Cartilage regeneration remains a significant challenge in the field of regenerative medicine. Acellular matrix-based cartilage tissue regeneration offers an innovative approach to repairing cartilage defects by providing a scaffold for new tissue growth. Its significance lies in its potential to restore joint function, mitigate pain, and improve the quality of life for patients suffering from cartilage-related injuries and conditions. Recent advances in acellular matrix-based cartilage regeneration have focused on enhancing scaffold properties for improved cell adhesion, proliferation, and differentiation. Moreover, several scaffold techniques such as combining ADM and ACM with cartilage tissue, as well as biphasic scaffolding enjoy rising research activity. Incorporating bioactive factors and advanced manufacturing techniques holds promise for producing more biomimetic scaffolds, advancing efficient cartilage repair and regeneration. Obstacles in acellular matrix-based cartilage regeneration include achieving proper integration with surrounding tissue and ensuring long-term durability of the regenerated cartilage. Further, issues such as high costs and limited availability of suitable cells for scaffold seeding must be considered. The heterogeneity and limited regenerative capabilities of cartilage need to be addressed for successful clinical translation. Research should focus on exploring advanced biomaterials and developing new techniques, regarding easily reproductible scaffolds, ideally constructed from clinically validated and readily available commercial products. Findings underline the potential of AM-based approaches, especially rising exploration of tissue-derived ADM and ACM. In future, the primary objective should not only be the regeneration of small cartilage defects, but rather focus on fully regenerating a joint or larger cartilage defect.

Aims: Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy.Methods: A clinical ambispective dual-centre study was performed to determine whether PAP reduces postoperative infection rates after soft tissue-only wrist arthroscopies. Retrospective and prospective data was collected at two hospitals with departments specialized in hand surgery. During the study period, 464 wrist arthroscopies were performed, of these 178 soft-tissue-only interventions met the study criteria and were included. Signs of postoperative infection and possible adverse drug effects (ADEs) of PAP were monitored. Additionally, risk factors for surgical site infection (SSIs), such as diabetes mellitus and BMI, were obtained.Results: The overall infection rate of SSI was zero. Neither in the PAP group (n = 69) nor in the control group (n = 109) were signs of postoperative infection observed. Observed symptoms of ADEs were three-times higher in the PAP group when compared to the control-group (16.3 vs 5.5%; p = 0.043). No major ADEs were observed, but one in ten patients in the PAP group reported mild to severe intestinal or hypersensitivity symptoms.Conclusion: We demonstrate that the number needed to treat (NNT) with PAP to prevent one postoperative infection in soft-tissue arthroscopies of the wrist is > 109. Conversely, symptoms of ADEs were reported by one out of ten patients given PAP. Considering the high NNT to prevent postoperative infection and the large number of ADEs caused by PAP, we recommend not to use PAP routinely in soft-tissue arthroscopies of the wrist. Subsequent large-scale studies should be conducted to substantiate these results.Cite this article: Bone Jt Open 2023;4(4):219–225.

Background: The reconstruction of plantar load-bearing foot defects faces many plastic surgeons with a major challenge. The optimal patient- and defect-oriented reconstructive strategy must be selected. Methods: To analyze the current trends and recommendations in reconstruction of plantar load-bearing foot defects, we conducted an international survey among plastic surgeons querying them about their recommendations and experiences. Results: The survey revealed that the most common strategies for reconstruction of the foot sole are locoregional and microvascular free flaps, emphasizing the relevance of plastic surgery. Among microvascular free flaps, muscle and fascio-cutaneous free flaps are by far the most frequently used. The target qualities of the reconstructed tissue to be considered are manifold, with adherence being the most frequently mentioned. We observed a noteworthy correlation between the utilization of muscle flaps and a preference for adherence. In addition, we identified a substantial correlation between the usage of fascio-cutaneous free flaps and further target qualities, such as good skin quality and sensitivity. Conclusions: Our findings provide insights into the clinical reality and highlight important aspects that must be considered in reconstruction of the weight-bearing areas of the foot providing support in the selection of the appropriate therapy.

Background: Free muscle flaps can develop significant postoperative edema and wound exudation, thereby increasing interstitial pressure and potentially compromising microcirculation. While concerns exist regarding negative pressure wound therapy (NPWT) to compress free flaps and hinder monitoring, recent studies have indicated a reduction in edema and an increase in blood flow. Objective: To compare microcirculation in free latissimus dorsi muscle (LDM) flaps dressed with and without NPWT. Methods: This retrospective cohort study analyzed prospectively collected data of patients who received free LDM flap reconstruction. Patients were separated into two groups according to management with or without NPWT. Microcirculation was evaluated continuously for up to 72 h utilizing laser doppler flowmetry and tissue spectrometry. Results: In total, n = 61 patients (26 females, 35 males) with an average age of 56.90 (17.4) years were included. NPWT was applied in 12 patients, while a regular cotton dressing was used in 49 patients. Overall, no significant differences in the number of minor and major complications were observed between groups. Both groups showed an increase in microvascular flow over the investigated time period. The flow showed higher absolute values in the NPWT group, reaching statistical significance at 12 h post-anastomosis, p = 0.038. There was a tendency for lower rHb values in the NPWT group, without reaching statistical significance. Conclusions: The presented study confirms the increase in microvascular flow after NPWT application. Whilst ensuring continuous free flap monitoring utilizing laser doppler flowmetry and spectrometry, the data further support the safety of NPWT application without risking vascular compromise due to external compression.

Aims: In the treatment of basal thumb osteoarthritis (OA), intra-articular autologous fat transplantation has become of great interest within recent years as a minimally invasive and effective alternative to surgical intervention with regard to pain reduction. This study aims to assess its long-term effectiveness.Methods: Patients diagnosed with stage one to three OA received a single intra-articular autologous fat transplantation. Fat tissue was harvested from the abdomen and injected into the trapeziometacarpal (TMC) joint under radiological guidance, followed by one week of immobilization. Patients with a minimum three-year post-procedure period were assessed for pain level (numerical rating scale), quality of life (Mental Health Quotient (MHQ)), the abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH)), and grip and pinch strength, as well as their overall impression of the treatment. Wilcoxon tests compared data from pre-intervention, and at one and three years post-intervention.Results: Out of 136 treated joints, the study involved 87 patients (37 patients were loss to follow-up, and 12 patients (9%) who underwent resection arthroplasty) with a median follow-up of 4.9 years (IQR 5.4 to 5.9). Pain, both at rest and during stress, significantly improved at one year and remained stable through three years. Sex, age, and stage of disease were not associated with postoperative pain levels. Patient-reported outcome measures for QuickDASH and MHQ improved up to at least three years post-treatment. Patients reported high satisfaction and willingness to recommend the procedure. Grip and pinch strength did not significantly change over time.Conclusion: The data show that autologous fat transfer has a longer-lasting effect in two-thirds of re-examined patients. If patients had an initial positive response, the pain-reducing effect lasted for at least three years. Therefore, this minimally invasive approach can offer a valuable treatment alternative for basal thumb OA.

Zusammenfassung: Hintergrund Aufgrund eines fortgeschrittenen Rektumkarzinoms kann eine Eviszeration mit Rektumamputation notwendig werden. Dabei können vor allem bei entsprechenden Voroperationen und neoadjuvanter Radiatio, ausgedehnte sowie tiefgreifende Weichteildefekte entstehen, die eine freie mikrovaskuläre Gewebetransplantation nötig werden lassen. In dieser Fallserie zeigen wir die erfolgreiche Kombination der muskulokutanen M. vastus lateralis-Lappenplastik (MVL) mit direktem Anschluss an die A. glutealis superior. Material und Methoden Wir untersuchten über einen Zeitraum von 47 Monaten, 11 retrospektiv Fälle von Patienten, bei denen dorsale Beckendefekte nach Eviszeration und Rektumamputation bestanden, die mit lokalen oder regionalen Mitteln nicht zu verschließen waren. Bei all diesen Patienten erfolgte bei ausgedehnten Defekten mit tiefen pararektal Wundhöhlen eine Defektdeckung durch eine freie myokutaner MVL-Lappenplastik mit direkte Gefäßanschluss an die superioren Glutealgefäße. Ergebnisse Die Defektgröße betrug im Mittel 290,0 cm² (SD: 131,2; Range: 200–600 cm²). Die Defekttiefe betrug im Mittel 10,5 cm. Die Defekte machten somit MVL-Lappenplastiken mit einer mittleren Größe von 336,3 cm² notwendig. Es waren aufgrund von Nachblutungen drei operative Revisionen nötig. Es traten weder arterielle noch venöse Thrombosen sowie kein Lappenverlust auf. Einzig wurde eine Lappenspitzennekrose beobachtet, die sekundär per Direktnaht korrigiert werden konnte. Die Auswertung des Case-Mix ergab einen Wert von im Mittelwert 24,251 (SD: 21,699; Range: 7,036–65,748) Punkten, was die Komplexität der Fälle unterstreicht. Schlussfolgerungen Unsere Ergebnisse zeigen, dass eine freie mikrovaskuläre MVL-Lappenplastik eine praktikable Therapieoption für pararektale Defekte darstellt, die nicht durch lokoregionale Methoden verschlossen werden können. Die A. glutea superior ist dafür ein sicheres und suffizientes Anschlussgefäß. In Kombination lassen sich auch ausgedehnte Defekte erfolgreich verschließen.