Grafting Technique Research Articles

The use of a 3D printed titanium implant for arthrodesis in the management of large osseous defects in the ankle

BackgroundLarge osseous defects (LOD) in the ankle occur because of multiple aetiologies. Advancement in 3-dimensional (3D) printing technologies has led to the use of custom implants and instrumentation their management. A 3D printed patient-specific porous titanium cage which allows for peripheral osteo-integration and autogenous bone-grafting could be an ideal implant in these cases. MethodsRetrospective review of a multi-centre, multi-surgeon consecutive cohort of patients requiring either TTC or AA for a large osseous defect between June 2019 – August 2020. A custom titanium prosthesis was 3D-printed according to CT measurements for implantation. ResultsMean follow up was 19.5 months (range 12–24 months). Plain radiographs and CT scans at 12 months confirmed osseointegration (stability) in 11of 13 patients (84%). Two patients developed late infection, one requiring revision surgery. Conclusions3D-Printed titanium implants in the management of LODs in the ankle offer a comparable success rate to other reported procedures, with unlimited geometric possibilities in the design allowing for accurate length correction. Their structural stability may offer an advantage over conventional bone graft techniques and limits the amount of bone-graft required. Levels of evidenceLOE III

(412) Concurrent Penile Plication and Extratunical Pericardial Grafting for Peyronie's Disease: A Step-by-Step Technique

Abstract Introduction Surgical indications for Peyronie's Disease (PD) may constitute severe penile curvature or deformity including unilateral/bilateral corporal indentation/hinging, hour glassing, and concomitant erectile dysfunction. Penile plication, incision/excision of tunical plaques with grafting techniques are widely used. Recently, extratunical grafting has emerged as newer surgical technique that aims to treat corporal indentation, deformities, or tunical tissue loss in select PD cases. Objective In this video, we demonstrated step by step surgical technique for concurrent penile plication and extratunical pericardial grafting via circumcision incision in patient with severe ventral PD. Methods Video demonstration was edited using surgical footage with additional explanatory slides and audio. Results Video demonstration attached. Conclusions This video demonstrates step by step surgical technique for concurrent penile plication and extratunical pericardial grafting that can be used as an adjuvant surgical technique in treating corporal indentation, hinge effect or deformity with or without penile plication. Disclosure No

(042) Inflatable Penile Prosthesis Placement In Transgender Neophallus Using Novel Human Cadaver Pericardium (Tutoplast®) Graft Sock Technique

Abstract Introduction Placement of an inflatable penile prosthesis (IPP) in a transgender patient’s neophallus carries unique considerations versus cis-gender IPP in mitigating infection, erosion, and overall complication rates. Traditionally, the IPP implants used in cis-males are also employed in transmasculine patients. However, there are unique challenges in the transmasculine population, with one of the most significant being the lack of anatomical corpus cavernosum and crura for cylinder placement and anchoring. To account for this, multiple grafting approaches and materials have been utilized in IPP neophallus placement with the goal of facilitating cylinder anchoring and stability. Here we detail our experiences using a novel grafting approach with Tutoplast® pericardium graft in a “sock” and “cap” technique in IPP placement in a transgender neophallus. Objective Our objective is to evaluate postoperative satisfaction and device functionality in patients undergoing transgender neophallic IPP placement using our technique. Methods We describe our experience and surgical technique in IPP neophallus placement utilizing a single cylinder with novel distal and proximal cylinder human cadaver pericardium (Tutoplast®) graft. Results We performed neophallus IPP placement with this novel grafting technique, with operative images and graft details shown below. Patients had no complaints post-operatively, with cylinder and pump found to be in good position at first post-operative visit 6 weeks following surgery. There was no difficulty with urinating through the neophallus. All patients report continued satisfaction with device as well as ability to perform penetrative intercourse with device activated. All patients reported satisfaction and no complications at last follow-up (range: 3.5 months to 13 months), with all patients possessing continued satisfactory erectile function. One patient noted occasional mild pain in neophallus that self-resolves and does not cause any concern. Conclusions In neophallus IPP placement, the anatomical differences compared to cis-gender IPP operations require unique considerations such as cylinder grafting material selection for proximal cylinder fixation and mitigation of device erosion rates. Utilizing human cadaver pericardium (Tutoplast®) graft in distal and proximal cylinder coverage shows positive preliminary outcomes in our patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Run Wang, MD, FACS is a consultant for Boston Scientific and Teleflex.

Rutin Gel with Bone Graft Accelerates Bone Formation in a Rabbit Model by Inhibiting MMPs and Enhancing Collagen Activities.

Bone graft techniques are used to compensate for bone loss in areas with deficient regeneration. However, matrix metalloproteases (MMPs) can limit bone formation by degrading extracellular matrices, which are required for bone regrowth. Noteworthily, rutin is a natural flavonoid compound that inhibits the genetic expression of various MMPs. Therefore, rutin may serve as an inexpensive and stable alternative to the growth factors used to accelerate dental bone graft healing. This study aimed to evaluate the potential of mixing rutin gel with allograft bone to accelerate the healing of bone defects in an in vivo rabbit model. Bone defects were surgically induced in New Zealand rabbits (n = 3 per group) and subsequently treated with bone grafts along with rutin or control gel. Overall, treatment with rutin significantly prevented the expression of several MMPs and increased type III collagen in the gingiva around the surgical site. Additionally, rutin-treated animals showed enhanced bone formation with higher bone marrow content in the jawbone defect area compared with the control group. Taken together, these findings demonstrate that rutin gel, when added to bone grafts, quickly enhances bone formation and may serve as a suitable alternative to expensive growth factors for the same purpose.

(138) Smaller Tunical Defect With Pre-graft Plication Technique During Peyronie's Disease Surgery May Reduce Postoperative Erectile Function Loss

Abstract Introduction Peyronie’s disease (PD) is a progressive and benign acquired connective tissue disease characterized by disordered wound healing and local fibrosis of the tunica albuginea (TA). PD has two phases: acute and chronic. Surgery is the gold standard option for the correction of penile deformity in the PD chronic phase. Methods used in surgical treatment include plication, graft repair, and penile prosthesis implantation. Plaque incision (PIG) or excision (PEG) and graft placement are performed during graft repair. However, this technique can cause postoperative erectile dysfunction (ED) related to the size of the TA defect. Objective In our clinic, we use a novel "pre-graft plication technique" to reduce disruption of the integrity of the TA in patients with unidirectional curvature > 60 degrees. In this technique, we place 2 or 3 Essed–Schroder sutures on the convex side of the curvature before incision or excision and grafting on the plaque side. Thus, we pull the curvature angle down before PIG/PEG. We aim to improve post-op erectile function by using smaller grafts and TA incisions (figure 1). Our goal for this study was to compare the results of this technique with the standard PIG/PEG technique. Methods All patients who were operated on for PD in our clinic between 2010 and 2021 were screened. Patients aged between 40 and 70 years who underwent grafted PD repair were included in the study. Patients who underwent previous penile surgery or hormonal therapy, had significant preoperative ED (IIEF-5 < 17), or who received diagnoses of malignancy or depression were excluded from the study. We found 45 patients on whom we applied the pre-graft plication technique (group 1) and 32 patients on whom we applied the standard grafting technique who were appropriate for our inclusion and exclusion criteria. Demographic characteristics of the patients, comorbidities, preoperative IIEF-5 scores, stretched penile lengths, plaque sizes detected during surgery, graft sizes and types, postoperative IIEF-5 scores at the 3rd and 12th months, and 3-month postoperative penis lengths were recorded. Penile massage and daily 5 mg tadalafil were recommended as post-op rehabilitation. The results were compared with Student’s T-test. Results There were no significant differences between the groups in terms of preoperative IIEF-5 scores, penile lengths, age, or comorbidities. While there was no significant difference between the groups in the plaque sizes detected during the operation, the graft size used was significantly smaller in Group 1 than in Group 2. At follow-up, the IIEF-5 scores of the Group 1 were, on average, 1.97 and 2.36 points higher than Group 2 at 3 and 12 months of follow-up, respectively. This difference was statistically significant. There was no significant difference between the groups in terms of penile length (table-1). Conclusions Reducing post-op erectile function loss is possible with pre-graft plication technique. The extra plication suture does not cause a significant reduction in penile length. Disclosure No

(481) Experience with Plaque Excision and Dermal Grafting in the Surgical Treatment of Peyronie's Disease

Abstract Introduction Plaque incision and grafting (PIG) is indicated for men with complex or severe penile curvature, several surgical options to treat PD have been performed. Surgical treatment use graft, as these procedures aim to maintain penile length. Objective To assess outcomes following plaque excision and dermal grafting in the surgical treatment of Peyronie's disease. Methods A prospective study, was performed at Binh Dan Hospital (Ho Chi Minh City – VietNam), from 1/2016 – 12/2020. Surgical correction for curvature is indicated when the PD duration is >12 months, and when the stable phase of PD is >6 months, all case use plaque excision and dermal grafting technique. Results our study have 52 patients, - History illnes: 42.1% diabetes, 26.3% hypertension, 36.84% hyperlipid. - Age mean: 58.31 ± 8.5 years (min: 48 – max 72). - Chief complaine: penile deformities (36.8%), pain (31.6%), palpable lumps (26.3%). - 52.6% have psychological effects. - Fibrous plaque on corpus: Anterior (5.2%), Mid (47.37%), Posterior (47.37%). - Plaque size: 72.59 ± 75.78mm2 (15.51 mm2 – 207 mm2). + Primary outcome measures - Complications (follow one month): alter sensation (16.7%), edema (21.05%), infection (1.9%), pain (10.53%) - Penile straightening: 89%. - Penile length: no changes (82.7%), shorter (17.3%). + Secondary outcome measures - Recurrent curvature: 3 cases – 01 case need operation second time. - Post-operative erectile dysfunction: 7 cases (13.46%). - Patient satisfaction: 82.3% Conclusions Surgical correction of penile curvature is the mainstay for PD treatment. Dermal graft: effectiveness in terms of satisfaction, length change, straightening, economic efficiency and complications. Suitable for patients with underlying medical conditions. Adequate preoperative patient counseling. Disclosure No

Structural Approach to Secondary Repair of the Unilateral Cleft Lip Nasal Deformity.

Management of the unilateral cleft lip nasal deformity is complex because of the underlying significant asymmetry of the lower lateral cartilages and soft tissues of the nasal base. Suturing and grafting techniques may leave the patient with residual asymmetries of the nasal tip and nostrils. Some of this residual asymmetry may be attributable in part to the anchoring effect of the vestibular skin attachments to the lower lateral cartilages. This article discusses the use of lateral crural release, repositioning, and support with lateral crural strut grafts to manage the nasal tip. The technique involves freeing the vestibular skin from the undersurface of the lateral crura and domes and placement of lateral crural strut grafts with or without amputation of the ipsilateral dome and lateral crura to allow precise resuturing to the caudal septal extension graft. This technique is coupled with the use of a caudal septal extension graft to stabilize the nasal base and provide a strong foundation for the repair. Treatment of the nasal base may require skeletal augmentation to aid in creating symmetry of the alar insertions. Costal cartilage is needed in most cases to provide adequate structural support. Nuances in technique are discussed to help maximize outcomes.

500 Wound Coverage for Massive Burn Injuries ≥50% TBSA – A Systematic Review and Meta-Analysis

Abstract Introduction Early wound coverage remains one of the most essential variables influencing survival of extensively burned patients, especially with a total burned surface area (TBSA) of more than 50%. In patients with limited donor sites, techniques such as e.g. the Meek micrograft procedure or cultured epidermal allografts have proven to be viable methods. In this systematic review (SR) and meta-analysis (MA) we studied the outcomes of different techniques for wound coverage in patients with massive burn injuries ≥50% TBSA within the last 17 years. Methods According to PRISMA guideline the medical databases PubMed, Cochrane, Embase, Web of Science Medical records were screened in 5 languages from 01/2005 until 01/2022 by three reviewers, independently. Inclusion criteria were prospective or retrospective studies on patients with massive burns of ≥50% TBSA. Results After a two-stage review process, 33 studies were identified for the SR and MA. Regions of publication were Asia (n=15), North America (n=8), Europe (n=7), Australia (n=3). In total, 1678 patients with a mean age of 31.4 ± 14.2 years were included. The male to female ratio was 2.25 : 1. Mean TBSA was 66,5 ± 12.2%. Methods of wound coverage consisted of Meek micrografts, cultured epithelial autografts and/or allografts. The mean length of stay was 76.5 ± 32.4 days. Initial graft-take was 78,0 ± 15.8%. Grafting techniques did neither substantially differ in the length of stay nor the healing rate. Conclusions In patients with massive burn injuries of ≥50% TBSA the length of stay and the healing rates were comparable between Meek micrograft procedure, cultured epithelial allografts and combined techniques. Applicability of Research to Practice Wound coverage by Meek micrograft procedure with expansion of up to 1:10 and a potential combination with cultured epithelial allografts should be considered early in patients with massive burn injury.

A flap graft technique for the reconstruction of extensor mechanism of the knee in a case of peri-articular synovial sarcoma managed by limb salvage

Synovial sarcoma is a malignant soft tissue tumour arising from the primitive mesenchymal cells which has a delayed progression has a slow progression and often mis-diagnosed. A fifty-two years old female presented with complaint of swelling, pain and inability to move her left knee for three years duration. Presented with recurrence for which Wide excision of the tumour, with reconstruction of knee using custom mega-prosthesis and extensor mechanism reconstruction was done. Patient had a good functional outcome and no recurrence.

Development and Evaluation of a High-Fidelity Rhinoplasty Simulator.

Rhinoplasty is a challenging procedure with a steep learning curve. Surgical simulators provide a safe platform to gain hands-on experience without compromising patient outcomes. Therefore, rhinoplasty is an ideal procedure to benefit from an effective surgical simulator. A high-fidelity rhinoplasty simulator was developed using three-dimensional computer modeling, three-dimensional printing, and polymer techniques. The simulator was tested by six surgeons with experience in rhinoplasty to assess realism, anatomic accuracy, and value as a training tool. The surgeons performed common rhinoplasty techniques and were provided a Likert-type questionnaire assessing the anatomic features of the simulator. A variety of surgical techniques were performed successfully using the simulator, including open and closed approaches. Bony techniques performed included endonasal osteotomies and rasping. Submucous resection with harvest of septal cartilage, cephalic trim, and tip suturing, as well as grafting techniques including alar rim, columellar strut, spreader, and shield grafts, were performed successfully. Overall, there was agreement on the simulator's anatomic accuracy of bony and soft-tissue features. There was strong agreement on the simulator's overall realism and value as a training tool. The simulator provides a high-fidelity, comprehensive training platform to learn rhinoplasty techniques to augment real operating experience without compromising patient outcomes.

Pinocembrin alleviates pyroptosis and apoptosis through ROS elimination in random skin flaps via activation of SIRT3.

Random skin flap grafting is the most common skin grafting technique in reconstructive surgery. Despite progress in techniques, the incidence of distal flap necrosis still exceeds 3%, which limits its use in clinical practice. Current methods for treating distal flap necrosis are still lacking. Pinocembrin (Pino) can inhibit reactive oxygen species (ROS) and cell death in a variety of diseases, such as cardiovascular diseases, but the role of Pino in random flaps has not been explored. Therefore, we explore how Pino can enhance flap survival and its specific upstream mechanisms via macroscopic examination, Doppler, immunohistochemistry, and western blot. The results suggested that Pino can enhance the viability of random flaps by inhibiting ROS, pyroptosis and apoptosis. The above effects were reversed by co-administration of Pino with adeno-associated virus-silencing information regulator 2 homolog 3 (SIRT3) shRNA, proving the beneficial effect of Pino on the flaps relied on SIRT3. In addition, we also found that Pino up-regulates SIRT3 expression by activating the AMP-activated protein kinase (AMPK) pathway. This study proved that Pino can improve random flap viability by eliminating ROS, and ROS-induced cell death through the activation of SIRT3, which are triggered by the AMPK/PGC-1α signaling pathway.

Intermediate-term results of TachoSil grafting to correct residual curvature during inflatable penile prosthesis implantation in patients with Peyronie's disease.

Grafting techniques may be mandatory to improve residual penile curvature during inflatable penile prosthesis (IPP) implantation in Peyronie's disease patients. We aimed to report the intermediate-term outcomes of grafting with TachoSil (Corza Health, San Diego, USA) in patients with severe erectile dysfunction and concomitant complex Peyronie's disease through a prospective cohort study. We included 25 patients that underwent the PICS (penile implant in combination with Sealing) technique from 2017 to 2020 and were evaluated 24 months after surgery. Their mean age was 61.8 ± 8.7 years. Total straightness of the penis was achieved in 21 cases, while 4 (16%) patients presented a residual penile curvature of less than 15°. The mean penile length increased significantly (15 ± 1.2 to 16.4 ± 1.6 cm, p < 0.001). No intraoperative complications occurred, while, postoperatively, two patients developed fever and three scrotal hematoma, which resolved spontaneously. At three and six weeks, as well as at 24 months after surgery, no further complications occurred, and no cases of penile glans hyposensitivity were observed. At the 24-month follow-up evaluation, the 5-item score of the International Index of Erectile Function was 23.7 ± 1.4 (range: 20.5-25) and all patients responded positively to questions 2 and 3 of the sexual encounter profile questionnaire (p < 0.001 for all outcomes compared to baseline). Accordingly, the Erectile Dysfunction Inventory of Treatment Satisfaction score improved from 45.8 ± 6 at baseline to 25.6 ± 4.6 at 24 months, p < 0.001. Grafting with TachoSil to improve residual penile curvature during IPP is a safe and effective procedure. Nevertheless, careful patient selection and counseling, surgeon's experience with the technique, and strict postoperative penile rehabilitation are the main factors for treatment success and high satisfaction rates.

Retrospective analysis of ultrathin skin grafting over carbon dioxide ablated lesions supplemented with excimer lamp (308 nm) therapy in stable vitiligo.

Background Of all the tissue or cellular grafting techniques used in the treatment of vitiligo, melanocyte transplant/transfer through ultrathin skin grafting (UTSG) provides rapid onset of regimentation. The regimentation process is further accelerated with a combination of psoralen and ultraviolet A radiation, or psoralen and ultraviolet A obtained by sunlight or narrowband ultraviolet light B, or excimer laser/lamp (308 nm). Aims We assessed the efficacy of carbon dioxide laser ablation followed by melanocyte transplant/transfer through ultrathin skin graft sheet/sheets and further treated by excimer lamp therapy in patients with stable vitiligo. Methods One hundred ninety-two patients with stable vitiligo were treated with UTSG following carbon dioxide laser ablation and patients were then put on excimer lamp therapy. Primary efficacy was determined in terms of grades of regimentation and colour match at the end of 1-year. Results A total of 192 stable vitiligo patients with a mean age of 32.71 ± 8.55 years were recruited. Of the total 410 lesions, 394 showed excellent regimentation indicating a success rate of 96.1% at 1-year follow-up, whereas 16 (3.9%) lesions present on fingertips and toe tips showed poor or no regimentation at 3-month and 1-year follow-up. With regards to colour match, 394 (96.1%) lesions had achieved excellent colour match, and 16 lesions (3.9%) had poor or no colour match at 1-year follow-up. Limitations This was a single-center study with a small sample size. Conclusion The effectiveness of carbon dioxide laser ablation followed by melanocyte transfer/transplant through ultra-thin skin graft sheet/sheets when combined with excimer lamp therapy provides favourable cosmetic outcomes with rapid onset of regimentation in stable vitiligo.

Non-invasive monitoring of tomato graft dynamics using thermography and fluorescence quantum yields measurements.

Grafting involves a sequence of modifications that may vary according to genotypes, grafting techniques and growing conditions. This process is often monitored using destructive methods, precluding the possibility of monitoring the entire process in the same grafted plant. The aim of this study was to test the effectiveness of two non-invasive methods -thermographic inference of transpiration and determination of chlorophyll quantum yields- for monitoring graft dynamics in tomato (Solanum lycopersicum L.) autografts, and to compare the results with other reliable measures: mechanical resistance parameters and xylem water potential. The mechanical resistance of grafted plants steadily increased from 6 days after grafting (DAG), 4.90±0.57 N/mm, to reach values similar to non-grafted plants at 16 DAG, 8.40±1.78 N/mm. Water potential showed an early decrease (from -0.34±0.16 MPa in non-grafted plants to -0.88±0.07 MPa at 2 DAG), recovering at 4 DAG to reach pre-grafting values at 12-16 DAG. Thermographic inference of transpiration dynamics displayed comparable changes. Monitoring maximum and effective quantum yield in functional grafts showed a comparable pattern: an initial decline, followed by recovery from 6 DAG onwards. Correlation analyses revealed a significant correlation between variation in temperature (thermographic monitoring of transpiration), water potential (r = 0.87; p = 0.02) and maximum tensile force (r = 0.75; p = 0.05). Additionally, we found a significant correlation between maximum quantum yield and some mechanical parameters. In conclusion, thermography monitoring, and to a lesser extent maximum quantum yield measurements, accurately depict changes in key parameters in grafted plants and serve as potential timing indicators of graft regeneration, rendering them valuable tools for monitoring graft functionality.

Single Layered Free ILM Graft Technique in Large Macular Holes with Associated ERM

ABSTRACT Purpose We aimed to describe single layered free ILM graft technique (FIGT) and present results of this technique in the primary surgery of large macular holes (MHs). Methods In this retrospective study, we identified MHs with a minimum hole diameter >400 μm that underwent FIGT by a single surgeon. Nineteen eyes were found to have an associated epiretinal membrane (ERM) and four eyes demonstrated a patchy ILM staining intraoperatively. A single layered FIGT was performed first by peeling the ILM around the hole and then creating a free ILM flap and transplanting it to cover the hole. All cases were evaluated for anatomical closure and visual improvement. Results Twenty-three eyes of 22 patients (mean age 68.7 ± 7.4 years) were included in the study. The mean follow-up was 9.6 ± 4.9 months. Flap closure was observed in two eyes (8.6%) at week 1, while all eyes (100%) showed a complete closure at month 1. Mean preoperative visual acuity of 1.42 ± 0.66 LogMAR increased to 1.11 ± 0.51, 0.99 ± 0.34, 0.92 ± 0.38, 0.74 ± 0.37, 0.52 ± 0.28, 0.64 ± 0.39 respectively at week 1, month 1, month 3, month 6, year 1 and final follow-up postoperatively (p < .05 for all). In none of the eyes ERM recurred, nor flap contraction developed. Conclusion The study showed encouraging results using free ILM graft in the primary surgery of large MHs. This technique might be considered in large MHs that are associated with ERM or demonstrate patchy ILM staining. Further studies are needed to prove the effectiveness also in the long-term.

PC8. Prophylactic Axillary Lymphovenous Bypass Using the Branched Vein Graft Technique

PURPOSE: Prophylactic lymphovenous bypass reduces the risk of lymphedema after axillary lymph node dissection (ALND). Extensive axillary dissection often creates a large gap between disrupted lymphatic vessels and potential recipient veins. The wide distribution of lymphatics throughout the lateral axilla further compounds the difficulty of including all injured vessels for bypass. We describe the technical details and preliminary clinical outcomes of patients who underwent prophylactic lymphovenous bypass using a branched vein graft (BVG) from the superficial circumflex iliac vein (SCIV). METHODS: A retrospective review was performed, focusing on operative details and clinical results. Technique: A 8-10 cm BVG containing valves is harvested from the SCIV and coupled to an appropriate recipient vein. A 27-gauge cannula is used to intubate the BVG lumen at various branch openings as appropriate. This allows a 10-0 suture to be passed outward through the cannula. Lymphatic vessels are then captured and intussuscepted into the BVG with 4 - 6 mm of overlap, without any bunching or kinking. Upon completing the bypass, the intussuscepting suture is removed to avoid lymphatic obstruction. Valves in the graft prevent reflux. RESULTS: Seven patients were identified for inclusion. A median of 3 disrupted lymphatic vessels were encountered per case (range 1-5). Follow-up was 3 weeks to 6 months. Six patients demonstrated no clinical evidence of lymphedema. 1 patient had trace swelling localized to the thumb at 2 months. CONCLUSION: The branched vein graft technique effectively facilitates the immediate bypass of multiple injured lymphatics over a wide area after ALND.

Does autologous fat grafting serve the need for reconstructive surgery in oral cancer patients? A prospective evaluation in cosmetic surgery patients.

The prevalence of cancer is growing daily. Oral cancer, which is primarily triggered by tobacco use, can have detrimental effects on facial appearance. Despite significant advances in the molecular underpinnings of cancer, surgery, chemotherapy and radiotherapy have become standard cancer treatment methods. These treatments remove the tumor but can significantly alter patient's appearance, which can impact their physical and mental wellbeing. The soft tissue augmentation technique of autologous fat grafting (AFG), commonly referred to as lipofilling, is frequently used in cosmetic and reconstructive surgery to promote facial rejuvenation and body form remodeling. The advantages of AFG include its biocompatibility, low immunogenicity and allergenicity, as well as its capability to heal wounds. To explore the advantages of and patient satisfaction with the AFG technique as a potential facial restoration procedure in oral cancer patients. We examined the effects of facial AFG in cosmetic surgery patients and investigated the prevalence of postoperative problems. Patient satisfaction and potential complications after autologous fat filling in different areas of the facial space were investigated using clinical evaluations, patient-reported outcomes and photographic assessments. All of the patients were satisfied with the results in terms of improved facial shape, skin glossiness, skin elasticity, ptosis, and facial expressions. More than 80% of the patients and surgeons reported overall satisfaction. Based on these findings, we hypothesize that the AFG approach may be beneficial as a reconstructive therapy for patients with oral cancer following treatment. This technique will improve the patient's physical appearance, confidence and mental wellbeing.

Weighted Gene Co-Expression Network Analysis Reveals Key Pathways and Hub Genes Associated with Successful Grafting in Pecan (Carya illinoinensis)

Patch budding (bud grafting) is a commonly used method for pecan reproduction; however, the grafting survival rate varies with cultivars. Clarifying the underlying mechanisms of successful grafting is pivotal for graft technique improvement. Here, weighted gene co-expression network analysis (WGCNA) was conducted to dissect the key pathways and genes related to the successful grafting of pecan. Based on the transcriptome data of two contrasting cultivars (an easy-to-survive cultivar ‘Pawnee’ and a difficult-to-survive cultivar ‘Jinhua’) in response to budding, all the genes with variable transcripts were grouped into 18 modules. There were two modules that were significantly correlated with the trait of different cultivars. Enrichment analysis showed that several enriched gene ontology (GO) terms were related to oxidative detoxification and genes associated with hormone signaling pathway occupied a high ratio for the two modules. A total of 52 hub genes were identified, and 48 showed promoter polymorphisms between the two cultivars. Our study suggested that oxidative detoxification and hormone signaling were probably the key pathways for the successful grafting of pecan. The 48 hub genes identified here might be the key genes that led to the divergence of graft survival rates among different pecan cultivars. Our results will lay a foundation for future graft technique improvement in pecan.

Yield and yield components of superior cocoa (Theobroma cocoa L.) clones rejuvenated by ring budding technique

The ring budding technique gave a higher suitability for rejuvenation of cocoa plants compared to side cleft grafting it can be combined with the use of superior clones for optimal production. However, information related to this is still limited. The research aimed to determine the effects of ring budding technique on yield components and yields of three types of superior cocoa clones. The experiment was arranged in a Nested Design. The first factor is the type of vegetative propagation technique, consisting of side cleft grafting and ring budding. The second factor was clones, which consisted of clones KKM 22, RCC 70 and RCC 71. Clones were nested in vegetative propagation. The research was conducted from September 2020 to January 2021 at the Pagilaran Company. Observations were made on several yield component variables. The data were analyzed using Analysis of Variance (ANOVA) and continued with the Least Significant Difference Test (LSD) at the 5%. The results showed that the number of pods and the weight of beans per cocoa stand were significantly higher in the ring budding technique than the side cleft grafting. This condition caused the dry bean weight per hectare much higher as well. The three cacao clones, which were rejuvenated by ring budding, gave a good response and high yields. Meanwhile, only KKM 2 gave good response and high yield after treated with side cleft grafting technique, while RCC 70 and RCC 71 clones gave low yields. The KKM 22 clone is the best option in terms of rehabilitation with ring budding and side cleft grafting.

Results of arthroscopic cancellous bone grafting for treatment of scaphoid nonunion in comparison with open cancellous bone grafting.

This study primarily aimed to report the outcome of the arthroscopic cancellous bone grafting technique for treating scaphoid nonunion. The secondary aim was to compare the bone union rate and time, and the ability to correct the angulation of the scaphoid, between arthroscopically treated patients (n = 27), and patients treated with open cancellous bone grafting (n = 27). Nine surgeons (two in the arthroscopic and seven in the open group) with Level III experience operated on the patients. The pain score, grip strength and Quick Disability of the Arm, Shoulder and Hand score improved significantly after the arthroscopic treatment (p = 0.0001). Arthroscopic cancellous bone grafting achieved union in 25 out of 27 patients. A retrospective comparison with open cancellous bone grafting showed four nonunions. Arthroscopically treated patients healed 5.4 weeks faster compared with the open group (p = 0.033). Patients treated with open grafting had a higher risk of failure (odds ratio = 2.17), although this was not found significant (p = 0.39). The open method corrected the angulation deformity better (dorsal cortical angle correction of 4°) than the arthroscopic method (dorsal cortical angle correction of 1°), but this was not statistically significant neither within the groups (p = 0.55, p = 0.87) nor postoperatively between the groups (p = 0.98). The height-to-length ratio was not different before and after the surgery for the arthroscopic group (p = 0.44) and the open group (p = 0.27), or postoperatively between the groups (p = 0.44).Level of evidence: III.