Graft Thickness Research Articles

Comparison of Acetabular Labral Reconstruction With 7-mm Tibialis Anterior Allograft and 5-mm Iliotibial Band Autograft at Minimum 2-Year Follow-up

Background: Labral reconstruction has been described as a treatment option for irreparable labral tear. Labral graft size ranges from 5 to 7 mm2 for reconstruction. A thicker labral graft could support mechanical stability and protect cartilage better. No study has compared the effect of graft thickness on clinical outcomes. Purpose/Hypothesis: The purpose of this study was to compare patient-reported outcomes between hips reconstructed with an autologous iliotibial band (AUITB; 5 mm2) graft and with an allogenic tibialis anterior (ALTA; 7 mm2) tendon graft. Our hypothesis was that hips reconstructed with a thicker allograft (7 mm2) would have better clinical outcomes than those with a smaller autograft (5 mm2). Study Design: Cohort study; Level of evidence, 2. Methods: A total of 42 patients (aged 21 to 54 years) underwent arthroscopic hip segmental labral reconstruction during the study period of January 2016 to November 2018. Twenty patients had reconstruction with AUITB grafts (5 mm2) and 22 with ALTA grafts (7 mm2). Both groups had minimum 2 year follow-up. Patients were evaluated with patient-related outcome scores: modified Harris Hip Score, Nonarthritic Hip Score, and Hip Outcome Score–Sports Specific. Pain evaluation was performed using a visual analog scale. Results: There were significant differences in all studied variables when comparing pre- and postoperative scores. Yet, there were no differences in terms of patient-related outcome scores between the groups postoperatively. Postoperative visual analog scale scores averaged 2.1 for the AUITB group vs 1.9 for the ALTA group (P = .89); modified Harris Hip Score, 82.7 vs 83.3 (P = .77); Nonarthritic Hip Score, 81.1 vs 82.2 (P = .81); and Hip Outcome Score–Sports Specific, 81.6 vs 82.5 (P = .67). Conclusion: No differences were found in terms of clinical outcomes between the 7-mm2 ALTA graft and the 5-mm2 AUITB graft. Both graft types and thicknesses might be considered comparable choices for primary reconstruction. Although a thicker-graft labral reconstruction seemed to have more ability to cover joint surface, clinical results did not show any superiority of a thicker graft whether it is autologous or allogenic.

Femtosecond laser-assisted corneoscleral lamellar keratoplasty for peripheral corneal disease

Objective: To evaluate the effect of femtosecond laser-assisted corneoscleral lamellar keratoplasty (FL-CSLK) on peripheral corneal disease (PCD). Methods: Retrospective cohort study. Six patients (6 eyes) with PCD who underwent FL-CSLK in Qingdao Eye Hospital from March 2014 to March 2017 were grouped as the FL-CSLK group, including 4 males and 2 females, aged (46.7±17.9) years. In addition, 8 patients (8 eyes) with PCD who underwent traditional corneoscleral lamellar keratoplasty in the same period were included in the control group. The items for analyses were as follows: visual function recovery, including visual acuity, equivalent spherical power, and astigmatism; the state of the cornea, including the healing time of the corneal epithelium, the transparency of the graft, the thickness of the corneal graft and implant bed, and the loss rate of corneal endothelial cells; intraoperative and postoperative complications, including high intraocular pressure, interlayer effusion, delayed corneal epithelial healing, immune rejection, and primary recurrence. Paired t-test was used to compare the best corrected visual acuity (BCVA), equivalent spherical power, and astigmatism before and after operation. The BCVA and corneal graft epithelial healing time between the two groups were compared by independent sample t-test. Results: The 6 patients in the FL-CSLK group included 2 cases of Mooren ulcer, 3 cases of Terrien marginal degeneration, and 1 case of pellucid marginal degeneration. The control group consisted of 4 eyes with Mooren ulcer and 4 eyes with Terrien marginal degeneration. The BCVA (logarithm of the minimum angle of resolution) in the FL-CSLK group was 0.35±0.09 at 6 months after operation, which was significantly higher than that before operation (1.17±0.15; t=9.01, P<0.001) and at 6 months after operation in the control group (0.78±0.29; t=-3.96, P=0.003). The equivalent spherical power was (4.8±2.7) D, lower than that before operation (t=-3.71, P=0.014), and the astigmatism power was (10.1±4.1) D, lower than that before operation (t=6.04, P=0.002) in the FL-CSLK group. The healing time of the graft epithelium in the FL-CSLK group and control group was (8.5±3.3) days and (12.8±6.1) days, respectively, with no significant difference (t=-1.54, P=0.149). The central thickness of the graft in the FL-CSLK group was (525±47) μm at 6 months after operation, the central thickness of the implant bed was (189±119) μm, and the loss rate of the corneal endothelium was 7.5%±2.1%. In the control group, 1 case had intraoperative perforation, 2 cases had intracorneal hemorrhage, and 1 case had intracorneal epithelial implantation cysts and graft ulcer. There were no intraoperative and postoperative complications in the FL-CSLK group. Conclusions: FL-CSLK can yield good clinical results in the treatment of PCD. The smooth optical interface made by femtosecond lasers can help the patient achieve a good visual prognosis. The procedure reduces the risk of corneal perforation and thus improves the surgery safety.

Does arthroscopic superior capsule reconstruction using porcine dermal xenograft represent a viable option in case of massive irreparable posterosuperior rotator cuff tear?

The aim of the present study was to evaluate clinical and structural outcomes of patients with a massive irreparable rotator cuff tear treated with arthroscopic superior capsule reconstruction using an acellular porcine dermal xenograft. We hypothesized that this procedure would lead to improvement in clinical and functional results and that structural failure would not influence the final clinical results. A retrospective analysis on arthroscopic superior capsule reconstruction performed from October 2016 to January 2019 was conducted. The procedure was performed in patients with a massive irreparable posterosuperior rotator cuff tear without a severe glenohumeral arthropathy (Hamada I and II) and complaining a painful pseudoparalysis. Clinical evaluation and MRI study were performed before surgery and after at least 14months. A comprehensive group of 21 patients with 11 females and 10 males and a mean age of 57 ± 8.5years underwent arthroscopic superior capsule reconstruction. The graft had a thickness of 1.5mm in the first 9 cases (43%) since it was used in a single layer. The graft was thereafter doubled for technique evolution in the following 12 cases (57%) achieving a graft thickness of 3mm. Active ROM significantly improved with a mean increase of active forward flexion from 72.8° ± 7.5° to 120.6° ± 4.5°, active abduction from 68.3° ± 10.2° to 140.2° ± 8.8° and external rotation from 38.2° ± 11.2° to 56.7° ± 6.8° at the last follow-up. The mean Constant score significantly improved from 40.4 ± 6.7 to 73.3 ± 8.2. A graft tear revealed in 52% (11/21) of overall patients was significantly more frequent in single layer graft when compared to double layer (77% vs 33%, p < 0.05). Location and type of graft tear significantly influenced final outcomes. Patients with a healed (graft continuity with bone at medial and lateral insertion) or medial graft tear showed statistically significant better outcomes when compared with patients in which the graft was completely reabsorbed or torn on humeral side (p < 0.05). Arthroscopic superior capsule reconstruction using an acellular porcine dermal xenograft may be a viable alternative to treat massive posterosuperior rotator cuff tear in patients with a painful pseudoparalysis without anterosuperior escape. Structural failure may strongly influence final outcomes with significant role played by tear location.

Clinical Outcomes of Nanothin Descemet Stripping Automated Endothelial Keratoplasty in Korean Patients with Corneal Endothelial Dysfunction

PurposeTo evaluate the clinical outcomes of nanothin Descemet stripping automated endothelial keratoplasty (DSAEK) in Korean patients with corneal endothelial dysfunction.MethodsWe retrospectively reviewed medical records of the patients who underwent nanothin DSAEK (graft thickness ≤50 μm) due to corneal endothelial dysfunction and followed up more than 1 year. We evaluated best-corrected visual acuity (BCVA), central corneal thickness, and corneal endothelial cell density at preoperative and 1, 3, 6, and 12 months postoperatively.ResultsSixteen eyes of 16 patients with the mean follow-up period of 13.00 ± 0.96 months were included. The mean graft thickness after deswelling was 45.25 ± 4.59 μm (range, 38.0–50.0 μm). The mean logarithm of the minimum angle of resolution BCVA improved from 1.37 ± 0.53 preoperatively to 0.68 ± 0.46, 0.55 ± 0.35, 0.40 ± 0.25, and 0.39 ± 0.25 at 1, 3, 6, and 12 months postoperatively (p = 0.005, p < 0.001, p < 0.001, and p < 0.001), respectively. The mean central corneal thickness improved from 752.00 ± 129.11 to 555.75 ± 54.66 μm at 12 months postoperatively (p = 0.006). The mean graft endothelial cell density decreased from 2,859.62 ± 228.34 to 1,542.25 ± 627.34 cells/mm2 at 12 months postoperatively (p = 0.012). The postoperative complications included increased intraocular pressure (n = 3, 18.75%) and graft dislocation (n = 1, 6.25%), all of which were successfully managed by anterior chamber paracentesis or rebubbling. No other serious complications were encountered.ConclusionsNanothin DSAEK produced significant and stable visual improvements without severe postoperative complications in Korean patients with corneal endothelial dysfunction.

Evaluation of Using Dermis-Fat Graft in Oro-Nasal Fistula Repair

ABSTRACT Background One of the most devastating complication that follows cleft palate surgery is oro- nasal fistula. It can lead to many problems like fluid and food regurgitation, poor oral hygiene and retropharyngeal incompetence. The repair of palatal fistula had long presented a remarkable challenge to the plastic surgeon. Repair of these fistulae required the use of more than the usual two-layered closure procedures; demanding the introduction of a ‘Third layer’ of tissue to enhance smooth healing, and thereby reduce the chance of closure failure which predispose to fistulization. In this study we used an autogenous graft of ‘’ dermis and fat (dermis-fat) graft ‘’ to serve as the third protective, supportive and enhancive layer. Aim of the study: To evaluate the use of dermis-fat graft as autogenous tissue to achieve three layers closure of the palatal fistula. PATIENT AND METHOD The study included 22 patients ( 13 males, 9 females ), ranging in the ages between 2 to 40 years (13 males versus 9 females). The fistula size varies from 4 mm to 25 mm in diameter. Timing of fistula repair ranged between 6 months up to more than 4 years, Fistula assessment was done focusing on size, site, number and shape. Then assessment of surrounding tissue viability and pliability Results, operated upon, having 30 oro-nasal, We used minimal thickness of the graft ( 4-6 mm ) in 23 fistulae, and 7-8 mm thick graft in 7 ones. 24 cases was having full healing while in 2 fistulae partial wound dehiscence occurred. In another 2 fistulae there was obliteration of the buccal sulcus. While partial graft exposure in 2 other fistulae. We experienced no hematoma, or infection or airway obstruction. conclusion Using of interpositional dermis-fat graft had shown to have promising result in closure of oro-nasal fistula that followed cleft palate surgery. It provided durable, stable, and flexible coverage with minimal donor site morbidity. It can be used for fistula of less than 1.5 cm of various locations.

Comparison of the Coracoid, Distal Clavicle, and Scapular Spine for Autograft Augmentation of Glenoid Bone Loss: A Radiologic and Cadaveric Assessment

Background: Glenohumeral instability caused by bone loss requires adequate bony restoration for successful surgical stabilization. Coracoid transfer has been the gold standard bone graft; however, it has high complication rates. Alternative autologous free bone grafts, which include the distal clavicle and scapular spine, have been suggested. Study Design: Controlled laboratory study. Purpose: The purpose of this study was to determine the percentage of glenoid bone loss (GBL) restored via coracoid, distal clavicle, and scapular spine bone grafts using a patient cohort and a cadaveric evaluation. Methods: Autologous bone graft dimensions from a traditional Latarjet, congruent arc Latarjet, distal clavicle, and scapular spine were measured in a 2-part study using 52 computed tomography (CT) scans and 10 unmatched cadaveric specimens. The amount of GBL restored using each graft was calculated by comparing the graft thickness with the glenoid diameter. Results: Using CT measurements, we found the mean percentage of glenoid restoration for each graft was 49.5% ± 6.7% (traditional Latarjet), 45.1% ± 4.9% (congruent arc Latarjet), 42.2% ± 7.7% (distal clavicle), and 26.2% ± 8.1% (scapular spine). Using cadaveric measurements, we found the mean percentage of glenoid restoration for each graft was 40.2% ± 5.0% (traditional Latarjet), 53.4% ± 4.7% (congruent arc Latarjet), 45.6% ± 8.4% (distal clavicle), and 28.2% ± 7.7% (scapular spine). With 10% GBL, 100% of the coracoid and distal clavicle grafts, as well as 88% of scapular spine grafts, could restore the defect (P < .001). With 20% GBL, 100% of the coracoid and distal clavicle grafts but only 66% of scapular spine grafts could restore the defect (P < .001). With 30% GBL, 100% of coracoid grafts, 98% of distal clavicle grafts, and 28% of scapular spine grafts could restore the defect (P < .001). With 40% GBL, a significant difference was identified (P = .001), as most coracoid grafts still provided adequate restoration (congruent arc Latarjet, 82.7%; traditional Latarjet, 76.9%), but distal clavicle grafts were markedly reduced, with only 51.9% of grafts maintaining sufficient dimensions. Conclusions: The coracoid and distal clavicle grafts reliably restored up to 30% GBL in nearly all patients. The coracoid was the only graft that could reliably restore up to 40% GBL. Clinical Relevance: With “subcritical” GBL (>13.5%), all autologous bone grafts can be used to adequately restore the bony defect. However, with “critical” GBL (≥20%), only the coracoid and distal clavicle can reliably restore the bony defect.

Fabrication and characterization of photopatterned 3D cell-laden grafts

Three-dimensional (3D) cell-laden grafts are useful tools as models for drug screening and mechanistic study in developmental biology. Such grafts are typically fabricated on a flat substrate, released to be freestanding, and incubated in a cell-culture media. In this study, we examined the effect of cell culture conditions on the thickness of cell-laden grafts. We found that floating culture increased the thickness of the grafts, which was attributed to the relief of restraining forces from the substrate that resulted in the growth of the graft. Due to the limited sample size and large variation in the thickness of individual grafts, however, further investigation is required to conclude the reason for the change in the thickness. This research potentially leads to a simple approach for the fabrication of 3D cell-laden grafts with larger thickness than traditional pseudo-two-dimensional (2D) grafts created by bioprinting.

Endoscopic ultrasound in the monitoring of the intestinal allograft

ObjectiveChronic rejection (CR) of the small intestinal allograft includes mucosal fibrosis, bowel thickening and arteriopathy in the outer wall layers and the mesentery. CR lacks non-invasive markers and reliable diagnostic...

Minimally Invasive Successful Reconstruction of a Severely Traumatized Upper Extremity Using Platelet-Rich Plasma and Tissue Scaffold: A Case Report

Minimally invasive reconstruction combines principles of tissue engineering and regenerative medicine for healing complex wounds. This approach was successfully demonstrated on a 64-year-old diabetic and hypertensive male patient, who was brought unconscious to our emergency after surviving an automobile collision with severe brain and right-dominant upper extremity injuries. Uncontrolled hyperglycemia, severe anemia, diffuse axonal brain injury, wrist drop, and loss of thumb extension and abduction were noted. Extensive degloving, skin necrosis, extensor and flexor forearm muscle crush injuries, and ruptured extensor tendons were observed. Serial wound debridement combined with platelet-poor plasma injection into the muscles, platelet-rich plasma injections into the tendons and subcutis, and low-negative pressure wound therapy were performed sequentially to salvage the injured soft-tissues. Improvements were noticed during the second exploration after 5 days. Surviving muscles showed adequate vascularization and revival of innervation during the third exploration after another 5 days. Thereafter, absorbable synthetic tissue scaffold was applied over a sizeable 270 cm 2 wound as a flap-alternative. Tissues regenerated well within the scaffold during the next 2 months, halving the wound area to 132 cm 2 . A thick split-skin graft was applied over the remaining granulating neodermis, which “took” completely. Six months postoperatively, the patient regained most hand functions and performed all activities satisfactorily, while the grafted area appeared almost identical to surroundings. Minimally invasive reconstruction thus produced satisfying results with fewer shorter simpler surgeries, minimal anesthesia, short-duration hospitalization, lower health care costs, lesser risks, and excellent patient-reported outcomes.

Assessment of functional outcome of arthroscopic assisted anterior cruciate ligament reconstruction using quadrupled hamstring auto-graft: Case series

Background: We assessed the functional outcome of the patient following ACL reconstruction using quadrupled hamstring autograft.Methods: In this case series of 21 patients who had ACL insufficiency underwent arthroscopic assisted ACL reconstruction using quadrupled hamstring autograft from November 2019 to March 2021. The functional outcome of patients was assessed with Lyscholm Knee Scoring System and IKDC score.Results: The injury was predominant in males. A larger percentage of cases was operated less than 6 months from the date of injury. The mean graft diameter was 7.90 mm, with a positive correlation to the function of the knee. The preoperative mean Lysholm score of 59.19 improved to 94.95 after surgery. The mean preoperative IKDC score improved from 46.81 to 81.95. Excellent outcome was seen in a majority of patients. Two patients had an infection and one patient had reduced range of motion. The timing of surgery and rehabilitation influence the outcome largelyConclusion: ACL reconstruction surgery with quadrupled hamstring graft provides an excellent outcome in ACL injuries when the surgery is timed well, with sufficient graft thickness and good rehabilitation.

Anterior segment optical coherence tomography findings after penetrating keratoplasty

AbstractPurposeThis study aimed to assess the contribution of early anterior segment optical coherence tomography (AS‐OCT) after penetrating keratoplasty (PK) by analyzing the appositions of posterior graft‐host junction (GHJ), the tomographic aspect of the graft and the iridocorneal angle (ICA).MethodsA prospective cross‐sectional study including 33 eyes of 32 patients treated with penetrating keratoplasty for various preoperative diagnosis (hydrops, keratoconus, bullous keratopathy, infectious keratitis, ocular trauma, corneal perforation, corneal dystrophy and graft failure). All patients underwent complete ophthalmic examination. Early AS‐OCT (Day 1‐10 postoperative) was done to assess the posterior GHJ, the central corneal thickness, the posterior graft corrugations and the ICA. GHJ patterns were classified as well‐apposed, and mal‐apposed (gap, step, and protrusion). Tomographic features were correlated to best‐corrected visual acuity, and postoperative complications.ResultsThe mean early postoperative central corneal thickness was 643.63 μm. Posterior corrugations were found in 47% of cases, in patients with graft thickness higher than 590 μm. ICA was open except in 4 eyes, among them, two eyes presented anterior synechia, and developed ocular hypertension and graft rejection. A total of 132 graft‐ host cross‐sections were analyzed. 67% were well‐apposed and 33% were mal‐apposed. Steps have been noted in 8 eyes, followed by Gapes in 3 eyes, and Protrusion in 2 cases. Graft‐steps were present in 4 GHJ and all of these patients had keratoconus as a preoperative diagnosis. Among them, one eye underwent surgical revision for persistent graft edema. Host‐steps were detected in 4 mal‐apposed junctions. Best‐corrected visual acuity showed significant difference with the gap and step patterns of malapposition junctions.ConclusionsAS‐OCT is a non‐invasive imaging tool offering high‐resolution corneal imaging. It visualizes the posterior GHJ and ICA beyond a non‐transparent cornea. It is useful for evaluating and monitoring the PK outcomes allowing early detection and management of postoperative complications.

Efficacy in Integration of Partial Thickness Grafts between Adjuvants and Free Evolution

Introduction: Partial-thickness grafts tend to have an integration after 5 days according to their healing, in various studies, different ways of promoting 100% integration have been shown, with different ways of achieving it, in terms of surgical technique, dressings, negative pressure therapies, and adjunctive topical medications.

A simple technique for definite closure of full thickness abdominal wall defect in open abdomen after temporary applied split thickness graft

Open abdomen (OA) has gained a wide acceptance in the management of abdominal surgical catastrophes. Definite reconstruction of OA is an operative challenge as various methods are used. Dynamic techniques are preferred for the closure of OA. If other methods fail to close the OA, then temporary split thickness skin graft can be applied and refer the definite closure for later. We used a modification of an existing technique, in a 47-year-old female patient with a big midline incisional hernia due to temporary closure of OA with partial-thickness skin graft, who was operated for permanent closure of the defect. In order to avoid complications from extensive dissection, we invaginated the grafted area and realigned the recti muscles with on lay mesh reinforcement with excellent outcome. This technique of inverting the previous grafted area when it can be applied is an easy and safe method with rewarding results.

Full-Thickness Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction

Background: Quadriceps tendon autograft is used increasingly worldwide for primary anterior cruciate ligament (ACL) reconstruction, but remains at the third place after patellar tendon and hamstring grafts. It has shown very good results in biomechanical and clinical studies, but most of the authors describe a partial thickness tendon graft. Indications: This presentation describes the technique for a full-thickness quadriceps tendon autograft with an original technique of fixation on the femur and provides tips and tricks to avoid pitfalls. Technique Description: Arthroscopic preparation of the tunnel is performed before graft harvesting, to obtain the exact length of the graft needed. The femoral tunnel is drilled through the anteromedial portal, 30 to 40 mm long. For the tibial tunnel, a classic drill guide system is used, set at an inclination of 40°. The total length from the tibia to the femur is measured, which allows to position the femoral fixation on the cortex without pulling it into the soft tissue. Harvesting of the graft is done using a double-bladed scalpel, using the entire thickness of the quadriceps tendon. The bone block is detached with an oscillating saw and osteotome, and the defect in the quadriceps tendon closed in 2 layers. The graft is calibrated according to the tunnel preparation and sutured on the bony end with non-absorbable sutures tied to an endobutton. Tibial fixation is achieved by tying 2 non-absorbable sutures over a cortical screw in maximum tension with a sliding type knot, to automatically adjust the tension. Final fixation is performed with a titanium interference screw. Results: In the senior author series over the last 20 years, there was only 1 intraoperative patella fracture, treated with osteosynthesis. In accordance with the literature, full-thickness quadriceps tendon graft is strong and allows back to play at the same level as before the injury, in most cases, with lower donor site morbidity than patellar tendon and hamstrings grafts, without a difference in muscle strength compared with partial thickness grafts. Discussion/Conclusion: ACL reconstruction with full-thickness quadriceps tendon has shown very good clinical outcomes, with very few complications. It can be recommended for primary and revision ACL reconstruction.

Superior Capsular Reconstruction: Proposed Biomechanical Advantages

AbstractThe intact rotator cuff provides dynamic stability for the glenohumeral joint through range of motion by compressing the humeral head to the center of the glenoid. Maintenance of articular congruity provides a stable fulcrum for the more forceful muscles of the shoulder girdle. Massive rotator cuff tears disrupt the concavity-compression mechanism and lead to unopposed superior pull of the deltoid. As a result, superior migration of the humerus, abutment of the acromion, and, in some cases, progression to cuff tear arthropathy occur. Arthroscopic superior capsular reconstruction has emerged as an effective treatment in select indications. Several potential biomechanical advantages to SCR have been described on the basis of cadaver studies. By tethering the greater tuberosity to the glenoid, superior migration is resisted, and the center of rotation is stabilized. The interpositional spacer effect describes reduced subacromial contact pressure, and the reduction is greater with thicker grafts. Side-to-side suturing of the graft to residual tendon and capsule achieves capsular continuity and may further improve the stabilizing function of the residual capsule and prevent medial-lateral elongation of the graft. Although these biomechanical principles overlap to some degree, their summation offers an explanation for the improved pain and function seen in patients who undergo superior capsular reconstruction.

Ridge Volume Stability of Maxillary Anterior Implants Placed with Simultaneous Lateral Guided Bone Regeneration during Healing: a Radiographic Analysis.

To assess bone volume stability and identify critical bone graft thickness for guided bone regeneration (GBR) simultaneous to implant placement in the maxillary anterior region. Eighteen patients were included in the study and received placement of one maxillary anterior implant combined with GBR using deproteinised bovine bone mineral (DBBM) and resorbable collagen membrane. The multilevel buccal bone thickness (BT) was measured by CBCT 1 to 2 weeks and 5 to 8 months post-implantation (at implant uncovering surgery). Significant buccal alveolar crest collapse (ACCb 1.20 to 1.70 mm) occurred during the mean healing period of 5.3 months (P = 0.000). A greater percentage of ACCb occurred at the coronal aspect of the implant, with 59.24% ± 19.22% at the implant platform and 34.10% ± 30.50% 6.0 mm below the implant platform, respectively. Linear regression analysis demonstrated that if BT was 1.8 to 2.0 mm at the implant platform at uncovering surgery, then it was estimated to have been 4.1 to 4.5 mm immediately post-implantation. ACCb after maxillary anterior implant placement with simultaneous GBR occurred more coronally than apically. Excessive alveolar ridge augmentation, up to 4.0 mm of hard tissue buccal to the implant platform, should be achieved at the time of surgery to compensate for this potential resorption.

Shoulder Superior Capsular Reconstruction Hybrid Graft Thickness Greater Than Preoperative Acromiohumeral Distance Increases Graft Retear Rate and Subacromial Erosion

To evaluate the impact of graft thickness on clinical outcomes and graft retear after superior capsular reconstruction (SCR) using a hybrid graft combining both fascia lata autograft and dermal allograft in patients with massive rotator cuff tear (MRCT). Between January 2017 and February 2019, this study enrolled 58 patients with MRCT who underwent SCR using a hybrid graft combining both fascia lata autograft and dermal allograft. We evaluated clinical outcomes and compared differences between the graft intact and the graft retear group. Moreover, subgroup analysis was performed for patients having a preoperative acromiohumeral distance (AHD) less than or equal to the used graft thickness (group 1) and the results were compared with those for preoperative AHD greater than the used graft thickness (group 2). Fifty-five patients who underwent MRCT with a mean age of 65.1 ± 5.7 years old were followed up during a mean period of 30.5 ± 6.5 (range, 24-37) months. There were significant differences in clinical outcome measures preoperatively and postoperatively (P < .05). There were no significant differences in clinical outcomes between the graft intact and graft retear groups (P > .05). The subgroup analysis revealed that the retear (68.6% vs 30.4%, P= .004) and subacromial erosion rates (91.4% vs 60.9%, P= .005) were significantly greater in for patients having a preoperative AHD less than or equal to the used graft thickness (group 1). SCR using a hybrid graft combining both fascia lata autograft and dermal allograft is promising with improved clinical scores (P < .05) irrespective of the graft integrity. The use of a graft with a thickness greater than a patient's preoperative AHD could increase graft retear and subacromial erosion rates after SCR. However, there was no significant difference in clinicaloutcomes according to the relationship between used graft thickness and preoperative AHD. Level IV, therapeutic case series.

One-step zwitterionization and quaternization of thick PDMAEMA layer grafted through subsurface-initiated ATRP for robust antibiofouling and antibacterial coating on PDMS

In this work, we demonstrate the grafting of thick poly((2-dimethylamino) ethyl methacrylate) (PDMAEMA) layer on PDMS via subsurface-initiated atom transfer radical polymerization (SSI-ATRP). The self-migration of DMAEMA monomers into the subsurface of PDMS is proven to be the dominant factor for the success of SSI-ATRP. The as-prepared thick microscale graft layer on PDMS shows much better abrasion resistance than nanoscale graft layer obtained by conventional surface-initiated atom transfer radical polymerization (SI-ATRP) under identical condition. Taking advantage of the tertiary amines of PDMAEMA, the simultaneous zwitterionization and quaternization of the PDMAEMA thick layer is realized through a facile one-step process. The effect of zwitterionization and quaternization degree on the antibiofouling and antibacterial properties is investigated. The results show that a relatively high zwitterionization degree (75 mol%) and a low quaternization degree (25 mol%) exhibit a good well-balanced effect on both fouling repellence and bactericidal activity. This work may lead to the development of robust bifunctional antibiofouling and antibacterial surfaces via SSI-ATRP strategy.

I-PDEK: Microscope-integrated OCT-assisted pre-Descemet endothelial keratoplasty.

Four patients with pseudophakic corneal edema were subjected to pre-Descemet endothelial keratoplasty (PDEK) under the direct guidance of microscope-integrated optical coherence tomography (i-OCT). i-OCT facilitated successful type 1 big bubble formation during donor preparation, debridement of the hypertrophic epithelium, planning and placement of surgical wounds, descemetorrhexis with removal of remnant Descemet membrane tags, and identification of correct donor orientation and interface details. It was also possible to discern the stability of intraocular lens, flat iris configuration, adequate stromal hydration, and wound apposition on i-OCT. Preoperative visual acuity was counting fingers (50%), 0.78 logMAR (25%), and 1.48 logMAR (25%), whereas postoperative visual acuity was 0.6 logMAR (50%) and 0.3 logMAR (50%). At 6-months of follow-up, all grafts were clear and well attached, the mean central corneal thickness, graft size, graft thickness, and endothelial cell loss were 557.25 ± 13.45 μm, 7.75 ± 0.20 mm, 25.5 ± 2.64 μm, and 21.6 ± 0.02%, respectively. To conclude, i-OCT helped during various surgical steps of PDEK.

P092 EVOLUTIVE MANAGEMENT OF THE OPEN ABDOMEN WITH POSTERIOR SEPARATION TECHNIQUE FOR DEFINITIVE RECONSTRUCTION

Abstract Aim Traumatic evisceration in politrauma patients is rare, with a prevalence of 1 in 40,000 trauma patients. The main mechanism is high-energy trauma to an acute surface. Our objective is to apply theoretical knowledge regarding the complex abdominal wall as an independent entity, analyzing the particular case of a patient operated in our center. Material and Methods Description of a clinical case using data extracted from the electronic medical record and bibliographic search in Pubmed. Results The reviewed literature was applied to a traumatic evisceration case with a Grade IV on the Dennis Abdominal Trauma Scale. The decisions made during the different stages in the multidisciplinary management of the traumatic evisceration were discussed. The role of Negative Pressure Therapy, the use of biological meshes, full thickness grafts and / or the Posterior Separation of Components were used to achieve a continent and functional abdomen after an injury of that magnitude during a 4-year follow-up with excellent results. Conclusions At the moment there is no consensus on the management of these traumatic evisceration situations. It depends in many cases on the experience of the surgeon. These cases should be treated individually based on the size and location of the lesions. The approach must be carried out in different stages, always thinking about achieving an early closure of the abdomen and preserving the anatomy of the abdominal wall. The best strategy for open abdomen reconstruction is not well defined, but we believe that Posterior Component Separation is a good option.