暂无摘要。

Sources of autografts such as palmaris longus or plantaris are often limited or absent. We present our experience using a low donor-site morbidity method of harvesting strips of extensor carpi radialis brevis and longus (ECRB and ECRL) as free tendon autografts in upper extremity soft tissue reconstructions. Retrospective chart review identified five patients who received reconstructive upper extremity surgeries using ECRB and ECRL partial tendon autografts from January 2014 to October 2021 with at least a 12-month follow-up period. Mayo wrist scores were calculated to demonstrate clinical outcomes. All five patients (mean follow-up: 21 months) were able to return to regular activities while demonstrating improvements in 6- and 12-month postoperative Mayo wrist scores. There was minimal donor site morbidity and no ruptures of parent tendons following harvest. This study provides additional support for utilizing partial strips of ECRB and ECRL in repairing upper extremity tendon gap and ligament deformities.

OBJECTIVE: To determine whether femoral tunnel length (FTL) affects clinical or functional outcomes following primary Anterior cruciate ligament reconstruction (ACLR) with single-bundle quadriceps tendon autograft, both with and without a patellar bone block.
METHODS: An electronic search of MEDLINE, EMBASE, and Cochrane databases was carried out via OVID. Data pertaining to study characteristics, patient demographics, surgical techniques, femoral tunnel length, and subjective/objective clinical outcomes was abstracted. Studies were stratified into two groups based on FTL; a short femoral tunnel (S-FT) group of ≤25 mm, and a long femoral tunnel (L-FT) group of >25 mm. There was a high degree of heterogeneity between studies, prohibiting meta-analysis.
RESULTS: Seven studies comprising 368 total patients with a mean age of 30.3 years (range: 23.4-34 years) were included for analysis. The S-FT group included 126 patients and the L-FT group 242 patients. Both groups demonstrated statistically significant postoperative improvements across both subjective and objective clinical and functional outcomes. Average complication rates were 11.9% (range: 0%-29%) in the S-FT group and 4.5% (range: 1%-14%) in the L-FT group. Ranges of re-rupture rates were 0%-2% and 0%-3% for the S-FT and L-FT groups, respectively (n.s.).
CONCLUSIONS: Both S-FT and L-FT groups demonstrated comparable postoperative outcomes following primary ACLR with single bundle quadriceps tendon autograft. There were slightly superior, although non-significant, outcomes reported with short femoral tunnel length, however, this may have been confounded by the variation in surgical technique used.
METHODS: IV.

UNASSIGNED: Socket preservation is a surgical procedure aimed at preserving the dimensions of the alveolar bone following tooth extraction. It is performed by filling the extraction socket with bone graft material with or without a barrier membrane. Recently, dentine obtained from extracted teeth has been tried as an autograft for socket preservation. Studies have compared the use of dentin to other bone grafts, however, systematic reviews evaluating the efficacy of dentin for socket preservation are limited. Hence, this systematic review protocol is proposed to generate evidence on the efficacy of dentin as a viable alternative to other bone graft materials for socket preservation.
UNASSIGNED: This systematic review protocol was prepared according to the Methodological Expectations of the Cochrane Intervention Reviews (MECIR) guidelines. It will be conducted using the Cochrane Handbook for Systematic Review of Interventions. PubMed, Scopus, Web of Science, EMBASE, Epistemonikos, Cochrane Central, and EBSCO databases and clinical trial registries, will be searched for all randomized controlled trials (RCTs) and non-randomized studies that have used autologous dentin graft (either in particulate/putty, or/matrix form) for socket preservation. The radiographic and clinical assessment of bone and soft tissue healing of the preserved sockets along with patient-related outcomes following surgery will be assessed. The risk of bias assessment of the RCTs and Non-RCTs will be assessed using the \'Cochrane Risk of Bias assessment tool (ROB II) and ROBINS-I respectively. The certainty of evidence will be assessed by the GRADE approach.
UNASSIGNED: This evidence is important for dental clinicians and the public to make an informed decision when choosing graft material for socket preservation. The extracted teeth are considered biological waste; however, this evidence provides scope for using a less invasive autograft for bone regenerative procedures.
UNASSIGNED: PROSPERO: CRD42021201958 (Registered on 15/02/2021).

BACKGROUND: A phase 3b, open-label, multicenter, expanded-access study (NCT04123548) evaluated safety and clinical outcomes of StrataGraft treatment in adults with deep partial-thickness thermal burns with intact dermal elements.
METHODS: Adult patients with 3 % to < 50 % total body surface area burns were treated with a single application of ≤ 1:1 meshed StrataGraft and followed for 24 weeks. Primary endpoint was count and percentage of patients with treatment-emergent adverse events (TEAEs). Secondary endpoints included confirmed wound closure (WC) at Week 12, durable WC at Week 24, time to WC, scar evaluation, and wound infection-related events.
RESULTS: Fifty-two patients with 96 treatment sites were enrolled. Pruritus was the most common TEAE (22 patients [42.3 %]). Twenty serious TEAEs occurred in 10 patients (19.2 %); none were related to StrataGraft. There were 4 (7.7 %) deaths (aspiration, myocardial infarction, self-injury, Gram-negative rod sepsis); none were related to StrataGraft. Confirmed WC was achieved by Week 12 in 33 patients (63.5 %; 95 % CI: 50.4-76.5 %) and 69 treatment sites (71.9 %; 95 % CI: 62.9-80.9 %). Durable WC was achieved by Week 24 in 29 patients (55.8 %; 95 % CI: 42.3-69.3 %) and 58 treatment sites (60.4 %; 95 % CI: 50.6-70.2 %).
CONCLUSIONS: StrataGraft demonstrated clinical benefit. Safety data were consistent with previously reported findings.

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) is most commonly performed with hamstring tendon (HT) or bone-patellar tendon-bone (BTB) autografts, although the quadriceps tendon (QT) autograft has recently increased in popularity. This systematic review and meta-analysis review compares QT and HT autografts for primary ACLR with a sole focus on randomised controlled trials (RCTs).
METHODS: A prospective protocol was registered on PROSPERO (CRD42023427339). The search included MEDLINE, Embase and Web of Science until February 2024. Only comparative RCTs were included. The primary outcome was the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form score. Secondary outcomes included: other validated patient-reported outcome measures (PROMs), objective strength scores, complications, and return to sport and work.
RESULTS: From 2,609 articles identified, seven were included (n = 474 patients). This meta-analysis did not identify a significant difference in post-operative IKDC scores (5 articles; p = 0.73), Lysholm scores (3 studies; p = 0.80) or Tegner activity scales (2 studies; p = 0.98). There were no differences in graft failure rates (4 studies; p = 0.92) or in overall adverse events (4 studies; p = 0.83) at 24 months post-ACLR as per meta-analysis. Donor site morbidity scores were significantly lower in the QT group (MD -4.67, 95% CI -9.29 to -0.05; 2 studies, 211 patients; p = 0.05, I2 = 34%).
CONCLUSIONS: There were no differences between QT and HT in PROMs, graft failure rates or overall complications based on low- to moderate-quality evidence. There may possibly be lower donor site morbidity with the QT autograft, however, the evidence is not sufficient to draw definitive conclusions.

We review a case of total penile skin replacement with split-thickness micromesh skin graft (micromesh STSG) due to paraffinoma.

BACKGROUND: Traditional fixation of autografts in the treatment of burns involves the use of sutures and staples. A novel fibrin sealant, Artiss, has been introduced as an alternate method of fixation and has shown promising safety and efficacy results in the adult population. Our study assessed the effectiveness of fibrin sealant to secure autologous split thickness skin grafts (ASTSG) in the pediatric burn population.
METHODS: We performed a retrospective cohort study of pediatric patients under 18 years of age who received autografting for the treatment of burns at our institution between 2017 and 2023. We compared ASTSG secured with fibrin sealant to those managed traditionally with sutures or staples. Outcomes of interest include the need for return trips to the operating room (OR), time to wound healing, graft take, and total time in the operating room.
RESULTS: 83 patients underwent a total of 142 individual ASTSGs for management of unique body area injuries. 66.3 % were male, median age was 79 months, and scald was the most common mechanism of injury (41.0 %). Forty-five (39.5 %) traditionally affixed ASTSG required at least one return to the OR while only one (3.6 %) ASTSG secured with fibrin sealant required an additional return to the OR (p < 0.001). Graft take was similar in both groups (92.9 % for fibrin sealant vs. 93.9 % for traditional methods, p = 1). Time to wound healing was also similar: 16 vs. 15 days for fibrin glue and traditional methods, respectively (p = 0.23).
CONCLUSIONS: Outcomes from autograft fixation with fibrin sealant were comparable to those treated with traditional methods, with a reduction in the need for return trips to the operating room. These data suggest that fibrin sealant is a suitable alternative to traditional fixation methods in pediatric autografting.

BACKGROUND: Iliac crest autograft is frequently used to fill in bone defects after osteotomies. Nonetheless, surgery for bone autograft procurement is associated with morbidity and pain at the donor site. Alternatives to it have been explored, but there is no consensus to guide their application as a routine practice in several orthopedic procedures. Thus, this study was designed to compare the efficacy and safety between iliac crest autograft and allograft in medial opening wedge high tibial osteotomy.
METHODS: Forty-seven patients with a symptomatic unilateral genu varum and an indication for high tibial osteotomy were randomly assigned to receive either autograft or allograft to fill the osteotomy site. Operative time, bone healing, and complication rates (delayed union, nonunion, superficial and deep infection, loss of correction, and hardware failure) were recorded after a one-year follow-up. Data were expressed as Mean ± Standard Deviation and considered statistically significant when p < 0.05.
RESULTS: The time to radiologic union was similar between both groups (Allograft: 2.38 ± 0.97 months vs. Autograft: 2.45 ± 0.91 months; p = 0.79). Complication rates were also similar in both groups, with one infection in the allograft group and two in the autograft group, two delayed unions in the allograft group, and three in the autograft group. The operative time differed by 11 min between the groups, being lower in the allograft group (Allograft: 65.4 ± 15.1 min vs. Autograft: 76.3 ± 15.2 min; p = 0.02).
CONCLUSIONS: Iliac crest allografts can be safely and effectively used in medial opening wedge high tibial osteotomy as it promotes the same rates of bone union as those achieved by autologous grafts, with the benefits of a shorter operative time.
BACKGROUND: U1111-1280-0637 1 December 2022, retrospectively registered.

Anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopedic procedures, and huge variation exists in the surgical technique. Single bundle hamstrings autograft reconstruction is a common method and has good clinical outcomes. A criticism of the hamstrings autograft is a small graft diameter, often less than 8-mm, which has been associated with increased re-rupture rates. Several graft preparation techniques for single bundle hamstrings autograft exist. Perioperative decisions include the number of tendons utilized, number of graft strands, graft configuration, and femoral and tibial fixation methods. Awareness of the minimum tendon and graft length required to produce each graft variation is necessary to avoid common pitfalls. However, intraoperative graft modification is possible to maximize graft diameter, and obtain proper fixation. The objective of this current concepts review is to describe the indications, surgical anatomy, technique, intraoperative tips, clinical outcomes, and complications for single bundle hamstrings autograft preparation techniques in ACLR.