimal tissue ingrowth and synovitis due to wear particles from fiber-to-fiber abrasion. In this study, we present a novel fiber-reinforced hydrogel (FRH) that mimics the hierarchical structure of the native human tendon for synthetic tendon graft material. Ultrahigh molecular weight polyethylene (UHMWPE) fibers were impregnated with either biosynthetic polyvinyl alcohol/gelatin hydrogel (FRH-PG) or with polyvinyl alcohol/gelatin + strontium-hardystonite (Sr-Ca2ZnSi2O7, Sr-HT) composite hydrogel (FRH-PGS). The scaffolds were fabricated and assessed to evaluate their suitability for tendon graft applications. The microstructure of both FRH-PG and FRH-PGS showed successful impregnation of the hydrogel component, and the tendon scaffolds exhibited equilibrium water content of ∼70 wt %, similar to the values reported for native human tendon, compared to ∼50 wt % water content retained in unmodified UHMWPE fibers. The tensile strength of FRH-PG and FRH-PGS (77.0-81.8 MPa) matched the range of human Achilles' tendon tensile strengths reported in the literature. In vitro culture of rat tendon stem cells showed cell and tissue infiltration into both FRH-PG and FRH-PGS after 2 weeks, and the presence of Sr-HT ceramic particles influenced the expression of tenogenic markers. On the other hand, FRH-PG supported the proliferation of murine C2C12 myoblasts, whereas FRH-PGS seemingly did not support it under static culture conditions. In vivo implantation of FRH-PG and FRH-PGS scaffolds into full-thickness rat patellar tendon defects showed good collagenous tissue ingrowth into these scaffolds after 6 weeks. This study demonstrates the potential viability for our FRH-PG and FRH-PGS scaffolds to be used for off-the-shelf biosynthetic tendon graft material.

Pre-emptive rituximab and plasma exchange does not prevent disease recurrence following living donor renal transplantation in high-risk idiopathic SRNS.

Children with non-genetic steroid-resistant nephrotic syndrome (SRNS) are at high risk of disease recurrence (DR) and graft loss following renal transplant (RT). Although pre-emptive plasma exchange (PE) and rituximab have been suggested to prevent DR, there is insufficient published data to support this practice. The aim is to study the role of pre-emptive PE and rituximab in the prevention of DR in children with non-genetic SRNS undergoing living donor (LD) RT. Prospective single-centre study of four consecutive children (age 6-17years) with non-genetic SRNS (including two with previous graft loss due to DR) who underwent LD RT between July 2014 and September 2016. All patients received a single dose of rituximab 375mg/m2 2-4weeks prior to the RT and four sessions of PE in the week prior to RT. All patients had previously undergone bilateral native nephrectomies. All children had early DR (2-26days) following LD RT. Following early initiation of PE, three children achieved partial remission (PR) or complete remission (CR) 5-22days after commencing treatment. One child continued to have heavy proteinuria along with graft dysfunction despite 52 sessions of PE and lost the graft 5months after RT. At the latest follow-up of 36-60months following RT, one child remains in CR and two are in PR. The latest eGFR was 45-104ml/min/1.73m2. Pre-emptive rituximab and PE does not prevent DR in high-risk non-genetic SRNS. Prompt initiation of PE following DR appears to achieve PR or CR in the majority of patients.

Surgical angiogenesis for scaphoid non-union: a literature review

&nbsp; Non-union of scaphoid bone fractures, though an uncommon occurance, are a signficant cause of morbidity in young patients. This review outlines the current understanding of vascularised bone grafts and non-union, and examines the most current clinical literature regarding the role of these procedures in modern orthopaedic practice. Composite evidence from level III studies would support using osseous grafts on a vascular pedicle for patients with non-union of the proximal end of the scaphoid with associated avascular necrosis and in cases of revision surgery where a previous non-vascularised graft has failed to achieve bony union. &nbsp

Comparing Follicular Transection Rate in Revision FUE Cases Who Previously Underwent Various Types of Hair Restoration Surgery: An Exploratory Study

Background: Follicular unit excision (FUE) has come a long way in establishing itself as an alternative technique for hair restoration. There exists a plethora of scholarly work on FUE, albeit there is a paucity of evidence on variables that affect the outcome of revision FUE. A successful hair restoration surgery is, among other things, predicated on the surgery9s follicular transection rate (FTR). Objective: The objective of this study was to determine whether there is an association between FTR and the type of hair restoration surgery patients had prior to their revision FUE; three surgical procedures were compared: strip harvesting (SH), FUE, and punch grafting (PG). Material & Methods: The sample size for this exploratory study was 40 (i.e., n=40), and all the subjects were men with different grades of androgenetic alopecia. The subjects had undergone an FUE revision surgery from January to December 2014, and had their FTR and partial transection rate (PTR) calculated for each session. We compared patients9 FTR and PTR among cases who had undergone various hair restoration techniques prior to their revision FUE. We defined FTR as complete transection of the graft, where all follicles in the graft are transected; PTR was defined as the incomplete transection of the graft, where at least one follicle in a graft is intact. Chi-square test of independence was conducted to compare FTR and PTR across revision FUE cases of patients who previously underwent SH, PG, or FUE. Results: Out of a total of 40 cases, 52.5% (21) had undergone FUE surgery earlier, 35% (14) SH, and 12.5% (5) PG as the primary surgery. The average FTR in patients who had undergone strip surgery earlier was 3.22 per 100 grafts, while it was 3.33 per 100 grafts and 3.54 per 100 grafts in those who had undergone previous FUE and punch grafting, respectively. Chi-square test of independence showed that there was no significant relationship between the type of hair restoration procedure cases had prior to their revision FUE and the FTR and PTR. Nonetheless, our results support a trend where FTR and PTR are likely to be high if the prior surgery is FUE; moreover, post-hoc calculations for statistical power showed that the current study was under-powered. Conclusion: Our findings suggest the type of hair restoration surgery men with androgenetic alopecia underwent prior to having a revision FUE might influence the success of the revision FUE. In addition, we noted revision FUE cases of male androgenetic alopecia are least likely to have high FTR if they had previously undergone strip harvesting. Furthermore, our calculations for statistical power from our exploratory study would be very useful for sample size determination in future studies.