Tissue Autograft Research Articles

The microfracture technique to treat full thickness articular cartilage defects of the knee

Full thickness defects of the articular cartilage rarely heal spontaneously. While some patients do not develop clinically significant problems from chondral defects, most eventually develop degenerative changes associated with the cartilage damage over time. Techniques to treat chondral defects include abrasion, drilling, tissue autografts, allografts, and cell transplantation. The senior author has developed a procedure referred to as the “microfracture”. This technique enhances chondral resurfacing by providing a suitable environment for tissue regeneration and by taking advantage of the body's own healing potential. This technique has now been used in more than 1400 patients. Specially designed awls are used to make multiple perforations, or “microfractures”, into the subchondral bone plate. The perforations are made as close together as necessary, but not so close that one breaks into another. Consequently, the microfracture holes are approximately three to four millimeters apart (or 3 to 4 holes per square centimeter). Importantly, the integrity of the subchondral bone plate is maintained. The released marrow elements form a “super clot” which provides an enriched environment for tissue regeneration. Follow up with long term results of more than 8 years have been positive and very encouraging.

Pretibial cyst formation after anterior cruciate ligament surgery with soft tissue autografts

Four cases of subcutaneous pretibial ganglion, with direct communication to the tibial tunnel after autologous reconstruction of the anterior cruciate ligament (ACL) with hamstrings or iliotibial band, are reported. Tibial graft fixation was with a staple in three cases, and with a screw and soft tissue washer in one. The average time to ganglion development was 44 months, and all occurred more than 2 years after ACL surgery. At the time of cyst development, no patient had subjective or objective knee instability. No patient had evidence of tibial tunnel enlargement. All ganglion communicated with the tibial tunnel. This communication was shown with magnetic resonance imaging in two cases, which showed the origin at the joint. Three patients elected to have the ganglion removed; in each of these there was a direct communication with the tibial tunnel. Additionally, hardware was removed in all cases, and local autologous bone grafting of the tibial tunnel aperture was done in two. Minimum follow-up after surgical excision was 2 years, without evidence of recurrence. Arthroscopy 1998 Mar;14(2):215-20

Septal perforation repair with acellular human dermal allograft.

Connective tissue autografts are commonly used as interpositional grafts between septal flaps in the repair of septal perforations. The most common graft materials used include temporalis fascia and pericranium, both of which are accompanied by donor site morbidity, do not provide septal bulk, and are exceedingly thin and difficult to manage. To study the use of an acellular human dermal allograft (AlloDerm, LifeCell Corp, The Woodlands, Tex) as a connective tissue interpositional graft in septal perforation repair. Private facial plastic surgery and reconstructive practice of 1 of the authors (R.W.H.K.), Houston, Tex, and the private and university practice of another author (H.F.), Alexandria, Egypt. Twelve consecutive patients with septal perforation who received the acellular dermal allograft constituted this evaluation. The causes of the septal perforations were previous nasal surgery, previous nasal cautery, or cocaine use by the patient. Interposition grafting between mucoperichondrial flaps for septal perforation repair was accomplished with decellularized human dermal grafts. Follow-up periods ranged from 3 to 14 months. The repair was considered successful when, on postoperative examination at 3 months, the right and left mucoperichondrial flaps were entirely healed. From the experience of 1 author (R.W.H.K.) with the repair of more than 75 septal perforations, no perforation that was healed at 3 months broke down at a later date, unless trauma or cocaine use occurred after the operation. An outcome was considered acceptable but nondesirable if a perforation was still present after the operation but the number and severity of the patient's symptoms were reduced and the perforation was considerably smaller than before the operation. Eleven of the 12 patients had successful outcomes with complete closure of their perforations. The 1 remaining patient had an acceptable result but incomplete closure; his initial perforation of 3 cm was reduced to 5 mm, making him asymptomatic after surgery. Acellular human dermal grafts can be used as connective tissue interpositional grafts in the repair of septal perforations with success rates similar to the use of temporalis fascia, mastoid periosteum, or pericranium. One distinct advantage is the absence of donor-site morbidity. In addition, this graft material is thicker and easier to place and suture and may give more substance to the repaired septum.

Microfracture technique forfull-thickness chondral defects: Technique and clinical results

Articular cartilage defects rarely heal spontaneously. The changes are progressive and they become irreversible if no intervention is applied. Many techniques have been used in the past to include abrasion, drilling, tissue autografts, allografts, and cell transplantation. Physicians have taken a greater interest in treating chondral defects recently in part because of our better understanding of cartilage biology and pathology, and because of advances in imaging and arthroscopy. The senior author has developed a procedure referred to as the “microfracture” technique to enhance chondral resurfacing by providing a suitable environment for tissue regeneration. This technique has now been used in more than 1,200 patients. An arthroscopic awl is used to make multiple holes, or “microfractures,” in the subchondral bone plate of full-thickness chondral defects. The holes are made as close together as necessary, but not so close that one breaks into another, thus damaging the subchondral plate between them. This technique usually results in microfracture holes that are approximately 3 to 4 millimeters apart (or 3 to 4 holes per square centimeter). The arthroscopic awls produce much less thermal necrosis of the bone than would a hand-driven or motorized drill. The released marrow elements form a “super clot” which provides an enriched environment for tissue regeneration. Long-term results, with follow-up covering more than 8 years, have been and continue to be very positive.

Nasal Septal Perforation Repair: 25-Year Experience with the Flap and Graft Technique

A predictably successful technique for surgical closure of nasal septal perforation has been employed in over 100 patients in the past 25 years. It employs bipedicled mucosal advancement flaps designed to maximize blood supply (for flap viability) and an underlying connective tissue autograft (fascia or pericranium) for structural reinforcement.

Collagen alterations in adipose autografts

The author describes the collagen alterations in adipose tissue autografts as evaluated by the Picrosirius red stain used with polarized light microscopy. Four female patients--candidates for classical abdomino-plasty--previously had adipose tissue autografts at the infraumbilical region. The grafting intervals were 60, 30, 21, 15, 12, 8, and 5 days prior to the abdominoplasty. The findings demonstrate a type I collagen capsule circumscribing the graft, besides several alterations in the synthesis, degradation, and remodeling of type I and type III collagen within the transplanted tissue. These alterations evolved in bands from the periphery to the central region of the graft disclosing a clear sequence of events. The completion of this process, from the collagen synthesis to its degradation, depends on the total volume injected at a single point and may take a few months to one year or more.

Thick Free Gingival and Connective Tissue Autografts for Root Coverage

Studies have shown partial to complete root coverage of denuded root surfaces with the use of thick free gingival autografts (FGGs) or subepithelial connective tissue autografts (CTGs). The purpose of this study was to determine which technique would result in more predictable root coverage of Miller Class I and II marginal tissue recession defects. Paired defects in 10 patients were randomly selected for treatment with either the FGG or the CTG. With stents as reference points, soft tissue recession was measured with a calibrated probe presurgically and 3 and 6 months postsurgically. No significant differences between paired sites in presurgical defect dimensions were found. One patient was dropped from the study for noncompliance with postoperative instructions. The mean percentage of root coverage for the CTG 3 and 6 months postsurgery for the remaining 9 patients was 78% and 80%, respectively. The mean percentage of root coverage for the FGG was 43% at both periods. The difference in root coverage between the 2 techniques was significant (P < 0.03). Complete root coverage was gained in 5 of 9 CTGs but only in one of 9 FGGs. Both techniques resulted in a significant improvement in keratinized tissue and probing attachment level, with most of the changes having occurred during the first three months postoperatively. Results suggest that the CTG may provide a greater percentage of root coverage than the FGG and that both techniques will effectively increase the width of keratinized tissue.

Current concepts in pediatric burn care: surgery of severe burns.

Optimal surgical therapy of severe burns in children has been controversial for a long time. A review of the current literature shows that prompt surgical excision of necrotic tissue and immediate autografting have become the standard in most burn centers. The authors present a concept based on prompt excision of third degree burns and discuss the problems of intermediate cover arising in massive burns.

Nasal septal perforations

A predictably successful technique for surgical closure of nasal septal perforation is described. It employs bipedicled mucosal advancement flaps designed to maximize blood supply (for flap viability) and an underlying connective tissue autograft (fascia or pericranium) for structural reinforcement.

Coverage of the Denuded Root Surface Using the Free Soft Tissue Autograft

This paper presents a new soft tissue graft technique that allows the surgeon not only to increase the zone of attached gingiva, but also to cover previously denuded root surfaces. Predictability of the procedure is discussed and the results are related to the health of the periodontium and to the patient's self-image.

Apparently increased plasma parathyrin values after total parathyroidectomy and parathyroid tissue autograft

Apparently increased plasma parathyrin values after total parathyroidectomy and parathyroid tissue autograft

Transplantation of the rabbit medial collateral ligament. I. Biomechanical evaluation of fresh autografts

This investigation was designed to study the biomechanical recovery of a free bone-ligament-bone graft that was returned to its normal extra-articular position, with as little disturbance to its mechanical and biological environments as possible. Twenty-five adult New Zealand white rabbits had their right bone-medial collateral ligament (MCL)-bone complex removed completely and replaced immediately using internal fixation. Animals were allowed unrestricted cage activity before sacrifice in groups of five at intervals of 3, 6, 12, 24, and 48 weeks posttransplantation. Contralateral legs served as internal controls and a separate series of normal animals served as external controls. All MCLs were tested biomechanically using a detailed testing protocol. Results showed early deterioration of 20-35% in autograft complex structural behavior, with weakening of both ligament substance and insertions. Viscoelastic behavior of these ligaments was also affected, showing increases in the amount of both cyclic load-relaxation and static load-relaxation at early healing intervals. These properties were statistically indistinguishable, however, from controls at 48 weeks. Failure behavior of autografts was even better preserved, reaching a low of 65% of control values at 24 weeks and recovering to within 10% of controls at 48 weeks. These results, plus the major changes in failure modes that occurred over that duration, suggest that autograft incorporation is a slow but dynamic process. These results further suggest that at least some connective tissue autografts, when placed under, as yet undefined, "proper biological and mechanical conditions," can retain and recover a number of biomechanical properties over a period of 1 year. The longer-term fate of these autografts and the exact nature of their similarities or differences from other graft alternatives (e.g., tendon for ligament), however, is unknown.

Root coverage with the free gingival graft. Factors associated with incomplete coverage.

The free soft tissue autograft when used for increasing the amount of attached gingiva is a relatively simple surgical procedure. The use of the free soft tissue autograft for root coverage, however, is a much more technically demanding procedure requiring the periodontist to consider additional factors. Overlooking or failing to properly address a single one of these factors can result in incomplete coverage. The purpose of this paper is to outline those factors that must be considered when complete root coverage is attempted.

Etiology of infertility in monkeys with endometriosis: Measurement of peritoneal fluid prostaglandins

To study the relationship between peritoneal fluid prostaglandins and infertility associated with endometriosis, we autografted endometrial or adipose tissue to the pelvic peritoneum in 21 monkeys. Peritoneal washings were collected prior to tissue transplantation and during a subsequent laparotomy performed for biopsy of the implants. Monkeys were mated and peritoneal washings were collected during three subsequent cycles. The content of prostaglandin F2 alpha (PGF2 alpha) in adipose tissue autografts was significantly less (p less than 0.05) than in endometrial tissue autografts. The PGF2 alpha concentration in peritoneal fluid increased significantly (p less than 0.05) only in monkeys that developed moderate or severe endometriosis. Prostaglandin E levels in tissue autografts or peritoneal fluid were similar in all animals. Infertility in monkeys with endometriosis was associated with luteinized unruptured follicles, luteal phase defects, and pelvic adhesions. Although PGF2 alpha concentrations in peritoneal washings obtained during these cycles were increased in comparison with those of ovulatory cycles, the difference was not significant. A relationship between spontaneous abortion and prostaglandin concentrations in peritoneal fluid was not established.

Adrènal medulla grafts survice and exhibit catecholamine-specific fluorescence in the primate brain

Parkinson's disease most consistently involves pathologic changes in the substantia nigra, which is the major source of dopamine to the striatum. It has been shown that either fetal substantia nigra or adrenal medulla tissue implanted into the rat brain survives, produces dopamine, and improves behavioral abnormalities induced by deprivation of the caudate nucleus of its dopaminergic innervation. Thus, catecholaminecontaining grafts could be potential replacements for destroyed or damaged dopaminergic neurons in patients with Parkinson's disease. To explore the potential of this therapeutic approach, fetal substantia nigra or host adrenal medulla were grafted to the denervated caudate nucleus of the rhesus monkey. Under the specific conditions of our experiment, fetal substantia nigra did not survive in either of two animals tested. On the other hand, some tissue from adrenal medulla grafts survived in all four animals tested. These grafted cells contained catecholamines, as indicated by the presence of specific glyoxylic acid-induced catecholamine fluorescence. In two of the four animals, however, the grafts contained fewer than 10 surviving cells, and in the other two animals, about 190 and 300 cells were found, respectively. Despite the small numbers of cells, this is the first demonstration that peripheral tissue autografts can survive implantation into the nonhuman primate central nervous system.

Pancreas and islet transplant registry data

AbstractFrom December 16, 1966, to June 30, 1983, some 337 pancreas transplants in 316 diabetic patients from 305 cadaveric and 32 living related donors were performed at 46 institutions throughout the world. A total of 60 pancreas transplants in 56 patients were performed prior to July 1, 1977, with only 2 functioning for more than 1 year. Therefore, the present era includes 277 pancreas trans‐plants performed in 262 patients at 39 institutions. Seventy‐four of these were done in 1982, while 72 were performed in the first 6 months of 1983 with 11 new institutions reporting. Of the 262 patients in the present era, 74 (28%) have died with 48 (18%) of these dying within the first 3 months of transplantation. Of the 190 pancreas transplants performed up to December, 1982, and available for evaluation of 1‐year graft function, 31 (16%) are currently functioning; another 8 (4%) functioned for 1 year but then failed (7) or the recipient died (1). Of the 72 transplants done in the first 6 months of 1983, there are 26 (37%) still functioning. Results are expressed according to technique of handling the ductal drainage, association with kidney transplantation, and association with the type of immunosuppression. Seventeen non‐diabetic patients (13 with chronic pancreatitis, 4 with adenocarcinoma) had autotransplantation of a segment of the pancreas after pancreatectomy. Thirteen were said to function but follow‐up data are incomplete. There were 73 islet tissue allografts reported as of June 30, 1980, but none of the patients achieved insulin independence. Since then an additional 86 islet tissue allografts have been reported without any insulin independence achieved to make a total of 159 performed without normoglycemia. A total of 79 pancreatectomized patients have received islet tissue autografts with 50% being reported as insulin independent, but the results are difficult to interpret.

Etiology of infertility in monkeys with endometriosis: luteinized unruptured follicles, luteal phase defects, pelvic adhesions, and spontaneous abortions

To elucidate the etiology of infertility due to endometriosis, we autografted endometrial or adipose tissue to the pelvic peritoneum of 21 cynomolgus monkeys. These primates were divided into five groups: control animals with adipose tissue autografts (n = 5), animals with microscopic endometriosis (n = 5), animals with mild endometriosis (n = 5), animals with moderate endometriosis (n = 4), and animals with severe endometriosis (n = 2). During three subsequent menstrual cycles, each animal underwent (1) serial assay of peripheral serum gonadotropins and steroids; (2) mating timed according to daily serum 17 beta-estradiol; and (3) laparotomy to document an ovulatory stigma. The chemical and term pregnancy rates were lower among monkeys with moderate or severe endometriosis, as compared with control animals. The impaired fertility in monkeys with endometriosis appeared to be mediated primarily by failure of follicular rupture and/or pelvic adhesions.

Loss of anterior interdental tissue: Periodontal and prosthodontic solutions

The restoration of anterior spaces with a loss of interdental tissue has been reviewed. A surgical technique combining a subepithelial connective tissue autograft and a free gingival graft has been described. This preprosthodontic surgical approach is recommended as the treatment of choice. When surgery is contraindicated, the use of a cantilevered porcelain papilla is suggested.

Free soft tissue autografts. Hemostasis and protection of the palatal donor site with a microfibrillar collagen preparation.

The use of free soft tissue autograft procedures has been well established and documented. However, little attention has been devoted to the care of the donor site which most frequently consists of palatal mucosa. The purpose of this study was to evaluate the hemostasis and protection of the palatal donor site of free soft tissue autografts using a microfibrillar collagen hemostat preparation. Twenty healthy adult subjects were selected. Ten patients in the experimental group received the microfibrillar collagen hemostat as a dressing while the control group received a conventional dressing. The results demonstrated that 10 minutes after the split thickness mucosal grafts were removed, the mean volume of blood absorbed by the sampling technique was 0.96 ml in the treated wounds vs. 1.85 ml in the control. There were no apparent differences in the quality of healing or the pain perceived by the patients in the experimental and control groups. It was concluded that the microfibrillar collagen hemostat produced rapid and effective hemostasis and protected the denuded palatal donor sites obviating the need for a conventional periodontal dressing.

Prediction of in vivo function of human parathyroid tissue autografts by in vitro testing

AbstractIn an effort to overcome problems of hypoparathyroidism in patients undergoing reoperation for persistent hyperparathyroidism, a systematic plan has been evolved. All patients who have reoperation and in whom abnormal tissue has been identified have had that tissue removed and portions of it cryopreserved. Following successful reoperation those patients who have prolonged hypoparathyroidism, who cannot be maintained off of vitamin D and calcium, undergo autografting with cryopreserved tissue. Prior to autografting, the parathyroid tissue has been thawed and assessed for the appropriateness of parathyroid hormone suppressibility in response to varying levels of ambient calcium concentration. This report documents that this in vitro test of suppressibility correctly predicts in vivo parathyroid autograft function of both fresh and cryopreserved parathyroid autografts.