Graft Compatibility Classification within Aurantioideae Based on Biometric Traits and the Anatomy of Graft Union

Citrus relatives are a relevant source of valuable traits for use in citrus breeding, including resistance to diseases such as Huanglongbing (HLB). Resistant rootstocks may impact tree responses to HLB. This requires graft compatibility, which has been poorly investigated within the Aurantioideae. In this study, the biometric characteristics and the anatomy of the graft union of 86 scion/rootstock combinations were assessed. This comprised 18 genotypes/species and 8 genera from Citrinae, Balsamocitrinae, and Clauseninae subtribes sensu Swingle and Reece. Most graft combinations were found to be noncompatible. Phylogenetic proximity did not ensure successful grafting as, for example, Orange jasmine autografts failed, whereas some intergeneric grafts were successful (>60% of graft-take). Plant scion height was directly related to graft-take, but the correlation between the scion and rootstock stem diameters was not a reliable indicator of graft compatibility. Rangpur/Tabog, Tabog/Rangpur, Wampee/Rangpur, Wampee/Pomeroy, Wampee/Swingle, Pomeroy/Wampee, and Swingle/Wampee were the most compatible intergeneric graft combinations. Graft-take success for this was at similar levels to those of sweet orange grafted on common citrus rootstocks. The position as a scion or rootstock in the combination affected the performance and was specific to the genotypes tested. The lack of differentiation between xylem-derived calli and the accumulation of phenolic compounds at the graft union were clear anatomical and biochemical markers, respectively, of incompatibility for most Aurantioideae combinations. In the field, within a set of the ten most promising combinations, Hamlin/Rangpur (control) was the only one that became infected by ‘Candidatus Liberibacter asiaticus’. This was first observed 12 months after planting. Overall, the assessment of biometric traits and anatomy of the graft union allowed Aurantioideae genotypes to be divided into four clusters, with respect to their graft compatibility, as follows: fully compatible with high graft-take and plant growth; potentially compatible with high graft-take but lower plant growth; partially incompatible with lower graft-take and poor plant growth; and fully incompatible with a complete absence of graft-take.

EFFICACY OF PERMEATAL ENDOSCOPIC MYRINGOPLASTY IN INACTIVE (MUCOSAL) CHRONIC OTITIS MEDIA

Objective: To determine the efficacy of permeatal ednoscopic myringoplasty, in inactive (mucosal) COM regarding, graft take and hearing improvement. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Department, Pak Emirates Military Hospital, Rawalpindi, from Aug 2019 to Feb 2020. Methodology: This was conducted on a sample size of n=100. Patients having inactive (mucosal) COM with dry central small, medium and large perforations were included. Patients were divided in to three groups on the basis of age, group A 15-30 years, group B 31-45 years and group C 46-60 years. All the patients underwent per-meatal endoscopic myringoplasty, without raising the tympano-meatal flap, under general anesthesia. Patients were followed up over a period of six months. Graft take was assessed by microscopy. Hearing was assessed by Pure Tone Audiometry (PTA) with improvement in air bone gap to 15db as primary end point. Data was collected on structured performa. Data was analyzed using SPSS version 17. Results: In this study, 33 (33%) were males and 67 (67%) were females. Age ranged 15-60 years. Out of 5 patients lost to follow up. A total of 95 completed their follow up. Based on age of the patients, in group A, successful graft take was 100%. In group B, it was 91% & in group C it dropped to 46%. On the basis of tympanic membrane perforation size, the graft success rate in small perforations was 94.8%; in medium sized perforations it was 86.8% and in large sized perforations of tympanic membrane it was........

Comparison of Efficacy among Three Dermal Substitutes in the Management of Critical Lower-Limb Wounds: The Largest Biases-Reduced Single-Center Retrospective Cohort Study in Literature

Background and objectives: The skin recently became the main focus of regenerative medicine and, in this context, skin substitutes are fully entering into the plastic surgeon’s armamentarium. Among the various types of skin substitutes, dermal substitutes (DSs) are the most used. Our study aims to retrospectively compare three renowned and extremely similar DS in the management of critical lower limb wounds in the largest cohort analysis currently present in literature. Materials and Methods: We followed a strict protocol of application and evaluation of the DS for each patient and wound and, after a meticulous bias reduction process, we compared final outcomes in terms of efficacy and speed in achieving the defect coverage. Results: Among patients who did not receive a skin graft after the DS, we registered a wound healed surface of 50% for Pelnac, 52% for Integra, and 19% for Nevelia, after 30 days from the external silicon layer removal; among those who received a skin graft after the DS, we observed a significantly lower mean percentage of graft take after 7 days with Pelnac (53%) compared to Integra and Nevelia (92% and 80%, respectively). The overall percentage of wound healed surface obtained after 30 days from the external silicon sheet removal, either with or without skin graft, was 71% for Pelnac, 63% for Integra and 63% for Nevelia. We also ran a sub-group analysis only including grafted wounds with a negative microbiological test and the mean percentage of graft take was similar this time. Eventually, we assessed the influence of the wound’s “chronicity” on its healing, comparing the mean graft take only in “acute” wounds who received a skin graft and it resulted 63% for Pelnac, 91% for Integra and 75% for Nevelia. Conclusions: Integra demonstrates the highest rate of skin graft viability and the highest rate of skin graft takes after 7 days. Pelnac shows the quickest induction of secondary healing in acute wounds. Nevelia is not different from Integra and shows a superior graft take compared to Pelnac, but features the lowest secondary healing induction rate. No differences exist between the three DSs in terms of wound healing after 30 days from the skin graft or from the removal of the external silicon layer.

Chronic Paronychia of Great Toe Treated with Excision of Nail Plate along with Surrounding Tissue and Split Thickness Skin Graft: An Observational Prospective Study

Paronychia is an inflammatory condition of alongside of nail of toe or finger. It is seen commonly in housewives and housemaids. Paronychia may be acute or chronic. Majority of patients with acute paronychia respond well to nonsurgical treatment. Patients with chronic paronychia of great toe do not respond to nonsurgical treatment. Patients suffer from chronic pain in finger or toe. Many treatment methods are available for chronic paronychia of great toe. All have merits, demerits, and different outcomes. This study is conducted to find out the outcome of a modified surgical technique in chronic paronychia of great toe of patients. This is a method adopted with a little modification of existing method.This study was conducted among 50 patients of chronic paronychia of great toe, who were between 15 to 55 years of age, from December 2019 to December 2020. These patients were operated and kept on follow-up for 1 year and observed for different outcomes likes skin graft take off, complete wound healing of operated area, relief from chronic pain of great toe, acceptance of cosmetic appearance, and recurrence of disease. Clinical data was recorded in case record form by examining the patient, asking questions to them, and conducting descriptive analysis. Results in terms of skin graft take off, complete wound healing of operated area, relief from chronic pain of great toe, acceptance of cosmetic appearance, and recurrence of disease were assessed during follow-up period. Postoperative result showed that 98% of patients had complete wound healing and complete graft take up, acceptance of cosmetic appearance was 94%, recurrence was 2%, and 90% were relieved from chronic pain of disease great toe. It was concluded that this was a better method for treatment of chronic paronychia of great toe.

Inlay butterfly versus underlay cartilage tympanoplasty

Background Tympanic membrane grafting is one of the most common otological procedures. Underlay technique of tympanoplasty was described by Shea in 1960. Utech in 1959 introduce the cartilage in middle ear surgery. The search for an ideal graft material and technique for tympanoplasty was adopted by numerous contributions from surgeons all over the world. Professor Roland Eavey in 1998 introduced a transcanal inlay technique which offers advantages of surgical ease and speed as well as patient comfort. Results This study included 46 patients; 23 patients had inlay butterfly myringoplasty (group A), and 23 patients had underlay cartilage tympanoplasty. In group A, 65 % of the patients had a completely healed tympanic membrane postoperatively. Mean AB gap closure was 3.94 db. In underlay group B, 82.6% of the patients had a completely healed tympanic membrane postoperatively. Mean AB gap closure was 4.7 db. These outcomes show no statistically significant difference between both groups in terms of graft take and hearing improvement (p > 0.1). Conclusions Inlay butterfly myringoplasty is an easy, reliable, and time saving procedure that should be possible as a choice to underlay procedure. Results are comparable with underlay technique in terms of graft take rate and hearing improvement. Procedure is better regarding diminishing operative time, postoperative pain, and duration before resuming usual activities.

Effect of Grafting Dates on Graft-take Success and Sapling Growth of Persian Walnut (Juglans regia L.) Under Open Field Condition of Jumla, Nepal

A field experiment was carried out at Horticultural Research Station, Rajikot, Jumla to determine the best grafting date of walnut for the highest graft-take success and sapling growth. The experiment was conducted during the two consecutive years 2017, and 2018. Two varieties namely ‘Hartley’ and ‘Payne’ and four different dates of grafting viz. 15th March, 22nd March, 29th March, and 5th April were used as the treatment and the experiment was laid out in split-plot design. Each treatment was assigned with ten grafts with five replications per treatment. The measured parameters for the experiments included graft-take success (%), final scion diameter (cm), growth on scion diameter (%), number of primary branches per plant, plant spread (cm), and number of leaf per plant. The pooled value of observation for two years showed highly significant effect of variety and grafting date on grafting-take. ‘Hartley’ variety showed maximum graft-take success (73.2%) and ‘Payne’ with the least success (54.0%). The pooled value of two successive years showed the highest graft-take success (70.0%) on 15th of March, significantly at par with 22nd March (64.5%) and 29th March (67.0 %) grafting. Grafting on 15th March was also superior in terms of number of leaves (31.7), and least was observed for grafting on 29th March (20.5). In essence, variety ‘Hartley’ was found to record higher graft-take success with 15th March as the optimum grafting date under Jumla condition.

Negative-pressure dressings in lower limb skin grafts: a randomised control trial of PICO versus standard dressings

Objective: Negative-pressure wound therapy (NPWT) can reduce the incidence of exudate and haematoma beneath a split-thickness skin graft (SSG) compared with traditional standard dressings. However, NPWT has not been universally adopted for lower limb SSGs despite evidence that its use is linked with improved graft take and a tendency towards early mobilisation. PICO (Smith and Nephew®), an ultra-lightweight NPWT device now available in Australia, can provide a smaller, more manageable NPWT dressing. The primary objective of this study was to compare lower limb graft take rate in PICO versus standard dressing groups, and a secondary objective was comparing quality of life (QOL) in these groups. Method: A prospective, randomised control trial was conducted of 71 lower limb wounds from 59 patients, with 36 wounds randomised to standard dressings and 35 to PICO dressings. Graft take was measured and expressed as a percentage of total wound area. Postoperative mobilisation day, patient comfort, complication frequencies, ease of dressing removal and QOL scores were also recorded. Results: The graft area percentage was not statistically significantly different between the PICO and standard dressing groups (p=0.054). All patients in the PICO group were mobilised by postoperative day one, but 8 per cent in the standard dressing group were still not mobilised by postoperative day five (PICO vs standard, p=0.003). There was no statistically significant difference in patient comfort, patient QOL or complication frequency in the PICO versus standard dressing group at any postoperative visit, but the PICO dressings were statistically significantly easier to remove (p=0.04). Conclusion: PICO dressings are not inferior or superior to standard dressings for lower limb SSGs.

Tissue healing

This chapter describes in detail the processes of acute and chronic wound healing, and how these can be influenced by the plastic surgeon. Wound healing as it is relevant to graft take is also described. The chapter also discusses hypertrophic and keloid scar formation.

A study to evaluate and compare the outcomes of endoscope versus microscope assisted myringoplasty

<p class="abstract"><strong>Background:</strong> In microscope assisted middle ear procedures surgeons can only observe the parts of the tympanic cavity, the hidden areas, such as the facial recess and sinus tympani, would not be visualised which needs to be exposed for performing tympanoplasty. The aim of the study was to compare the outcomes of microscope versus endoscope assisted myringoplasties in terms of duration of the procedure, graft take up, improvement in hearing and incidence of any complications.</p><p class="abstract"><strong>Methods:</strong> A prospective comparative study was conducted for a period of one year. A total of 72 patients with CSOM were randomised into two groups of 36 each. Group A patients (n=36) underwent traditional myringoplasty under a microscope and group B patients (n=36) endoscopic assisted myringoplasty was performed. Post-operatively all the patients were followed up for a period of one year. During the follow-up period patients were assessed for the graft take up, hearing improvement, incidence of complications and recurrence rate between the two groups.</p><p class="abstract"><strong>Results:</strong> Successful graft uptake was observed in 88.8% among patients underwent microscope assisted myringoplasty and it was 94.4% in endoscopic assisted myringoplasty. The mean duration of surgery was 123 mins in microscopic assisted group compared to 92 mins in endoscopic assisted group and the difference was found to be statistically significant. Similarly, the cosmetic results and the post-operative pain were more favorable for endoscopic assisted group than microscopic assisted group and the difference was found to be statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> Enoscopic assisted procedure could be considered as a better alternative for microscopic assisted myringoplasty.</p>

Mind the Gap: Alveolar Bone Graft Revision in the Era of Computed Tomography

Objective: To determine the rate of revision alveolar bone grafting (ABG) in patients with cleft lip and palate (CLP) before and after the introduction of postoperative computed tomography (CT). Design: Retrospective case–control study analyzing the incidence of revision ABG in patients with and without postoperative CT scans for graft success evaluation. Setting: Academic tertiary care pediatric hospital. Patients: Eighty-seven patients with CLP or cleft lip and alveolus treated with autologous iliac crest bone grafting for alveolar clefts over a 10-year period (January 2009 to March 2019) with minimum 6-month follow-up. Fifty patients had postoperative CT evaluation; 37 did not. Interventions: Postoperative CT to determine ABG success, versus standard clinical examination and 2-dimensional radiographs. Main Outcome Measures: Requirement for revision ABG, defined as failure of the original graft by clinical or radiographic examination. Results: Fifty-eight percent of patients underwent a postoperative CT scan at median interval of 10 months after surgery. Patients with postoperative CT evaluation had a 44% rate of revision ABG (22/50) for inadequate graft take, compared to 5% (2/37) in patients without postoperative CT ( P < .001; 95% CT, 31%-58% in the CT group, 1%-16% in the non-CT group). Conclusions: Computed tomography evaluation after ABG is associated with a significantly increased revision rate for inadequate graft take. The presence of a secondary palatal fistula at the time of original ABG is not associated with revision requirement. Lack of standardized dental and orthodontic records complicates the study of ABG outcomes and presents an area for systems-based improvement.