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At least 19 recordsLinked to original sources
PubMed1986

Quantitative comparisons of healing in cranial fresh autografts, frozen autografts and processed autografts, and allografts in canine skull defects.

Adult dog skull defects larger than 17 mm do not spontaneously heal. A quest for a potentially viable, cosmetically, mechanically, and technically acceptable template for human cranial reconstruction prompted a comparison of processed autogeneic and allogeneic bone implants with a fresh autograft control in the dog. Quantitative reproducible observations demonstrated that fresh calvarial bone autografts were superior to the nonviable implants in volume percent defect filled, mm2 new cortical bone, mm2 new and old cortical bone, and cortical bone porosity. Frozen autografts achieved 75%, antigen-extracted, autolyzed, partially demineralized auto- and allografts, 50% of the overall efficiency of fresh autografts. Fresh cancellous bone added to allografts did not improve long-term repair. Remodeling of all grafts appeared consistent with osteoconductive invasion by peripheral host endosteal and diploic elements; host external periosteum and dura contributed less. Central osteoinductive recruitment of mesenchymal cells from muscle or dura seemed not to occur in the adult dog. Partially demineralized dog calvarial grafts were resorbed without acting as a template for new bone formation. Surface demineralization, antigen extraction, and autolytic digestion of autografts and allografts, with or without fresh iliac bone, did not improve calvarial bone regeneration in adult dogs.

Animals↗
PubMed1999

Allogeneic bone marrow transplant or second autograft in patients with acute leukemia who relapse after an autograft. Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT).

Among 2752 patients with acute leukemia who had recurrent leukemia after autograft in remission and were reported to the EBMT, 94 underwent an allogeneic bone marrow transplant and 74 received a second autograft. Recipients of HLA-mismatched related or unrelated bone marrow had an increased transplant-related mortality (TRM, P = 0.017) and a decreased leukemia-free survival (LFS, P = 0.03), compared to recipients of HLA matched related or unrelated bone marrow. Outcome in recipients of HLA-compatible related or unrelated bone marrow was compared to those receiving a second autograft. TRM at 2 years was 51 +/- 8% in recipients of matched allografts and 26 +/- 6% following a 2nd autograft (P < 0.05). Two-year LFS was 27 +/- 7% and 35 +/- 6% in the two groups, respectively (NS). Multivariate analysis in these two groups showed that TRM was increased in patients who were in 2nd or later remission at 1st autograft (P < 0. 05) and allograft recipients (P < 0.05). Relapse was more common in patients with ALL (P < 0.001), above 25 years of age (P < 0.02), autograft performed later than 1991 (P < 0.05), and in second autografts (P < 0.05). LFS was decreased in patients >25 years of age (P < 0.01), if the interval from first autograft to relapse was 8 months or less (P < 0.01) and if TBI was used at first autograft (P < 0.05).

Adolescent↗
PubMed2000

The dismal outcome in patients with acute leukaemia who relapse after an autograft is improved if a second autograft or a matched allograft is performed. Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT).

All patients receiving autografts for acute leukaemia in remission between 1 January 1981 and 31 December 1996 and reported to the European Group for Blood and Marrow Transplantation and had a relapse, were included. The patients underwent an allograft (n = 90, group A), were treated with chemotherapy (n = 2584, group B) or received a second autograft (n = 74, group C). The 2-year survival after relapse was 32 +/- 5%, 11 +/- 1% and 42 +/- 6% in groups A, B and C, respectively. In group A, those with an HLA-A, -B and -DR compatible related or unrelated donor had a 2-year survival of 37 +/- 7% compared to 13 +/- 8% for those receiving a graft from an HLA mismatched donor (n = 20). The following factors were associated with better survival in multivariate analyses: an interval from first autograft to relapse >5 months (P < 0.00001), a first autograft performed later than 1991 (P < 0.00001), patient age below 26 years (median, P < 0.002), group B vs HLA mismatches from group A (P = 0.002), group C vs group B (P < 0.005), patients who were not treated with total body irradiation at first autograft (P < 0.02) and patients in first remission at first autograft (P = 0.02). To conclude, the poor outcome in these patients was improved if a second autograft was feasible (P < 0.005), or if an HLA-matched allograft was performed (NS). Bone Marrow Transplantation (2000).

Acute Disease↗
PubMed1988

Fate of long-term parathyroid autografts in patients with chronic renal failure treated by parathyroidectomy: a histopathological study of autografts, parathyroid glands and bone.

The aims of the study were to (1) determine the histopathology of parathyroid autografts in patients with renal failure treated by parathyroidectomy, (2) relate this to any evidence of hyperfunction, such as histological osteitis fibrosa and (3) determine whether there were any features in the donor parathyroid glands which correlated with autograft behaviour. Fourteen patients were studied; 106 implanted parathyroid fragments were identified in nine at necropsy and in the remaining five patients multiple fragments were obtained at the time of autograft surgical reduction. Of the patients studied at necropsy, in two the autografts were small and hypofunctional and in one of these the implants appeared partially involuted. In neither was there osteitis fibrosa. In the others there were varying degrees of hyperplasia and osteitis fibrosa. Four of the surgically excised autografts were markedly hyperplastic but there was no unequivocal evidence of malignancy. In one case, requiring repeated reduction of rapidly growing autograft tissue, there were frequent mitoses in the donor parathyroid gland and in the autograft. The presence of atypical cellular features and frequent mitoses in intraoperative frozen sections of a parathyroid gland militate against its use for implantation.

Adult↗
PubMed2002

[Anterior cruciate ligament reconstruction: patellar tendon autograft versus four-strand hamstring tendon autografts. A comparative study at one year follow-up].

PURPOSE OF THE STUDY: The purpose of our study was to compare outcome at one year after anterior cruciate ligament reconstruction for chronic laxity using the patellar tendon autograft or four-strand hamstring tendon autografts. MATERIAL AND METHOD: This non-randomized study included 129 consecutive patients operated on between October 1996 and September 1998. Ninety patients were available for assessment at one year: 50 in the patellar tendon group and 40 in the hamstring tendon group. The two groups were comparable for all criteria except sex. A single operator assessed all patients using the IKDC 93 chart. Laxity was measured by comparison with the healthy knee using the KT1000 at maximal manual tension. Preoperative laxity was 8.0 +/- 3.0 mm in the patellar tendon group and 7.6 +/- 3.0 in the hamstring tendon group. All ligamentoplasties were performed arthroscopically using a blind femoral tunnel. The patellar tendon was fixed with two metallic interference screws and the four-strand hamstring autografts with two different methods: an RCI(R) interference screw or a cortical system associating a femoral Endobutton(R) and tibial fixation with a bicortical tibial screw. Lateral tendonesis was performed with the fascia lata in 60% of the patients in the patellar tendon group and in 45% of those in the hamstring tendon group. Rehabilitation exercises were initiated early and were the same in the two groups. RESULTS: Overall results were satisfactory in more than 80% of the patients in both groups. The final IKDC score was significantly better in the patellar tendon group and subjective patient satisfaction was better in the hamstrings group. Residual pain was significantly less pronounced in the hamstrings tendon group (p=0.004). Laxity was improved significantly better in the patellar tendon group: average residual laxity=2.7 +/- 2.1 mm versus 4.5 +/- 2.8 mm (p=0.03) in the hamstrings tendon group; hard stop at the Lachman test in 96% of the patellar tendon group and 78% in the hamstrings tendon group (p=0.007). Residual laxity was significantly less pronounced in the women in the patellar tendon group. There was no significant difference in laxity by type of fixation in the hamstrings tendon group. Recovery in terms of level of activity and type of sport was the same in the two groups. DISCUSSION: These two surgical techniques provide good functional outcome at one year with better control of laxity with patellar tendon autografts and better relief of pain with four-strand hamstrings autografts. Longer follow-up would be useful to assess laxity long after hamstring reconstruction. We compared the type of transplant and the fixation method together as a single unity, but progress in four-strand hamstring autograft fixation will certainly allow even more optimal results and improved correction of laxity. In our opinion, the patellar tendon autograft remains the gold standard for high-performance athletes practicing a contact-pivot sport, but both types of ACL reconstruction are most useful. We select patients for four-strand hamstring tendon reconstruction as a function of age, sex, and type of sports activities.

Adolescent↗
PubMedDate not supplied

Pterygium surgery: conjunctival rotation autograft versus conjunctival autograft.

BACKGROUND AND OBJECTIVES: To compare the safety and efficacy of conjunctival rotation autograft to conjunctival autograft in primary pterygium surgery. PATIENTS AND METHODS: A prospective randomized study was performed of 39 eyes in 31 patients who had undergone pterygium surgery. Nineteen eyes were treated by conjunctival rotation autograft (Group A). Twenty eyes were treated by conjunctival autograft (Group B). Follow up ranged from 8 to 12 months (mean 11 months). Recurrence was defined as postoperative regrowth of 2 mm fibrovascular tissue onto clear cornea in the area of previous pterygium excision. Four eyes were excluded from the study. Delayed wound healing occurred in 11.76% of eyes, and 5.88% of eyes had persistent congestion in Group A. A loose graft was present in 5.55% of eyes, and 5.55% of eyes had dellen formation in Group B. CONCLUSION: We conclude that conjunctival rotation autograft and conjunctival autograft are both equally effective methods to reduce the recurrence rate after pterygium surgery. Conjunctival rotation autograft can be tried as an alternative attractive procedure for pterygium surgery to reduce the chances of recurrence. However, a larger, randomized, prospective double masked study with more patients and a longer follow up will eventually demonstrate the superiority of one procedure over the other.

Adult↗
PubMed2004

The comparison of patellar tendon-bone autografting and free flexor-tendon autografting in infraspinatus defect of the shoulder: biomechanical and histological evaluation in a sheep model.

The purpose of this study was to investigate the biomechanical and histological features of patellar tendon-bone autografting and free flexor-tendon autografting, which were fixed by two different techniques at the tendon-bone junction in reconstruction of an infraspinatus defect in sheep. Merino type sheep ( n=10) were divided into two groups. Following a defect in the infraspinatus tendon, in group I (flexor-tendon autografting) the free end of the flexor tendon was passed through the holes in the greater tuberosity for fixation. In group II (patellar tendon-bone autografting), fixation was obtained by impaction of the tibial bone plug to the greater tuberosity. Twelve weeks later, animals were sacrificed and specimens were evaluated biomechanically and histologically. Recovery of tensile mechanical properties was achieved to a level of approximately 50% in Group I and 70% in Group II at the end of the 12th week. No difference in the stiffness values was found. In group I, there was a difference between operated and contralateral (non-operated) tendons for the ultimate tensile strength values, but no difference was found in group II. Histologically, in group I, the defective area, which filled with a hypercellular connective tissue, could hardly be differentiated from the normal tendon tissue. In group II, complete incorporation of the bone block was seen in all specimens. These results suggested that patellar tendon-bone autografting is more advantageous than free flexor-tendon autografting in infraspinatus defect, providing rapid healing and better mechanical properties, especially in the early period of healing.

Animals↗
PubMedDate not supplied

Arthroscopic reconstruction of the anterior cruciate ligament. A comparison of patellar tendon autograft and four-strand hamstring tendon autograft.

We compared the outcome of anterior cruciate ligament reconstruction using hamstring tendon autograft with outcome using patellar tendon autograft at 2 years after surgery. Patients had an isolated anterior cruciate ligament injury and, apart from the grafts, the arthroscopic surgical technique was identical. Prospective assessment was performed on 90 patients with isolated anterior cruciate ligament injury undergoing reconstruction with a patellar tendon autograft; 82 were available for follow-up. The hamstring tendon autograft group consisted of the next 90 consecutive patients fulfilling the same criteria; 85 were available for follow-up. Clinical review included the Lysholm and International Knee Documentation Committee scores, instrumented testing, thigh atrophy, and kneeling pain. These methods revealed no difference between the groups in terms of ligament stability, range of motion, and general symptoms. Thigh atrophy was significantly less in the hamstring tendon group at 1 year after surgery, a difference that had disappeared by 2 years. The KT-1000 arthrometer testing showed a slightly increased mean laxity in the female patients in the hamstring tendon graft group. Kneeling pain after reconstruction with the hamstring tendon autograft was significantly less common than with the patellar tendon autograft, suggesting lower donor-site morbidity with hamstring tendon harvest.

Adolescent↗
PubMed1999

Conjunctival rotation autograft for pterygium. An alternative to conjunctival autografting.

OBJECTIVE: To determine the safety and efficacy of conjunctival rotation autografting (CRA) as an alternative to conventional conjunctival autograft after pterygium excision. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Consecutive patients seen at the Pterygium Clinic of the Singapore National Eye Centre who were thought to be unsuitable for conventional conjunctival autografting underwent a modified surgical procedure, which the authors describe as CRA. There were 51 rotation autografts performed on 45 eyes of 43 patients. INTERVENTION: In this procedure, the underlying fibrovascular pterygium tissue was removed and the original epithelium (with minimal subepithelial tissue included) replaced over the bare sclera with a 180 degrees rotation. Surgeries were performed by one surgeon (DT) from April 1995 to May 1996. MAIN OUTCOME MEASURE: Pterygium recurrence and complications of CRA were measured. RESULTS: The mean follow-up time was 12 months (range, 2-22 months). There were 46 primary and 5 recurrent pterygia. The indications for CRA were combined cataract and pterygium surgery (39.2%), double pterygia (31.4%), the need to preserve the superior conjunctiva (21.6%), and superior conjunctival scarring (7.8%). There were two recurrences (4% recurrence rate), one occurring at 4 months and the other occurring at 7 months after surgery. No significant complications were encountered. However, 50% of the grafts remained mildly injected for more than 3 months, and some remained injected for up to 13 months after surgery (average of 4 months). Pigmentary changes were also noted in six grafts (12%). CONCLUSION: Conjunctival rotation autografting is a useful technique of conjunctival grafting in cases in which it is not possible or desirable to use the superior conjunctiva as a donor source.

Adult↗
PubMed2006

Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis.

OBJECTIVES: To compare bone-patellar tendon-bone autografts with hamstring autografts for reconstruction of the anterior cruciate ligament. DATA SOURCES: Medline, WebSPIRS, Science Citation Index, Current Contents databases, and Cochrane Central Register of Controlled Trials. Review methods All randomised controlled trials reporting one or more outcome related to stability (instrumented measurement of knee laxity, Lachman test, or pivot shift test) and morbidity (anterior knee pain, kneeling test, loss of extension, or graft failure). Study quality was assessed by using a 5 point scale. Random effect models were used to pool the data. Heterogeneity in the effect of treatment was tested on the basis of study quality, randomisation status, and number of tendon strands used. RESULTS: 24 trials of 18 cohorts (1512 patients) met the inclusion criteria. Study quality was poor for nine studies and fair for nine studies. The weighted mean difference of the instrumented measurement of knee laxity was 0.36 (95% confidence interval 0.01 to 0.71; P = 0.04). Relative risk of a positive Lachman test was 1.22 (1.01 to 1.47; P = 0.04), of anterior knee pain 0.57 (0.44 to 0.74; P < 0.0001), of a positive kneeling test 0.26 (0.14 to 0.48; P < 0.0001), and of loss of extension 0.52 (0.34 to 0.80; P = 0.003). Other results were not significant. CONCLUSION: Morbidity was lower for hamstring autografts than for patellar tendon autografts. Evidence that patellar tendon autografts offer better stability was weak. The poor quality of the studies calls into question the robustness of the analyses.

Adult↗
PubMed1998

Automated production of cultured epidermal autografts and sub-confluent epidermal autografts in a computer controlled bioreactor.

The objective of this work was to engineer an automated system for the production of cultured epidermal autografts and sub-confluent cultured epidermal autografts. Human epidermal cells were grown directly on a transparent FEP film, which was held in place and surrounded by a polycarbonate growth chamber. The growth chambers were stacked to accommodate various surface area requirements. To monitor the development of the grafts, the upper-most growth chamber in the stack was periodically placed on a standard phase contrast microscope. The growth chambers were connected to a multi-channel peristaltic pump, which was controlled automatically to manage fluid-handling operations. Sub-confluent graft production involved removing the epidermal-film composite from the growth chambers and cutting desired graft geometries. Producing cultured epidermal autografts involved (1) removing the confluent epidermal-film composite from the growth chambers, (2) treating the composites with dispase, and (3) clipping the detached cultured epidermis to a synthetic support. Twelve to fifteen days were required to produce sub-confluent grafts (total surface area 3500-4500 cm2 50% confluent) and 18 to 24 d were required to produce standard cultured epidermal autografts (total surface area 3500-4500 cm2). The system reduces the tedious manual labor associated with producing cultured epidermal autografts.

Bioreactors↗
PubMed1993

A comparison of the passage of regenerating axons through old degenerated nerve autografts and fresh nerve autografts in rats.

We have compared the passage of regenerating axons through old degenerated nerve autografts and fresh nerve autografts in two groups of Sprague Dawley rats. In one group the right sciatic nerve was divided and repaired with the graft taken from the distal segment of the left sciatic nerve, which had been severed 15 weeks before. In the other group the right sciatic nerve was repaired with the graft taken from the intact left sciatic nerve. Eight weeks later the myelinated axons were counted at three different locations in the grafted right sciatic nerve in both groups. The old degenerated nerve autografts were less effective in allowing the passage of regenerating axons than the fresh nerve autografts, but the difference was not great. This provides justification for the use of old degenerated nerve as an additional graft where a large number of autogenous nerve grafts are required, such as in the operative treatment of injuries to the brachial plexus.

Animals↗
PubMedDate not supplied

Comparison of cultured epidermal autograft and massive excision with serial autografting plus homograft overlay.

The chief determinant of mortality in severe burn injuries has been the size and severity of the wound. Early massive excision of the wound has increased the median lethal dose to 98% of total body surface area burn but presents the problem of wound closure. Autograft substitutes must be used for a large burn. We report our experience with early massive excision in the treatment of 47 pediatric patients with burns who had greater than 80% total body surface area burn and greater than 80% full-thickness burn. Four patients died within hours of admission. Fifteen patients died of sepsis and multiorgan failure; the primary source of bacterial contamination was the open wound. The 28 survivors received approximately 2.0 m2 2:1 homograft until autograft became available. A case report of a 10-year-old boy illustrates the use of two types of cultured epidermal autograft, one "homegrown" and one commercially produced.

Burns↗
PubMed1993

A morphological comparison of interposed freeze-thawed skeletal muscle autografts and interposed nerve autografts in the repair of the rat facial nerve.

Freeze-thawed co-axially aligned skeletal muscle autografts provide a new concept in peripheral nerve repair, and are being investigated in the repair of mixed motor/sensory nerves. These grafts provide an orientated matrix of large basement membrane tubes through which regenerating axons can migrate and reinnervate the distal nerve. Using the buccal branch of the rat facial nerve as a model, we compared five freeze-thawed muscle autografts with five interposed nerve autografts. Some 300 days after grafting, the morphology of the distal nerve was evaluated. When the two groups were assessed morphometrically, it was found that nerve grafts showed a small but significant improvement over muscle grafts in respect of indices of the fibre maturation.

Animals↗
PubMed1994

[Reconstruction of acetabular insufficiency in initial total hip endoprosthesis surgery using a massive autograft (fate of the implanted autograft more than one year after surgery)].

The authors present a method of reconstruction of insufficient acetabula by autografts from heads of femurs before primary implantation of the cemented total endoprosthesis of the coxa. They reconstruct the osseous acetabulum of the patient by prolonging it, filling or reinforcing its floor, although in one third of the patients it is difficult to find a borderline between these three groups. Coxarthroses are primary and secondary and of those almost half are secondary dysplastic coxarthroses. The group of patients comprises 32 women and 17 men, their mean age at the time of operation was 58.5 years. The authors follow-up, using clinical and X-ray methods, the fate of "massive autografts". Within six months the autograft is already firmly linked with bone and within 12 months it is reconstructed. A bone graft, unless burdened, is gradually reabsorbed. This process is intensive in particular between the 3rd and 6th month after operation and by the 12th month the graft is reabsorbed.

Acetabulum↗
PubMed1999

Unfractionated peripheral blood stem cell autografts and CD(34+)-enriched autografts have similar long-term culture initiating capacity in multiple myeloma.

CD(34+)-enriched peripheral blood stem cells (PBSC) are increasingly being used as an autograft in patients with multiple myeloma (MM). The rationale for the use of the CD34+-enriched fraction in MM is the ability to obtain a graft with a significant reduction of contamination by plasma cells. However, the effect of such a manipulation on the proliferating potential of the engrafted cells is not known. We wished to study, as part of a randomized trial comparing the outcome in MM patients transplanted with either CD(34+)-enriched cells or unfractionated PBSC, the primitive hematopoietic cell content of the autografts using long-term culture initiating cell (LTC-IC) assays in 7 MM patients. In 3 patients CD(34+)cell-enriched fraction was compared to unfractionated PBSC whereas in the remaining 4 patients the LTC-IC assay was performed on total PBSC. The mean percentage of CD34+ cells of the CD34+ selected fraction in three patients was 82% (range 71%-96%) whereas the same percentage in PBSC varied from 0.6% to 10% in 4 patients (mean: 4.2%). Out of three patients transplanted with CD34+ cell fraction, two patients were found to have a very similar LTC-IC generating potential in their CD34+ versus PBSC fractions as this was assessed by the clonogenic cell output at week+5 per 10(4) CD34+ cells initiating the culture (PBSC: 92 and 168 and CD34+ fraction: 102 and 16, respectively) whereas one patient had a slightly different values (PBSC: 51 and CD34+ fraction: 103). When the PBSC fraction was compared in all 7 patients, the LTC-IC generation potential was very heterogenous, varying from 1.4 to 168. To determine if the selection procedure influences the numbers of LTC-IC's in both fractions, we have performed limiting dilution assays to determine both the frequency of distribution of hematopoietic colonies and the frequency of LTC-IC's in two patients. The frequency of distribution of hematopoietic colonies was linear in both CD34+ and PBSC fractions as was the frequency of LTC-IC when the corrections were made with regard to the CD34+ cell-content of the cultures (1/20). Our results indicate that the CD34+ selection procedure used in all three patients (Ceprate) is not deleterious for the generation of LTC-IC's and these findings support the rationale for the use of this procedure in multiple for the purposes of tumor depletion.

Adult↗
PubMedDate not supplied

Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up.

Seventy-two patients with subacute or chronic rupture of the anterior cruciate ligament were randomly assigned to autograft reconstruction with four-strand gracilis and semitendinosus tendon (N = 37) or with patellar tendon-bone (N = 35) from the ipsilateral side. The groups were similar in terms of age, sex, level of activity, degree of laxity, meniscal lesions found surgically, and rehabilitation program. The follow-up was performed at another hospital by independent observers after 6, 12, and 24 months. Sixty-one patients (32 with hamstring tendon grafts and 29 with patellar tendon grafts) complied with the follow-up routine for the full 24 months. No differences were found between the groups with respect to Cincinnati functional score, KT-1000 arthrometer measurements, or stairs hopple test results. The subjective result and the single-legged hop test result were better for the hamstring tendon group after 6 and 12 months, but no differences were found after 24 months. The hamstring tendon group showed better isokinetic knee extension strength than did the patellar tendon group after 6 months, but not after 12 and 24 months. There was a significant weakness in isokinetic knee flexion strength among the hamstring tendon group. Anterior knee pain was not significantly different between the groups, but kneeling pain was significantly less common in the hamstring tendon group after 24 months.

Adolescent↗