Search results for: fat graft

Authors: S. Alireza Mirghasemi, Javad Parvizi, Narges R. Gabaran, Shervin Rashidinia, Mahdi M. Bijanabadi, Dariush G. Savadkoohi

Abstract:

Background: The anterior cruciate ligament is one of the most frequent ligament to be disrupted. Surgical reconstruction of the anterior cruciate ligament is a common practice to treat the disability or chronic instability of the knee. Several factors associated with success or failure of the ACL reconstruction including preoperative laxity of the knee, selection of the graft material, surgical technique, graft tension, and postoperative rehabilitation. We aimed to examine the biomechanical properties of any graft type and initial graft tensioning during ACL reconstruction using 3-dimensional computational finite element simulation. Methods: In this paper, 3-dimensional model of the knee was constructed to investigate the effect of graft tensioning on the knee joint biomechanics. Four different grafts were compared: 1) Bone-patellar tendon-bone graft (BPTB) 2) Hamstring tendon 3) BPTB and a band of gracilis4) Hamstring and a band of gracilis. The initial graft tension was set as “0, 20, 40, or 60N”. The anterior loading was set to 134 N. Findings: The resulting stress pattern and deflection in any of these models were compared to that of the intact knee. The obtained results showed that the combination of a band of gracilis with the former graft (BPTB or Hamstring) increases the structural stiffness of the knee. Conclusion: Required pretension during surgery decreases significantly by adding a band of gracilis to the proper graft.

Keywords: ACL reconstruction, deflection, finite element simulation, stress pattern

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Authors: Mehrdad Taghipour, Mina Rostami, Mahdi Eskandarlou

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Partial-thickness skin graft is the cornerstone for scalp defect repair. Given the potential side effects following harvesting from these sites, this study aimed to compare the outcomes of graft harvesting from scalp and lower limb. This clinical trial was conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to Plastic Surgery Clinic at Besat Hospital, Hamadan, Iran during 2018-2019. Sampling was done by simple randomization using random digit table. The donor site in case group and control group was scalp and lower limb respectively. Overall, 28 patients (70%) were male and 12 (30%) were female. Basal cell carcinoma (BCC) and trauma were the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The mean diameter of defect was 24.28±45.37 mm for all of the patients. The difference between diameters of defect in both groups were statistically meaningful while no such difference between graft diameters was seen. The graft “Take” was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale and the satisfaction was higher in them per Likert scale. Scalp can safely be used as donor site for skin graft to be used for scalp defects associated with better results and lower complication rates compared to other donor sites.

Keywords: donor site, graft, scalp, partial thickness

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Authors: Azza. A. Al-Ghamdi, Abir. A. Abdel-Naby

Abstract:

The construction of Nitro -N-amino phenyl maleimide branches onto Cellulose acetate (CA) substrate by free radical graft copolymerization using benzoyl peroxide as initiator led to formation of highly thermal stable copolymers as shown from the results of gravimetric analysis (TGA). CA-g-2,4-dinitro amino phenyl maleimide exhibited higher thermal stability than the CA-g-4-nitro amino phenyl maleimide as shown from the initial decomposition temperature (T_o). This is due to the ability of nitro group to form hydrogen bonding with hydroxyl group of the glucopyranose ring which increases the crystallinity of polymeric matrix. The crystalline shapes representing the graft part are clearly distinct in the Emission scanning electron microscope (ESEM) morphology of the copolymer. A suggested reaction mechanism for the grafting process was also discussed.

Keywords: Cellulose acetate, Crystallinity, Graft copolymerization, Thermal properties

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Authors: Dita Mayasari, Zahrina Mardina, Riki Siswanto, Agresta Ifada, Ova Oktavina, Prihartini Widiyanti

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Heart failure is a serious major health problem with high number of mortality per year. Bypass is one of the solutions that has often been taken. Natural vascular graft (xenograft) as the substitute in bypass is inconvenient due to ethic problems and the risk of infection transmission caused by the usage of another species transgenic vascular. Nowadays, synthetic materials have been fabricated from polymers. The aim of this research is to make a synthetic vascular graft with great physical strength, high biocompatibility, and good affordability. The method of this research was mixing PLGA and collagen by magnetic stirrer. This composite were shaped by spinneret with water as coagulant. Then it was coated by chitosan with 3 variations of weight (1 gram, 2 grams, and 3 grams) to increase hemo and cytocompatibility, proliferation, and cell attachment in order for the vascular graft candidates to be more biocompatible. Mechanical strength for each variation was 5,306 MPa (chitosan 1 gram), 3,433 MPa (chitosan 2 grams) and 3,745 MPa (chitosan 3 grams). All the tensile values were higher than human vascular tensile strength. Toxicity test showed that the living cells in all variations were more than 60% in number, thus the vascular graft is not toxic.

Keywords: chitosan, collagen, PLGA, spinneret

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Authors: Azadeh Yaraghchi, Reza Bagherian Sararoodi, Niknaz Salehi Moghadam, Mohammad Hossein Mandegar, Adis Kraskian Mujembari, Omid Rezaei

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Background: Quality of life is one of the most important consequences of disease in psychosomatic disorders. Many psychological factors are considered in predicting quality of life in patients with coronary artery bypass graft (CABG). The present study was aimed to determine the relationship between perceived social support and quality of life in patients with coronary artery bypass graft (CABG). Methods: The population included 82 patients who had undergone CABG from October 2014 to May 2015 in four different hospitals in Tehran. The patients were evaluated with Multi-dimension scale of perceived social support (MSPSS) and after three months follow up were evaluated by Short-Form quality of life questionnaire (SF-36). The obtained data were analyzed through Pearson correlation test and multiple variable regression models. Findings: A relationship between perceived social support and quality of life in patients with CABG was observed (r=0.374, p<0.01). The results showed that 22.4% of variation in quality of life is predicted by perceived social support components (p<0.01, R2 =0.224). Conclusion: Based on the results, perceived social support is one of the predictors of quality of life in patients with coronary artery bypass graft. Accordingly, these results can be useful in conceiving proactive policies, detecting high risk patients and planning for psychological interventions.

Keywords: coronary artery bypass graft, perceived social support, psychological factors, quality of life

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Authors: R. Janyaphadungpong, A. Pimkhaokham

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This prospective clinical study determined the insertion torque (IT) value and monitored the changes in implant stability quotient (ISQ) values during the 12 weeks healing period from implant placement without bone graft (control group) and with bone graft using the guided bone regeneration (GBR) technique (study group). The relationship between the IT and ISQ values of the implants was also assessed. The control and study groups each consisted of 6 patients with 8 implants per group. The ASTRA TECH Implant System™ EV 4.2 mm in diameter was placed in the posterior mandibular region. In the control group, implants were placed in bone without bone graft, whereas in the study group implants were placed simultaneously with the GBR technique at favorable bone defect. IT (Ncm) of each implant was recorded when fully inserted. ISQ values were obtained from the Osstell® ISQ at the time of implant placement, and at 2, 4, 8, and 12 weeks. No difference in IT was found between groups (P = 0.320). The ISQ values in the control group were significantly higher than in the study group at the time of implant placement and at 4 weeks. There was no significant association between IT and ISQ values either at baseline or after the 12 weeks. At 12 weeks of healing, the control and study groups displayed different trends. Mean ISQ values for the control group decreased over the first 2 weeks and then started to increase. ISQ value increases were statistically significant at 8 weeks and later, whereas mean ISQ values in the study group decreased over the first 4 weeks and then started to increase, with statistical significance after 12 weeks. At 12 weeks, all implants achieved osseointegration with mean ISQ values over the threshold value (ISQ>70). These results indicated that implants, in which guided bone regeneration technique was performed during implant placement for treating favorable bone defects, were as predictable as implants placed without bone graft. However, loading in implants placed with the GBR technique for correcting favorable bone defects should be performed after 12 weeks of healing to ensure implant stability and osseointegration.

Keywords: dental implant, favorable bone defect, guided bone regeneration technique, implant stability

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Authors: Nikita Sankhe

Abstract:

A Frenum is a band or fold of mucous membrane, which is usually with enclosed muscle fibers, that attaches the lip and cheek to the alveolar mucosa or the gingiva and the underlying periosteum. It curbs or limits the movements of an organ. A frenum becomes a problem if its attachment is too close to the marginal or papillary gingiva, namely localized gingival recession and a midline diastema or it may pull the gingival margin away from the tooth allowing plaque accumulation and inhibit toothbrushing. Frenectomy is the complete removal of the frenum including its attachment to the underlying bone. Miller suggested a technique where by a closure was done across the midline by laterally positioned gingiva. Healing by primary intention resulted in aesthetically acceptable attached gingiva across the midline. This paper aims at showing how a lateral pedicle graft technique combined with frenectomy proves to be more advantageous than any other technique.

Keywords: frenum , frenectomy , lateral pedicle graft , classical frenectomy

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Authors: Blanca Fatela Cantillo, Silvia Iglesias Cerrato, Guadalupe Garrido Ceca

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Purpose: Bleb dysfunction is a late complication following glaucoma filtration surgery. We describe our surgical technique for excision and reconstruction of a hypertrophic bleb complication using bovine pericardium patch graft (Tutopatch®) and amniotic membrane. Material and methods: The case report presents a hypertrophic bleb over the cornea with good intraocular pressure control. The hanging bleb without leak caused dysesthesia and high irregular astigmatism. Bleb reconstruction involved the excision of corneal fibrous material and avascular conjunctiva, preserving the original scleral and tennon. Bovine pericardium patch graft (Tutopatch®) was sited over these with fixed sutures, reinforcing the underlying scleral, and the conjunctiva advanced. The superior epithelium corneal defect was covered using an amniotic membrane. Conclusion: Repair of bleb dysfunction with varied techniques has been reported, including conjunctival advancement, use of scleral patch graft, dural patch graft, or pericardium. Additional use of amniotic membrane promotes epithelialization and exhibits anti-fibrotic and anti-inflammatory features. Reconstruction with bovine pericardium patch graft and amniotic membrane resulted in pain relief, visual rehabilitation, and good aesthetic results, with preservation of bleb function.

Keywords: reconstruction, hypertrophic bleb, bovine pericardium, amniotic membrane, dysesthesia of the bleb

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Authors: Mahdi Eskandarlou, Mehrdad Taghipour

Abstract:

Background: Partial-thickness skin graft is the cornerstone for scalp defect repair. Routine donor sites include abdomen, thighs, and buttocks. Given the potential side effects following harvesting from these sites and the potential advantages of harvesting from scalp (broad surface, rapid healing, and better cosmetics results), this study is trying to compare the outcomes of graft harvesting from scalp and lower limb. Methods: This clinical trial is conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to plastic surgery clinic at Besat Hospital during the time period between 2018 and 2019. Sampling was done by simple randomization using random digit table. Data gathering was performed using a designated checklist. The donor site in case group and control group was scalp and lower limb, respectively. The resultant data were analyzed using chi-squared and t-test and SPPS version 21 (SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). Results: Of the total 40 patients participating in this study, 28 patients (70%) were male, and 12 (30%) were female with and mean age of 63.62 ± 09.73 years. Hypertension and diabetes mellitus were the most common comorbidities among patients with basal cell carcinoma (BCC) and trauma being the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The most common anatomic location of defect for case and control groups was temporal and parietal, respectively. Most of the defects were deep to galea zone. The mean diameter of defect was 24.28 ± 45.37 mm for all of the patients. The difference between diameter of defect in both groups was statistically meaningful, while no such difference between graft diameter was seen. The graft 'Take' was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale, and the satisfaction was higher in them per Likert scale. Conclusion: Scalp can safely be used as donor site for skin graft to be used for scalp defects, which is associated with better results and lower complication rates compared to other donor sites.

Keywords: donor site, leg, partial-thickness graft, scalp

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Authors: Andrew Tan Hwee Chye, Yeo Zhen Ning

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This study aims to meta-analyse clinical studies comparing femoral tunnel position (FTP), femoral tunnel length (FTL) and graft bending angle (GBA) of single-bundle Anterior Cruciate Ligament (ACL) reconstruction using Transtibial (TT), Anteromedial (AM) and Outside-in (OI) techniques. A meta-analysis comparing the FTP, FTL and GBA of single-bundle ACL reconstruction utilising the TT, AM and OI was performed. Prospective Comparative Studies (PCS) and Retrospective Comparative Studies (RCS) from PubMed, Cochrane Library, and Embase were included. A total of 17 studies were included in this study. TT had the longest FTL, when compared to AM (Mean difference = 7.38, 95% CI: 3.76 to 11.00, P < 0.001) and OI (Mean difference = 9.47, 95% CI: 4.89 to 14.05, P < 0.001). In the deep-to-shallow direction, the OI resulted in a significantly deeper femoral tunnel as compared to the TT (Mean difference = 4.36, 95% CI: 1.39 to 7.33, P = 0.004) (Figure 6B). The AM technique also contributed to a significantly lower tunnel position as compared to the OI technique (Mean difference = 2.34, 95% CI: 0.76 to 3.92, P = 0.004). There were no significant differences in the graft bending angle between TT, AM and OI techniques. AM and OI techniques provide a more anatomical position as compared to the TT. Although FTL in the TT is longer than the AM and OI, all three techniques exceed the critical length of 25mm. There are no differences in the GBA between the three techniques.

Keywords: femoral tunnel position, femoral tunnel length, anterior cruciate ligament, transtibial, graft bending angle, anteromedial, outside-in

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Authors: Wisam Ismail, Sarah Hosgood, Michael Nicholson

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The research hypothesis is that early post-transplant allograft fibrosis will be linked to donor factors and that acute rejection and/or delayed graft function in the recipient will be independent risk factors for the development of fibrosis. This research hypothesis is to explore whether acute rejection/delay graft function has an effect on the renal transplant fibrosis within the first year post live donor kidney transplant between 1998 and 2009. Methods: The study has been designed to identify five time points of the renal transplant biopsies [0 (pre-transplant), 1 month, 3 months, 6 months and 12 months] for 300 live donor renal transplant patients over 12 years period between March 1997 – August 2009. Paraffin fixed slides were collected from Leicester General Hospital and Leicester Royal Infirmary. These were routinely sectioned at a thickness of 4 Micro millimetres for standardization. Conclusions: Fibrosis at 1 month after the transplant was found significantly associated with baseline fibrosis (p<0.001) and HTN in the transplant recipient (p<0.001). Dialysis after the transplant showed a weak association with fibrosis at 1 month (p=0.07). The negative coefficient for HTN (-0.05) suggests a reduction in fibrosis in the absence of HTN. Fibrosis at 1 month was significantly associated with fibrosis at baseline (p 0.01 and 95%CI 0.11 to 0.67). Fibrosis at 3, 6 or 12 months was not found to be associated with fibrosis at baseline (p=0.70. 0.65 and 0.50 respectively). The amount of fibrosis at 1 month is significantly associated with graft survival (p=0.01 and 95%CI 0.02 to 0.14). Rejection and severity of rejection were not found to be associated with fibrosis at 1 month. The amount of fibrosis at 1 month was significantly associated with graft survival (p=0.02) after adjusting for baseline fibrosis (p=0.01). Both baseline fibrosis and graft survival were significant predictive factors. The amount of fibrosis at 1 month was not found to be significantly associated with rejection (p=0.64) after adjusting for baseline fibrosis (p=0.01). The amount of fibrosis at 1 month was not found to be significantly associated with rejection severity (p=0.29) after adjusting for baseline fibrosis (p=0.04). Fibrosis at baseline and HTN in the recipient were found to be predictive factors of fibrosis at 1 month. (p 0.02, p <0.001 respectively). Age of the donor, their relation to the patient, the pre-op Creatinine, artery, kidney weight and warm time were not found to be significantly associated with fibrosis at 1 month. In this complex model baseline fibrosis, HTN in the recipient and cold time were found to be predictive factors of fibrosis at 1 month (p=0.01,<0.001 and 0.03 respectively). Donor age was found to be a predictive factor of fibrosis at 6 months. The above analysis was repeated for 3, 6 and 12 months. No associations were detected between fibrosis and any of the explanatory variables with the exception of the donor age which was found to be a predictive factor of fibrosis at 6 months.

Keywords: fibrosis, transplant, renal, rejection

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Authors: Hakan Duger, Alparslan Ersoy, Canan Ersoy

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Diabetes mellitus is the most common etiology of end-stage renal disease (ESRD). Also, diabetic nephropathy is the etiology of ESRD in approximately 23% of kidney transplant recipients. A successful kidney transplant improves the quality of life and reduces the mortality risk for most patients. However, patients require close follow-up after transplantation due to medical complications. Diabetes mellitus can affect patient morbidity and mortality due to possible effects of immunosuppressive therapy on glucose metabolism. We compared the frequency of medical complications and the outcomes in diabetic and non-diabetic kidney transplant recipients. Materials and Methods: This retrospective study conducted in 498 patients who underwent kidney transplant surgery at our center in 10-year periods. The patients were divided into two groups: diabetics (46 ± 10 year, 26 males, 16 females) and non-diabetics (39 ± 12 year, 259 males, 197 females). The medical complications, graft functions, causes of graft loss and death were obtained from medical records. Results: There was no significant difference between recipient age, duration of dialysis, body mass index, gender, donor type, donor age, dialysis type, histories of HBV, HCV and coronary artery disease between two groups. The history of hypertension in diabetics was higher (69% vs. 36%, p < 0.001). The ratios of hypertension (50.1% vs. 57.1%), pneumonia (21.9% vs. 20%), urinary infection (16.9% vs. 20%), transaminase elevation (11.5% vs. 20%), hyperpotasemia (14.7% vs. 17.1%), hyponatremia (9.7% vs. 20%), hypotension (7.1% vs. 7.9%), hypocalcemia (1.4% vs. 0%), thrombocytopenia (8.6% vs. 8.6%), hypoglycemia (0.7% vs. 0%) and neutropenia (1.8% vs. 0%) were comparable in non-diabetic and diabetic groups, respectively. The frequency of hyperglycaemia in diabetics was higher (8.6% vs. 54.3%, p < 0.001). After transplantation, primary non-function (3.4% vs. 2.6%), delayed graft function (25.1% vs. 34.2%) and acute rejection (7.3% vs. 10.5%) ratios of in non-diabetic and diabetic groups were similar, respectively. Hospitalization durations in non-diabetics and diabetics were 22.5 ± 17.5 and 18.7 ± 13 day (p=0.094). Mean serum creatinine levels in non-diabetics and diabetics were 1.54 ± 0.74 and 1.52 ± 0.62 mg/dL at 6th month. Forty patients had graft loss. The ratios of graft loss and death in non-diabetic and diabetic groups were 8.2% vs. 7.1% and 7.1% vs. 2.6% (p > 0.05). There was no significant relationship between graft and patient survivals with the development of medical complication. Conclusion: As a result, medical complications are common in the early period. Hyperglycaemia was frequently seen following transplantation due to the effects of immunosuppressant regimens. However, the frequency of other medical complications in diabetic patients did not differ from non-diabetic one. The most important cause of death is still infections. The development of medical complications during the first 6 months did not significantly affect transplant outcomes.

Keywords: kidney transplantation, diabetes mellitus, complication, graft function

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Authors: Hami Ashraf, Farid Kosari

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Graft-versus-host disease (GvHD) is a common complication of allogeneic hematopoietic stem cell transplantation that can lead to significant morbidity and mortality. Histopathological examination of affected tissues is an essential tool for diagnosing and grading GvHD in animal models, which are used to study disease mechanisms and evaluate new therapies. In this systematic review, we identified and analyzed original research articles in PubMed, Scopus, Web of Science, and Google Scholar that described grading systems for GvHD in animal models based on histopathological features. We found that several grading systems have been developed, which vary in the tissues and criteria they assess, the severity scoring scales they use, and the level of detail they provide. Skin, liver, and gut are the most commonly evaluated tissues, but lung and thymus are also included in some systems. Our analysis highlights the need for standardized criteria and consistent use of grading systems to enable comparisons between studies and facilitate the translation of preclinical findings to clinical practice.

Keywords: graft-versus-host disease, GvHD, animal model, histopathology, grading system

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Authors: Fakhreia A. Al Sagheer, Enas I. Ibrahim, Khaled D. Khalil

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N-Acryloyl morpholine, NAM, was grafted onto chitosan utilizing homogeneous conditions with 1% acetic acid as the solvent, and potassium persulfate and sodium sulfite as the redox initiator. The effects of various reaction parameters, such as time, temperature, and monomer and initiator concentrations, on the percentage of grafting (G%) and the grafting efficiency (E%) were determined. The graft copolymer showed a remarkably improved crystallinity, as compared to the unmodified chitosan, based on the FESEM, XRD, and DSC results. Chitosan-g-poly(N-acryloyl morpholine) (Cs-PNAM), the copolymer obtained by using this procedure, was characterized by utilizing FTIR, FESEM, TGA, and XRD analysis. As expected, the results of an evaluation of antibacterial and antifungal activities show that the grafted chitosan copolymers exhibit stronger inhibitory effects against both types of microbes than does chitosan. Moreover, the size of the inhibition zone created by the graft copolymer was observed to be proportional to its G% corresponding to its morpholine content. Fortunately, the graft copolymer showed a marked growth inhibition against candidiasis (C.Albicans and C.Kefyr). We conclude that the graft copolymer may be highly effective in the prevention and treatment of candidiasis. In addition, the extent and pH dependence of uptake of different types of dyes (acidic: EBT, and MV; and basic: MB) by grafted chitosan in pH 6.5 aqueous solutions was determined. The results show that, the grafted copolymer exhibited a greater affinity to absorb the acid dyes more than the basic ones especially at relatively low temperature. Thus the modified chitosan can be used, in wastewater treatment, as efficient economic absorbent especially for anionic dyes from the industrial processing effluents.

Keywords: chitosan, N-Acryloyl morpholine, homogeneous grafting, antimicrobial activity, dye uptake

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Authors: Takaaki Nemoto

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Case presentation: A 69-year-old Japanese man presented with a low-grade fever and fatigue that had persisted for one month. The patient had an aortic dissection on the aortic arch 13 years prior, an abdominal aortic aneurysm seven years prior, and an aortic dissection on the distal aortic arch one year prior, which were all treated with artificial blood-vessel replacement surgery. Laboratory tests revealed an inflammatory response (CRP 7.61 mg/dl), high serum creatinine (Cr 1.4 mg/dL), and elevated transaminase (AST 47 IU/L, ALT 45 IU/L). The patient was admitted to our hospital on suspicion of prosthetic vascular graft infection. Following further workups on the inflammatory response, an enhanced chest computed tomography (CT) and a non-enhanced chest DWI (MRI) were performed. The patient was diagnosed with a pulmonary fistula and a prosthetic vascular graft infection on the distal aortic arch. After admission, the patient was administered Ceftriaxion and Vancomycine for 10 days, but his fever and inflammatory response did not improve. On day 13 of hospitalization, a lung fistula repair surgery and an omental filling operation were performed, and Meropenem and Vancomycine were administered. The fever and inflammatory response continued, and therefore we took repeated blood cultures. M. fortuitum was detected in a blood culture on day 16 of hospitalization. As a result, we changed the treatment regimen to Amikacin (400 mg/day), Meropenem (2 g/day), and Cefmetazole (4 g/day), and the fever and inflammatory response began to decrease gradually. We performed a test of sensitivity for Mycobacterium fortuitum, and found that the MIC was low for fluoroquinolone antibacterial agent. The clinical course was good, and the patient was discharged after a total of 8 weeks of intravenous drug administration. At discharge, we changed the treatment regimen to Levofloxacin (500 mg/day) and Clarithromycin (800 mg/day), and prescribed these two drugs as a long life suppressive therapy. Discussion: There are few cases of prosthetic vascular graft infection caused by mycobacteria, and a standard therapy remains to be established. For prosthetic vascular graft infections, it is ideal to provide surgical and medical treatment in parallel, but in this case, surgical treatment was difficult and, therefore, a conservative treatment was chosen. We attempted to increase the treatment success rate of this refractory disease by conducting a susceptibility test for mycobacteria and treating with different combinations of antimicrobial agents, which was ultimately effective. With our treatment approach, a good clinical course was obtained and continues at the present stage. Conclusion: Although prosthetic vascular graft infection resulting from mycobacteria is a refractory infectious disease, it may be curative to administer appropriate antibiotics based on the susceptibility test in addition to surgical treatment.

Keywords: prosthetic vascular graft infection, lung fistula, Mycobacterium fortuitum, conservative treatment

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Authors: Islam Sherif, Ahmed Ashour, Ahmed Hassan, Hatem Osman

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Anterior Cruciate Ligament (ACL) injuries are common among athletes and individuals participating in sports with sudden stops, pivots, and changes in direction. Arthroscopic surgery is the gold standard for ACL reconstruction, aiming to restore knee stability and function. Recent years have witnessed significant advancements in arthroscopic surgery techniques, graft materials, and technological innovations, revolutionizing the field of ACL reconstruction. This presentation delves into the latest advancements in arthroscopic surgery techniques for ACL reconstruction and their potential impact on patient outcomes. Traditionally, autografts from the patellar tendon, hamstring tendon, or quadriceps tendon have been commonly used for ACL reconstruction. However, recent studies have explored the use of allografts, synthetic scaffolds, and tissue-engineered grafts as viable alternatives. This abstract evaluates the benefits and potential drawbacks of each graft type, considering factors such as graft incorporation, strength, and risk of graft failure. Moreover, the application of augmented reality (AR) and virtual reality (VR) technologies in surgical planning and intraoperative navigation has gained traction. AR and VR platforms provide surgeons with detailed 3D anatomical reconstructions of the knee joint, enhancing preoperative visualization and aiding in graft tunnel placement during surgery. We discuss the integration of AR and VR in arthroscopic ACL reconstruction procedures, evaluating their accuracy, cost-effectiveness, and overall impact on surgical outcomes. Beyond graft selection and surgical navigation, patient-specific planning has gained attention in recent research. Advanced imaging techniques, such as MRI-based personalized planning, enable surgeons to tailor ACL reconstruction procedures to each patient's unique anatomy. By accounting for individual variations in the femoral and tibial insertion sites, this personalized approach aims to optimize graft placement and potentially improve postoperative knee kinematics and stability. Furthermore, rehabilitation and postoperative care play a crucial role in the success of ACL reconstruction. This abstract explores novel rehabilitation protocols, emphasizing early mobilization, neuromuscular training, and accelerated recovery strategies. Integrating technology, such as wearable sensors and mobile applications, into postoperative care can facilitate remote monitoring and timely intervention, contributing to enhanced rehabilitation outcomes. In conclusion, this presentation provides an overview of the cutting-edge advancements in arthroscopic surgery techniques for ACL reconstruction. By embracing innovative graft materials, augmented reality, patient-specific planning, and technology-driven rehabilitation, orthopedic surgeons and sports medicine specialists can achieve superior outcomes in ACL injury management. These developments hold great promise for improving the functional outcomes and long-term success rates of ACL reconstruction, benefitting athletes and patients alike.

Keywords: arthroscopic surgery, ACL, autograft, allograft, graft materials, ACL reconstruction, synthetic scaffolds, tissue-engineered graft, virtual reality, augmented reality, surgical planning, intra-operative navigation

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Authors: Manal Ahmed, Amal Shehata, Shereen Deeb

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The study's purpose was to determine the effect of the perioperative protocol of care on clinical outcomes among patients undergoing coronary artery bypass graft. Subjects: A sample of 100 adult patients who were planned for coronary artery bypass graft, were selected and divided alternatively and randomly into two equal groups (50 study -50 control).The study was carried out at National heart Institute in Cairo and open heart surgical intensive care unit in Shebin El-Kom Teaching Hospital. Instruments: Four instruments were used for data collection: Interviewing questionnaire, dyspnea analogue scale, Biophysiological measurement instrument, and Compliance assessment sheet. Results: There were statistically significant differences between both groups regarding most respiratory system assessment findings at discharge. More than two-thirds of the study group of the current study had a continuous and regular commitment to diet regimen, which ranked first followed by the compliance of daily living activities then quitting smoking. Conclusions: The perioperative protocol of care has a significant improving effect on respiratory findings, dyspnea degree, duration of mechanical ventilation, length of hospital stay, compliance to diet, therapeutic regimen, daily living activities, and quit smoking among study group undergoing CABG. Recommendations: Perioperative protocol of care should be carried out for CABG patients at open-heart surgical units as well as an illustrative colored booklet about CAD, CABG and perioperative care should be available and distributed to all CABG patients.

Keywords: perioperative, effect, clinical outcomes, coronary artery, bypass graft, protocol of care

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Authors: Constantinos S. Mammas, Andreas Lazaris, Adamantia S. Mamma-Graham, Georgia Kostopanagiotou, Chryssa Lemonidou, John Mantas, Eustratios Patsouris

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The process to build a better safety culture, methods of error analysis, and preventive measures, starts with an understanding of the effects when human factors engineering refer to remote microscopic diagnosis in surgery and specially in organ transplantation for the evaluation of the grafts. Α high percentage of solid organs arrive at the recipient hospitals and are considered as injured or improper for transplantation in the UK. Digital microscopy adds information on a microscopic level about the grafts (G) in Organ Transplant (OT), and may lead to a change in their management. Such a method will reduce the possibility that a diseased G will arrive at the recipient hospital for implantation. Aim: The aim of this study is to analyze the ergonomics of digital microscopy (DM) based on virtual slides, on telemedicine systems (TS) for tele-pathological evaluation (TPE) of the grafts (G) in organ transplantation (OT). Material and Methods: By experimental simulation, the ergonomics of DM for microscopic TPE of renal graft (RG), liver graft (LG) and pancreatic graft (PG) tissues is analyzed. In fact, this corresponded to the ergonomics of digital microscopy for TPE in OT by applying virtual slide (VS) system for graft tissue image capture, for remote diagnoses of possible microscopic inflammatory and/or neoplastic lesions. Experimentation included the development of an OTE-TS similar experimental telemedicine system (Exp.-TS) for simulating the integrated VS based microscopic TPE of RG, LG and PG Simulation of DM on TS based TPE performed by 2 specialists on a total of 238 human renal graft (RG), 172 liver graft (LG) and 108 pancreatic graft (PG) tissues digital microscopic images for inflammatory and neoplastic lesions on four electronic spaces of the four used TS. Results: Statistical analysis of specialist‘s answers about the ability to accurately diagnose the diseased RG, LG and PG tissues on the electronic space among four TS (A,B,C,D) showed that DM on TS for TPE in OT is elaborated perfectly on the ES of a desktop, followed by the ES of the applied Exp.-TS. Tablet and mobile-phone ES seem significantly risky for the application of DM in OT (p<.001). Conclusion: To make the largest reduction in errors and adverse events referring to the quality of the grafts, it will take application of human factors engineering to procurement, design, audit, and awareness-raising activities. Consequently, it will take an investment in new training, people, and other changes to management activities for DM in OT. The simulating VS based TPE with DM of RG, LG and PG tissues after retrieval, seem feasible and reliable and dependable on the size of the electronic space of the applied TS, for remote prevention of diseased grafts from being retrieved and/or sent to the recipient hospital and for post-grafting and pre-transplant planning.

Keywords: digital microscopy, organ transplantation, tele-pathology, virtual slides

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Authors: W. G. Kim, J. M. Chang, W. S. Kim

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Immunologically non-treated and acellularized porcine xenografts were implanted as an arterial graft in goats and comparatively analyzed for the explanted grafts with gross observation, as well as light microscopy and immunohistochemistry, following the predetermined periods. For immunologically non-treated xenografts, bilateral porcine carotid arteries were harvested, and after short-term freezing at -70°C, were implanted into goats. The preparation of acellularized xenograft vessels has been performed with Nacl-SDS solution and stored at the freezer until use. The goats were randomly assigned for three periods of observation (3, 6, and 12 months after implantation), four animals were observed at each of these times. Periodic ultrasonographic examinations were performed during observation period. Following the predetermined periods, the explanted grafts were analyzed. Among 12 animals, one goat died prematurely, and a total of 22 grafts were evaluated. Gross observations revealed non-thrombotic patent smooth lumens. Microscopic examinations of the explanted grafts showed satisfactory cellular reconstruction up to the 12-month observation period. The proportions of CD3 positive T lymphocytes among inflammatory cells infiltrations were very low. In conclusion, these findings, as a whole, suggest that porcine vessel xenografts can be clinically acceptably implanted in the goats as a form of small-diameter vascular graft, regardless of the acellularized xenograft or immunologically non-treated xenograft.

Keywords: xenograft, arterial graft, long-term survival animals, immunology

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Authors: Shu-Chuan Liao, Chia-Ti Chang, Ko-Shao Chen

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Titanium and its alloy are widely used in many fields such as dentistry or orthopaedics. Due to their high strength low elastic modulus that chemical inertness and bio inert. The micro-arc oxidation used to formation a micro porous ceramic oxide layer film on Titanium surface and also to improve the resistance corrosion. For improving the biocompatibility, micro-arc oxidation surfaces bio-inert need to introduce reactive group. We introduced boundary layer by used plasma enhanced chemical vapor deposition of hexamethyldisilazane (HMDS) and organic active layer by UV light graft reactive monomer acrylic acid (AAc) therefore we can immobilize Chondroitin sulphate on surface easily by crosslinking EDC/NHS. The surface properties and composition of the modified layer were measured by scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS) and X-ray diffraction (XRD) and water contact angle. Water contact angle of the plasma-treated Ti surface decreases from 60° to 38°, which is an indication of hydrophilicity. The results of electrochemical polarization analysis showed that the sample plasma treated at micro-arc oxidation after plasma treatment has the best corrosion resistance. The result showed that we can immobilize chondroitin sulfate successful by a series of modification and MTT assay indicated the biocompatibility has been improved in this study.

Keywords: MAO, plasma, graft polymerization, biomedical application

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Authors: Sarah Hamdan Al-Jahdali, Khaled Alsaad, Abdullah Al-Sayyari

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Objectives: To study the prevalence, clinicopathological features, risk factors and outcome of biopsy proven polyoma (BK) virus infection among Saudi kidney transplant recipients and compare them to negative BK virus group. Methods: We retrospectively reviewed the charts of all the patients with biopsy-proven polyoma (BK) virus infection in King Abdulaziz Medical City in Riyadh between 2005 and 2011. The details of clinical presentation, the indication for kidney biopsy, the laboratory findings at presentation, the natural history of the disease, thepathological findings, the prognosis as well as the response to therapy were all recorded. Results: Kidney biopsy was performed in 37 cases of unexplained graft dysfunction. BK virus was found in 10 (27%). Out of those 10, 3 (30%) ended with graft failure. BK virus occurred in all patients who received ATG induction therapy 100% versus 59.3% in the non BK virus patients (p=0.06). Furthermore, the risk of BK virus was much less in those who received acyclovir as an anti-viral prophylaxis as compared to those who did not receive it (p=0.01). Also, patients with BK virus weighed much less (mean 46.7±20.6 Kgs) than those without BK virus at time of transplantation (mean 64.3±12.1). Graft survival was better among deceased donor kidneys compared to living ones (P=0.016) and with older age (P=0.005). Conclusion: Our findings suggest the involvement of ATG induction therapy, the lack of antiviral prophylaxis therapy and lower weight at transplant as significant risk factors for the development of BK virus infection.

Keywords: BKVAN, BKV, kidney transpant, Saudi Arabia

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Authors: Dahna Alkahtani, Faryal Suraya, Fadah Alanazi

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Background: Buccal mucosal graft for urethral augmentation has surpassed other grafting options, and is now considered the standard of choice for substitution Urethroplasty. The graft has gained its popularity due to its excellent short and long-term results, easy harvesting as well as its ability in withstanding wet environments. However, although Buccal mucosal grafts are an excellent option, it is not free of complications, potential intraoral complications are bleeding, pain, swelling, injury to the nerve resulting in numbness, lip deviation or retraction. Objectives: The current study aims to evaluate the intraoral complications of buccal mucosa grafts harvested from one cheek, and used in Augmentation Urethroplasty. Methodology: The study was conducted retrospectively using the medical records of patients who underwent open augmentation urethroplasty with a buccal mucosa graft at King Khalid University Hospital, Saudi Arabia. Data collection of demographics included the type of graft used, presence or absence of strictures and its etiological factors. Pre-operative and post-operative evaluations were carried out on the subjects including the medical history, physical examination, uroflowmetry, retrograde urethrography, voiding cystourethrography and urine cultures were also noted. Further, the quality of life and complications of the procedure including the presence or occurrence of bleeding within 3-days post-procedure, the severity of pain, oral swelling after grafting, length of return to normal daily diet, painful surgical site, intake of painkillers, presence or absence of speech disturbance, numbness in the cheeks and lips were documented. Results: Thirty-two male subjects with ages ranging from 15 years to 72 years were included in the current study. Following the procedure, a hundred percent of the subjects returned to their normal daily diet by the sixth postoperative day. Further, the majority of the patients reported experiencing mild pain accounting for 61.3%, and 90.3% of the subjects reported using painkillers to control the pain. Surgical wound Pain was reportedly more common at the perineal site as 48.4% of the subjects experienced it; on the other hand, 41.9% of the patients experienced pain in the oral mucosa. The presence of speech disorders, as assessed through medical history, was found to be present in 3.2% of patients. The presence of numbness in the cheeks and lips was found in 3.2% of patients. Other complications such as parotid duct injury, delayed wound healing, non-healing wound and suture granuloma were rare as 90.3% of the subjects denied experiencing any of them, there were nonetheless reports of parotid duct injury by 6.5% of the patients, and non-healing wound by the 3.2% of patients. Conclusion: Buccal Mucosa Graft in Augmentation Urethroplasty is an ideal source of allograft, although not entirely painless; it is considerably safe with minimal intra-oral complication and undetectable strain on the patients’ quality of life.

Keywords: augmentation, buccal, graft, oral

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Authors: Jitendra Jain, Cassandra Hidajat, Hansraj Riteesh Bookun

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Graft patency underpins long-term prognosis after coronary artery bypass grafting surgery (CABG). The benefits of the combined use of only the left internal mammary artery and radial artery, referred to as total arterial revascularisation (TAR), on long-term clinical outcomes and quality of life are relatively unknown. The aim of this study was to identify whether there were differences in long term clinical outcomes between recipients of TAR compared to a cohort of mostly arterial revascularization involving the left internal mammary, at least one radial artery and at least one saphenous vein graft. A retrospective analysis was performed on all patients who underwent TAR or were re-vascularized with supplementary saphenous vein graft from February 1996 to December 2004. Telephone surveys were conducted to obtain clinical outcome parameters including major adverse cardiac and cerebrovascular events (MACCE) and Short Form (SF-36v2) Health Survey responses. A total of 176 patients were successfully contacted to obtain postop follow up results. The mean follow-up length from time of surgery in our study was TAR 12.4±1.8 years and conventional 12.6±2.1. PCS score was TAR 45.9±8.8 vs LIMA/Rad/ SVG 44.9±9.2 (p=0.468) and MCS score was TAR 52.0±8.9 vs LIMA/Rad/SVG 52.5±9.3 (p=0.723). There were no significant differences between groups for NYHA class 3+ TAR 9.4% vs. LIMA/Rad/SVG 6.6%; or CCS 3+ TAR 2.35% vs. LIMA/Rad/SVG 0%.

Keywords: CABG; MACCEs; quality of life; total arterial revascularisation

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Authors: Scott M. Black, Craig Maclean, Pauline Hall Barrientos, Konstantinos Ritos, Asimina Kazakidi

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Aortic aneurysms and dissections are leading causes of death in cardiovascular disease. Both inevitably lead to hemodynamic instability without surgical intervention in the form of vascular stent-graft deployment. An accurate description of the aortic geometry and blood flow in patient-specific cases is vital for treatment planning and long-term success of such grafts, as they must generate physiological branch perfusion and in-stent hemodynamics. The aim of this study was to create patient-specific computational fluid dynamics (CFD) models through a multi-modality, multi-dimensional approach with boundary condition optimization to predict branch flow rates and in-stent hemodynamics in custom stent-graft configurations. Three-dimensional (3D) thoracoabdominal aortae were reconstructed from four-dimensional flow-magnetic resonance imaging (4D Flow-MRI) and computed tomography (CT) medical images. The former employed a novel approach to generate and enhance vessel lumen contrast via through-plane velocity at discrete, user defined cardiac time steps post-hoc. To produce patient-specific boundary conditions (BCs), the aortic geometry was reduced to a one-dimensional (1D) model. Thereafter, a zero-dimensional (0D) 3-Element Windkessel model (3EWM) was coupled to each terminal branch to represent the distal vasculature. In this coupled 0D-1D model, the 3EWM parameters were optimized to yield branch flow waveforms which are representative of the 4D Flow-MRI-derived in-vivo data. Thereafter, a 0D-3D CFD model was created, utilizing the optimized 3EWM BCs and a 4D Flow-MRI-obtained inlet velocity profile. A sensitivity analysis on the effects of stent-graft configuration and BC parameters was then undertaken using multiple stent-graft configurations and a range of distal vasculature conditions. 4D Flow-MRI granted unparalleled visualization of blood flow throughout the cardiac cycle in both the pre- and postsurgical states. Segmentation and reconstruction of healthy and stented regions from retrospective 4D Flow-MRI images also generated 3D models with geometries which were successfully validated against their CT-derived counterparts. 0D-1D coupling efficiently captured branch flow and pressure waveforms, while 0D-3D models also enabled 3D flow visualization and quantification of clinically relevant hemodynamic parameters for in-stent thrombosis and graft limb occlusion. It was apparent that changes in 3EWM BC parameters had a pronounced effect on perfusion distribution and near-wall hemodynamics. Results show that the 3EWM parameters could be iteratively changed to simulate a range of graft limb diameters and distal vasculature conditions for a given stent-graft to determine the optimal configuration prior to surgery. To conclude, this study outlined a methodology to aid in the prediction post-surgical branch perfusion and in-stent hemodynamics in patient specific cases for the implementation of custom stent-grafts.

Keywords: 4D flow-MRI, computational fluid dynamics, vascular stent-grafts, windkessel

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Authors: Elena Petersen, Inna Kornienko, Svetlana Guryeva, Sergey Dobdin, Anatoly Skripal, Andrey Usanov, Dmitry Usanov

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One of the most important unsolved problems in modern medicine is the increase of chronic diseases that lead to organ dysfunction or even complete loss of function. Current methods of treatment do not result in decreased mortality and disability statistics. Currently, the best treatment for many patients is still transplantation of organs and/or tissues. Therefore, finding a way of correct artificial matrix biofabrication in case of limited number of natural organs for transplantation is a critical task. One important problem that needs to be solved is development of a nondestructive and noninvasive method to analyze dynamic changes of mechanical characteristics of a matrix with minimal side effects on the growing cells. This research was focused on investigating the properties of matrix as a marker of graft condition. In this study, the collagen gel with human primary dermal fibroblasts in suspension (60, 120, 240*103 cells/mL) and collagen gel with cell spheroids were used as model objects. The stiffness and elasticity characteristics were evaluated by a semiconductor laser autodyne. The time and cell concentration dependency of the stiffness and elasticity were investigated. It was shown that these properties changed in a non-linear manner with respect to cell concentration. The maximum matrix stiffness was observed in the collagen gel with the cell concentration of 120*103 cells/mL. This study proved the opportunity to use the mechanical properties of matrix as a marker of graft condition, which can be measured by noninvasive semiconductor laser autodyne technique.

Keywords: graft, matrix, noninvasive method, regenerative medicine, semiconductor laser autodyne

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Authors: Abhishek Dave, Manisha Singh

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Purpose: The study aims to evaluate the outcomes of combined Penetrating keratoplasty (PKP) and Vitreo-Retinal (VR) surgery in patients having endophthalmitis with poor corneal clarity. Methods: PKP with VR Surgery was performed in 43 eyes. This is a retrospective analysis of their preoperative, intraoperative and microbiological characteristics and anatomical and functional outcomes. Results: Corneal opacification was due to corneal ulcer in 30 (69.7%), graft infection in 8 (18.6%), bullous keratopathy in 4 and corneal scar in 1 eye. Postoperative visual acuity improved in 20 (46.5%), not changed in 14 (32.5%) and deteriorated in 9 eyes (20.9%). Poor anatomic success was seen in 15 (34.88%) eyes (9-phthisis bulbi, 6-eviscerated). Graft remained clear in 24 eyes (1 year). Microbiology revealed bacteria in 26, fungus in 14 and no growth in 3 eyes. Six out of 11 patients having poor vision in the fellow eye, too, achieved functional success. Conclusion: PKP with VR surgery is a complex but globe-salvaging procedure for poor prognosis eyes, which otherwise would need evisceration.

Keywords: penetrating keratoplasty, VR surgery, endophthalmitis, corneal ulcer

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Authors: Syazwani Ramli, Norhidayu Muhamad Zain

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Nowadays, the use of gelatin as biomaterials in tissue engineering are evolving especially in skin graft and wound dressing applications. Towards year 2018, Malaysia is in the way of planning to get the halal certification for biomedical device in order to cater the needs of Muslims and non-Muslims in Malaysia. However, the use of gelatins in tissue engineering are mostly derived from non-halal sources. Currently, gelatin production mostly comes from mammalian gelatin sources. Moreover, within these past years, just a few studies of the uses of gelatin in tissue engineering from halal perspective has been studied. Thus, this paper aims to give overview of the use of gelatin from different sources from halal perspectives. This review also discussing the current status of halal for the emerging biomedical devices. In addition, the different sources of gelatin used in tissue engineering are being identified and provides better alternatives for halal gelatin. Cold- water fish skin gelatin could be an effective alternative to substitute the mammalian sources. Therefore, this review is important because the information about the halal biomedical devices will delighted Muslim consumers and give better insight of halal gelatin in tissue engineering application.

Keywords: biomedical device, gelatin, halal, skin graft, tissue engineering

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Authors: Azza A. Al-Ghamdi, Abir S. Abdel-Naby

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Cellulose acetate (CA) is a natural biodegradable polymer. It forms transparent films by the casting technique. CA suffers from high degree of water permeability as well as the low thermal stability at high temperatures. To adjust the CA polymeric films to the manufacture of food packaging, its thermal and mechanical properties should be improved. The modification of CA by grafting it with N-Amino phenyl maleimide (N-APhM) led to the construction of hydrophobic branches throughout the polymeric matrix which reduced its wettability as compared to the parent CA. The branches built onto the polymeric chains had been characterized by UV/Vis, ¹³C-NMR and ESEM. The improvement of the thermal properties was investigated and compared to the parent CA using thermal gravimetric analysis (TGA), differential scanning calorimetry (DSC), differential thermal analysis (DTA), contact angle and mechanical testing measurements. The results revealed that the water-uptake was reduced by increasing the graft percentage. The thermal and mechanical properties were also improved.

Keywords: cellulose acetate, food packaging, graft copolymerization, thermal properties

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Authors: Esmaeil Biazar

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A nanofibrous PHBV nerve conduit has been used to evaluate its efficiency based on the promotion of nerve regeneration in rats. The designed conduits were investigated by physical, mechanical and microscopic analyses. The conduits were implanted into a 30-mm gap in the sciatic nerves of the rats. Four months after surgery, the regenerated nerves were evaluated by macroscopic assessments and histology. This polymeric conduit had sufficiently high mechanical properties to serve as a nerve guide. The results demonstrated that in the nanofibrous graft with cells, the sciatic nerve trunk had been reconstructed with restoration of nerve continuity and formatted nerve fibers with myelination. For the grafts especially the nanofibrous conduits with cells, muscle cells of gastrocnemius on the operated side were uniform in their size and structures. This study proves the feasibility of artificial conduit with Schwann cells for nerve regeneration by bridging a longer defect in a rat model.

Keywords: sciatic regeneration, Schwann cell, artificial conduit, nanofibrous PHBV, histological assessments

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Authors: Mohamed Abdelmongy

Abstract:

Autologous Blood for Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Systematic Review and Meta-analysis Hossam Zein1,2, Ammar Ismail1,3, Mohamed Abdelmongy1,4, Sherif Elsherif1,5,6, Ahmad Hassanen1,4, Basma Muhammad2, Fathy Assaf1,3, Ahmed Elsehili1,7, Ahmed Negida1,7, Shin Yamane9, Mohamed M. Abdel-Daim8,9 and Kazuaki Kadonosono9 https://www.ncbi.nlm.nih.gov/pubmed/30277146 BACKGROUND: Pterygium is a benign ocular lesion characterized by triangular fibrovascular growth of conjunctival tissue over the cornea. Patients complain of the bad cosmetic appearance, ocular surface irritation and decreased visual acuity if the pterygium is large enough to cause astigmatism or encroach on the pupil. The definitive treatment of pterygium is surgical removal. However, outcomes are compromised by recurrence . The aim of the current study is to systematically review the current literature to explore the efficacy and safety of fibrin glue, suture and autologous blood coagulum for conjunctivalautograft fixation in primary pterygium surgery. OBJECTIVES: To assess the effectiveness of fibrin glue compared to sutures and autologous blood coagulum in conjunctival autografting for the surgical treatment of pterygium. METHODS: During preparing this manuscript, we followed the steps adequately illustrated in the Cochrane Handbook for Systematic Reviews of Interventions version 5.3, and reported it according to the preferred reporting of systematic review and meta-analysis (PRISMA) statement guidelines. We searched PubMed, Ovid (both through Medline), ISI Web of Science, and Cochrane Central Register of Controlled Trials (Central) through January 2017, using the following keywords “Pterygium AND (blood OR glue OR suture)” SELECTION CRITERIA: We included all randomized controlled trials (RCTs) that met the following criteria: 1) comparing autologous blood vs fibrin glue for conjunctivalautograft fixation in primary pterygium surgery 2) comparing autologous blood vs sutures for conjunctivalautograft fixation in primary pterygium surgery DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results, assessed trial quality, and extracted data using standard methodological procedures expected by Cochrane. The extracted data included A) study design, sample size, and main findings, B) Baseline characteristics of patients included in this review including their age, sex, pterygium site and grade, and graft size. C) Study outcomes comprising 1) primary outcomes: recurrence rate 2) secondary outcomes: graft stability outcomes (graft retraction, graft displacement), operation time (min) and postoperative symptoms (pain, discomfort, foreign body sensation, tearing) MAIN RESULTS: We included 7 RCTs and The review included662eyes (Blood: 293; Glue: 198; Suture: 171). we assess the 1) primary outcomes: recurrence rate 2) secondary outcomes: graft stability outcomes (graft retraction, graft displacement), operation time (min) and postoperative symptoms (pain, discomfort, foreign body sensation, tearing) CONCLUSIONS: Autologous blood for conjunctivalautograft fixation in pterygium surgery is associated with lower graft stability than fibrin glue or sutures. It was not inferior to fibrin glue or sutures regarding recurrence rate. The overall quality of evidence is low. Further well designed RCTs are needed to fully explore the efficacy of this new technique.

Keywords: pterygium, autograft, ophthalmology, cornea

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