Search Results (573)

Approximately 185,000 people in the United states experience limb loss each year. There is a need for an intuitive neural interface that can offer high-fidelity control signals to optimize the advanced functionality of prosthetic devices. Regenerative peripheral nerve interface (RPNI) is a pioneering advancement in neuroengineering that combines surgical techniques with biocompatible materials to create an interface for individuals with limb loss. RPNIs are surgically constructed from autologous muscle grafts that are neurotized by the residual peripheral nerves of an individual with limb loss. RPNIs amplify neural signals and demonstrate long term stability. In this narrative review, the terms “Regenerative Peripheral Nerve Interface (RPNI)” and “RPNI surgery” are used interchangeably to refer to the same surgical and biological construct. This narrative review specifically focuses on RPNIs as a targeted approach to enhance prosthetic control through surgically created nerve–muscle interfaces. This area of research offers a promising solution to overcome the limitations of existing prosthetic control systems and could help improve the quality of life for people suffering from limb loss. It allows for multi-channel control and bidirectional communication, while enhancing the functionality of prosthetics through improved sensory feedback. RPNI surgery holds significant promise for improving the quality of life for individuals with limb loss by providing a more intuitive and responsive prosthetic experience. Full article

Background: Autologous fat grafting is increasingly used in daily clinical practice across various surgical fields, including the treatment of chronic wounds, scars, burns, and non-healing perianal fistulas. Recently, some studies have shown that non-enteric cutaneous fistulas can also benefit from adipose tissue injections, but the efficacy remains unclear. This study aims to systematically review the literature on fat grafting in the context of non-enteric cutaneous fistulas and to assess treatment outcomes. Methods: A comprehensive search of the PubMed/Medline database was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines up to January 2024 without restrictions on the time period or the language of publication. Results: Seven studies meeting the inclusion criteria were analyzed, encompassing 13 patients with non-healing cutaneous fistulas treated with injections of autologous fat. The mean age of the patients was 58 ± 3 years, of which 85% had comorbidities. Fat grafting resulted in complete healing in 92% of the cases, with a mean fistula persistence of 158 days before treatment. Treatment protocols varied among patients, including preparation of the fistulous tract, fat processing techniques, and suturing of the fistulous orifice. Conclusions: The results highlight the potential of autologous fat grafting in promoting tissue regeneration and healing of non-enteric cutaneous fistulas. Standardized protocols are essential to confirm and optimize treatment efficacy and, eventually, improve patient outcomes. Further research with a larger sample size and standardization is needed to confirm fat graft efficacy. Full article

The cornea, the transparent anterior window of the eye, critically refracts light and protects intraocular structures. Corneal pathologies, including trauma, infection, chemical injury, metabolic diseases, genetic conditions, and age-related degeneration, can lead to significant visual impairment. While penetrating keratoplasty or full-thickness corneal transplantation remains a standard and effective intervention for severe corneal dysfunction, limitations in donor tissue availability and the risk of immunogenic graft rejection necessitate alternative therapeutic strategies. Furthermore, for cases of isolated epithelial disfunction, a full-thickness cornea graft may not be required or effective. This review examines the potential of corneal epithelial constructs derived from autologous stem cells with functional barrier properties for corneal reconstruction and in vitro pharmacotoxicity testing. In this review, we delineate the current limitations of corneal transplantation, the advantages of stem cell-based approaches, and recent advances in generating engineered corneal epithelium. Finally, we address remaining technical challenges and propose future research directions aimed at clinical translation. Full article

Introduction: The optimal management of hallux sesamoid fracture nonunions remains a subject of ongoing debate, particularly in the context of personalized medicine. This systematic review aimed to synthesize current evidence regarding surgical strategies for this rare but disabling condition. Methods: A comprehensive literature search was conducted in accordance with the PRISMA guidelines. Results: Six studies met the inclusion criteria, encompassing a total of 80 patients. Surgical techniques varied and included open and arthroscopic sesamoidectomy, autologous bone grafting (alone or combined with screw fixation), and percutaneous screw fixation. When reported, outcomes were generally favorable, with union rates ranging from 90.5% to 100% and with consistent postoperative improvements in clinical function. Complication and reoperation rates were both 6.5%. The most frequent reoperation was sesamoidectomy for persistent pain or nonunion, followed by hardware removal. Conclusions: Despite the limited and low-quality evidence, available data suggest that individualized surgical planning can lead to favorable outcomes with low complication rates. Sesamoidectomy remains the most reliable salvage procedure in refractory cases. These findings support a personalized, stepwise approach to treatment—prioritizing sesamoid preservation, when feasible, while reserving excision for symptomatic nonunions. Further studies are needed to validate tailored algorithms and refine patient-specific decision-making in this challenging clinical scenario. Full article

Minimally invasive cosmetic procedures, such as dermal fillers, botulinum toxin injections, autologous fat grafting, intense pulsed light (IPL) treatments, and platelet-rich plasma (PRP) treatments, are increasingly popular worldwide due to their convenience and aesthetic benefits. While generally considered safe, these procedures can result in rare but serious ophthalmological complications. The most catastrophic adverse events include central retinal artery occlusion and ischemic optic neuropathy, which may lead to irreversible vision loss. Other complications include diplopia, ptosis, dry eye, and orbital cellulitis, with varying degrees of severity and reversibility. Awareness of potential ocular risks, appropriate patient selection, and adherence to safe injection techniques are crucial for preventing complications. This narrative review summarizes the incidence, mechanisms, clinical features, risk factors, diagnostic approaches, and management strategies of ocular complications associated with aesthetic medical procedures. A narrative literature review was conducted, emphasizing data from clinical studies, case series, and expert consensus published between 2015 and 2025. Special attention is given to anatomical danger zones, the pathophysiological pathways of filler embolization, and the roles of hyaluronidase and hyperbaric oxygen therapy in acute management. Although many complications are self-limited or reversible, prompt recognition and intervention are critical to prevent permanent sequelae. The increasing prevalence of these procedures demands enhanced education, informed consent, and interdisciplinary collaboration between aesthetic providers and ophthalmologists. Full article

Cryotherapy could stimulate immune responses and induce abscopal effects. A novel technique was developed for treating spinal bone tumors involving the use of frozen tumor-containing autologous bone grafts for anterior spinal reconstruction following total en-bloc spondylectomy, with the aim of activating cryoimmunity. This study focused on analyzing changes in the T-cell receptor (TCR) repertoire after surgery to evaluate T-cell diversity. Blood samples were collected pre- and post-operatively, with subsequent RNA extraction and immunosequencing. Compared to pre-surgery samples, the diversity and abundance of the Complementarity-Determining Region 3, regions of the TCR α and β chains decreased, suggesting that more selective clones may have emerged and influenced immune responses. Through TCR repertoire analysis, this study demonstrated that transplantation of frozen tumor-containing autologous bone impacted the immune system. This study is expected to provide a foundation for developing treatments that may enhance immune activation. Full article

Background: Persistent neuromuscular deficits following anterior cruciate ligament reconstruction (ACLR) are frequently attributed to arthrogenic muscle inhibition (AMI). The type of autologous graft used may influence the trajectory of neuromuscular recovery. Objective: To investigate the influence of graft type—bone–patellar tendon–bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT)—on the contractile properties of periarticular knee muscles over a 9-month post-operative period. Hypothesis: Each graft type would result in distinct recovery patterns of muscle contractility, as measured by tensiomyography (TMG). Methods: Thirty-one patients undergoing ACLR with BPTB (n = 8), HT (n = 12), or QT (n = 11) autografts were evaluated at 3, 6, and 9 months post-operatively. TMG was used to measure contraction time (Tc) and maximal displacement (Dm) in the rectus femoris, vastus medialis, vastus lateralis, and biceps femoris. Results: Significant within-group improvements in Tc and Dm were observed across all graft types from 3 to 9 months (Tc: p < 0.001 to p = 0.02; Dm: p < 0.001 to p = 0.01). The QT group showed the most pronounced Tc reduction in RF (from 30.16 ± 2.4 ms to 15.44 ± 1.6 ms, p < 0.001) and VM (from 31.05 ± 2.6 ms to 18.65 ± 1.8 ms, p = 0.004). In contrast, HT grafts demonstrated limited Tc recovery in BF between 6 and 9 months compared to BPTB and QT (p < 0.001), indicating a stagnation phase. BPTB exhibited persistent bilateral deficits in both quadriceps and BF at 9 months. Conclusions: Autograft type significantly influences neuromuscular recovery patterns after ACLR. TMG enables objective, muscle-specific monitoring of contractile dynamics and may support future individualized rehabilitation strategies. Full article

Objectives: Torus mandibularis (TM) is a benign bony exostosis on the lingual surface of the mandible, typically developing from the third decade of life with slow progression; its etiology remains unclear. As TM excision causes no functional or aesthetic disadvantages, its use as autologous bone graft material (e.g., for pre-implant or sinus lift augmentation) has been suggested. In this study, we investigate the prevalence and expression of TM in a southern German population with regard to age and gender. Additionally, we examine whether TM undergoes dynamic changes over time, with the hypothesis that TM may show temporal growth. Material and Methods: A retrospective analysis of CBCT scans from 210 randomly selected patients (105 males, 105 females) was performed. Patients were divided into three age groups (≤40, 41–60, ≥61 years; 70 per group), and TM was measured using OsiriX MD. For the longitudinal study, 146 CBCTs from 73 patients were compared over intervals of 2–9 years. Surface changes were assessed via 3D overlay using GOM Inspect. Results: TM was found in 30.5% of patients, and its prevalence was significantly higher in males (38%) than females (23%), with no age-related differences identified. Most TMs measured <2 mm (n = 51); only five exceeded this size. No dynamic growth was observed over time. Conclusion and Clinical Implications: TM is a common anatomical variant, more frequently detected through 3D imaging than clinical examination. In most cases, size remains minimal (<2 mm), limiting its clinical use as augmentation material in rare individual cases. Full article

Background: Chronic wounds represent a persistent clinical challenge and impose a considerable burden on healthcare systems. These lesions often require multidisciplinary management due to underlying factors such as microbial colonization, impaired immunity, and vascular insufficiencies. Regenerative therapies, particularly autologous approaches, have emerged as promising strategies to enhance wound healing. Adipose tissue-derived stem cells (ADSCs) and platelet-rich plasma (PRP) may improve outcomes through paracrine effects and growth factor release. Methods: A prospective observational study was conducted on 31 patients with chronic wounds that were unresponsive to conservative treatment for over six weeks. Clinical and photographic evaluations were employed to monitor healing. All patients underwent surgical debridement, with adjunctive interventions—negative pressure wound therapy, grafting, or flaps—applied as needed. PRP infiltration and/or autologous adipose tissue transfer were administered based on wound characteristics. Wound area reduction was the primary outcome measure. Results: The cohort included 17 males and 14 females (mean age: 59 years). Etiologies included venous insufficiency (39%), diabetes mellitus (25%), arterial insufficiency (16%), and trauma (16%). Most lesions (84%) were located on the lower limbs. All patients received PRP therapy; five underwent combined PRP and fat grafting. Over the study period, 64% of the patients exhibited >80% wound area reduction, with complete healing in 48.3% and a mean healing time of 49 days. Conclusions: PRP therapy proved to be a safe, effective, and adaptable treatment, promoting substantial healing in chronic wounds. Autologous adipose tissue transfer did not confer additional benefit. PRP may warrant inclusion in national treatment protocols. Full article

Background: Pancreatic Ductal Adenocarcinoma (PDAC) is one of the most common malignancies associated with thrombotic events. While there is research present on various techniques of portal vein reconstruction, there is limited published data on the techniques and/or considerations of reconstruction in the setting of complete portal vein occlusion. We therefore sought to analyze and present our experience of this clinical scenario. Methods: This was a retrospective analysis of a prospectively collected database. All patients who underwent portal vein resection and/or reconstruction during a pancreatic resection were included. Post-operatively, all patients underwent a contrast-enhanced CT scan on post-operative day 1 to assess for any portal vein thrombus. Results: Pancreatic resection with portal vein reconstruction was performed in 183 patients. Complete PV occlusion was seen in 12 patients at the time of surgery. In those patients with an occluded PV, reconstruction options included primary repair with end-end anastomosis (n = 2) or use of an interposition graft (n = 9). Interposition graft conduits included the left renal vein (n = 6), tubularized bovine pericardium (n = 3), and femoral vein (n = 1). Post-operative portal vein thrombus was seen in 4/12 patients. The majority of patients (n = 7) were discharged on therapeutic anticoagulation, 4 were discharged on an antiplatelet, and 1 patient received neither. Conclusions: Based on our series, we would recommend attempting PV reconstruction in these patients with an interposition graft (with autologous left renal vein or bovine pericardium). We believe that with this technique, the post-operative thrombosis risk is similar to PV reconstructions in non-occluded patients. Full article

Background/Objectives: During alveolar cleft grafting, the use of autogenous cancellous bone harvested from the iliac crest is still considered the gold standard. Due to the risk of donor-site morbidity and excessive graft resorption, alternative grafting materials (e.g., intraoral bone, xenografts) are being tested. The aim of this study was to compare the efficacy of using an autologous tooth-derived graft material and iliac crest cancellous bone in the reconstruction of the alveolar cleft in patients with a unilateral cleft lip and palate. Methods: A total of 21 patients with a unilateral cleft lip and palate, who underwent alveolar bone grafting between 2020 and 2023 were included in the study. In 11 cases, the donor site was the iliac crest; in the rest of the cases, deciduous teeth were harvested, processed, and used as an autologous particulate graft material for alveolar reconstruction. The mean follow-up time was 30.0 months, CBCT scans were taken, and the results were compared based on the ranking system published by Stasiak et al. Results: The Wilcoxon signed-rank test showed that the amount of bone on the cleft side was significantly less than that on the contralateral non-cleft side (ATB: p = 0.002, iliac crest: p = 0.005). The Mann–Whitney U test showed that there were no significant differences in bone quantity on the cleft side between the two groups (U = 47.5, p = 0.617). Conclusions: The use of ATB might be a feasible alternative to autologous bone during alveolar cleft reconstruction. This type of graft shows long-term stability, which is comparable to the bone harvested from the iliac crest. Full article

Background: The incidence of anterior cruciate ligament ruptures in football has experienced a marked increase in recent years, affecting both professional and amateur players. This injury is characterised by being highly disabling, causing the player to withdraw from the field of play for prolonged periods and there is no clear consensus on how to carry out the different phases of rehabilitation, which poses a major challenge for health professionals. Case presentation: This study followed a semi-professional player who suffered an anterior cruciate ligament tear following two forced valgus actions without direct contact in the same match. Outcome and follow-up: The patient underwent surgery using an autologous hamstring graft. He followed a progressive rehabilitation programme consisting of one preoperative phase and six phases after the operation. After a 12-month follow-up, with exercises aimed at perfecting step-by-step basic and specific physical skills, the player showed a complete functional recovery, achieving the desired parameters. Conclusions: This case highlights the importance of structured rehabilitation adapted to the specific needs of the football player through an approach with coherent progressions, which considers the muscle chains that determine the movements performed on the football pitch. Full article

Plasma-derived fibrin hydrogels are widely used in tissue engineering because of their excellent biological properties. Specifically, human plasma-derived fibrin hydrogels serve as 3D matrices for autologous skin graft production, skeletal muscle repair, and bone regeneration. Nevertheless, for advanced applications such as in vitro skin equivalents and engineered grafts, the intrinsic limitations of native fibrin hydrogels in terms of long-term mechanical stability and resistance to degradation need to be addressed to enhance the usefulness and application of these hydrogels in tissue engineering. In this study, we chemically modified plasma-derived fibrin by incorporating succinimidyl alginate (SA), a version of alginate chemically modified to introduce reactive succinimidyl groups. These NHS ester groups (N-hydroxysuccinimide esters), attached to the alginate backbone, are highly reactive toward the primary amine groups present in plasma proteins such as fibrinogen. When mixed with plasma, the NHS groups covalently bond to the amine groups in fibrin, forming stable amide linkages that reinforce the fibrin network during hydrogel formation. This chemical modification improved mechanical properties, reduces contraction, and enhanced the stability of the resulting hydrogels. Hydrogels were prepared with a final fibrinogen concentration of 1.2 mg/mL and SA concentrations of 0.5, 1, 2, and 3 mg/mL. The objective was to evaluate whether this modification could create a more stable matrix suitable for supporting skin tissue development. The mechanical and microstructure properties of these new hydrogels were evaluated, as were their biocompatibility and potential to create 3D skin models in vitro. Dermo-epidermal skin cultures with primary human fibroblast and keratinocyte cells on these matrices showed improved dermal stability and better tissue structure, particularly SA concentrations of 0.5 and 1 mg/mL, as confirmed by H&E (Hematoxylin and Eosin) staining and immunostaining assays. Overall, these results suggest that SA-functionalized fibrin hydrogels are promising candidates for creating more stable in vitro skin models and engineered skin grafts, as well as for other types of engineered tissues, potentially. Full article

Background and Objectives: To evaluate the feasibility and clinical outcomes of a novel non-mesh robot-assisted sacrocolpopexy (RSC) using autologous round ligament (ARL) grafts in patients with pelvic organ prolapse (POP). Materials and Methods: This retrospective study included 92 patients who underwent non-mesh RSC with ARL grafts at Kagoshima University Hospital between August 2020 and June 2024. All patients met the inclusion criteria for symptomatic POP-Q stage II or higher and elected to undergo non-mesh RSC. The procedures were performed using the da Vinci^® Xi or the hinotori™ Surgical Robot System. The clinical characteristics, operative data, complications, and recurrence rates were analyzed. Results: ARL harvesting was feasible in all patients, and the non-mesh RSC procedure was completed without conversion to open surgery or any intraoperative complications. The median operative time was 251 min, and the median blood loss was 30 mL. Postoperative complications of Clavien-Dindo grade ≥ 2 occurred in five patients (5%), all of whom developed pelvic infections. De novo stress urinary incontinence was observed in one patient (1%). POP recurrence occurred in seven patients (8%) during a median follow-up of 3 months (range, 3–18 months), all of whom presented with cystocele. Five patients underwent reoperation, and two were managed conservatively. All patients experienced postoperative symptomatic improvement. A higher BMI and advanced POP-Q stage were significant predictors of recurrence. Conclusions: This is the first report of non-mesh RSC using an ARL graft. The procedure is feasible and effective, avoids the use of synthetic mesh, and offers short-term outcomes comparable to those of mesh-based RSC. ARL-based RSC represents a promising alternative, especially for patients at risk of mesh-related complications. Long-term follow-up is required to confirm durability. Full article

Background: Peripheral artery disease (PAD) affects over 200 million individuals globally, leading to significant morbidity and mortality. For patients with complex lesions of the superficial femoral artery requiring revascularization, autologous vein bypass surgery remains a viable treatment option. Postoperative anticoagulation is critical for maintaining graft patency, but the optimal choice between direct oral anticoagulants (DOACs) and warfarin remains uncertain. Objectives: This study aims to evaluate the patency of below-the-knee autologous vein bypasses in PAD patients receiving either DOACs or warfarin over a two-year period. Methods: A retrospective cohort study was conducted at a tertiary care hospital in Berlin, Germany, including patients who underwent femoropopliteal or femorocrural bypass surgery between 2017 and 2022. Patients were divided into two groups based on postoperative anticoagulation therapy: DOACs or warfarin. The primary outcome was graft patency at 24 months. Results: Out of 192 patients, after applying exclusion criteria, 36 were analyzed. The mean bypass patency was longer in the warfarin group (18.3 months) compared to the DOAC group (14.3 months). However, the log-rank test p-value (0.524) suggests that this difference is not statistically significant. Given the log-rank test’s limitations in accounting for confounders, a multivariable Cox regression was performed, including age, sex, comorbidities, bypass type and antiplatelet use. The model (Omnibus p = 0.93) showed no statistically significant effect for any variable. Conclusions: DOACs appear to be a viable alternative to warfarin in maintaining graft patency in below-the-knee autologous vein bypasses for PAD patients. The lack of a need for regular INR monitoring with DOACs may offer a practical advantage in clinical settings. Full article