Surgical Graft Research Articles

Treatment of Peripheral Vascular Graft Infections with Xenogeneic Grafts—A Single-Center Experience

Introduction: Vascular graft infections (VGEIs) are rare but severe complications in vascular surgery. The choice of reconstruction material following graft removal is critical, particularly for infection prevention. This study evaluates the use of No-React® BioIntegral Surgical Grafts, made from bovine pericardium, in the treatment of VGEIs. Materials and Methods: A retrospective study of 12 patients (mean age 66.5 years; 67% male) treated between 2020 and 2022 was conducted. The follow-up period included in the study extended from the date of the procedure to 30 June 2024. Results: The study observed a 0% reinfection rate, underscoring the anti-infective potential of No-React® grafts. However, in-hospital complications were frequent, affecting six (50%) patients, with sepsis (3; 25%) related to preoperative VGEIs being the most common. Most importantly, in-hospital mortality was notably high (42%), primarily driven by infection-related sepsis. The overall complication rate after discharge was 14%, with only one case of graft occlusion (1/7) observed. Among discharged patients (7; 58%), the three-month survival rate was 71%. In-hospital complications were a predictive factor for overall survival (OS) (HR = 15.88, 95% CI = 1.81–139.47). Conclusions: Xenogeneic No-React® grafts show promise for managing VGEIs, offering low reinfection rates. However, high morbidity and mortality underline the challenges of treating patients with severe VGEIs. Early postoperative complications were a key predictor of OS. Further research is needed to confirm these findings and optimize treatment protocols for VGEIs.

Evaluating the Sapien® XT Valve in Native Right Ventricular Outflow Tracts After Tetralogy of Fallot Repair: Mid- and Long-Term Results.

Although the long-term outcomes of the surgical grafts are well defined and reported, the data regarding the mid-and long-term results of the balloon-expandable percutaneous valves in the native right ventricular outflow tract (RVOT) is limited. We retrospectively evaluated 42 patients who underwent PPVI (Sapien® XT valve) to native RVOT due to severe pulmonary regurgitation (PR) and/or moderate to severe pulmonary stenosis (PS) between August 2015 and November 2020. The median patient age at the time of PPVI was 13.4years (6.1-36.5years). The median body weight of the patients was 42kg (15-110kg). The rate of patients who were followed up without the need for percutaneous or surgical intervention was 97.4% at the end of year 1, 89.3% at the end of year 3, and 85.8% at the end of year 5. At the end of year 6, the proportion of patients requiring no procedure remained constant, with year 5 at 85.8%, but decreased to 70.2% at the end of year 7. Although the early results are very encouraging, it is seen that PPVI in patients with RVOT in the long term brings some problems. The most important of these is tricuspid valve problems, which were not considered before the procedure. Patients requiring reintervention due to pulmonary regurgitation show similar characteristics to surgical valves' long-term results.

Impact of Altered Graft Position During Living Donor Liver Retransplantation and its Outcomes.

Liver retransplantation (reLT), which is the only treatment for liver graft failure, remains challenging not only because of its technical nature but also because it is performed in high-risk patients. Nineteen patients who underwent reLT (second LT, n = 18; third LT, n = 1) between 1999 and 2021 were divided into two groups according to the graft laterality between prior transplantation and reLT (ipsilateral group, n = 9; contralateral group, n = 10). The aim of this study was to evaluate the short- and the long-term outcomes of patients who underwent living donor reLT and compared graft survival between ipsilateral and contralateral grafts. For hepatic vein reconstruction, the previous anastomotic orifice of the recipient was used in 8 (88.9%) patients in the ipsilateral group, while a new orifice on inferior vena cava of the recipient was created in 8 (80%) patients in the contralateral group. The conduit for the portal vein and hepatic artery were employed in 2 and 2 patients in the ipsilateral group and in 5 and 0 patients in the contralateral group, respectively. The overall incidence of hepatic artery and portal vein complications was 11.1% and 11.1% in the ipsilateral group, and 30% and 11.1% in the contralateral group, respectively. The 1-, 5-year graft survival rates were 70.8%, 66.7% in the ipsilateral group, and 70%, 70% in the contralateral group, respectively. There was no difference between ipsilateral and contralateral grafts in reLT in terms of surgical complications and graft survival.

Extension of the Right Renal Vein in Deceased Donor Kidney Transplantation: A Literature Review and Analysis at Our Center.

The length of the right renal vein is a crucial vascular factor in kidney transplantation. Its shorter length compared to the left renal vein complicates venous anastomosis. The aim of this article is to review the literature on this topic and provide data from our experience. A bibliographic review was conducted in PubMed using the keywords "kidney transplant," "deceased donor," "right kidney," and "renal vein extension." Three studies evaluating the feasibility and clinical outcomes of right renal vein extension in transplants were selected and analyzed. Additionally, a retrospective analysis of kidney transplants performed at Hospital Universitario Cruces in 2023 was carried out, focusing on cases where the technique of extending with a vena cava patch was used. Parameters such as surgical time, vascular complications, graft viability, and postoperative renal function were evaluated. The reviewed studies indicate that the extension of the right renal vein is safe and effective, facilitating surgery and reducing warm ischemia time as well as the incidence of complications such as renal artery kinking. The analysis of transplants at our center in 2023 showed similar results, with a simplified procedure and no increase in the risk of complications. The extension of the right renal vein with a vena cava patch is an effective technique that does not increase morbidity or compromise graft viability, improving long-term clinical outcomes.

Comparing Lumbar Spine Cages and Bone Grafts in Spinal Arthrodesis: A Meta-Analysis of Clinical Outcomes.

The role of interbody cages in lumbar arthrodesis remains debated despite widespread adoption. This meta-analysis aimed to compare clinical and radiological outcomes between synthetic cages and structural bone grafts in lumbar fusion surgery from the latest updated evidence based on subgroup-based analysis and stratification of outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct a literature search across major databases through December 2024. Studies comparing lumbar interbody fusion outcomes between cage and bone graft cohorts were included in this analysis. Random-effects meta-analyses were performed for fusion rates, radiographic parameters, clinical outcomes, and complications. Subgroup analyses stratified results by surgical approach, cage material, and graft type. Twenty studies (1,452 patients) met inclusion criteria. Cage utilization demonstrated significantly higher fusion rates (96.3% versus 90.8%, RR=2.74, p=0.03) and greater disc height maintenance (MD=0.73 mm, 95% CI=0.45-1.01). Polyetheretherketone (PEEK) cages showed superior fusion rates compared to titanium (RR=1.00 versus 0.94, p=0.042). Back pain improvement was greater in the cage group (MD=0.65, 95% CI=0.08-1.22), while complication and reoperation rates remained comparable. No significant differences were observed in lordosis restoration or Oswestry Disability Index (ODI) scores. Synthetic cage implementation in lumbar arthrodesis is associated with superior fusion rates and disc height maintenance, especially with PEEK devices. These benefits occur without increased complications, supporting cage utilization in appropriate clinical scenarios. Future studies should focus on long-term outcomes and cost-effectiveness analyses.

Sport-specific differences in ACL injury, treatment and return to sports: Basketball.

Basketball is an intense, fast-paced game that is physically, highly demanding. Certain aspects of the game, such as the quick pivoting and cutting movements, predispose the players to serious knee injuries, including anterior cruciate ligament (ACL) tears. While an ACL tear can be a devastating condition for players, multidisciplinary management of the injury can provide the players with a reasonable chance to return to play at the pre-injury level. This article aims to review the general principles and guidelines for the management of ACL injury in basketball players. The diagnosis, surgical treatment, rehabilitation and return to sports are discussed from European and North American perspectives. With a comprehensive and multidisciplinary approach to this condition, medical professionals can provide injured basketball players with a favourable prognosis for returning to play at the pre-injury level. To return to normal life and basketball after ACL reconstruction, the proposed approach includes (1) the selection of the appropriate surgical graft and technique, (2) maintaining a healthy and persistent mental state during rehabilitation, and (3) following a scientific rehabilitation programme based on personalized recovery. LEVEL OF EVIDENCE: Level V.

Arterial conduits for coronary bypass grafting: the set-point concept

Abstract Endothelial cells control the vascular tone of arterial grafts used for coronary artery bypass surgery and react to changes in local shear stress. The vascular adaptations induced by endothelial cell activation affect the outcome of surgical grafts and can be predicted based on the set-point theory. In this Hypothesis piece, it is proposed that the set-point concept should inform surgical decision making for coronary artery bypass surgery.

Xanthogranulomatous osteomyelitis: multimodality imaging of a rare case involving tibial diaphysis with review of literature.

The case report discusses xanthogranulomatous osteomyelitis, a rare inflammatory bone condition that can resemble malignancy on imaging studies. The report details a case of a 42-year-old woman with left leg pain, swelling, and redness lasting 4months. Imaging revealed a lytic lesion in the left tibia with endosteal erosion, and MRI showed extraosseous soft tissue extension. An open biopsy confirmed xanthogranulomatous osteomyelitis. Following surgical curettage and bone grafting, the patient recovered well at subsequent follow-ups until 1year after surgery. The article emphasizes the importance of distinguishing xanthogranulomatous osteomyelitis from other malignancies and discusses its epidemiology, clinical presentation, diagnostic techniques, and relevant imaging features, highlighting the potential for misdiagnosis based on overlapping characteristics with conditions like lymphoma and Ewing sarcoma.

Aortic Stenosis and Coronary Artery Disease: Decision-Making Between Surgical and Transcatheter Management.

Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist and share pathophysiological mechanisms. The proportion of patients with AS and CAD requiring revascularization varies widely because of uncertainty about best clinical practices. Although combined surgical aortic valve replacement and coronary artery bypass grafting has been the standard of care, management options in patients with AS and CAD requiring revascularization have expanded with the advent of transcatheter aortic valve replacement (TAVR). Potential alternative treatment pathways include revascularization before TAVR, concomitant TAVR and percutaneous coronary intervention, percutaneous coronary intervention after TAVR and deferred percutaneous coronary intervention or hybrid procedures. Selection depends on underlying disease severity, antithrombotic treatment strategies, clinical presentation, and symptom evolution after TAVR. In patients undergoing surgical aortic valve replacement, the addition of coronary artery bypass grafting has been associated with improved long-term mortality, especially if CAD is complex. although it is associated with higher periprocedural risk. The therapeutic impact of percutaneous coronary intervention in patients with TAVR is less well-established. The multitude of clinical permutations and remaining uncertainties do not support a uniform treatment strategy for patients with AS and CAD. Therefore, to provide the best possible care for each individual patient, heart teams need to be familiar with the available data on AS and CAD. Herein, we provide an in-depth review of the evidence supporting the decision-making process between transcatheter and surgical approaches and the key elements of treatment selection in patients with AS and CAD.

Graft inflow modulation in recipients with portal hypertension.

The extended application of living donor liver transplantation (LDLT) has revealed the problem of graft size mismatching, potentially leading to the "small-for-size syndrome" (SFSS). SFSS is a rare dysfunction that may affect a partial liver graft, characterized by coagulopathy, cholestasis, ascites, and encephalopathy. A key role in the physiopathology of SFSS is played by portal hypertension (PHT) to which a small allograft is submitted after reperfusion, resulting in sinusoidal congestion and hemorrhage. Portal overflow injures the liver directly through nutrient excess, endothelial activation, and sinusoidal shear stress, and indirectly through arterial vasoconstriction. Thus, SFSS prevention relies not only on increasing graft volume (implementing the use of larger grafts or auxiliary/dual liver transplantation), but also on the control of the increased portal vein pressure (PVP) and portal vein flow (PVF). To this aim, surgical graft inflow modulation techniques (GIM) such as splenic artery ligation (SAL), splenectomy and hemiportocaval shunts, can be considered when an imbalance between the PVP and the hepatic arterial flow (HAF) is acknowledged. However, such strategies have their pros and cons, and a deep knowledge of the indications and complications is needed. Furthermore, pharmacological modulation has also been proposed. This review is aimed to update available literature on the current knowledge and strategies for modulating portal vein flow in LDLT.

A young female patient with severe traumatic hemifacial degloving avulsion injury successfully managed with reconstruction and full thickness skin graft: case report

Introduction and importance: Road traffic accidents can result in severe ocular injuries, jeopardizing vision. High-speed collisions may lead to facial avulsion and degloving injuries, which pose risks such as airway compromise, bleeding, soft tissue loss, disfigurement, and post-traumatic impairments that necessitate prompt reconstruction. Case presentation: A 24-year-old woman sustained injuries in a motorcycle accident, which resulted in a left hemifacial avulsion, a degloving injury, and the loss of her left brow. Additionally, she lost the lower eyelid on the left side and a portion of the left maxilla near the medial canthus. Despite these injuries, the movements of her left eye remained normal. Clinical discussion: The primary objectives of periorbital reconstruction are to restore the patient’s vision with minimal discomfort while ensuring stable coverage for orbital protection and achieving functional reconstruction of the defect. Although there are various surgical reconstruction techniques available, skin grafting and regional flap reconstruction methods are the most commonly employed. Conclusion: The patient expressed satisfaction with the outcome and reported improved social comfort. After a one-year follow-up, both the patient’s facial functions and vision were found to be normal.

TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus conventional surgical aortic valve replacement and coronary bypass grafting for treatment of patients with aortic valve stenosis and complex or multivessel coronary disease (TCW): an international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial

Patients with severe aortic stenosis present frequently (∼50%) with concomitant obstructive coronary artery disease. Current guidelines recommend combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) as the preferred treatment. Transcatheter aortic valve implantation (TAVI) and fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) represent a valid treatment alternative. We aimed to test the non-inferiority of FFR-guided PCI plus TAVI versus SAVR plus CABG in patients with severe aortic stenosis and complex coronary artery disease. This international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial was conducted at 18 tertiary medical centres across Europe. Patients (aged ≥70 years) with severe aortic stenosis and complex coronary artery disease, deemed feasible for percutaneous or surgical treatment according to the on-site Heart Team, were randomly assigned (1:1) to FFR-guided PCI plus TAVI or SAVR plus CABG according to a computer-generated sequence with random permuted blocks sizes stratified by site. The primary endpoint was a composite of all-cause mortality, myocardial infarction, disabling stroke, clinically driven target-vessel revascularisation, valve reintervention, and life-threatening or disabling bleeding at 1 year post-treatment. The trial was powered for non-inferiority (with a margin of 15%) and if met, for superiority. The primary and safety analyses were done per an intention-to-treat principle. This trial is registered with ClinicalTrials.gov (NCT03424941) and is closed. Between May 31, 2018, and June 30, 2023, 172 patients were enrolled, of whom 91 were assigned to the FFR-guided PCI plus TAVI group and 81 to the SAVR plus CABG group. The mean age of patients was 76·5 years (SD 3·9). 118 (69%) of 172 patients were male and 54 (31%) patients were female. FFR-guided PCI plus TAVI resulted in favourable outcomes for the primary endpoint (four [4%] of 91 patients) versus SAVR plus CABG (17 [23%] of 77 patients; risk difference -18·5 [90% CI -27·8 to -9·7]), which was below the 15% prespecified non-inferiority margin (pnon-inferiority<0·001). FFR-guided PCI plus TAVI was superior to SAVR plus CABG (hazard ratio 0·17 [95% CI 0·06-0·51]; psuperiority<0·001), which was driven mainly by all-cause mortality (none [0%] of 91 patients vs seven (10%) of 77 patients; p=0·0025) and life-threatening bleeding (two [2%] vs nine [12%]; p=0·010). The TCW trial is the first trial to compare percutaneous treatment versus surgical treatment in patients with severe aortic stenosis and complex coronary artery disease, showing favourable primary endpoint and mortality outcomes with percutaneous treatment. Isala Heart Centre and Medtronic.

Ultra-low contrast strategy for routine coronary procedures via distal transradial access: real-world experience with consecutive all-comers patients from the DISTRACTION registry.

The association of contrast volume to the risk of contrast-related acute kidney injury (CR-AKI) appears to have resulted in a change in daily practice toward using lower contrast volume for all patients. Distal transradial access (dTRA) has advantages in terms of faster haemostasis and lower rates of proximal radial artery occlusion. The present study aimed to describe the authors' experience with the combination of ultra-low contrast (ULC) strategy and dTRA for routine coronary procedures in a real-world and broad population of all-comers patients. Of 6852 patients consecutively included into the DISTRACTION registry from February 2019 to July 2024, successful ULC coronary procedures via dTRA were achieved in 4328 (63.2%). Related data were retrospectively assessed. Most patients were male with acute coronary syndromes, and the mean patient age was 63.6 ± 15 years. Access-site crossover occurred in only 3% of cases. Right dTRA was the most frequently utilized primary access site, and was almost always performed with standard 6-French radial sheaths. ULC strategy was feasible for every scenario, with the overall contrast volume less than or equal to 40 mL for 96.4% of all patients, regardless of coronary bypass surgical grafts presence, percutaneous coronary intervention immediately following coronary angiography, anatomical or clinical complexity, or unavailability of intravascular ultrasound guidance. Neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA were recorded. The rates of CR-AKI were very low (1.1%). When performed by experienced operators, the minimalist combination of ULC strategy and dTRA for routine coronary procedures, regardless of baseline creatinine clearance, appears to be safe and feasible.

Extended use of axillary impella 5.5 as a bridge to post-infarct ventricular septal defect repair.

Post-infarct ventricular septal defect (VSD) carries high mortality. Since emergent repair of post-infarct VSD is challenging, hemodynamic stabilization utilizing temporary mechanical circulatory support crucially provides time to delay intervention and allows necessary scar tissue formation which improves the fragility of myocardium and leads to a definitive repair. To date, there remains no standard for achieving hemodynamic stability, including usage and mode of temporary mechanical circulatory support. We describe a patient with acute post-infarct VSD in cardiogenic shock successfully supported with Impella 5.5 for 67days as a bridge to surgical repair and coronary artery bypass grafting.

Skin graft take rate among minor burns – A cohort study to investigate the effect of factors such as burn depth, burn size, and timing of the operation

BackgroundIt has been known for decades that early excision of burns reduces morbidity and mortality. Early surgical excision and skin grafting has become the most important part of successful healing in burn management, especially in major burns. However, it is not entirely clear whether early excision and skin transplantation has the same advantages in smaller burns and there is no consensus on the timing of skin grafting in this group. The aim was to investigate the effect of timing and other factors for skin graft take rate among minor burns. MethodsThis retrospective study included patients with thermal injury, a burn size smaller than 11 % total body surface area (TBSA), and who were treated with a skin graft operation. Take rate at the second dressing change after operation was used as main outcome, a cut-off of 95% take rate was for the multivariable logistic regression. ResultsA total of 195 patients were included, median (IQR) age was 42 (9–68) years, 65 % were male, and median (IQR) area of deep burns was 2 (1–4) % of the body surface area (BSA). Multivariable regression showed that smaller area of deep burns and scalds (compared with flame and contact burns) were associated with a take rate of ≥ 95 %. Age, timing of the skin graft transplantation, and plasma C-reactive protein showed no independent effect on take rate. The regression model was significant but weak (ROC AUC 0.71, 95 % CI 0.62–0.79). ConclusionOur results suggest that the extent and depth of the burn are the most important factors for skin graft take rate among minor burns, while timing of the transplantation is not associated with take rate for the skin graft. The advantageous effect of scalds may be interpreted to mean that scalds in general are more superficial than flame and contact burns, a difference that may not be detected by the use of a Lund and Browder chart. The conclusion is, however, tempered by the retrospective study design and the relatively low discriminatory power in our study.

Pharmacological Thromboprophylaxis Effectiveness in Low-Risk Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial

Background: There is a paucity of evidence and controversies regarding prophylaxis strategies in low-risk patients undergoing knee arthroscopy. This study aims to evaluate the effectiveness and safety of aspirin and low-molecular-weight heparin (LMWH) in an arthroscopic anterior cruciate ligament (ACL) reconstruction for low-risk patients. Methods: We performed a preoperational evaluation a week before surgery for any sign of pulmonary embolism (PE) and deep vein thrombosis (DVT). For this purpose, we used single limited compression Doppler ultrasonography (CUS) of the lower extremities. Rehabilitation started before the time of the surgery to improve the range of motion (ROM) and quadriceps muscle function. A team of 3 orthopedists performed the procedures. The same surgical technique and graft were used with spinal anesthesia, and operation time was recorded. Results: The mean age of participants was 31.4 ± 5.6 years, with 93 individuals (67%) being men and 23% women. No cases of DVT or PE were observed. Three cases in the LMWH group and one case in the aspirin group experienced minor surgical site bleeding. One case of hemarthrosis with normal ultrasonography occurred in the LMWH group. Regarding safety and effectiveness, there was no statistically significant difference between the parallel arms. Conclusion: The use of LMWH or aspirin after simple arthroscopic ACL reconstruction in low-risk patients showed no difference in effectiveness. Hence, the routine use of thromboprophylaxis in this setting is questionable although adverse events are rare

Treatment of Renal Artery Aneurysm by ex situ Repair and Autotransplantation: A Nationwide Cohort Study

Introduction: Renal artery aneurysm (RAA) is a rare vascular disease with a mortality rate of up to 80% upon rupture. This study aimed to investigate the safety and efficacy of ex situ repair and autotransplantation for endovascularly untreatable RAA. Methods: A retrospective nationwide cohort study was conducted in RAA patients undergoing ex situ repair and autotransplantation in the Netherlands. Surgical techniques, postoperative complications, and graft outcomes were assessed. Results: Ex situ repair was performed in 9 patients with 11 RAAs. Eight RAAs were located at the first bifurcation, one on the main trunk, one on the first branch, and one on the second branch. Nephrectomy was performed via laparoscopy (n = 7), robotic-assisted laparoscopy (n = 1), and laparotomy (n = 1). Postoperative complications were recorded in 4 patients, including bowel obstruction, delirium, pneumonia, and hydronephrosis due to double-J dislocation. The median estimated glomerular filtration rate was 83 mL/min/1.73 m2 pretransplant and 88 mL/min/1.73 m2 posttransplant. By an average follow-up of 32 months, 2 patients had died due to lung adenocarcinoma and stroke, while all autotransplanted kidneys had good patency and remained functional. Conclusions: Ex situ repair and autotransplantation are safe and feasible for endovascularly untreatable RAA cases. Larger cohorts with longer follow-up periods are necessary to further evaluate the role of this surgical approach.

A penetrating aortic ulcer rapidly evolving into aortic dissection in a patient presenting with respiratory tract infection to the emergency department: an acute aortic syndrome case report

BackgroundPenetrating aortic ulcers (PAU) are life-threatening conditions which derive from severely advanced atherosclerotic lesions of the aorta. The clinical course is unpredictable; thus clinical vigilance should be maintained. It is very challenging to separate PAU from co-existing AAS as predisposing factors and findings overlap.Case presentationCase of 58-year-old gentleman, who presented for atypical chest pain in the setting of respiratory tract infection. Computed Tomographic angiography (CTA) of the chest showed a large PAU and intramural hematoma which rapidly progressed into an acute aortic dissection in the emergency department. Close follow up with cardiac point of care ultrasound one hour later detected an intimal flap which was not initially present on CTA. Patient underwent surgical aortic graft replacement and had an uneventful in-hospital stay.DiscussionThis case underlines the importance of broadening differential diagnoses in atypical presentations in patients with risk factors. Prompt intervention and careful management are imperative to optimize patient outcomes and prevent complications of aortic lesions. Cardiac point of care ultrasound can help in detecting progression of dynamic atherosclerotic diseases such as acute aortic syndrome.

Engineered autologous nasal cartilage for repair of nasal septal perforations: a case series.

This phase I clinical trial assessed the use of autologous nasal chondrocyte tissue-engineered cartilage (N-TEC) for functional repair of nasal septal perforations (NSP). The most widely used technique to treat NSP, namely interposition grafting with a polydioxanone (PDS) plate combined with a deep temporal fascia (DTF) graft, is still suboptimal towards patient satisfaction and revision rates. Patients ( n =5, all female, age range: 23-54 years) had a 0.5-2.0cm diameter NSP. N-TEC was manufactured by expansion and 3D culture of autologous nasal septum chondrocytes into Chondro-Gide collagen membranes. N-TEC was then shaped intraoperatively and enveloped in the harvested DTF before suturing it into the NSP. Safety (primary outcome) was assessed by the number of serious adverse reactions (SAR) until 12 months. Secondary outcomes included feasibility, assessed by surgical graft manipulation, and efficacy, assessed using subjective scoring (nasal obstruction symptom evaluation, NOSE, and visual analog scale, VAS, scores) and objective breathing function tests. Structural closure of NSP after 12 months was defined using endoscopy and computed tomography (CT) scans. NSP treatment by N-TEC implantation was safe and feasible, as no SAR and no challenge in graft manipulation was recorded for any of the patients. One year postoperative, subjective scoring improved in all patients, unless already optimal (average improvement of 23 and 28.6 points out of 100, respectively, for NOSE and VAS scores). Objective respiratory function overall confirmed - with the exception of one case - the observations above (average improvement of 172ml/s). NSP were closed and the mucosae completely healed in three patients. Autologous N-TEC is a valid treatment for NSP and warrants further clinical tests.

Predicting Blood Loss in Aneurysmal Bone Cyst Surgery.

Preoperative estimation of intraoperative blood loss is essential for its management and literature is lacking with respect to factors influencing blood loss in aneurysmal bone cysts (ABC) surgery. The purpose of this study is to identify risk factors and predictors for blood loss in ABC surgery. An IRB-approved retrospective review was performed from 2011 to 2021 at a pediatric tertiary care center. A database identified pediatric patients (<18y old) undergoing surgical curettage and bone grafting for ABC. Lesions in the skull and ribs were excluded. Data collected included demographic data (age, sex), Enneking stage, Capanna type for limb lesions, lesion location, lesion volume (calculated as Transverse × Craniocaudal × Anteroposterior), and history of pathologic fracture before surgical management. Blood loss was recorded as (1) absolute blood loss during surgery and (2) relative loss of total blood volume for individual patients based on their weight and age. Statistical testing was performed using bivariate statistics (Mann-Whitney, Kruskal-Wallis) and multivariate regression analysis. We identified a total of 102 lesions in 101 patients with a mean age of 11.5 years at the time of surgery (range 1.0 to 18.2). Absolute blood loss and relative blood loss increased significantly (P<0.001 for both) with respect to lesion volume. Risk factors for absolute and relative blood loss were identified as type 3 Enneking lesions and those located at the spine/pelvis for all lesions (P<0.05), while for lesions in the limbs, those located in the shoulder/hip were identified as a risk factor for both absolute and relative blood loss. In multivariate analysis, age, lesion location, and lesional volume were predictive of absolute blood loss (P<0.05). While multivariate analysis for relative blood loss identified lesion location and lesional volume of >100mm3 (P=0.004) as predictors. Our study enhances the understanding of intraoperative blood loss in ABC surgery. Findings from this study help identify patients at risk of increased blood loss. Age and lesion volume are factors to consider before estimating blood loss in ABC surgery. Surgeons should be cautious of bleeding risk associated with enneking type 3 lesions, spine/pelvic lesions, and locations precluding the use of a tourniquet. Level III.