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Autologous fat grafting is a widely used technique in plastic and reconstructive surgery, but its efficacy is often limited by the poor survival rate of transplanted adipose tissue. This study aims to enhance the survival of fat grafts by investigating the role of thymosin beta-4 (Tβ4) in facilitating mitochondrial transfer from adipose-derived stem cells (ADSCs) to adipocytes and newly formed blood vessels within the grafts via tunneling nanotubes (TNTs). We demonstrate that Tβ4 upregulates the Rac/F-actin pathway, leading to an increased formation of TNTs and subsequent transfer of mitochondria from ADSCs. This process mitigates oxidative stress, reduces apoptosis, and promotes revascularization, thereby improving the quality and volume retention of fat grafts. Our findings provide a novel mechanistic insight into the enhancement of fat graft survival and suggest that mitochondrial transplantation and Tβ4 are potential therapeutic strategies to improve clinical outcomes in autologous fat transfer procedures. • Tβ4 treatment significantly enhances mitochondrial transfer from ADSCs to fat grafts via tunneling nanotubes. • Upregulation of the Rac/F-actin pathway by Tβ4 is crucial for facilitating mitochondrial transfer and improving fat graft survival. • Tβ4-induced mitochondrial transfer correlates with reduced apoptosis and increased vascularization in fat grafts. • Mitochondrial transplantation and Tβ4 are potential therapeutic strategies to promote fat graft longevity by modulating mitochondrial dynamics. [ABSTRACT FROM AUTHOR]

Background: Burn injuries are a major global health concern, especially when large areas of the body are affected, limiting the availability of healthy skin for autologous skin grafting. This makes traditional skin grafting challenging. Skin substitutes have been developed to address these challenges. To date, there is limited research on Pelnac dermal substitute use for treatment of acute deep dermal burn injuries. This study aims to evaluate the effectiveness of Pelnac dermal substitute in treating such injuries on the upper limb. Methods: This randomized control trial was conducted on 46 cases of acute burn injuries presented to the Kasr Al-Ainy Cairo University Hospital's burns unit from March 2021 to August 2022. The patients were divided into two groups: the Graft-Only Group, consisting of 23 patients, and the Pelnac Group, comprising 23 patients. The primary outcome was the graft take success rate. The secondary outcomes included scar quality assessment, functional outcomes, and patient satisfaction with aesthetic appearance and functional recovery. Results: In terms of coverage success, Graft only Group achieved 100% success rate, while Pelnac take was unsuccessful in the first 17 patients. Upon observing the first successful case, we noted that there was no dermis remaining after excision, prompting us to implement more thorough debridement from the outset to reach the subcutaneous fat or fascia. Consequently, the Pelnac coverage was successful in the subsequent four patients, with a 22.7% success rate, (followed by autografting as a second stage). In terms of scar quality improvement, as measured by the Vancouver Scar Scale, the Pelnac group had a significantly lower average VSS value (2.40∓1.52) compared to Graft Only Group (7.45∓1.68) with (P<0.001). Pelnac Group also had significantly higher patient satisfaction with aesthetic appearance compared to the graft-only group (P < 0.001). There were no significant differences between the two groups regarding patient satisfaction with functional recovery and the average DASH score (P > 0.05). Conclusions: Pelnac could be regarded as a promising modality for the treatment of acute full thickness burns and can be used in partial thickness burns, specifically in instances of major burns with extensive surface area damage. In these cases, more thorough debridement from the start, reaching a bed of fat or fascia, and then applying Pelnac to increase its take is essential, to serve as a protective cover for the wound bed where it helps to prevent fluid loss and contamination. Level of Evidence: Level I, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesions of the talus (OLTs) with a large subchondral cyst have been shown to have inferior clinical outcomes after reparative techniques. Replacement techniques such as autologous osteoperiosteal transplantation (AOPT) and autologous osteochondral transplantation (AOCT) are indicated for large lesions. The aim of the study was to compare the short-term clinical and radiographic outcomes between patients undergoing AOPT and those undergoing AOCT for large cystic OLTs. Methods: Patients who underwent AOPT or AOCT for medial large cystic OLTs between May 2019 and June 2023 were retrospectively evaluated. According to their characteristics, 1:1 propensity‐score matching was performed, and 65 pairs of patients with ages ranging from 18 to 60 years old were recruited. Clinical outcomes were compared between both groups with the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Visual Analogue Scale (VAS). The Ankle Activity Score (AAS), time to return to sports activity (RTA), rate of return to sports level, complications, and results of a subjective evaluation were also collected. The integrity of subchondral bone and the quality of repaired cartilage were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score 12 months postoperatively. Second-look arthroscopy was performed 12 months postoperatively, and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society (ICRS). Results: The within-group comparison showed significant improvements in pain severity and function in both groups post-treatment compared with pre-treatment. Between-group analysis, however, showed no significant statistical difference between groups in any of the variables for clinical and radiographic outcomes, except for donor-site morbidity of the AOPT group, which showed a better outcome compared to the AOCT group. Conclusions: In the treatment of large cystic OLTs, for patients with a chondral lesion of the patellofemoral joint that is unsuitable for AOCT, AOPT may be a safe and effective choice, with lower donor-site morbidity of the normal knee joint. [ABSTRACT FROM AUTHOR]

Background: Subchondral bone cysts (SBCs) can significantly impact the outcomes of cartilage repair procedures such as autologous chondrocyte implantation (ACI). However, the etiology and progression of SBCs following ACI remain poorly understood. This case report highlights a progressively enlarging SBC following ACI using all-suture anchors, treated with autologous osteochondral transplantation (AOT). Case presentation: A 58-year-old female with progressive right knee pain, varus alignment, and Kellgren-Lawrence grade 3 osteoarthritis underwent atelocollagen-associated ACI combined with medial opening wedge high tibial osteotomy. Longitudinal radiological assessment revealed bone hole enlargement corresponding to all-suture anchor sites, with one hole continuing to expand up to 15 months postoperatively, reaching a size of 11 × 13 × 13 mm. This expanding SBC exhibited a connection to the joint cavity via a tiny fissure, scant osteosclerotic rim on CT, and fluid intensity on MRI. Histological analysis of tissue obtained during subsequent AOT revealed several findings. The SBC was located at the anterior portion of the medial femoral condyle, just beneath the all-suture anchor. Osteochondral necrosis was observed surrounding the anchor site, with no evidence of foreign body reaction. The cyst was filled with a mucoid substance and featured an aggregation of foamy macrophages. A sclerotic wall indicative of a strain response was observed. Notably, the presence of osteoclasts along the adjacent bone surface indicated ongoing bone resorption. The patient underwent AOT, which resulted in confirmed bone union. Postoperative follow-up demonstrated successful integration of the osteochondral graft and improved knee function scores over three years. Conclusion: This case report documents SBC formation following knee surgery with all-suture anchors and provides histological evaluation of such a cyst. The observed histological findings may contribute to our understanding of SBC pathophysiology in the context of cartilage repair procedures. This case underscores the importance of secure suturing techniques in high-stress areas and suggests the potential benefit of extended post-operative monitoring of SBC progression beyond one year. These observations may inform future strategies for the early detection of SBC formation and its progression, as well as timely intervention to prevent further joint damage in similar cases, though further research is needed to establish broader clinical implications. [ABSTRACT FROM AUTHOR]

Kidney autotransplantation is a surgical procedure with multiple indications and advancing technological approaches. Kidney autotransplantation is used to address complex kidney-related diseases including renal vascular lesions, ureteral diseases, tumors, loin pain-hematuria syndrome, and conditions affecting a solitary kidney or both kidneys. Renal artery lesions, including aneurysms and stenoses, often necessitate kidney autotransplantation in cases involving renal artery bifurcation or distant failure of endovascular repair. Complex ureteral lesions such as ureteral avulsions are commonly treated with kidney autotransplantation. Renal tumors, especially centrally located tumors or those involving the renal hilum, are treated using this technique while preserving renal function. It is worth emphasizing that this would be a rarely used last-resort technique in the modern era of minimally invasive nephron-sparing surgery. Kidney autotransplantation may be indicated for the rare condition of loin pain-hematuria syndrome when conservative measures fail. Additionally, individuals with solitary or bilateral kidney disease benefit from kidney autotransplantation to preserve their renal function. Traditional open-kidney autotransplantation involves renal extraction, workbench repair, and renal reimplantation. Technological advancements have introduced minimally invasive techniques including laparoscopic- and robot-assisted kidney autotransplantation, which reduce surgical trauma and recovery times. These techniques have shown promising outcomes, and robotic platforms have the potential to further reduce complications. In this study, we reviewed diverse indications and recent technological innovations in the field of kidney autotransplantation. [ABSTRACT FROM AUTHOR]

Background: A total of 50% of patients with AL amyloidosis have t(11;14) translocation, allowing us to use the selective oral BCL-2 inhibitor venetoclax in their treatment. Case presentation: Our patient was admitted to the gastroenterology department due to weight loss and abdominal pain. An abdominal CT scan revealed some enlarged lymph nodes; therefore, he was referred to the hematology department. A bone marrow biopsy showed massive amorphous amyloid deposition. The sample was positive on Congo red staining and exhibited double refraction under a polarized light microscope. Serum-free light chains and the difference between involved and uninvolved free light chains (dFLCs) were elevated. Using fluorescent in situ hybridization, we detected t(11;14) translocation. Further examinations confirmed the involvement of the liver, colon and heart. Stage II AL amyloidosis was confirmed. Our patient received combined induction therapy with CyBorD and venetoclax due to the presence of the t(11;14) translocation. After six cycles, the patient achieved complete remission. Autologous stem cell transplantation (ASCT) was performed. At 100 days post-ASCT, the patient had complete hematologic remission. Venetoclax maintenance treatment was initiated. The follow-up examinations showed that the patient is in very good partial remission. Conclusions: In the case of our AL amyloidosis patient with t(11;14) translocation, the combined treatment with CyBorD and venetoclax was well tolerated and effective. [ABSTRACT FROM AUTHOR]

Objective: To systematically evaluate the efficacy of culture and nonculture autologous melanocyte transplantation and other methods for stable vitiligo. Methods: PubMed, Embase, WebofScience, TheCochraneLibrary, Chinese Journal Full-text Database (CNKI), VIP Chinese Scientific Journal Full-text Database (VIP), Wanfang database, were included in the clinical study of autologous cell transplantation for the treatment of stable vitiligo. For the meta-analysis of the corresponding studies with Revman5.3 software. Results: 17 high-quality studies were included in this meta-analysis, totaling 1199 patients, Meta-analysis showed that there was no significant difference in the efficacy of autologous cultured melanocytes transplantation (CMT) and melanocytes + keratinocytes, CMT and autologous nonculture suspension transplantation (NCES) in stable vitiligo (P > 0.05); There was a significant difference between CMT and CMT + phototherapy in stable vitiligo (P < 0.00001); There was no significant difference in the efficacy of NCES and NCES + other components, NCES and NCES + other therapies, and NCES and NCES + phototherapy for stable vitiligo (P > 0.05); There was a significant difference in the efficacy of cell transplantation and cell transplantation and cell transplantation + other therapy, cell transplantation and cell transplantation + phototherapy,cell transplantation and cell transplantation + narrow spectrum ultraviolet (NBUVB) in stable vitiligo (P < 0.00001). Conclusion: Both NCES and CMT transplantation treated stable vitiligo and had no direct relationship with the components contained in the suspension. Melanocyte transplantation and melanocyte transplantation combined with other treatment methods is better than single melanocyte transplantation for vitiligo. Due to the number and quality of included studies, the above conclusions need to be confirmed by more reasonably designed randomized controlled clinical studies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety, reliability, and effectiveness of bioceramic rods (BR) in treating osteonecrosis of the femoral head (ONFH), compared with other treatments such as core decompression and autologous bone grafting. Design: Systematic review and meta-analysis. Data sources: Pubmed, Embase, and CNKI databases from January 2011 to July 2023. Eligibility criteria for study selection: Included studies involved patients treated with bioceramic rods. Studies were required to have a follow-up time of more than six months and no statistically significant differences in baseline information between groups in controlled studies. Exclusions included literature reviews, case reports, conference abstracts, animal experiments, and studies without defined success criteria or lacking analysis on factors influencing efficacy. Main outcome measures: The primary outcome measure was the Harris Hip Score (HHS) improvement rate. Secondary outcomes included the femoral head stability and survival rate, alongside the hip replacement rate. Results: The systematic review revealed significant improvements in symptom relief and functional recovery using BR for the treatment of ONFH. An average follow-up of 20.44 months showed an overall HHS improvement rate of 33.93%. Hip preservation efficacy with BR was superior to core decompression and autologous bone grafting. The overall femoral head survival rate was 84.42%, with results sustained for three years. The success rate of hip preservation was notably higher with early intervention, which showed better outcomes when the overall HHS improvement exceeded 27%, and rates of excellent and good outcomes approached 90%. Conclusions: Bioceramic rods offer a safe, minimally invasive, reliable, and effective treatment option for ONFH, ensuring substantial symptom relief and functional recovery. The technique's success in early disease stages suggests a strong potential for broader clinical adoption. Although additional benefits from combining BR with stem cells, platelet-rich plasma, and traditional Chinese medicine are noted, definitive conclusions on enhanced therapeutic effects remain inconclusive. [ABSTRACT FROM AUTHOR]

Purpose: To perform a systematic review and meta-analysis exploring the effectiveness of porcine small intestinal submucosa (pSIS) compared with autologous grafts for tympanic membrane perforation repair. Methods: A prospective meta-analysis protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews) on June 5th, 2024, under protocol CRD42024551979. PubMed, Embase/Ovid and Cochrane Central databases were searched from inception to 28/05/2024 for studies comparing the use of pSIS versus autologous grafts (perichondrium, cartilage, temporalis fascia or cartilage-perichondrium) for tympanic membrane perforation repair. The outcomes evaluated were persistent perforation after surgery, operative time and hearing outcome. Statistical analyses were performed using the online Review Manager (Cochrane Collaboration). A subgroup analyses were carried out for the paediatric population. Results: We included 1,407 patients (1447 ears) from seven records; six retrospective cohort studies and one randomised controlled trial (RCT). pSIS graft was used in 563 ear surgeries (38.1%). Four studies included children with a mean age ranging from 7.3 to 11.7 years and the other 3 studies included adults with a mean age ranging from 30.8 to 48.4 years. Follow-up ranged from 2 to 132 months. There was no statistically significant difference in the failure rate (persistent perforation) between pSIS graft and autologous graft (RR 0.95; 95% CI 0.67–1.33; p = 0.76). However, reduced operative time was associated with using pSIS grafts (MD -16.12 min; 95% CI -22.94-9.31; p = < 0.00001). Conclusion: Tympanic membrane perforation repair with pSIS grafts had a similar failure rate and hearing outcome compared to autologous grafts and demonstrated an association with reduced operative time. [ABSTRACT FROM AUTHOR]

The presence of sufficient bone volumes is one of the most important criteria for the success of oral implant osseointegration. Therefore, the rehabilitation of edentulous atrophic maxillae represents the greatest challenge in terms of oral rehabilitation. Techniques such as bone grafts, angled implants, short implants, tuberosity, and pterygoid implants may not always be a viable alternative in the subsequent rehabilitation of the posterior atrophic maxilla. A breakthrough occurred when Brånemark first introduced longer, custom-designed implants inserted into the zygomatic bone to support craniofacial prosthesis in the 1980s. When used in the treatment of atrophic jaws, zygomatic implants provide a safe and effective alternative, with stable long-term results. Objectives: We aimed to retrospectively evaluate zygomatic bone resorption ten years after the placement of zygomatic implants. Methods: A retrospective observational study was designed to evaluate bone resorption over ten years following the placement of zygomatic implants. In a study group of 50 patients, using Hounsfield scales, the area of the zygoma and its bone density were established and evaluated. The NewTom NNT Analysis software (NewTom®, Imola, Italy) was employed to trace the bone and implant limits on CBCT scans. Using this software, the three-dimensional information of the postoperative CBCT image was compared with the ten-year postoperative CBCT image, allowing for the assessment of the zygomatic bone resorption and bone density. Results: Highly significant statistical differences to an alpha level of 0.01 were identified between T0 (pre-op), T1 (12 months), and T2 (120 months) concerning zygomatic bone density, both in the first and in the second quadrants. The post hoc Bonferroni test revealed that significant statistical differences were observed between T0 and the remaining timepoints (T1 and T2), with the latter two exhibiting similar values. Conclusions: The evaluation of the resorption at the level of the zygoma, ten years after the placement of zygomatic implants, reveals that there are no significant losses between the initial and final controls. Therefore, it follows that this type of implant rehabilitation represents a viable alternative approach in patients with bone atrophy of the maxilla, offering a predictable therapeutic solution that enables immediate full function and excellent long-term success rates. However, we must not neglect the potential for future innovations in GBR involving the use of barrier membranes, either resorbable or non-resorbable, and even the application of titanium alveolar customized osteogenic scaffold, in conjunction with autologous bone grafts or biomaterials. [ABSTRACT FROM AUTHOR]

Objectives: This prospective clinical study investigated the efficacy of adjunctive antibiotic therapy (doxycycline) and the patient's risk factors during initial healing of autogenous canine tooth transplantations. Methods: Sixty-seven patients (ranging from 11 to 37 years of age) treated with tooth transplantations were allocated to three parallel groups based on the tooth's intraoperative extraoral storage time (EST 0–3, 4–6, and 7–15 min) receiving different antibiotic regimens: (1) no antibiotics; (2) intraoperative intravenous (i.v.) single-shot antibiotics; and (3) intraoperative i.v. single-shot plus postoperative oral antibiotics for five days. Initial healing was rated according to pain intensity and clinical signs of pathology over a 21-day period. The influence of the following parameters was investigated using RStudio (linear regression and partial eta squared statistics): group, sex, age, nicotine abuse, tooth apex condition, preoperative ankylosis, displacement severity, jaw location, the number of simultaneous transplantations and other interventions, preoperative orthodontic extrusion, EST, and intraoperative complications. Results: No significant influence for sex (43 females, 24 males), tooth apex condition (19 open, 48 closed), displacement severity, jaw location (51 upper, 16 lower jaw), EST (mean 4.99 min), intraoperative complications (n = 13), or antibiotic regimen on pathology signs or pain intensity were found. Six patients reported medication side effects. Preoperative ankylosis (n = 15) and unsuccessful orthodontic extrusion (n = 16) increased postoperative pain (p = 0.020, ηP2 = 0.08; p = 0.035, ηP2 = 0.07). Multiple transplants (n = 14) and interventions in multiple regions (n = 27) affected pain and pathology (p = 0.002, ηP2 = 0.14; p = 0.001, ηP2 = 0.17). Increased age and nicotine abuse (n = 6) were associated with increased pathology signs (p = 0.024, ηP2 = 0.08; p = 0.029, ηP2 = 0.07). Conclusions: The results suggest that personalized rather than routine antibiotic therapy might be sufficient for initial healing in canine tooth transplantation. Deteriorating factors include preoperative ankylosis, orthodontic extrusion, an increased number of surgical sites, age, and nicotine abuse. Clinical Significance: Routine antibiotic prevention regimes may not be mandatory for initial healing in autogenous tooth transplantation, but a nuanced antibiotic strategy tailored to each patient's specific risk factors, which is in line with the principle of antibiotic stewardship, is needed. [ABSTRACT FROM AUTHOR]

To engineer an acellular mesh to reconstruct the urethra to replace the current surgical practice of using autologous tissue grafts. Cell based approaches have shown progress. However, these have been associated with high costs and logistical challenges. Acellular meshes were engineered using liquid collagen. They underwent in vitro, mechanical and bench testing by surgeons. Sixty-nine male New Zealand rabbits were used to refine the design. The final prototype based on the TissueSpan patented technology was then implanted again in a 2 cm long urethral defect in 9 rabbits and in a 4 cm long defect in 6 dogs. The TissueSpan technology platform allows for the manufacturing of tubular and rectangular meshes in different diameters and thicknesses. The tubular mesh acted as physical conduit to gap the urethral defect with a patent urethra demonstrated after 1 month in both animal models. The mesh was absorbed within 1-3 months. Spontaneous urothelial coverage of the mesh and smooth muscle cell migration into the surgical area was demonstrated even in a 4 cm long urethral defect. A first in man clinical trial was subsequently initiated. The acellular mesh may have the potential to be an off-the-shelf product for substitution urethroplasty. Its mechanical properties allow surgeons to easily create a physical conduit while its material properties favor tissue remodeling. A large-scale clinical trial is still required to further confirm the safety, performance, and patient benefit of this new medical device. [ABSTRACT FROM AUTHOR]

Background: Autologous fat grafting (AFG) often needs multiple sessions due to low volume retention. Young adipose tissue demonstrates a more pronounced therapeutic effect; thus, the cryopreservation of adipose tissue of young origin is particularly crucial. This study investigated the protective effect of a new cryopreservation solution combining trehalose, glycerol, and metformin on adipose tissue. Methods: This study initially examined the effect of various concentrations of metformin (0, 1, 2, 4, and 8 mM) on oxidative damage in adipose tissue to identify the optimal concentration. Subsequently, 1.5 mL of fresh human adipose tissue was subjected to freezing using trehalose + glycerol (TG group), trehalose + glycerol + metformin (TGM group), and the common cryoprotectant dimethyl sulfoxide (DMSO) + fetal bovine serum (FBS) (DF group). Samples were cryopreserved in liquid nitrogen for 2 weeks. After thawing, 1 mL of adipose tissue from each group was transplanted subcutaneously into the backs of nude mice. The cryoprotective effects on adipose tissue viability were evaluated during transplantation one month after transplantation. Results: The 2 mM concentration of metformin exhibited the lowest reactive oxygen species (ROS) level (29.20 ± 1.73) compared to other concentrations (P < 0.05). Cell proliferation and migration assays also supported the superior performance of the 2 mM concentration. Apoptotic analyses of stromal vascular fraction (SVF) cells showed the lowest levels in the 2 mM group. Compared to other cryopreservation groups, the adipose tissue in the TGM group closely resembled fresh adipose tissue in terms of gross structure and histological characteristics, with the lowest apoptosis rate of SVF cells. In vivo analysis revealed the highest tissue retention rate in the TGM group, with histological examination indicating robust structural integrity. Conclusion: The TGM cryopreservation solution, containing metformin, greatly preserves adipose tissue, reduces apoptosis, and improves tissue retention rates. This solution was non-toxic and safe, making it well-suited for tissue cryopreservation in clinical settings. [ABSTRACT FROM AUTHOR]

AbstractMinimal residual disease (MRD) has emerged as an important prognostic maker in patients with multiple myeloma at different stages of their treatment. Moreover, it is being increasingly incorporated as an endpoint in various clinical trials. Since maintenance therapy is an integral part of myeloma treatment, especially in the upfront setting post autologous transplantation, it is imperative to understand the role of MRD testing in the maintenance stetting. This review aims to examine the utility and dynamics of MRD testing in order to elucidate its prognostic role and possible incorporation in clinical decision making processes. [ABSTRACT FROM AUTHOR]

The skin functions as the body's primary defense barrier; when compromised, it can lead to dehydration, infection, shock, or potentially life-threatening conditions. Miniature pigs exhibit skin characteristics and healing processes highly analogous to humans. Mesenchymal stem cells contribute to skin injury repair through a paracrine mechanism involving exosomes. This research examines whether adipose-derived MSC exosomes effectively enhance healing following autologous skin grafting in miniature pigs. It also compares the roles and distinctions of ADSCs and ADSC-Exos in inflammatory responses and tissue regeneration. This study found significantly reduced levels of oxidative stress products and pro-inflammatory factors, while antioxidant factors, anti-inflammatory factors, and pro-regenerative factors were elevated, and anti-regenerative factor levels decreased. Moreover, the expression levels of key markers—namely, PI3K, Akt, and mTOR—in the regeneration-associated signaling pathway were increased. The alterations in these indicators indicate that ADSC-Exos can regulate inflammatory responses and promote regeneration. This study provides a novel theoretical foundation for the implementation of acellular therapy in clinical settings. [ABSTRACT FROM AUTHOR]

Background/Objectives: Combining autologous fat grafting with implant placement is meant to improve the quality of implant-based breast reconstruction. The present study explores the concept of multi-stage composite breast reconstruction with repeated sessions of autologous fat grafting to increase mastectomy flap thickness and provide better pre-pectoral implant coverage. Methods: Twenty-five consecutive patients underwent bilateral multi-stage composite expander-to-implant breast reconstruction and reverse expansion from August 2020 to April 2024. Subcutaneous thickness of the mastectomy flap was evaluated in predefined regions of interests of the breast on standardized MR images at two timepoints (before the first fat grafting session, with the tissue expander fully inflated, and 3 months after implant placement). Furthermore, the incidence of complications requiring surgery and implant-related complications were evaluated. All values are expressed as mean ± standard deviation, accepting statistical significance for a p-value < 0.05. Results: Patients underwent an average of 2.5 ± 0.6 fat grafting sessions, with a fat injection volume of 170 ± 60 mL per breast per session. The mean duration of the reconstructive process from mastectomy to final implant placement was 12 ± 5 months and the mean follow-up was 17 ± 8 months. The overall thickness of both breasts amounted to 190% of baseline thickness and was significantly higher in the upper breast quadrants than in the lower quadrants (p < 0.05). Tissue thickness increase correlated well with the number of fat grafting sessions and was independent of the patient's weight gain. Complications requiring surgery occurred in eight breasts during the reconstruction, with iatrogenic expander puncture being the most frequent (three cases, 6%). During follow-up, only one implant-related complication was observed (one case of bilateral rippling, 4%). No breast animation or symptomatic capsular contracture were observed. Conclusions: Multi-stage pre-pectoral composite expander-to-implant breast reconstruction using autologous fat grafting is an effective concept for breast reconstruction. Despite the need for multiple surgeries, the significant increase in subcutaneous tissue thickness, resulting in better soft tissue coverage, compensates for the longer reconstructive process. [ABSTRACT FROM AUTHOR]

Aim: This study aims to evaluate the management of oro-antral communications (OAC) and fistulas (OAF), focusing on treatment strategies based on defect size, epithelialization, and the presence of sinus infections, while exploring both traditional and emerging techniques. Materials and Methods: The systematic review was conducted following the PRISMA guidelines and registered on PROSPERO (CDR ID 623251). Using targeted keywords, articles in English published within the last 10 years were analyzed from databases such as PubMed, WoS and Scopus, selecting only clinical studies on human patients. After thorough screening, 20 publications were included in the qualitative analysis, among 734 initially identified. Results: Small OACs (<5 mm) were managed conservatively with hemostatic materials, while larger defects (>5 mm) required surgical closure, with the Bichat flap proving highly effective for large defects. Innovative treatments using autologous bone grafts and PRF showed promise in supporting tissue regeneration. In cases with sinusitis, the combination of FESS and intra-oral closure techniques resulted in high success rates for infection resolution and defect closure. Conclusions: Treatment outcomes for OAC and OAF are highly dependent on the size of the defect and the presence of sinusitis. Multidisciplinary collaboration, along with timely surgical intervention and adherence to medical therapies, is essential for successful management. Emerging techniques and minimally invasive procedures continue to improve patient outcomes, offering hope for more effective and sustainable solutions in complex cases. [ABSTRACT FROM AUTHOR]

Background: Quest for finding ideal graft material for covering dural defect continues. Dura mater (DM)/pachymeninges consists of two layers; hence possibility of splitting this layer has been explored. Objective: Microsurgical splitting of dura into two layers for covering the dural defect. Materials and Methods: Splitting of DM with number 15 surgical blade was carried out on ten cadavers. Splitting the dura into two distinct layers was possible in every specimen paving way for implementing in routine neurosurgical practice. This technique was implemented in covering accidental dural defects in seven cases with defects ranging from 1 cm to 3.5 cm. All cases were followed up for potential complications in the long run. Results: Harvesting autologous dural graft by splitting it into two layers was possible with number 15 scalpel in autopsy specimen and routine neurosurgical practice. All dural defects were repaired without any complication with follow-up of more than 1 year. Conclusions: Best replacement of dural defect is by dura itself. The technique of harvesting autologous dura by splitting into two layers is easy, inexpensive, and devoid of all graft-related complications found till date. Splitting of dura is technically demanding but possible in small- to medium-sized dural defects. This technique has inherent limitations arising due to the amount of surrounding dura available depending on the size of craniotomy and the size of the dural defect. This procedure cannot become a substitute for cases requiring the extensive sacrifice of the dura, especially during meningioma surgery. This technique emphasis value of good microsurgical techniques. [ABSTRACT FROM AUTHOR]

Background: Permanently replacing missing teeth in the younger population is a clinical challenge. However, dental autotransplantation offers a viable treatment option in this demographic. To be performed predictably, it requires proper diagnoses, planning, and adherence to established guidelines in a multidisciplinary approach. Such guidelines should use evidence-based dentistry to anticipate and limit complications. The aim of this study is to evaluate the current literature on dental autotransplantation, discuss an evidence-based protocol, highlight steps for minimizing complications, and present a case report on two autotransplantations conducted at the Graduate Periodontology clinic at the University of North Carolina at Chapel Hill, Adams School of Dentistry, in the context of representative cases. Methods: A literature search using PubMed was conducted with the goal of constructing a comparative table on both survival and success rates of autotransplantation, providing a comparison of protocols and clinical studies and informing this narrative review. This review is illustrated by cases with the intention to highlight critical steps, limitations, and strengths of this mode of treatment. Results and Conclusions: Given the information presented, it is concluded that autotransplantation is a valuable treatment option provided established guidelines are followed. It is particularly useful for the younger population where implants or other options are not appropriate or feasible. This study also highlights some of the gaps in knowledge in autotransplantation which present opportunity for further studies to be developed. [ABSTRACT FROM AUTHOR]

The advent of liposuction has driven the development and advancement of autologous fat grafting techniques. However, the absorption rate of grafts after fat tissue transplantation is high and often requires multiple surgeries. Long-term freezing of autologous fat tissue can reduce the number of liposuction, improve the efficiency of the treatment, and realize the possibility of “one liposuction, multiple transplantation”. Therefore, adipose tissue freezing technology is of great clinical significance for autologous fat grafting treatment. This paper reviews the research progress of adipose tissue cryopreservation protocol, and clarifies the challenges and directions of the current research, so as to provide reference for the subsequent research. [ABSTRACT FROM AUTHOR]

Purpose: Parathyroidectomy is beneficial in tertiary hyperparathyroidism (THPT) consequent to chronic renal failure. The craniofacial morphology of patients who undergo total parathyroidectomy and autologous transplantation (tPTX + AT) has not been widely studied. This study assessed the efficacy of tPTX + AT in THPT and evaluated possible improvements in craniofacial features. Methods: This retrospective analysis included patients who were diagnosed with medically refractory THPT and had undergone tPTX + AT between September 2013 and May 2021. The VAS was used to evaluate improvements in various symptoms including bone pain and pruritus. Changes in serum calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (iPTH) levels were also assessed. The impact of the procedure was assessed by comparing two-photon X-ray bone mineral density measurements obtained 1 year before and after surgery. Results: The VAS of pain and pruritus decreased significantly on the first postoperative day (P < 0.05). Calcium levels changed significantly (from 2.50 ± 0.22 mmol/L to 2.10 ± 0.26 mmol/L) on postoperative day 1 (P = 0.0000); iPTH levels also declined substantially on this day, reducing from 211.00 (122.10, 252.80) to 5.04 (2.96, 9.40) pmol/L. Bone mineral density increased significantly across various regions including the greater trochanter of the femur, intertrochanteric area, total hip, and third lumbar vertebra (P < 0.05). The angles between the upper incisor and mandibular plane and the lower lip and Ricketts E line (drawn from the tip of the nose to the soft tissue area) also improved (P = 0.043, P = 0.001). Conclusion: Total parathyroidectomy and autologous transplantation can rapidly alleviate bone pain and skin itching in THPT. It may also improve bone density and facial soft tissue. [ABSTRACT FROM AUTHOR]

Background and Aim: Cranial cruciate ligament (CrCL) injuries are a prevalent orthopedic issue in dogs, typically managed through surgical interventions such as tibial plateau leveling osteotomy and tibial tuberosity advancement. However, these techniques have limitations, including high costs and extended recovery periods. This study introduces an innovative CrCL repair method employing an autologous lateral digital extensor muscle tendon graft and evaluates the effects of plateletrich plasma (PRP) on tissue healing. Materials and Methods: Twenty-four healthy, male, local-breed dogs were divided into two groups. Group A underwent the surgical procedure without PRP, while Group B received intra-articular PRP during surgery. Outcomes were evaluated through clinical assessments of lameness, post-operative complications, and histological analysis over 10, 20, 30, and 40 days. Results: The PRP-treated group demonstrated statistically significant improvements in post-operative complication scores (p = 0.0025) and histological outcomes (p = 0.0002). However, graft maturation was unaffected by PRP treatment but improved over time (p = 0.0013). PRP-treated dogs exhibited faster recovery and enhanced tissue regeneration, with reduced inflammation and improved graft-bone attachment. Conclusion: This novel surgical approach demonstrates significant potential for improving outcomes in CrCL repair by combining autologous tendon grafting with PRP. The technique offers reduced complications and enhanced healing, providing a promising alternative to traditional methods. Further studies are recommended to validate its efficacy in clinical settings. [ABSTRACT FROM AUTHOR]

Bone reconstruction in the maxillofacial region typically relies on autologous bone grafting, which presents challenges, including donor site complications and graft limitations. Recent advances in tissue engineering have identified highly pure and proliferative dedifferentiated fat cells (DFATs) as promising alternatives. Herein, we explored the capacity for osteoblast differentiation and the osteoinductive characteristics of extracellular vesicles derived from DFATs (DFAT-EVs). DFATs were isolated from human buccal fat pads, cultured to confluency, and placed in either a standard or osteogenic induction medium. After culturing for 3 days, the conditioned medium was used to generate EVs using the size-exclusion chromatography and concentration filter method. Characterization of DFAT-EVs revealed typical EV morphology and positive markers (CD9 and CD63), with no differences between the two groups. In vitro assays demonstrated that EVs derived from the osteogenic induction medium (OI-EVs) significantly increased alkaline phosphatase activity and osteogenesis-related genes (Runx2 and collagen type I) compared to control EVs. Next-generation sequencing identified differentially expressed miRNAs, and gene ontology analysis suggested pathways involved in osteoblast differentiation. Isolating DFATs from buccal fat pads under osteogenic induction conditions offers a procedure confined to the oral cavity, eliminating the need for harvesting from other sites. Thus, DFAT-EVs hold promise for promoting bone regeneration in maxillofacial applications. [ABSTRACT FROM AUTHOR]

Excess bone resorption is commonly found when teeth are extracted or lost. This is a problem in the anterior teeth region because it will result in an unsightly long pontic on a narrow, hollowed-out ridge. Special techniques have been developed to treat problems of vertical and horizontal ridge resorption. This case describes a simple method to improve a localized horizontal buccal ridge defect and create an emergence profile in relation to the anterior maxillary teeth region, prior to the fabrication of a fixed partial denture. This technique involved the use of an autogenous bone graft and enriched bone graft matrix (also known as 'sticky bone') for hard tissue augmentation, so as to obtain a natural form and maintain a healthy periodontium. [ABSTRACT FROM AUTHOR]

Background: Autogenous tooth transplantation offers significant advantages and promising success rates for replacing non-retainable teeth. This study aimed to investigate the prognostic factors, especially the impact of root canal treatment (RCT), of autotransplanted teeth in an up-to-6-year follow-up cohort of 167 teeth in Southern China. Methods: We enrolled adult patients from the Southern Medical University-Shenzhen Stomatology Hospital between 2017 and 2023. Patients underwent autogenous tooth transplantation to replace non-retainable molars with upper or lower third molars with Moorrees tooth development stage ≥5. All surgical procedures were performed by an experienced surgeon. The included patients were followed up for 6~72 (median 28.5) months. Success, failure, and survival rate and prognostic factors were evaluated using univariable Kaplan-Meier, multivariable generalized linear regression, and multivariable COX regression analyses. Results: The overall success rate is 97.6% with four unsuccessful cases. Herein, two of them were removed, leading to an overall survival rate of 98.8%. A total of 159 cases (95%) received RCT in 3 months. Univariable log-rank analysis showed that RCT (RR 0.109, 95%CI 0.010 to 1.202, P = 0.028) and site relationship between donor and receipt sites (RR 3.359, 95% CI [1.210–9.329], P = 0.020) were two significant prognostic factors of autotransplanted teeth. Multivariable generalized linear regression revealed that RCT is the only significant factor protecting the success rate of autotransplanted teeth (HR 0.003, 95% CI [0.000–0.249], P = 0.010). However, in the Cox regression model, the effects of RCT (HR 0.009, 95% CI [0.000–2.514], P = 0.101) did not reach statistical significance. Other factors did not demonstrate a significant impact in this cohort. These results supported that autogenous tooth transplantation is a viable alternative to conventional implant treatment with strict indications. Our findings underscore the importance of RCT in transplanted teeth with closed or semi-closed apices. Multi-center observational studies with larger sample size and extended follow-up duration may be needed to validate the conclusion. [ABSTRACT FROM AUTHOR]

Purpose: Thyroidectomy is the treatment of choice for malignant thyroid diseases as well as for benign conditions who cannot be treated medically. The most common complication following thyroidectomy is hypocalcaemia and hypoparathyroidism that usually results from accidental damage or removal of one or more parathyroid glands. Parathyroid gland autotransplantation has been one of the most common intraoperative strategies applied to tackle this problem. The aim of this study is to assess whether parathyroid auto trasnplantation is associated with a decrease in postoperative hypoparathyroidism following thyroidectomy. Methods: We conducted a thorough systematic review and meta-analysis of relevant studies published up to February 2024 in MEDLINE, Scopus, Embase and Cochrane Library databases. We compared the incidence of postoperative hypoparathyroidism between the group of patients who underwent autotransplantation and the patients were the parathyroid glands were preserved in situ. A trial sequential analysis was performed subsequently to confirm the findings. Results: Eighteen studies fulfilled all the inclusion criteria and were ultimately included in our study. The total number of patients was 8,182 with 4,029 receiving parathyroid gland autotransplantation. Autotransplantation was associated with a higher incidence of immediate (within 24 h) and transient hypoparathyroidism (RR 1.58, 1.45–1.73, CI 95%, p < 0.00 and RR 1.60, 1.47–1.76, CI 95%, p < 0.001, respectively). However, it did not affect the rate of permanent postoperative hypoparathyroidism (RR 0.85, 0.51–1.41, CI 95%, p = 0.54). The subsequent trial sequential analysis confirmed these findings. Conclusion: Parathyroid autotransplantation does not lead to a decrease in the rate of permanent post-thyroidectomy hypoparathyroidism. The most important factor to decrease its incidence remains the accurate identification and preservation of the parathyroid glands intraoperatively. [ABSTRACT FROM AUTHOR]

Effective burn surgery is based on two fundamental principles: prompt excision of necrotic tissue and definitive coverage, preserving functional dermis and body contour. There is often compromise, either prioritizing the urgency of excision or opting for patient stability and optimal conditions prior to autografting. We propose a surgical concept that addresses this critical treatment gap. In 2022, we implemented a new three-phase protocol, EDM: (Excision phase, E) Immediate excision of the burn wound preserving body contour; (Dermis phase, D) definitive temporization of the wound bed, using biodegradable temporizing matrix, to prepare it for successful grafting. Upon complete dermal temporization, full autologous coverage in a single micrografting procedure is achieved (Meek phase, M). We performed a retrospective single-center cohort study to characterize the EDM protocol compared to the prior standard of care (>40% TBSA, n = 5 in EDM vs n = 10 matched controls). Primary outcomes were total surgeries required, total surgeries to achieve>90% healing, uninterrupted recovery time without surgery, and time on mechanical ventilation. The EDM group required fewer surgeries in total (5 vs 9.5; P =.01) and to achieve>90% healing (3 vs 6.5; P =.001). EDM patients experienced longer uninterrupted recovery (25 vs 13 days, P =.001). Additionally, EDM patients spent less time on mechanical ventilation (210 vs 1136 h, P =.005). The EDM protocol could improve surgical efficiency, ultimately having the potential to expedite rehabilitation for severely burned patients. The study underscores the potential of combining the fundamentals of burn surgery, with innovative surgical techniques and materials, in order to bridge the gap between excision and grafting. [ABSTRACT FROM AUTHOR]

Abstract Kidney autotransplantation is a surgical procedure with multiple indications and advancing technological approaches. Kidney autotransplantation is used to address complex kidney-related diseases including renal vascular lesions, ureteral diseases, tumors, loin pain-hematuria syndrome, and conditions affecting a solitary kidney or both kidneys. Renal artery lesions, including aneurysms and stenoses, often necessitate kidney autotransplantation in cases involving renal artery bifurcation or distant failure of endovascular repair. Complex ureteral lesions such as ureteral avulsions are commonly treated with kidney autotransplantation. Renal tumors, especially centrally located tumors or those involving the renal hilum, are treated using this technique while preserving renal function. It is worth emphasizing that this would be a rarely used last-resort technique in the modern era of minimally invasive nephron-sparing surgery. Kidney autotransplantation may be indicated for the rare condition of loin pain-hematuria syndrome when conservative measures fail. Additionally, individuals with solitary or bilateral kidney disease benefit from kidney autotransplantation to preserve their renal function. Traditional open-kidney autotransplantation involves renal extraction, workbench repair, and renal reimplantation. Technological advancements have introduced minimally invasive techniques including laparoscopic- and robot-assisted kidney autotransplantation, which reduce surgical trauma and recovery times. These techniques have shown promising outcomes, and robotic platforms have the potential to further reduce complications. In this study, we reviewed diverse indications and recent technological innovations in the field of kidney autotransplantation.

Abstract Purpose This study compares the efficacy of two different ranges of parathyroid transplantation weights with the aim of determining a preferable range for transplantation weight. Methods From May 2018 to June 2023, 79 patients underwent total parathyroidectomy with autotransplantation. Demographic data, symptoms, and pre- or postoperative biochemical indicators were compared between two different ranges of parathyroid transplantation weights. Results All 79 surgeries were successful, with a total of 316 parathyroid glands reported among the patients. The patients were diagnosed with parathyroid hyperplasia. Postoperatively, itching, bone pain, and muscle weakness disappeared, while serum parathyroid hormone and phosphate levels significantly decreased. With an average follow-up of 12 months, no transplant-dependent recurrence was observed. Conclusion Parathyroid transplantation with a weight of 30–50 mg is a feasible, safe, and effective surgical approach.

Vitiligo is a common depigmentation disorder classified into nonsegmental vitiligo (NSV) and segmental vitiligo (SV). SV accounts for 5–27.9% of patients with vitiligo. The primary pathogenesis of NSV involves the autoimmune‐mediated destruction of melanocytes. Recently, an autoimmune pathogenesis of SV was identified. High levels of melanocyte antigen‐specific CD8+ T cells are found in early SV lesional skin infiltrating around melanocytes along the basal layer. Mixed vitiligo suggests an overlap in pathogenesis between SV and NSV. In active SV, serum innate immune cytokines, and CD8+ T cell cytokines are increased. Oxidative stress in SV may activate autoimmune responses. SV pathogenesis is associated with a local cytotoxic response targeting epidermal melanocytes. Theories have been put forward to explain the segmental pattern in SV. The previous basis of the neurogenic theory that SV results from dermatomes is no longer accepted. However, there are still research reports supporting this theory. Evaluating the distribution pattern of SV lesions has provided clues to the mosaicism detection of suspected melanocytic defects at the site of SV lesions, supporting this theory. Evidence points to a cytotoxic response targeting mosaic melanocytes. Understanding SV's autoimmune pathogenesis prompts a reevaluation of immunosuppressive medical treatments for SV. The excellent results of autologous melanocyte transplantation in SV lesions compared with the moderate to limited results in patients with NSV support the mosaicism theory. [ABSTRACT FROM AUTHOR]

Ex vivo surgery and autotransplantation may provide a promising option for radical resection of conventionally unresectable liver tumors. Two cirrhotic patients with hepatocellular carcinoma (HCC), which has an "awkward seat" located in the "intrahepatic vascular triangle area (IVTA)" that consists of the middle hepatic vein (MHV), the right branches of the Glisson sheath, and the inferior vena cava (IVC), underwent in vivo extended right-half hepatectomy followed by ex vivo tumor resection and partial liver autotransplantation. Innovatively, the outflow of the tumor-free liver was reconstructed ex vivo using pre-frozen allograft blood vessels from brain-dead donors; the patients recovered well postoperation. We report the surgical experience to provide a novel curable surgical procedure for locally advanced IVTA liver tumors. [ABSTRACT FROM AUTHOR]

Human umbilical cord–derived mesenchymal stromal cells (UC-MSCs), which can be prepared in advance and are presumed to be advantageous for nerve regeneration, have potential as a cell source for Bio 3D conduits. The purpose of this study was to evaluate the nerve regeneration ability of Bio 3D conduits made from UC-MSCs using a rat sciatic nerve defect model. Methods: A Bio 3D conduit was fabricated using a Bio 3D printer by placing UC-MSC spheroids into thin needles according to predesigned 3D data. The conduit was transplanted to bridge the 5-mm gaps of Lewis rat sciatic nerve, and nerve regeneration was evaluated at 8 weeks (Bio 3D group). Transplantation of autologous nerve segments (autograft) and silicone tubes represented the positive and negative control groups, respectively. In a second experiment, immunological reactions were evaluated in Bio 3D, autograft, and allograft groups by histochemical staining of transplanted segments in Brown Norway rats. Results: The mean angle of attack value in the kinematic analysis was significantly better in the Bio 3D group (‒20.1 ± 0.5°) than in the silicone group (‒33.7 ± 1.5°) 8 weeks after surgery. The average diameters of myelinated axons were significantly larger in the Bio 3D group (3.61 ± 0.15 μm) than in the silicone group (3.07 ± 0.12 μm), and the number of myelinated axons was significantly higher in the Bio 3D group (11,201 ± 980) than in the silicone group (8117 ± 646). Histological findings (hematoxylin and eosin [HE] staining and anti-CD3 fluorescent immunostaining) showed that rejection was suppressed in the Bio 3D group compared to the allograft group. Based on macroscopic findings and histological findings (anti-human mitochondrial fluorescent immunostaining), UC-MSCs in the Bio 3D conduit disappeared gradually from week 1 to week 8. Conclusions: The Bio 3D conduit prepared from UC-MSCs was superior to the silicone tube and achieved comparable nerve regeneration to the autologous (autograft) group. Rejection was suppressed in the Bio 3D group compared to the allograft group. Although this study used a xenograft model, we speculate that rejection was low due to the characteristics of UC-MSCs. UC-MSCs are a useful cell source for Bio 3D conduits. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the effectiveness of alternative autologous vessel grafts in creating a Meso-Rex bypass (MRB) compared to the distal splenorenal shunt (DSRS) in resolving symptoms of portal hypertension in children. Methods: All children with EHPVO evaluated for surgery at Siriraj Hospital from January 2011 to December 2023 were reviewed. Alternative autologous vessel grafts were used in all cases where MRB was feasible. DSRS was performed in patients for whom MRB was not possible. Baseline characteristics and outcomes were compared between the two groups. Results: Eight children underwent successful MRB with alternative autologous vessel grafts, while six required DSRS. Children in the modified MRB group were significantly younger, with upper gastrointestinal bleeding the most common presenting symptom. In contrast, children in the DSRS group had significantly lower preoperative ammonia levels and platelet counts, with hypersplenism being the most common presenting symptom. All patients experienced complete relief of variceal bleeding and hypersplenism post-surgery. Complicated shunt thrombosis occurred after MRB using the gastric coronary vein graft. A significant decrease in ammonia levels was observed after MRB, whereas levels increased after DSRS. Conclusion: Alternative autologous vessel grafts are effective for constructing the MRB to resolve portal hypertension compared to DSRS. [ABSTRACT FROM AUTHOR]

Background: Ruptures of the anterior cruciate ligament (ACL) are common injuries. Reconstruction using autologous grafts is recommended to prevent further damage and functional impairment. Grafts are usually prepared with stabilizing sutures. The aim of this study was to evaluate if a 4-strand semitendinosus autograft preparation technique is non-inferior to conventional preparation techniques with regard to maximum tensile strength threshold. Methods: Fresh porcine flexor tendons were used as specimens in this study. Four different preparation techniques for quadruple-folded tendons were compared. Group 1 three suture FiberWire® (n = 20) and Group 2 one suture FiberWire® (n = 20) using Krakow stitches, Group 3 (n = 10) using SPEEDTRAP® and piercing the autograft and 4 (n = 9) using SPEEDTRAP® without piercing the autograft for preparation. Biomechanical tensile testing included 50 sinusoidal cycles of preloading between 50 and 150 N at 1 Hz and load-to-failure was measured at 20 mm/min. Results: Failure at the maximum load occurred at the filament for all samples, whereas failure of the suture/tendon interface was not observed. Load-to-failure was significantly higher in Group 1 (711 ± 91 N) than in all other groups. When comparing groups 2–4 load-to-failure was significantly higher in Group 2 (347 ± 24 N) than in Group 3 (258 ± 25 N, p < 0.02) but not than in Group 4 (325 ± 26N). Conclusion: In all 4 Groups the load to failure was higher than the maximum tension force on the construct that will be applied by hand (182N). Therefore, the needleless preparation technique seems to be a valuable alternative to conventional techniques for the insertion of the graft into the joint during joint-near tibial fixation technique. [ABSTRACT FROM AUTHOR]

The limited self-repair capacity of cartilage due to its avascular and aneural nature leads to minimal regenerative ability. Autologous chondrocyte transplantation (ACT) is a popular treatment for cartilage defects but faces challenges due to chondrocyte dedifferentiation in later passages, which results in undesirable fibroblastic phenotypes. A promising treatment for cartilage injuries and diseases involves tissue engineering using cells (e.g., chondrocytes), scaffolds (e.g., Alginate Sulfate (AlgSulf)), and biochemical signals (e.g., Salidroside and TGF-β). This study focuses on investigating the effects of AlgSulf scaffolds with varying degrees of sulfation, Salidroside, and TGF-β on the proliferation, viability, and phenotype maintenance of chondrocytes. The findings demonstrate that AlgSulf films with a degree of sulfation (DS) = 2, treated with a combination of Salidroside and TGF-β, significantly enhanced chondrocyte proliferation (p < 0.001 and p < 0.0001 in P2 and P4, respectively), preserved round cell morphology, and maintained cartilage-specific gene expression (Col2, Aggrecans, and SOX9) while downregulating fibroblastic markers (Col1, MMP13, IL-1β, and IL-6). Our findings suggest the potential of this combination for enhancing cartilage regeneration in tissue engineering applications. [ABSTRACT FROM AUTHOR]

Background/Objectives: Traditional autologous bone grafts as a treatment for bone defects have drawbacks like donor-site morbidity and limited supply. PerOssal®, a ceramic bone substitute, may overcome those drawbacks and could offer additional benefits like prolonged, local antibiotic release. This study investigates the clinical and radiological outcomes, including patient-reported outcomes, of using PerOssal® in nonunions (NU) and high-grade chronic osteomyelitis (COM). Methods: A single-center, retrospective study, investigating patients treated with PerOssal® between January 2020 and December 2023. Collected data include patient characteristics as well as various surgical and outcome parameters including the Lower Extremity Functional Scale (LEFS). Results: A total of 82 patients were analyzed. Reinfection occurred in 19.5% of cases. Osseous integration of PerOssal® was achieved in 89% of cases, higher in cavitary defects (91.5%) than segmental defects (72.7%). The revision rate was 32.9%, mainly due to wound healing disorders and reinfections. Mean LEFS score was 53.4 which was heavily influenced by sex (male: 50.7 vs. female: 63.4), revision surgery (no: 55.7 vs. yes: 49.1), reinfection (no: 56.6 vs. yes: 39.4), and osseous integration of PerOssal® (yes: 55.8 vs. no: 38.4). Conclusions: PerOssal® demonstrates promising outcomes in treating NUs and high-grade COM, especially in cavitary defects, with high osseous integration rates and acceptable functional results. However, reinfection remains a concern, particularly with difficult-to-treat pathogens and extensive surgical histories. Early, comprehensive surgical intervention and tailored antibiotic strategies are essential. Patient selection, defect characteristics, and comorbidities significantly influence success. Further research is needed to optimize treatment protocols. [ABSTRACT FROM AUTHOR]

ABSTRACT Background/Aim Material and Methods Results Conclusions Autotransplantation is a well‐documented procedure for replacing missing teeth in the anterior maxilla. This retrospective study aims to evaluate long‐term survival rate, success rate as well as esthetics and patient‐reported outcome of premolars autotransplanted to the anterior maxilla and secondarily to identify potential prognostic factors for survival, success, esthetic, and biological complications.One hundred and twenty‐two patients with 153 transplants were assessed on survival rate and potential prognostic factors, while 50 patients with 61 autotransplanted premolars underwent clinical, radiographic, and esthetic assessment. Clinical and radiographic parameters were recorded. Esthetic outcomes were evaluated using a comprehensive score system comparing transplanted teeth to neighboring tooth. All patients filled in a questionnaire about the esthetic outcome of the treatment.The survival rate of transplants after 16–38 years was 76%, with the majority showing no periodontal complications (95%). Radiographically, 46% of transplanted premolars showed no signs of pathosis. Ankylosis and inflammatory resorption were observed in 19% and 16%, respectively. Prognostic factors such as donor tooth type and root stage did not significantly affect transplant survival. Premolars transplanted at an immature stage had a significant lower risk of ankylosis, compared to more mature transplants. Esthetically, 72% of the transplants matched their neighboring teeth, and taking the biological success into consideration an overall success rate was 57.3%. In total, 71% of all patients were esthetically satisfied with their autotransplant, 18% were fairly satisfied, and 11% were dissatisfied.The transplants demonstrated high survival rate, albeit with biological complications such as ankylosis and inflammatory root resorption. Developmental stage of the root at the time of transplantation had a significant influence on ankylosis of transplanted teeth. Esthetic outcomes were generally satisfactory, although challenges were noted with certain restoration types and donor tooth selections. Overall, the majority of patients expressed satisfaction with their autotransplanted teeth. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Level of Evidence The stability of the graft in the bony tunnels is of utmost importance in the anterior cruciate ligament reconstruction (ACLR) since it ensures safe healing at the tendon‐bone interface. The hypothesis was that when a double tibial fixation was used in ACLR with a short graft of autologous hamstrings, tibial tunnel bone re‐growth and better graft integration would be observed at short‐term follow‐up.The analysis included a cohort of 112 patients after a primary ACLR with hamstring tendons who underwent postoperative magnetic resonance imaging (MRI) 3.0‐Tesla (3.0‐T) 6 months after the surgery. The patients were divided into three groups based on the tibial fixation technique: 40 had a screw (group S), 35 had a screw and cortical button (group S + B) and 37 had a screw and anchor (group S + A). Two orthopaedic specialists independently evaluated the images, who measured the screw‐free tunnel space, and assessed the presence of bone filling in the free tunnel. Furthermore, Ge's protocol was used to determine the graft healing in the tunnel.In 94 patients a screw‐free tunnel space was detected, and a filling of the tunnel was reported in 80.85% of the cases (76 patients), being partial in 15.79% (12 patients) and complete in 84.21% (64 patients). Patients who presented better graft integration (Ge1) had significantly higher values of screw‐free tunnel length compared to the other ones who had lower graft integration (Ge3)(p < 0.05).At 6 months postoperative MRI, tibial tunnel bone re‐growth and graft‐tunnel tibial integration after hamstring ACLR is significantly associated with the presence of free space between the anterior tibial cortex and the most distal portion of the interference screw, hence the use of a short and proximalized interference screw is suggested to restore bone stock after hamstring ACLR.Level IV retrospective comparative cohort study. [ABSTRACT FROM AUTHOR]

To investigate the protective mechanism of dexmedetomidine (DEX) on adipose-derived stromal cells (ADSCs) under oxidative stress model and its promotion effect on the retention rate of adipose granule transplantation by in vitro and in vivo experiments. The experiment was divided into control group, model group (ADSCs + H2O2+normal serum), DEX group (ADSCs + H202+DEX drug-containing serum), autophagy agonist group (ADSCs + H2O2+rapamycin (RAP)+normal serum), RAP + DEX group (ADSCs + H2O2+normal serum), RAP + DEX drug-containing serum), autophagy inhibitor group (ADSCs + H2O2+chloroquine (CQ)+normal serum), CQ + DEX group (ADSCs + H2O2+CQ + DEX drug-containing serum). HO-1, GSH-PX, SOD and CAT in ADSCs under oxidative stress model were measured. ROS fluorescence intensity and apoptosis ratio were detected. Expression of Nrf2, LC3-II/LC3-I and p62 were detected. In vivo , fat mixed with ADSCs or DEX -pretreated ADSCs was implanted subcutaneously in the lower back region of nude mice. Fat grafts were collected and analyzed at 2-, 4-, 6-, and 8-weeks post-transplantation. DEX pretreatment could reduce the expression of p62 to enhance the autophagy level of ADSCs under oxidative stress model. Additionally, cotransplantation of DEX-pretreated ADSCs with fat improved the long-term texture of fat grafts. DEX increased the fat graft survival and angiogenesis. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence This systematic review with meta‐analysis evaluates the long‐term efficacy of matrix‐assisted autologous chondrocyte transplantation (MACT) in terms of functional scores using scaffolds made of hyaluronic acid (HA) or collagen (C).Nineteen articles met the eligibility criteria for the analysis. Fourteen studies focused on patients treated with MACT with HA‐based scaffolds, four studies with C‐based scaffolds, and one study compared both scaffold types.A higher percentage of patients in the HA subgroup had undergone previous cartilage repair procedures, whereas multiple lesions were more common in the C subgroup. Both HA‐ and C‐treated patients showed significant functional improvement in terms of International Knee Documentation Committee with overall mean differences at 2 and 5 years, and for HA‐treated patients at 10 years. Likewise, concerning the Tegner activity scale, both subgroups demonstrated significant improvement at 2 years, with the HA subgroup showing more sustained improvement up to 10 years. The HA subgroup also had EQ‐VAS reduction at 2, 5 and 10 years. Failure rates were similar between and within groups, with a range from 0% to 42% at different follow‐ups.Patients experienced mid‐term benefits from MACT, using both HA‐based and C‐based scaffolds, and long‐term benefits from using HA‐based scaffolds. The low failure rate and the fact that most patients did not require knee replacement surgery are encouraging. Accordingly, despite their complexity and high costs, regenerative techniques like MACT are effective, as they can significantly delay or even prevent the need for total knee replacement.Level IV. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. BACKGROUND: Artificial skin substitutes are a flexible alternative to autografting in Mohs micrographic surgery (MMS), but the characteristics and clinical outcomes of skin substitutes are not well defined. OBJECTIVE: Summarize clinical data of skin substitutes in MMS for cutaneous malignancy. METHODS: A MEDLINE/Embase/Web of Science search was conducted. Articles with original data on outcomes after skin substitute use in MMS for cutaneous malignancy were included. Articles not in English or without original data were excluded. Bias was assessed using the Oxford CEBM Levels of Evidence Table. Outcomes were synthesized using weighted averages. This study was prospectively registered in PROSPERO. RESULTS: Of 1,007 articles, 40 met eligibility for inclusion. In total, 898 patients who underwent MMS and received a skin substitute were included. Xenografts were most commonly used (n = 613). Semi-synthetic grafts (∼$<1/cm2) and xenografts (∼$10/cm2) are most affordable. Overall, outcomes were excellent for all skin substitutes, with a small proportion of patients experiencing correctable complications. CONCLUSION: Skin substitutes are highly effective in MMS, with enormous potential. While the data demonstrate positive outcomes, they predominately draw from small, retrospective studies or case reports. There is also a scarcity of data comparing skin substitutes with each other or controls. Prospective studies are recommended. [ABSTRACT FROM AUTHOR]

Introduction Contemporary medical science has been using fat grafting in aesthetic and reconstructive procedures, consistently achieving successful outcomes. Hansen's disease, caused by Mycobacterium leprae , leads to hand deformities due to peripheral neuropathy, resulting in soft-tissue atrophy, volume loss, and compromised hand function. Tendon transfer surgery is a common remedy for functionality, but it often does not address aesthetic concerns and the patient's psychological impact of living with an atrophic hand. Autologous fat grafting can effectively address these concerns. Materials and Methods This prospective study evaluates the efficacy of fat grafting for hand rejuvenation in patients with Hansen's disease posttendon transfer surgery, focusing on aesthetic and psychological outcomes. We recorded data from 12 patients who underwent the procedure between 2015 and 2024. Using the Coleman technique, fat was harvested from the paraumbilical region of the abdomen and injected into various hand regions. Results Autologous fat grafting showed high patient satisfaction with significant improvements in hand contour, skin texture, and psychological health. The benefits of the procedure included improved self-esteem, enhanced quality of life, reduced social stigma, and psychological well-being. Conclusion Autologous fat grafting is a safe and effective technique for hand rejuvenation in patients with Hansen's disease, after functional treatment addressing both physical deformities and their psychological impacts. It could be considered one of the components in the comprehensive management of Hansen's disease–related hand deformities, significantly enhancing patients' overall quality of life. [ABSTRACT FROM AUTHOR]

For pediatric patients with full-thickness burns, achieving adequate dermal regeneration is essential to prevent inelastic scars that may hinder growth. Traditional autologous split-thickness skin grafts alone often fail to restore the dermal layer adequately. This study evaluates the long-term effect of using a NovoSorb® Biodegradable Temporizing Matrix (BTM) as a dermal scaffold in four pediatric patients, promoting dermal formation before autografting. Pediatric burn patients treated at the University Children's Hospital Zurich between 2020 and 2022 underwent a two-step treatment involving NovoSorb® BTM application, followed by autografting. Histological analysis, conducted through 22 punch biopsies taken up to 2.6 years post-application, demonstrated robust dermal reorganization, with mature epidermal regeneration and stable dermo-epidermal connections. Immunofluorescence staining showed rapid capillary ingrowth, while extracellular matrix components, including collagen and elastic fibers, gradually aligned over time, mimicking normal skin structure. By 2.6 years, the dermal layer displayed characteristics close to uninjured skin, with remnants of NovoSorb® BTM degrading within five months post-application. This study suggests that NovoSorb® BTM facilitates elastic scar formation, offering significant benefits for pediatric patients by reducing functional limitations associated with inelastic scarring. [ABSTRACT FROM AUTHOR]

Background: Autologous fat grafting is a widely used technique in plastic and reconstructive surgery for soft tissue augmentation. Despite its advantages, the primary limitation is the unpredictable retention rate of transplanted fat. Recent studies suggest that botulinum toxin type A (BTX‐A) can enhance fat graft survival by promoting angiogenesis and muscle paralysis. Aims: This review explores the potential of BTX‐A as an adjuvant in autologous fat grafting, providing insights into its mechanisms, benefits, and the need for further clinical validation. Patients/Methods: A literature review was conducted using PubMed, Web of Science, MEDLINE, and Embase. Keywords related to BTX‐A, fat grafting, fat graft survival, and angiogenesis were used. Comparative studies reporting histological changes following BTX‐A application in fat grafting were included. Exclusion criteria involved case reports with fewer than three animals, reviews, and letters. Results: The initial search yielded 108 articles, with seven experimental studies meeting the criteria. These studies demonstrated that BTX‐A enhances fat graft retention by promoting vascularization and adipose‐derived stem cell differentiation. However, these results are mainly based on small animal models. Conclusions: While BTX‐A shows promise in improving autologous fat grafting outcomes, its efficacy and safety in humans need validation through large‐scale clinical trials. Translating these preclinical findings into human trials is crucial to establish standardized protocols and optimize clinical outcomes. Future research should focus on optimizing dosage and injection sites, conducting long‐term follow‐up studies, and performing multicenter trials to verify the findings. [ABSTRACT FROM AUTHOR]

To evaluate whether patients with multiple myeloma (MM) could benefit from tandem autologous hematopoietic stem cell transplantation (auto-HSCT), PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched, and 10 eligible studies were included after data extraction and quality evaluation. Meta-analysis showed that compared to single autologous hematopoietic stem cell transplantation, tandem auto-HSCT does not improve OS, EFS or efficacy in MM patients, and may even lead to higher treatment-related mortality (TRM). MM patients who received autologous tandem allogeneic HSCT did not achieve better response compared to tandem autologous HSCT. In summary, compared to single autologous hematopoietic stem cell transplantation, tandem autologous hematopoietic stem cell transplantation cannot provide survival advantages for MM patients, and MM patients cannot benefit from autologous tandem allogeneic hematopoietic stem cell transplantation. [ABSTRACT FROM AUTHOR]

Background: Complete talar extrusion is a rare injury that is typically caused by high-energy impact. Treatment for a completely extruded talus is limited and has variable outcomes and complications. Tibiocalcaneal arthrodesis is one of the best treatments for restoring stability and reducing pain in the affected limb. Case Report: A 52-year-old male had complete talar extrusion after a pedestrian vs vehicle accident, and his recovery was complicated by wound dehiscence and recurrent infections of the ankle. Three years after his original injury, the patient was treated with a tibiocalcaneal arthrodesis with tantalum metal cone spacer, autologous bone grafting with tibial reamer irrigator aspirator, and retrograde hindfoot nail. The fusion healed well without signs of nonunion. Following wound healing and recovery, the patient was able to ambulate without any assistive devices. Conclusion: To our knowledge, our case is the first report of the use of a metal spacer in conjunction with autologous bone grafting multiple years after an initial complete talar extrusion injury. The patient's novel treatment resulted in good postoperative outcomes, including significant improvement in pain, ankle stability, and independent ambulation. [ABSTRACT FROM AUTHOR]