Materials used for knee ligament grafting

The authors have presented the review of scientific literature on producing grafts intended for surgical reconstruction of ligament ruptures. The treatment of ligament ruptures in reconstructive plastic surgery could be performed by using synthetic grafts, autologous and allogenic grafts from tissue donors. Advantages of synthetic grafts include the possibility of their regular manufacturing under sterile conditions, and providing mechanical properties, high biocompatibility. However, synthetic implants significantly increase the risk of synovitis and other complications, they can not be replaced by the native tissue, and have no ability to regeneration. Autologous grafts have ideal tissue compatibility and quick biointegration, could be harvested from different anatomical sites, but commonly the graft harvesting is followed by donor site morbidity and potential risk of injury nerves, elongates operation time, bad cosmetic results. The use of autografts may be also limited by anatomical features of the patient. Allogenic ligament biomaterial could provide wide range of grafts, but in our days there is no standardized methods for ligament graft sterilization and long storage. Wellknown sterilization methods, such as ionized radiation and chemical treatment, gave controversial results. One could conclude that estimation of ligament graft viability must include a complex study of biomechanical properties, cell and fibers integrity.

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Extracellular Matrix Bioscaffolds to Enhance ACL Healing: Impact on the Contribution of the MCL to Joint Stability

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53416 ◽

2011 ◽

Author(s):

Matthew B. Fisher ◽

Ho-Joong Jung ◽

Kwang E. Kim ◽

Patrick J. McMahon ◽

Savio L-Y. Woo

Keyword(s):

Extracellular Matrix ◽

Cruciate Ligament ◽

Donor Site ◽

Biomechanical Properties ◽

Clinical Results ◽

Donor Site Morbidity ◽

Surgical Reconstruction ◽

Suture Repair ◽

Joint Stability ◽

Stifle Joint

A torn anterior cruciate ligament (ACL) of the knee has poor healing potential, and thus, surgical reconstruction using soft tissue autografts is needed to restore knee stability. Unfortunately, these procedures have a high incidence of donor site morbidity and the progression to osteoarthritis in the long-term 1. In recent years, biological stimulation by means of growth factors and bioscaffolds has demonstrated successful early clinical results 2. Our research center has used extracellular matrix (ECM) bioscaffolds as a biological agent to improve ACL healing in a goat model 7, 8. Indeed, there was sufficient formation of neo-ACL tissue that led to up to a 30% reduction in the instability of the stifle joint by 12 weeks. Its biomechanical properties also increased by two-fold in comparison to those with suture repair alone 7, 8.

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Regeneration of Ligaments and Tendons With ECM Bioscaffolds

Volume 15: Processing and Engineering Applications of Novel Materials ◽

10.1115/imece2008-68870 ◽

2008 ◽

Author(s):

Savio L.-Y. Woo ◽

Matthew B. Fisher ◽

Alejandro J. Almarza

Keyword(s):

Patellar Tendon ◽

Cruciate Ligament ◽

Donor Site ◽

Biomechanical Properties ◽

The United States ◽

Donor Site Morbidity ◽

Knee Extension ◽

Surgical Reconstruction ◽

Tissue Quality ◽

Number Of Patients

Ligaments and tendons of the knee are subjected to large loads during sports and work related activities, and thus, are frequently injured. For the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), there are over 100,000 and 50,000 annual tears, respectively, in the United States alone. As a torn ACL has limited healing potential, surgical reconstruction using autograft replacements, such as the bone-patellar tendon-bone (BPTB) as well as the quadrupled semitendinosus and gracilis tendons, are performed in a large number of patients to restore knee stability. In spite of the over 25 years of experience, knee extension deficits and many long term complications associated with the BPTB autograft, including the progression of osteoarthritis, are serious post-surgical problems. Additionally, there are complications associated with donor site morbidity, anterior knee pain, arthrofibrosis, and inferior biomechanical properties of the patellar tendon (PT). In the case of MCL injuries, functional treatment is sufficient for rapid tissue healing; however, the neo-MCL is known to have significantly inferior tissue quality compared to the intact MCL, and the remodeling process can take years. Thus, it presents an increased chance for reinjury.

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SUPRACLAVICULAR ARTERY FLAP: A SAFE, VERSATILE AND A RELIABLE FLAP A NEW WORKHORSE IN HEAD AND NECK RECONSTRUCTION OUR CLINICAL EXPERIENCE

International Journal of Advanced Research ◽

10.21474/ijar01/12326 ◽

2021 ◽

Vol 9 (01) ◽

pp. 544-550

Author(s):

Mir Mushtaq ◽

◽

Bashir Ahmad Bhat ◽

Taj Din Wani ◽

Shabir Iqbal ◽

...

Keyword(s):

Head And Neck ◽

Donor Site ◽

Graft Loss ◽

Surgical Techniques ◽

Free Tissue Transfer ◽

Functional Results ◽

Donor Site Morbidity ◽

Head And Neck Reconstruction ◽

Wide Range

Background: Anterior cervical contractures of the neck represent a great challenge for plastic and reconstructive surgeons. Necks can be reconstructed with a wide range of surgical techniques. The supraclavicular flap is easy to harvest without the need for free tissue transfer. It provides a relatively large flap for neck resurfacing with tissue very similar to that of the neck. Material and Methods: This study was carried out in the Plastic Surgery Department of GMC Srinagar between November 2015 and October 2019. It involved 50 patients (40 females and 10 males), in whom supraclavicular artery flap was done to reconstruct head and neck. Follow-up period ranged from 2-27 months (average 12.3). Results: The study involved 50 patients. Mean age was 26.5 years (range 57-12 years). Thirty five patients had post-burn neck contractures, five patients had portwine stain face, three had marjolin ulcer, four patients had post traumatic and three had post bear maul defect. We harvested unilateral flaps in all of patients. In thirty five patients the flap was pedicled, three had adipofascial pedicle and twelve were islanded. The size of the reconstructed defect ranged from 23x10 to 14x6, and the size of the flap varied from 16x7cm to 25x11. Mean length was 21.7 cm. We used a partial thickness skin graft for donor site closure in 41 cases and closed primarily in 9 cases. Flap was used to resurface neck in 35 patients, face resurfacing in 10 patients, as intraoral lining in 3 patients. The following complications occurred: hematoma in 3 cases, partial distal necrosis in 2 cases, and donor site graft loss in 3 cases. Follow-up period ranged from 2-27 months Conclusion: The supraclavicular artery island flap is a thin, malleable fasciocutaneous flap that is easily and rapidly harvested, with a reliable pedicle and minimal donor site morbidity. It constitutes an alternative to local flaps, while providing equivalent functional results, and must be an integral part of the head and neck reconstructive surgeons therapeutic armamentarium.

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The First Stage of Acquired Syndactyly Reconstruction - A Rare Case Report

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20220112 ◽

2022 ◽

Vol 12 (1) ◽

pp. 87-91

Author(s):

Lucretya Yeniwati Tanuwijaya ◽

Agus Roy Rusly Hariantana Hamid ◽

I Gusti Putu Hendra Sanjaya

Keyword(s):

Case Report ◽

Skin Graft ◽

Skin Flap ◽

Donor Site ◽

Surgical Techniques ◽

Operation Time ◽

Donor Site Morbidity ◽

Reconstruction Procedure ◽

Local Skin ◽

And Function

Background: Acquired syndactyly is a very rare disorder on the interdigital area. Syndactyly with only soft tissue involvement can be a sequela of trauma, such as burn, inflammation or infection in the interdigital area, resulting in bony fusion following crush injury. Case Report: An 8-year-old boy came to our department with fusion from the base to the tip of the first to fourth right toes since the accidental step on burnt plastic 5 years ago. He complained of a poor appearance and discomfort when walking. Then we performed zigzag incision for first to second toes and third to fourth toes. Skin graft closure was performed to cover the defect on third to fourth toes. The second reconstruction surgery will be scheduled 6 months later. Discussion: The surgical techniques for foot syndactyly were derived from those for hand syndactyly, which are to separate the digital fusion by creating local skin flap. Additionally, skin graft might be necessary when recent surgeons avoid the use of skin graft for open treatment, primary closure by defatting, or intricate local flaps. These can shorten the operation time and minimize donor site morbidity. However, surgeons should consider the free tension closure of the wound by combining the skin graft after the flap. Conclusion: Reconstruction procedure for foot syndactyly aims to improve the appearance and function of the toes as well as to avoid progressive deformity through development. The skin graft addition in combination of skin flap shows promising outcome. Key words: acquired syndactyly, syndactyly reconstruction, zigzag flap, skin graft.

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Essex-Lopresti injuries: an update

EFORT Open Reviews ◽

10.1302/2058-5241.4.180072 ◽

2019 ◽

Vol 4 (4) ◽

pp. 143-150 ◽

Cited By ~ 4

Author(s):

Panagiotis T. Masouros ◽

Emmanuel P. Apergis ◽

George C. Babis ◽

Stylianos S. Pernientakis ◽

Vasilios G. Igoumenou ◽

...

Keyword(s):

Achilles Tendon ◽

Donor Site ◽

Donor Site Morbidity ◽

Interosseous Membrane ◽

Range Of Movement ◽

Recurrent Instability ◽

Bone Allografts ◽

Iatrogenic Nerve Injury ◽

Synthetic Grafts ◽

Essex Lopresti

Reconstruction of the central band of the interosseous membrane is an emerging procedure implemented in the treatment of longitudinal radioulnar dissociation (LRUD), usually in its chronic setting, after Essex-Lopresti injuries of the forearm. There are no sufficient clinical data to support reconstruction of the central band of the interosseous membrane in acute LRUD injuries. Clinical and cadaveric studies comparing autografts (palmaris longus, flexor carpi radialis and bone-patellar-bone), allografts (Achilles tendon) and synthetic ligaments have not shown superiority of one technique versus another; however, they have shown special concerns with respect to the use of synthetic grafts. Latrogenic fracture, decrease of rotational range of movement, iatrogenic nerve injury (superficial radial and median nerve), donor site morbidity with autografts and recurrent instability are the complications reported in literature after interosseous membrane reconstruction. Cite this article: EFORT Open Rev 2019;4:143-150. DOI: 10.1302/2058-5241.4.180072

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Use of Extracellular Matrix Bioscaffolds to Enhance ACL Healing: A Multidisciplinary Approach in a Goat Model

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19559 ◽

2010 ◽

Author(s):

Matthew B. Fisher ◽

Ho-Joong Jung ◽

Rui Liang ◽

Kwang Kim ◽

Patrick J. McMahon ◽

...

Keyword(s):

Cruciate Ligament ◽

Healing Process ◽

Donor Site ◽

Donor Site Morbidity ◽

Surgical Reconstruction ◽

Suture Repair ◽

Joint Stability ◽

Tissue Replacement ◽

Anterior Cruciate ◽

And Function

Due to the poor healing potential of the anterior cruciate ligament (ACL) of the knee, surgical reconstruction using soft tissue replacement grafts is performed to restore knee stability and function. However, the surgery has serious complications including a high incidence of donor site morbidity and the development of osteoarthritis in the long-term. Recently, functional tissue engineering approaches to heal an injured ACL using biological stimulation via growth factors and bioscaffolds have yielded some positive clinical and laboratory results. As the healing process for the ACL is slow, additional suture repair of the ACL has been needed to provide initial joint stability and to reduce the risk of injury to neighboring tissues.

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Frozen Vein Wrapping for Chronic Nerve Constriction Injury Reduces Sciatic Nerve Allodynia in a Rat Model

10.21203/rs.3.rs-600165/v1 ◽

2021 ◽

Author(s):

Michiaki Mukai ◽

Kentaro Uchida ◽

Naoya Hirosawa ◽

Kenichi Murakami ◽

Gen Inoue ◽

...

Keyword(s):

Sciatic Nerve ◽

Nerve Injury ◽

Donor Site ◽

Operation Time ◽

Donor Site Morbidity ◽

Control Group ◽

Heme Oxygenase 1 ◽

Autologous Vein ◽

Withdrawal Threshold ◽

Von Frey Filaments

Abstract BackgroundAutologous vein wrapping (VW) is used in the treatment of recurrent chronic constriction neuropathy and traumatic peripheral nerve injury. However, use of autologous veins is limited by the inability to obtain longer veins of sufficient length for larger sites. Frozen allograft tissue has several advantages, including its availability for large grafts, avoidance of donor-site morbidity, and shorter operation time. Here, we investigated the effect of frozen vein wrapping (FVW) in Wistar rats as a model of sciatic nerve injury. MethodsThe rats were grouped by treatment as (i) untreated after chronic constriction injury surgery (CCI; control group), (ii) treated with vein wrapping using freshly isolated vein (VW), and (iii) treated with vein wrapping using frozen vein (FVW). Mechanical allodynia was assessed with von Frey filaments on postoperative days (PODs) 1, 3, 5, 7, and 14. ResultsThe response of heme oxygenase-1 gene, Hmox-1, expression to VW and FVW was assessed by RT-PCR. Both VW and FVW significantly increased withdrawal threshold levels compared to the untreated control group on POD 1, 3, and 5. Both VW and FVW also showed increased HO-1 expression compared to the CCI group. ConclusionsOur results suggest that FVW may be a suitable therapeutic optionas a source of large grafts.

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DONOR SITE MORBIDITY OF FIBULAR FLAP

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i2.5220 ◽

2021 ◽

Vol 71 (2) ◽

pp. 387-91

Author(s):

Ghazanfar Ali ◽

Abdul Majid ◽

Danish Almas ◽

Shahid Hameed ◽

Rizwan Aslam ◽

...

Keyword(s):

Ankle Instability ◽

Donor Site ◽

Graft Loss ◽

Donor Site Morbidity ◽

Adverse Outcomes ◽

Military Hospital ◽

Free Fibula Flap ◽

Wide Range ◽

Free Fibula ◽

Fibular Flap

Objective: To present the early and late outcomes related to donor site morbidity of Free Fibular Flap. Study Design: Prospective observational study. Place and Duration of Study: Plastic surgery department, Combined Military Hospital Rawalpindi, from Jan 2009 to Jan 2020. Methodology: In total 361 patients were enrolled for the study through consecutive purposive sampling. All patients requiring free fibula flap for reconstruction of the defect were included in the study. However, the patients with Diabetes Mellitus, Smoking or peripheral vascular disease were excluded from the study. The patients were asked to visit on second week and then at three months for late outcomes. The results were entered SPSS-24 for analysis and interpretation of data. Results: Out of total 361 patients enrolled for study 293 (81.16%) were male and 68 (18.83%) were female. The men age was 51.43 years SD 14.6 (range 4 year to 68 years). In early outcomes, graft loss 29 (8.03%) and sensory deficit 19 (5.26%), are the commonest adverse outcomes. Results of late follow up revealed chronic pain in 29 (8.03%), ankle instability in 24 (6.64%), gait abnormality in 29 (8.76%) and claw toe in 33 (9.14%) patients. The American Orthopedic Foot and Ankle Society (AOFAS) score was 88.45%. Majority (52.63%) patients were very satisfied. Conclusion: The free Fibula is excellent choice for reconstruction of a wide range of osseous defects with minimum donor site morbidity and high satisfaction rate among the patients.Keywords:

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Does The Peroneus Longus Tendon Autograft Affect The Ankle Function? A Case Series

The Hip and Knee Journal ◽

10.46355/hipknee.v1i1.6 ◽

2020 ◽

Vol 1 (1) ◽

pp. 57-62

Author(s):

Muhammad Hilman Bimadi ◽

Krisna Yuarno Phatama ◽

Edi Mustamsir

Keyword(s):

Functional Outcomes ◽

Ligament Reconstruction ◽

Donor Site ◽

Case Series ◽

Donor Site Morbidity ◽

Full Thickness ◽

Knee Ligament ◽

Peroneus Longus ◽

Knee Ligament Reconstruction ◽

Tendon Autograft

Introduction: The peroneus longus (PL) tendon is one of the autograft choices for knee ligament injury because of its safety, length, and strength. However, studies that evaluated donor site morbidity after PL tendon graft are still limited. This case series aims to evaluate the functional outcomes of donor site morbidity after full-thickness PL tendon harvesting for knee ligament reconstruction.Presentation of Case:This study evaluated four patients who had a revision of knee ligament reconstruction surgery using PL tendon autograft from August until September 2018. The functional outcome of the donor site was evaluated before surgery, two weeks, and three months after surgery by using functional scores assessment of foot and ankle.Discussion:There are some donor sites of autograft, but several studies show that the PL tendon autograft has proven to be more favorable methods for knee ligament reconstruction based on the accessibility, safety, and strength of the harvested tendon. The studies also found that using PL tendon as an autograft, has a good result in donor site morbidity evaluation compared to others. This study provides a satisfying result on the functional outcome of the donor site morbidity evaluation.Conclusion:This study showed satisfactory functional outcomes of the foot and ankle after harvesting full-thickness PL tendon. All functional score assessment provides an excellent result in three months after surgery, although lateral ankle bulging has occurred in all patients. However, gait analysis and isokinetic test with a more significant number of patients and longer follow up periods are necessary for further study.

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Treatment of Volar Defects of the Finger using Dorsal Digital–metacarpal Flap Versus Free Medial Plantar Artery Flap: A Comparative Study

10.21203/rs.3.rs-39680/v2 ◽

2020 ◽

Author(s):

Quanzhe Liu ◽

Wenlai Guo ◽

Wenrui Qu ◽

Xiaolan Ou ◽

Rui Li ◽

...

Keyword(s):

Postoperative Complications ◽

Donor Site ◽

Graft Loss ◽

Operation Time ◽

Donor Site Morbidity ◽

Plantar Artery ◽

Significant Difference ◽

Medial Plantar Artery ◽

Volar Surface

Abstract Background: The treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear. This study compared the outcomes of free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction.Methods: This retrospective cohort study included 24 patients with soft-tissue defects on the volar surface of the finger from March 2014 to March 2017. The patients were divided into two groups: the MPAF group and the DDMF group. The operation time, complications, such as flap necrosis, graft loss, infection, paresthesia, and donor-site morbidity, as well as two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire was used for conduct follow-up assessment.Results: After more than 12 months of follow-up, the MPAF group had a longer operative time compared with DDMF group, but there was no significant difference in postoperative complications and the results (2-PD and Modified VSS score) were significant. In terms of overall function, MPAF was superior to DDMF (p < 0.005).Conclusion: MPAF and DDMF are reliable for reconstruction of the volar surface of the finger; however, MPAF offers better functional outcomes and is associated with a lower incidence of postoperative complications.

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