Grafting Technique Research Articles

INJECTABLE BONE GRAFT AND ALLOGRAFT BONE CHIPS IN THE TREATMENT OF BENIGN BONE LESION

This study aimed to compare the efficacy of injectable bone grafts and allograft bone chips in the treatment of benign bone lesions. A total of 34 patients were included, with varying types and locations of lesions. The results showed no significant differences between the two groups in terms of age, gender, lesions type, diagnosis, site of the lesion, and bone leakage. However, the remodelling time was significantly shorter in the injectables group (5+3 months) than in the bone chips group (12+5 months). This study contributes to the understanding of the benefits and limitations of different bone grafting techniques for the treatment of benign bone lesions.

Application of a Novel Versatile Mini Posterior Nasoseptal Graft in Endoscopic Transsphenoidal Pituitary Adenoma Surgery.

Skull base reconstruction is a key technique in patients undergoing endoscopic transnasal skull base surgery. Although a pedicled nasoseptal flap (PNSF) is often used to repair large skull base defects with high-flow cerebrospinal fluid leakage, bone exposure of the donor site of the PNSF can result in long-term crusting. To design a novel and versatile mini posterior nasoseptal graft for the reconstruction of defects in the sellar floor or PNSF or pedicled nasoseptal rescue flap (PNSRF) donor site in patients undergoing pituitary adenoma surgery. Patients who underwent pituitary adenoma removal through an endoscopic endonasal approach and repair of a sellar defect or PNSF/PNSRF donor site using the mini posterior nasoseptal graft technique from January 2019 to January 2020 were retrospectively evaluated. Pituitary adenomas were removed using a binostril 4-hand technique through a transnasal transsphenoidal transsellar approach or an expanded transsellar approach. Mini posterior nasoseptal grafts were successfully used in 70 patients who underwent pituitary adenoma removal through an endoscopic transsphenoidal sellar approach. Mini posterior nasoseptal grafts repaired sellar defects in 40 patients and donor site defects of the contralateral PNSF/PNSRF in 30 patients. None of these patients experienced cerebrospinal fluid leakage or major complications. A mini posterior nasoseptal graft is a safe and effective technique for repairing sellar defects after endoscopic transnasal pituitary adenoma surgery. This technique can also be used to repair defects in PNSF/PNSRF donor sites.

Facile fabrication of Artemisia sphaerocephala krasch gum hydrogels by radiation induced cross-linking polymerization and enhanced ultrahigh adsorption for methylene blue

Although Artemisia sphaerocephala krasch gum (ASKG) has attracted growing attention in the field of medical engineering and food industries, however, there are few studies on the gelation of ASKG. In this paper, acrylic acid modified ASKG hydrogels were prepared by radiation induced grafting, cross-linking and polymerization technique for the first time. The semi-IPN structure was prepared by the cross-linked ASKG network and poly-AAc dispersed within the network. The effects of the adsorbed dose on the swelling ratio and gel fraction were investigated. The different acrylic acid content modified ASKG hydrogels (ASKGAAc1 and ASKGAAc2) for methyl blue (MB) adsorption were investigated, and the ASKG hydrogels was also studied for comparison. The influence of pH, contact time, initial concentration, temperature, ion strength on MB adsorption were tested. The results showed that acrylic acid can promote the formation of hydrogel and greatly enhanced the adsorption of ASKG. The adsorption isotherms were well obeyed the Langmuir model, and the maximum adsorption capacity for MB of ASKG, ASKGAAc1 and ASKGAAc2 were 571.43, 1517.8 and 1654.9 mg/g, respectively. Moreover, the MB adsorption by ASKG based hydrogels was exothermic, spontaneous, and more favorable at lower temperature. Furthermore, the adsorption-desorption experiments demonstrated a good reusability of these hydrogels.

Guided bone regeneration in reconstruction of the jaw and role tissue engineering in dental membrane, a review of literature

Tooth loss can significantly impact the quality of human life, affecting overall well-being, appearance, and nutrition. In advanced dentistry, implant therapy has become a popular option for restoring edentulous regions. Guided Bone Regeneration (GBR) is a bone grafting technique that utilizes a protective barrier membrane to prevent soft tissue penetration. This study aims to review various GBR methods, focusing on topics such as bone resorption in the edentulous jaw, different types of GBR techniques, indications for GBR, and limitations associated with this approach.

Dual-Lumen Stenting of Dissected Superior Mesenteric Artery During Fenestrated Branched Endovascular Repair of a Post-dissection Thoracoabdominal Aortic Aneurysm.

Long-segment aortic branch dissections have been considered a relative contraindication for fenestrated-branched endovascular aneurysm repair (FB-EVAR). This case report describes a technique of dual-lumen stenting of a fully-dissected superior mesenteric artery (SMA) to preserve patency of the true and false lumens during FB-EVAR. A 67-year-old man presented with a 6.0 cm extent III chronic post-dissection thoracoabdominal aortic aneurysm. The patient had highly-complex anatomy including dissection of the entire SMA. The true and false lumens of the dissected SMA were noted to be supplying different branches, requiring preservation of both lumens. The patient underwent a staged physician-modified FB-EVAR. A modified endograft containing 5 fenestrations and 1 branch cuff was introduced and the celiac, true-lumen SMA, and 3 renal arteries were sequentially catheterized using staggered deployment of the modified endograft. The false lumen SMA stent was catheterized via the branch cuff. Molded parallel grafting ("eye-of-the-tiger") technique was used to achieve double D configuration between the true and false lumens of the SMA. This case demonstrates feasibility of dual-lumen stenting to incorporate dissected target vessels during FB-EVAR while preserving flow to both the true and false lumens and the second-order branches they supply. We report a novel technique that allows incorporation of branch vessels affected by long segment dissection during fenestrated branched endovascular aortic repairs. This has potential advantage of preserving flow to all secondary branches of the dissected target vessels, while reducing the risk of type Ic endoleak.

A bibliometric study of vascularized fibular grafting technique

Aims: Vascularized fibula graft (VFG) technique is one of these “gold standard” techniques in bone regeneration. Although there have been several bibliometrics studies in orthopedics, there haven’t been any on VFGs. By identifying the gaps in previous research, we sought to provide light on the scientific evolution of VFGs and provide direction for future investigations.
 Methods: In this bibliometric study, the Web of Science (WOS) database was used to access publications on VFG published between 1986-2022. A literature search was performed with selected keywords. The dataset obtained was downloaded from the WOS database as an output. This output was analyzed with VOSviewer and Biblioshiny tools.
 Results: A total of 430 documents on VFG included the study. A mean of 11.9 articles/year was published on VFG. The first article on VFG published in 1986. Since 2005, there has been an increasing trend in the number of articles and citations. The year with the highest number of both publications (n=32) and citations (n=756) was 2021. The publications on VFG have cited a total of 7300 times, an average of 16.98 citations per publication. Total 51 countries contributed to publications on the VFG between 1986-2022. The United States of America (USA) was identified as the global leader in terms of the number of publications (n=91, 21.163%), followed by Japan (n=58, 13.488%) and China (n=56, 13.023%). The USA had 91 manuscripts and 2162 citations with an H-index:29 and Japan had 58 manuscripts and 1145 citations with an H-index:22.
 Conclusion: The literature on VFG is quite limited. Most of the publications are from developed countries. Studies should be supported for this method that can be used in the treatment of many diseases, especially in developing countries.

Acetabular Labral Reconstruction: Review of Techniques and Outcomes.

To analyze advances in labral reconstruction, and to discuss the literature relating to efficacy, outcomes, and technical considerations of labral reconstruction. The available evidence suggests that labral reconstruction is a safe and effective procedure that can improve pain and function in patients with severe and/or complex labral tears. The superiority of labral reconstruction over labral repair is uncertain, and it remains unclear what graft type and technique should be used in labral reconstructions. Labral reconstruction assists in restoring the function of the labrum of the hip. It consistently restores stability of the hip joint and demonstrates good clinical outcomes at follow-up. The optimal graft type, technique, and extent are still debated, and more research is needed. Ultimately, despite this uncertainty, labral reconstruction is proving to be a valuable tool for hip preservation specialists.

Treatment of scaphoid nonunion by arthroscopic cancellous bone grafting

IntroductionIn order to avoid Scaphoid Nonunion Advanced Collapse (SNAC) type osteoarthritis, which progressively affects the radial and midcarpal joints, several vascularized and non-vascularized grafting techniques have been described. Over the past decade, there has been growing interest in arthroscopic cancellous bone grafts for scaphoid nonunion. The aim of this novel prospective study was to assess the healing rate of scaphoid grafts under arthroscopy, and the prognostic factors for healing. Material and methodsThis prospective study was carried out across 10 centers between September 2019 and April 2021, in patients aged 16 to 65. Scaphoid nonunion grafting was performed arthroscopically. Union was assessed on CT scans and displacement correction angles were measured preoperatively and then at 3 and 6months. We assessed mobility, Jamar wrist strength, functional results as per the Patient Related Wrist Score (PRWE) and the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) score. Risk factors for nonunion were assessed. ResultsWe included 77 patients with a mean age of 24years (18 to 55years) with a mean time between trauma and treatment of nonunion of 34.8months (6 to 180months). The population was represented by 46 manual workers and 20 were smokers. In 42 cases, the nonunion was proximal, in Schernberg zone I or II. At the last follow-up of 12.9months on average (Standard Deviation: 8.7months), union was achieved in 72 patients (93.5%). The average duration of union was 3.4months (Standard Deviation 1.6). Among the 5 patients who did not heal, grafting was performed in addition to the fixation. We did not identify any contributory factors for nonunion. ConclusionThis study demonstrated the effectiveness of arthroscopic treatment of scaphoid nonunion with a union rate at least equivalent to pedicled vascularized grafts. Smoking and delayed treatment were no longer considered unfavorable prognostic factors in the context of arthroscopic treatment. Level of evidenceIII.

A modified induced membrane 2-stage technique using a thoracodorsal artery perforator free flap followed by vascularized or non-vascularized free fibular transfer for the treatment of complex bone infection with concomitant severe soft tissue lesion–A case series of 9 cases

Treatment of post-traumatic complex bone infection is very challenging. The two principal bone reconstruction approaches are the single-stage vascularized bone graft technique and the two-stage induced membrane technique (IMT). Here we introduce a modified 2-stage induced membrane technique (MIMT) for complex long bone infection with a major bone defect and a concomitant severe soft tissue lesion. The 2-stage procedure consists of bone debridement, placement of a PMMA spacer and soft tissue reconstruction with a thoracodorsal artery perforator free flap (“Tdap”) at stage 1. At stage 2, the thoracodorsal artery perforator flap is elevated and a fibular strut graft (either vascularized of non-vascularized) is placed for bone reconstruction.We retrospectively analyzed the extents of lower extremity, long bone, post-traumatic bone infection treated via MIMT from 2008 to 2020. There were nine such cases (eight males) of mean age 59.8 (range 31 to 79) years. The osteomyelitis durations ranged from 3 to 360 months (mean 53 months). The cortical bone defect sizes was ranged from 9 to 14 cm (mean10.7 cm). All skin resurfacing employed Tdap. Vascularized fibular grafts were placed in six patients and non-vascularized grafts were placed in three. The fibular graft size ranged from 12.5 to 19 cm (mean 16.2 cm). Non-vascularized iliac bone grafts served as the fibula docking sites.Unfortunately, all patients suffered complications before bone union was achieved. One case of plate stress fracture and one case of screw fracture required plate and screw change. In three cases of cellulitis, one resolved by use of intravenous antibiotics, others required plate and screw removal. Wound disruption required re-suture and distal skin flap partial necrosis was covered by perforator-based island flap. One case of fibular stress fracture needed cast for 4 weeks. A peroneal nerve palsy patient recovered spontaneously. Bone union was achieved after 6 months in five patients and after 8 months in three (mean 6.9 months). All patients were able to walk unaided. The follow-up period ranged from 2 to 14 years (mean 6.2 years).MIMT saves the limbs in cases with difficult post-traumatic bone infection. It is valid treatment option for complex bone infections with severe soft tissue lesions. However, even with this technique potential complication must be considered.

Minced Free Fat Graft Versus Pedicle Fat Flap to Efface Orbital Rim Hollow in Lower Blepharoplasty.

Lower eyelid fat flap repositioning during transconjunctival lower blepharoplasty (TCLB) is a widely accepted technique for preventing postoperative tear trough deformity. Its drawbacks include retraction, limited volume, transcutaneous fixation, and a complex insertion technique. The minced lower eyelid fat graft was introduced to overcome these drawbacks. The aim of this study was to compare the outcome of preperiosteal pedicle fat flaps with minced free fat graft in TCLB. Participants who underwent the pedicle fat flap procedure from April 2019 to April 2020 (Group A) and the minced free fat graft from May 2020 to May 2021 (Group B) with at least 6 months of follow-up were included. Subjective (pain, infraorbital numbness) and objective (chemosis, residual skin wrinkles, hyperpigmentation, tear trough deformity, bumps) postoperative outcomes, satisfaction (visual analogue scale score) at the last follow-up, and reoperation rates were compared. There were 142 participants (94% females) with a mean age of 48.4 years (range: 21-71) and a follow-up of 8.2 months (range: 6-36). There were 73 participants in Group A and 69 in Group B, with no significant differences in age (P = .6), sex (P = .7), or follow-up (P = .3). In addition to TCLB, Groups A and B had simultaneous upper eyelid and eyebrow procedures (53% vs 49%, P = .2), lateral canthal plication (77% vs 83%, P = .4), and pinch skin excision (82% vs 88%, P = .3). Groups A and B did not have significant differences in postoperative numbness (6.8% vs 1.4%, P = .2), chemosis (11% vs 10%, P = 1), skin wrinkles (12.3% vs 8.7%, P = .6), hyperpigmentation (1.4% in both groups), bumps (2.7% vs 7.2%, P = .3), tear trough deformity (0.0% in both groups), satisfaction score (97.7% vs 98.1%, P = .4), or reoperation rate (12.3% vs 5.8%, P = .2). The desired aim of fat redistribution in TCLB seems to be equally achievable with minced fat graft and pedicle fat flap techniques.

The clinical efficacy of autogenous dentin blocks prepared chairside for alveolar ridge augmentation: A systematic review and meta-analysis.

This systematic review aimed to evaluate the current evidence on the effectiveness of autogenous dentin block graft prepared chairside for alveolar ridge augmentation and compare its clinical outcomes to the main available grafting materials and techniques. Three databases were screened, including prospective clinical studies, utilizing autogenous dentin blocks for ridge augmentation, with at least 3 months of postoperative follow-up. Eight articles were included, and four of them were meta-analyzed. Dentin blocks demonstrated similar vertical bone gain and significantly higher width gain, compared to bone blocks (WMD = 0.03, 95% CI -0.51 to 0.57, p = .92 and WMD = 1.34, 95% CI 0.57 to 2.12, p = .0007, respectively). Vertical and horizontal resorption were similar between the two groups (WMD = -0.36, 95% CI -0.91 to 0.18, p = .19, and WMD = -0.47, 95% CI -1.05 to 0.11, p = .11, respectively). Dentin blocks showed more incidences of postoperative complications, however, with no statistical significance (RR = 4.30, 95% CI 0.97 to 18.96, p = .054). The need for additional augmentation upon implant placement was also similar between both grafts (RR = 0.95, 95% CI 0.39 to 2.28, p = .90). Recorded incidences of graft exposure were low (2.27%), and no study stated surgical site infection. Within its limitations, this study indicates that the autogenous dentin blocks prepared chairside could be a possible alternative to the other established bone augmentation techniques for staged ridge augmentation. Nevertheless, future studies are needed to confirm its efficacy and implant success/survival in sites grafted with this material.

The advanced concepts for septal l-strut re-designing in septorhinoplasty for better strength and stability by considering of center of gravity.

This study contributes to the multidisciplinary understanding of septal L-strut reshaping and introduces innovative surgical design concepts based on engineering principles of static equilibrium. The objective is to enhance structural strength and stability, ultimately leading to improved surgical outcomes. Finite element analysis is employed to model the three-dimensional septal cartilage in septoplasty. A significant contribution of this work is the introduction of an innovative redesigns for the septal L-strut structure. These redesigns represent the first-ever attempt to incorporate the center of gravity theory into the modeling of the septal L-strut. Our findings emphasize the significance of attaining a lower center of gravity in the design of the septal L-strut, as it contributes to optimal core strength and stability. To achieve this, we recommend widening the caudal septum and shaping the interior fillet corner to its maximum size, taking into account its specific shape. Notably, the utilization of a standard 20x20 mm septal L-strut, the C-shaped technique, and the septal support graft technique provide superior strength due to enhanced basement support. To enhance surgical outcomes in septal L-strut procedures, design modifications are proposed to improve strength and stability, resulting in optimized performance. Recommendations include widening the caudal septum and incorporating fillet shapes in the geometry to lower the center of gravity.

Buccal Fat Pad Augmentation for Midfacial Rejuvenation: Modified Fat Grafting Technique and Ogee Line Remodeling.

The volume and position of the buccal fat pad (BFP) change with age, which manifests as a hollow midface. Previous studies showed that autologous fat grafting for BFP augmentation could effectively ameliorate midfacial hollowing. The aim of this study was to introduce a modified fat grafting technique for female patients with midfacial hollowing to restore the volume of BFP, and to evaluate the safety and effectiveness of this approach. Two cadavers were used for the dissection of the BFP and to demonstrate the surgical procedures. Forty-eight patients were treated for midfacial hollowing with the modified grafting strategy. The BFP was filled through a percutaneous zygomatic incision and an immediate amelioration in the hollow area was observed. Improvements were evaluated from measurements of the ogee line and ogee angle, FACE-Q questionnaires, and 3-party satisfaction ratings. Clinical profiles were reviewed and statistically analysed. The mean [standard deviation] ogee angle was 6.6° [1.9°] preoperatively and 3.9° [1.4°] postoperatively (average reduction, 2.7°). Patients' ogee lines were smoother postoperatively, with marked improvements in overall appearance, psychological well-being, and social confidence. Patients reported high satisfaction with decision-making and postoperative outcomes and felt 6.61 [2.21] years younger. Overall, 88%, 76%, and 83% of the cases were graded as good or excellent in improvement by surgeon, patient, and the third party, respectively. For age-dependent midfacial hollowing in female patients, the modified percutaneous grafting technique described here was safe and efficacious in restoring BFP volume. This technique produced a smoother ogee line and a natural, younger midfacial contour.

Regjenerimi vertikal dhe horizontal i kockës alveolare tek pacientët me sklerozë multiple

After tooth extraction, alveolar bone resorption is common and inevitable, which can lead to dimensional changes in the horizontal and vertical plane of the ridge. These chang- es range from an average vertical bone loss of 1.5 to 2 mm and an average horizontal loss of ridge width of 40 to 50% during six to twelve months of healing. The purpose of the study was to present the clinical case of a female patient with Multiple Sclerosis who underwent bone augmentation with xenograft and to show the degree of horizontal and vertical bone regeneration after bone augmentation. The work is a presentation of a case that was carried out in the private Dental Ordinance during the year 2021. The case presented is with horizontal and vertical resorption of the alveolar ridge, in which artificial bone – bone particles (Par- ticulate Bone Grafting Technique) produced by the Bionno- vation biomedical company was used. The measurement of parameters is quantitative. 6 months after guided bone regeneration, through 3D analysis we have the following re- sults: he length of the bone from 7.5mm became 10.7mm, while the width of the bone at the top of the alveolar ridge from 1.7mm to 3.4mm, while the part of the base of the ridge from 5.4mm to 7.4mm. Directed bone regeneration is a procedure that is recommended in cases where we do not have enough bone to place implants. The technique used is grafting through bone particles (Particulate Bone Grafting Technique).

Recent Advances in Membranes Used for Nanofiltration to Remove Heavy Metals from Wastewater: A Review.

The presence of heavy metal ions in polluted wastewater represents a serious threat to human health, making proper disposal extremely important. The utilization of nanofiltration (NF) membranes has emerged as one of the most effective methods of heavy metal ion removal from wastewater due to their efficient operation, adaptable design, and affordability. NF membranes created from advanced materials are becoming increasingly popular due to their ability to depollute wastewater in a variety of circumstances. Tailoring the NF membrane's properties to efficiently remove heavy metal ions from wastewater, interfacial polymerization, and grafting techniques, along with the addition of nano-fillers, have proven to be the most effective modification methods. This paper presents a review of the modification processes and NF membrane performances for the removal of heavy metals from wastewater, as well as the application of these membranes for heavy metal ion wastewater treatment. Very high treatment efficiencies, such as 99.90%, have been achieved using membranes composed of polyvinyl amine (PVAM) and glutaraldehyde (GA) for Cr3+ removal from wastewater. However, nanofiltration membranes have certain drawbacks, such as fouling of the NF membrane. Repeated cleaning of the membrane influences its lifetime.

Fingerprints of super spin-glass state in two-dimensional nanoscopic system

Novel two-dimensional magnetic assembly was designed, manufactured, and its static and dynamic magnetic response was investigated. The assembly contains Fe3O4 nanoparticles of nominal size 7 nm which were deposited on plasma-treated polypropylene substrate using a grafting technique. The nanoparticles create agglomerates with size distribution ranging nominally from 10 nm to 110 nm. The temperature dependence of zero-field and field-cooled susceptibility is consistent with glassy behavior. The relative shift of maximum in alternating susceptibility Γ ≈ 0.075 and zυ = 10 obtained from critical slowing down analysis also support the formation of the collective states akin to super spin-glass. However, the absence of collapse in dynamic scaling of alternating susceptibility data using predictions for three-dimensional spin-glass with Gaussian distribution of magnetic coupling and two-dimensional bimodal spin-glass suggests that the studied system is not representative of the used limiting models. The investigation of memory effects revealed the coexistence of relaxation phenomena of collective degrees of freedom and individual nanoparticles. The obtained results suggest that the studied assembly is appropriate for the investigation of super spin-glass state in two-dimensional magnetic system with dominant dipolar interaction.

Single Stage Excision and Thick Split Thickness Skin Graft Technique for Facial Giant Congenital Melanocytic Nevi with Consideration of Facial Aesthetic Subunits: A Case Report and Literature Review

Due to their three-dimensional anatomy, functional importance, and esthetic appeal, giant congenital melanocytic nevus (GCMN) of the face pose the greatest challenge to reconstructive surgeons, especially when there are few donors and a significant deformity. A 25-year-old male patient presented with a facial GCMN. GCMN management involves complete nevus removal and reconstruction using tissues of the same color, thickness, and as the surrounding skin. Some defect closure options were inapplicable due to the almost complete forehead defect. This study aims to report the author's successful experience treating an adult case of GCMN with single-stage excision and subunit facial restoration using thick split-thickness skin graft (STSG). In this case, thick STSG is considered to prevent the risk of secondary contracture and conspicuous discoloration. In addition to esthetic and functional outcomes, the patient's social status and self-esteem also improved. This technique promises esthetic results, such as reduced downtime, and improved psychological function.

Indications for and Limitations of Reconstruction of Auricular Defects with the "Mid-moon Flap" and Evaluation of Outcome by the Aesthetic Numeric Analogue Score.

A variety of skin grafting techniques and local flaps have been described for medium-sized auricular defect reconstruction. Despite this, the reconstruction of a medium-sized auricular defect starting from the opposite surface is not yet reported in the literature. In the present article, the authors describe a novel surgical approach, the "mid-moon flap" technique, used for 87 patients in that kind of reconstruction. Eighty-seven patients presenting tumors located on the pinnal surface were enrolled in this study. The patient distribution included 68 men and 19 women, aged from 52 to 94 years, with a median age of 77.4 years. For all the patients, a customized cutaneous flap, named the mid-moon flap, was performed for auricular defect reconstruction. Histopathology reports confirmed the diagnosis of malignant tumors, with complete excision of the lesions in all cases. Follow-ups ranged from 6 to 36 months, with a mean of 18 months. There were no recurrences of the malignancy during the study, and the aesthetic outcome was globally considered good. The authors reported that the mid-moon flap technique is most appropriate for medium-sized auricular defects for two principal reasons: it covers the recipient area very well and, at the same time, leaves almost imperceptible relics on the donor area without causing any morphofunctional alteration of the ear.

Poster 190: Utilization of Distal Clavicle Bone Grafting in the Treatment of a Mobile Mesoacromion: Rationale and Technique

Objectives: The treatment of symptomatic unstable os acromiale can be fraught with challenges. It is estimated that between 3-5% of the population has an unfused mesoacromion, but only a small fraction of those shoulders develop a painful, mobile mesoacromion that requires treatment. The variety of concomitant shoulder pathology and overlapping symptoms can make diagnosis and treatment difficult. Furthermore, there remains no consensus for the optimal surgical treatment when conservative methods fail. Surgical options include fragment excision, acromioplasty, and open reduction internal fixation (ORIF) with or without bone grafting. A variety of arthroscopic and open techniques have been described with a large amount of heterogeneity in the literature making comparison of these techniques difficult. Biomechanical forces through the clavicle and acromioclavicular (AC) joint throughout shoulder range of motion have been described in the literature. These forces have theoretical implications on the relationship between the distal clavicle and mesoacromion. Shear, rotational, translational and compression forces imparted against the acromion, by the clavicle and the acromioclavicular ligaments, impart those same forces on the mesoacromial defect via the linkage of the AC joint. There are currently no studies describing the utility in using the distal clavicle as a bone graft source during ORIF of symptomatic mesoacromion. The cross sectional shape and surface area of the distal clavicle is remarkably similar to that of the acromial process. We describe a surgical technique utilizing the distal clavicle as a bone grafting source and present a case series of 8 patients with 100% union rate. Methods: A retrospective analysis was done on 8 patients from 2001-2016 who underwent open reduction internal fixation (ORIF) with distal clavicle bone grafting of a symptomatic, mobile mesoacromion by a single surgeon. The technique utilizes a saber type incision for exposure of the acromion, AC joint, and distal clavicle. Small splits in the anterior and posterior deltoid are utilized to palpate the anterior and posterior aspect of the acromion. Two parallel Kirschner wires (K wires) are placed from anterior to posterior through the acromion crossing the mesoacromion site. The proximal and distal aspects of the site are prepared and rasped. The distal clavicle is skeletonized and 9mm of distal clavicle is removed using a micro saw. The distal clavicle is sliced to 2-3 mm thickness creating a "wafer" of local bone graft. Two narrow slots are placed into the wafer using a small rongeur. These slots are spaced at the exact distance of the parallel K wires. The wafer of bone graft is then placed into the prepared mesoacromion defect and allowed to straddle the K wires via the slots. The acromion is then clamped from front to back using a bone clamp and cannulated screws are placed over the K-wires. Supplemental tension band fixation was used for the earlier portion of the senior author’s practice. Over the course of the technique, with the development of modern screws, the supplemental tension band was felt to be unnecessary. Soft tissues were closed in a standard fashion. Results: The median patient age was 52.5 (range, 41-59) with 75% male and 87.5% Caucasian. The median body mass index (BMI) was 29.4 (range, 23.9-39.2), 62.5% were non-smokers, 25% were type 2 diabetics, 37.5% had hypertension and 25% had no comorbidities. The patients who underwent this procedure with a median follow-up of 6 years (range 2-18). All procedures were done utilizing the distal clavicle bone graft technique described above with fixation reinforced by tension band in 6 of the 8 patients. Seven of 8 patients had concomitant shoulder pathology which included either partial or full rotator cuff tears (n=6), AC arthritis (n=4), glenohumeral (GH) arthritis (n=2) and biceps injury (n=2). Six of 8 patients underwent additional procedures during the index mesoacromion ORIF including rotator cuff repair (n=3), biceps tenodesis (n=4), and AC or GH debridement (n=5). One patient had an acute superficial postoperative infection successfully treated with irrigation and debridement. Otherwise, there were no complications related to the index procedure. Postoperatively all patients had symptomatic relief and went on to radiographic union of the mesoacromion. Conclusions: There remains a paucity of literature to help guide surgical treatment of symptomatic mesoacromion. Studies are largely limited to retrospective reviews and case series with various surgical techniques utilized. Therefore, the importance of relying on surgical experience and expert opinion cannot be overemphasized. This is the first study describing the use of the distal clavicle as bone graft for ORIF of the mesoacromion. Use of a distal clavicle bone graft obviates the need for a separate bone graft harvest site. Furthermore, it reduces abutment, translational and rotational forces on the mobile mesoacromion, maintains acromion length, and increases surface area for bony union. This evolved technique resulted in 100% union rate in our series of 8 patients with a median 6 year follow-up.

Treatment of penile curvature with aldehyde free bovine pericardium graft: an original and prospective evaluation of a cohort of patients with peyronie’s disease

Introduction: Peyronie´s disease (PD) is a common condition that can cause penile curvature and /or deformities and therefore affecting the male sexual function. The most effective treatment for clinically significative and stable penile curvature due to PD is the reconstructive surgery that involves techniques that do not shorten the penile length. Among the techniques that correct the curvature restoring the penile length, the incision and/or excision of the plaque, followed by the reconstruction of the defect with a graft remains as the gold standard. Although several materials have been used as a graft in the treatment of penile curvature due to PD, none have shown results good enough to be considered as the first choice. Herein, we aimed to evaluate the results of the surgical treatment of patients with penile curvature due to PD using a new biograft. Methodology: We performed the surgical management with graft technique in twelve men suffering from penile curvature due to PD. Penile curvature was measured before and one year after the reconstructive procedure. The graft of choice was the bovine pericardium graft segment treated with L-Hydro aldehyde-free technology. Erectile function was evaluated by the IIEF questionnaire and penis length was measured by a rigid rule during the pharmacological induced erection test. Results: The overall success rate of correction of the penile curvature was 90.9% and the patient’s satisfaction rate was 91.7%. No serious adverse events were found and erectile function impaired in 18.2%.There was an increase in penile length in 91.7% and this ranged from 0.7 to 3.0 cm. Conclusion: Correction of penile curvature due to Peyronie's disease using the technique of incision and/or excision of the plaque with the aldehyde-free bovine pericardium graft has high success rates in terms of both penile shaft rectification and patient satisfaction. L-hydro bovine pericardium graft is easy to handle surgically, allows a tight anastomosis and does not present serious postoperative complications. Furthermore, it can be used simultaneously with penile implants and appears to have a role in restoring penile length.