OBJECTIVE: Autologous tenocyte implantation (OrthoATI™) therapy has demonstrated efficacy in treating patients with tendinopathy at various anatomical sites. This study evaluates the effect of patient age, gender, and tendon biopsy site on morphology, growth, and gene expression of autologous tendon cells used to treat chronic tendinopathy.
METHODS: Patients undergoing OrthoATI™ for tendinopathies between 2020 and 2022 were initially treated by biopsies taken from patella tendon (PT) or palmaris longus tendon (PL). The biopsies were sent to a Good Manufacturing Practice (GMP) cell laboratory where tendon cells were isolated, cultured, and expanded for four to six weeks. Cell morphology was assessed using phase contrast microscopy. Droplet digital PCR (ddPCR) was utilized for gene expression analysis. Dichotomous results were compared between groups using x2 or Fisher\'s exact tests with no adjustment for multiple comparisons. The nonparametric Mann-Whitney U and Kruskal-Wallis tests were utilized for the sex and age (<35y, 35-44y, 45-54y, >55y) analyses, respectively. All analyses were performed using IBM SPSS v27, and a two-tailed P-value of <0.05 was considered statistically significant.
RESULTS: 149 patients were included in the analysis. The PT was biopsied in 63 patients, and PL in 86 patients. There were no observer effects for age and gender between the PT and PL groups. There was no statistical significance between the PT and PL tendons for cell morphology, average cell population doubling time (PDT) (PT 83.9 vs PL 82.7 ​h, p ​= ​0.482), cellular yield (PT 16.2 vs PL 15.2 ​× ​106, p ​= ​0.099), and cell viability (PT 98.7 vs PL 99.0%, p ​= ​0.277). Additionally, ddPCR analyses showed no statistical significance found in tenogenic gene expression, including collagen type I (COL1, p ​= ​0.86), tenomodulin (TNMD, p ​= ​0.837) and scleraxis (SCX, p ​= ​0.331) between PT- and PL-derived tendon cells. An age stratification analysis found no effect on growth and gene expression. COL1 was found to be higher in males when compared to females (P ​< ​0.001), but otherwise no difference was seen in growth and gene expression in the gender analysis. No postbiopsy clinical complications were reported for either group.
CONCLUSIONS: This study has shown that the growth and bioactivities of tendon cells from tendon biopsies for OrthoATI™ are not affected by tendon donor site and age.
METHODS: IV.

UNASSIGNED: Skin grafting is a routinely employed technique to cover the skin defect. Though the skin grafts are technically effortless, they are tiresome because of the prolonged duration of hospital stay, labor-intensive, demanding repeated dressings, and also create a second wound. Platelet-rich plasma (PRP) is one that has a higher concentration of platelets than the blood. Alpha granules of the platelets are rich in growth factors.
UNASSIGNED: To assess the effect of PRP on split-thickness skin graft uptake and donor site healing.
UNASSIGNED: In a single-center-based prospective study done from August 2018 to June 2020, 60 patients with acute and chronic wounds were divided into two equal groups. Autologous PRP was applied on the recipient wound bed and donor site in PRP group, and conventional methods like staples/sutures were used to anchor the skin grafts and standard of care of the donor site in a control group.
UNASSIGNED: Instantaneous graft adhesion was observed in all patients of PRP group. The first graft inspection was delayed. Seroma, hematoma, total number of dressings, and duration of stay in hospital were significantly reduced in the PRP group. Donor site pain in the postoperative period was notably reduced in PRP group. PRP also remarkably hastened the donor site healing.
UNASSIGNED: The application of PRP promotes graft take, minimizes complications, enhances donor site wound healing, mitigates donor site pain, and has immense economic benefits due to the reduced number of dressing changes and shorter hospital stay.

Autografting with split-thickness skin grafts (STSG) remains an essential procedure in burn and reconstructive surgery. The process of harvesting STSG, however, leaves behind a donor site, an exposed area of partial-thickness dermis left to heal by secondary intention. There has yet to be a consensus amongst surgeons regarding optimal management of the donor site. The ideal donor site dressing is one that allows for expeditious healing while minimizing pain and infection. Despite numerous studies demonstrating the superiority of moist wound healing, many surgeons continue to treat STSG donor sites dry, with petroleum-based gauze. In this study, two burn centers performed a retrospective review of burn patients whose STSG donor sites were treated with either Xeroform® or Mepilex® Ag dressings. Infections were documented and in a subgroup analysis of patients, postoperative pain scores were noted and total opiate usage during hospitalization was calculated. Analysis revealed an overall infection rate of 1.2% in the Mepilex® Ag group and 11.4% in the Xeroform® group (p<0.0001). Patients with Xeroform® donor site dressings had increased odds of donor site infection (OR=10.8, p=0.002). In subgroup analysis, there were no significant differences in maximum pain scores between Mepilex® Ag and Xeroform® groups, nor were there differences in opiate usage. STSG donor sites dressed with silver foam dressings have a lower rate of donor site infection relative to those dressed with petroleum-based gauze. Moist donor site dressings such as foam dressings (including Mepilex® Ag) should be the standard of care in STSG donor site wound care.
La greffes de peau mince (GPM) demeure une procédure essentielle dans la chirurgie de brûlure et de reconstruction. La zone donneuse de greffe (ZDG) représente une perte de substance cutanée superficielle, cicatrisant spontanément. Il n’y a pas de consensus concernant la prise en charge optimale de la ZDG. Le pansement idéal de la ZDG doit promouvoir la cicatrisation et réduire la douleur ainsi que le risque infectieux. Malgré les nombreuses publications montrant l’intérêt d’un environnement humide pour la cicatrisation, de nombreux chirurgiens réalisent des pansements secs vaselinés. Cette étude rétrospective effectuée dans 2 CTB compare les pansements de ZDG réalisés au Xéroform® ou au Mepilex Ag®. Les infections ont été documentées et, dans un sous-groupe, les scores de douleur et la consommation d’opiacés au long de l’hospitalisation ont été notés. Les taux d’infection sont de 1,2% dans le groupe Mepilex Ag® et 11,4% avec Xéroform® (p<0,0001). Le risque d’infection de la ZDG est augmenté (OR 10,8 ; p = 0,002) en cas d’utilisation de Xéroform®. Il n’y avait pas de différence de douleur et de consommation d’opiacés entre les 2 groupes. Les ZDG recouvertes d’un pansement hydrocellulaire imprégné d’argent s’infectent moins que celles traitées avec une gaze imprégnée de vaseline. L’utilisation sur les ZDG d’un pansement humide comme une mousse hydrocellulaire (par exemple Mepilex Ag®) devrait devenir la norme.

UNASSIGNED: The use of the dorsal hamate as a free osteochondral bone graft or vascularized bone flap has become the mainstay for large, comminuted middle phalanx volar lip fractures. To date, few studies have been conducted in the assessment of donor site morbidity for the hemi-hamate graft or flap, and none have discussed modes of repair or reconstruction of this donor site.
UNASSIGNED: A retrospective analysis of 14 hemi-hamate arthroplasty (HHA) procedures, including 6 vascularized and 8 non-vascularized grafts, from two surgeons was performed. Four hamate defect reconstruction techniques were utilized: no formal reconstruction, autologous bone grafting, gel foam, or synthetic bone substitute. The dorsal capsule was repaired with either extensor retinaculum grafting or by direct closure. Wrist range of motion, pain scores, and radiographic alignment were assessed.
UNASSIGNED: At 6 months follow-up, all patients achieved full, pain-free wrist motion compared to the uninjured side, with visual analog scale pain scores of 0. Serial radiographs showed maintained carpal alignment without instability or subluxation. No differences based on the hamate defect reconstruction method or capsular repair technique was demonstrated.
UNASSIGNED: Safe return to pain free, unrestricted wrist function is achievable after HHA, regardless of hamate donor site management. Adequate dorsal capsular repair appears critical to prevent instability. Further study is needed to compare techniques, but choice may be guided by surgeon preference in the absence of clear evidence.

OBJECTIVE: This study aimed to evaluate the effectiveness of a chitosan-based dressing (CD) in achieving early wound healing and hemostasis at palatal donor sites in patients undergoing free gingival graft (FGG) surgery.
METHODS: Thirty-two patients requiring FGG were treated in this randomized controlled clinical trial. Complete epithelialization (CE) and color match (CM) at donor sites were assessed by a blinded examiner on postoperative days 7, 14, 21, and 28. Donor sites were compressed for 2 min with wet gauze (WG) alone in control group (CG) or WG + CD in test group (TG) immediately after graft harvesting, and immediate bleeding (IB) was recorded (yes/no). Delayed bleeding (DB) (for 1 week), and number of analgesic tablets consumed, and VAS scores for pain (for 2 weeks) were recorded by patient every day.
RESULTS: Twenty-eight patients (14 in each group) were included in final analysis. The prevalence of CE (at weeks 2 and 3) and VAS scores for CM scores were higher in TG but the intergroup differences were statistically significant only for CM (at week 4). Number of patients exhibiting IB and DB was significantly fewer in the TG (p < .05). Although average pain scores and analgesic consumption were higher in TG up to 5 days, differences between two groups were not statistically significant at any time point.
CONCLUSIONS: Our data suggests that the application of CD increased re-epithelialization and accelerated wound healing process, although it did not reach statistical significance. Moreover, CD was found to significantly reduce bleeding complications, but it did not decrease the pain levels.

UNASSIGNED: To assess patient comfort, wound healing, and scarring at the 6-month follow-up of split-skin graft donor sites treated with Ba-Hao burn ointment (BHBO) gauze, a compound preparation of traditional Chinese medicine since 1970s, compared with petrolatum gauze.
UNASSIGNED: Thirty patients admitted to the Department of Burns of the First Affiliated Hospital of Anhui Medical University between September 2021 and September 2022 participated in this randomized, prospective, self-control clinical study. After harvesting the split skin, donor sites were divided into two parts along the midline. BHBO gauze was applied to half of the donor wounds, and petrolatum gauze was applied to the other half. The wound healing time, pain scores on the postoperative Days 3, 6, and 9, and Vancouver Scar Scale (VSS) score at the 6-month follow-up were assessed.
UNASSIGNED: The wound healing time was significantly shorter in the BHBO group than in the control group (10.07 ± 1.48 days vs. 11.50 ± 1.74 days, p < 0.001). On postoperative Days 3 and 6, the pain scores quantified by visual analog scores were significantly lower in the BHBO group than in the control group (5.33 ± 1.54 and 4.17 ± 1.51, respectively vs. 7.57 ± 1.41 and 5.20 ± 1.47, respectively). The difference in the visual analog scale score on postoperative Day 9 between the groups was not significant (p > 0.05). Microbiological assessment revealed the absence of bacterial contamination in both groups. At the 6-month follow up, the VSS score was significantly lower in the BHBO group (6.67 ± 1.92) than in the control group (9.57 ± 1.55).
UNASSIGNED: BHBO resulted in faster donor-site healing, reduced postoperative pain, and improved scar quality at the 6-month follow-up than petrolatum gauze alone.

The radial forearm free flap (RFFF) is commonly used in the reconstruction of oral cancer patients. Traditional RFFF (TRFFF) techniques, which often require a secondary donor site to repair the forearm defect, may result in a scar extending to the dorsal hand. This can lead to significant functional and aesthetic concerns in the forearm. We designed a modified RFFF (MRFFF) that incorporates a glasses-shaped flap and features deep venous drainage. To evaluate its effectiveness we conducted a retrospective chart review of 105 patients with oral squamous cell carcinoma who underwent reconstructive surgery between 2018 and 2022. These patients were treated either with a TRFFF (n = 60) or the newly developed MRFFF (n = 45). Our inclusion criteria, guided by preliminary surgical experience prior to initiating the study, stipulated that single oral defects should be no larger than 6 × 6 cm2, and adjacent double defects no larger than 3 × 6 cm2. Flap size, pedicle length, harvesting duration, and anastomosis during the surgical procedure were compared between the two techniques. Preoperative and postoperative oral function, recurrence, mortality, and dorsal scarring were recorded. One-week, one-month, and six-month postoperative subjective aesthetics assessments, and self-reported postoperative donor hand function, were measured using the Michigan hand questionnaire (MHQ). There were no significant differences between the groups in terms of flap size, pedicle length, harvesting time, anastomosis time, postoperative oral function, recurrence, and mortality. However, patients with a MRFFF did not require a second donor graft site and did not have scars extending to the dorsal forearm. They also had significantly improved postoperative aesthetic outcomes (1 week: 70.6%, 1 month: 62.2%) and donor hand function (1 week: 54.6%, 1 month: 40.4%) compared with the TRFFF group (p < 0.001). The MRFFF eliminates the need for secondary donor sites and improves primary donor site outcomes. It is versatile and can be employed for either single or composite oral defects. Through extensive case studies, we have defined its specific scope: it is suitable for single defects measuring no more than 6 × 6 cm2, or for composite defects no larger than 3 × 6 cm2. Furthermore, it does not compromise the functional recovery of the recipient site, and should be widely adopted for all qualifying patients.

BACKGROUND: The deep inferior epigastric perforator (DIEP) free flap is the gold standard procedure for autologous breast reconstruction. Although breast-related complications have been well described, donor-site complications and contributing patient risk factors are poorly understood.
METHODS: We examined a multi-institutional, prospectively maintained database of patients undergoing DIEP free flap breast reconstruction between 2015 and 2020. We evaluated patient demographics, operative details, and abdominal donor-site complications. Logistic regression modeling was used to predict donor-site outcomes based on patient characteristics.
RESULTS: A total of 661 patients were identified who underwent DIEP free flap breast reconstruction across multiple institutions. Using logistic regression modeling, we found that body mass index (BMI) was an independent risk factor for umbilical complications (odds ratio [OR] 1.11, confidence interval [CI] 1.04-1.18, p = 0.001), seroma (OR 1.07, CI 1.01-1.13, p = 0.003), wound dehiscence (OR 1.10, CI 1.06-1.15, p = 0.001), and surgical site infection (OR 1.10, CI 1.05-1.15, p = 0.001) following DIEP free flap breast reconstruction. Further, immediate reconstruction decreases the risk of abdominal bulge formation (OR 0.22, CI 0.108-0.429, p = 0.001). Perforator selection was not associated with abdominal morbidity in our study population.
CONCLUSIONS: Higher BMI is associated with increased abdominal donor-site complications following DIEP free flap breast reconstruction. Efforts to lower preoperative BMI may help decrease donor-site complications.

UNASSIGNED: Vascularized fibula grafts (VFGs) have become one of the most preferred grafts for the reconstruction of bone defects. However, despite the many advantages over other graft options, recipient and donor site morbidities are also common. Donor site morbidity has been reported at rates ranging from 5% to 67%. The aim of this study was to present a single-center series examining the clinical, functional, and radiologic aspects of donor site morbidity following VFG harvesting.
UNASSIGNED: The study included 69 patients who underwent biological reconstruction with VFG for bone tumors, avascular necrosis of the femoral head, or bone defects after trauma. Patients were evaluated functionally, clinically, and radiologically for donor site morbidity.
UNASSIGNED: Donor site morbidity was observed in 33 of 69 patients (48%). The most complications were sensation deficits around the feet and ankles (20 of 69; 29%). Knee laxity was more common in patients who underwent osteoarticular fibular resection (P = .006).
UNASSIGNED: We found VFG to be an effective method for the reconstruction of large bone defects, but associated with a relatively high rate of complications. Complications requiring surgical intervention were rare and the majority of patients did not have long-term functional limitations.
UNASSIGNED: Level IV, retrospective case series.

UNASSIGNED: Skin graft involves removing a part of the skin and using it in another part of the body. One of the most common reasons for using a graft is burns. We aimed to compare the effect of Colactive plus Ag dressing with Vaseline gauze dressing in donor sites of split-thickness skin grafts of burned patients.
UNASSIGNED: The present study was conducted as a randomized clinical trial (RCT) in the Motahari burn Hospital, Tehran, Iran in 1401. The sampling method was done using Cochran\'s formula and available patients so 15 people were enrolled. The findings of the study were collected using a researcher-made form.
UNASSIGNED: The average duration of recovery, the amount and intensity of pain, and the amount of itching between the two types of Colative plus Ag plus Ag dressing with Vaseline gauze are statistically significant at the 95% confidence level. (P-value<0.05). In addition, the findings showed that the average amount of scar left by the wound in the two types of dressings examined is not statistically significant at the 95% confidence level (P-value > 0.05).
UNASSIGNED: The use of Colactive silver dressing has less pain, less itching in the donor area, and a shorter average recovery time than Vaseline gauze. The use of the Colactive plus Ag will be more effective than Vaseline gauze.