Allogeneic versus autogenous shell technique augmentation procedures: a prospective-observational clinical trial comparing surgical time and complication rates.

OBJECTIVES: Autogenous and allogeneic blocks for shell augmentation of the jaw have shown comparable results. This observational clinical study aimed to compare both materials for shell augmentation concerning surgery time and intra- and postoperative complications. MATERIAL AND METHODS: Bone augmentation with the shell technique using autogenous or allogenous bone was performed in 117 patients with segmental jaw atrophy. The primary study parameter was the surgical time, comparing both materials. Subsequently, intra- and postoperative complications were recorded. RESULTS: Allogeneic (n = 60), autogenous (n = 52), or both materials (n = 5) were used. The use of allogeneic material led to a significantly shorter operation time (p < 0.001). A more experienced surgeon needed significantly less time than a less experienced surgeon (p < 0.001). An increasing number of bone shells (p < 0.001), an additional sinus floor elevation, and intraoperative complications also significantly increased the operation time (p = 0.001). Combining allogeneic and autogenous shells (p = 0.02) and simultaneous sinus floor elevation (p = 0.043) significantly impacted intraoperative complications. No correlations were found between the included variables for postoperative complications (all p > 0.05). In total, 229 implants were inserted after a healing time of 4-6 months, with a survival of 99.6% after a mean follow-up duration of 9 months. CONCLUSIONS: Compared to the autogenous technique, allogeneic shell augmentation has a shorter surgical time and a similar rate of intra- and postoperative complications as autogenous bone. Together with its promising clinical results, this technique can be recommended.

First Clinical Case Report of a Xenograft-Allograft Combination for Alveolar Ridge Augmentation Using a Bovine Bone Substitute Material with Hyaluronate (Cerabone® Plus) Combined with Allogeneic Bone Granules (Maxgraft®).

BACKGROUND: A patient had lost the first left maxillary incisor in the esthetic zone. METHODS: The defect in the alveolar ridge was reconstructed for an implant-supported restoration using a new xenogeneic bone substitute containing hyaluronate, which was used in combination with allogeneic bone granules. RESULTS: After three years of follow-up, the dental implant was stable and showed no signs of infection. CONCLUSIONS: This is the first case report with a long-term follow-up time of three years of a successful clinical application of a xenograft-allograft combination (cerabone® plus combined with maxgraft®) for alveolar ridge augmentation before dental implantation. Cerabone® plus offers volume stability, provides reliable and efficient structural support of the oral soft tissues in the augmented region (particularly crucial in the aesthetic zone), and preserves the alveolar ridge shape.

Evaluating the efficacy of single-shot versus prolonged antibiotic prophylaxis in alveolar cleft osteoplasty - A retrospective cohort study.

This retrospective cohort study aimed to compare the outcomes of alveolar cleft osteoplasty using single-shot antibiotic prophylaxis versus a prolonged antibiotic regimen. The primary endpoints assessed were the incidence of infection, failure of surgical correction, and antibiotic-related side effects. Patients with orofacial clefts affecting the alveolar ridge who underwent alveolar cleft osteoplasty at a tertiary care center between 2015 and 2021 were included. The prolonged antibiotic group received extended antibiotic treatment, while the single-shot group received preoperative antibiotics only. Among 83 patients (mean age 12.8 years), 51 interventions were performed under prolonged antibiotic prophylaxis (mean duration 5.82 days) whereas in 40 interventions only single-shot prophylaxis was administered. There were no significant differences in infection frequency, surgical correction failure, implant loss, or adverse events between the groups. However, after single-shot antibiotic regimen, patients had significantly shorter hospital stays, being discharged on average one day earlier. The study suggests that single-shot antibiotic prophylaxis does not have drawbacks compared to prolonged antibiotic treatment in alveolar cleft osteoplasty. Considering increasing antibiotic resistance and potential side effects, omitting prolonged antibiotic prophylaxis is recommended for patients undergoing alveolar cleft osteoplasty.

Is one-stage lateral sinus lift and implantation safe in severely atrophic maxillae? Results of a comparative pilot study.

PURPOSE: The aim of this retrospective comparative study was to evaluate the survival of dental implants placed in the posterior maxilla with a residual bone height less than 3 mm using a one-stage lateral sinus lifting approach. The research question was whether in very severely atrophied maxillary bones (residual height < 3 mm), a sinus lift with simultaneous implant placement would be associated with a higher complication rate compared to single-stage sinus lifts at average residual alveolar process heights. METHODS: Complications of 63 implants, where the residual bone height was below 3 mm, were compared to a reference group of 40 implants, which were inserted using a one-stage lateral sinus lift in maxillae with at least 3 mm residual bone height. Implant survival, bleeding-on-probing, the presence of peri-implant mucositis and the occurrence of peri-implantitis were documented. RESULTS: The mean follow-up time for implant survival was 80.3 ± 25.9 months. One implant out of 63 was lost in the severely atrophic maxilla group and two implants out of 40 were lost in the reference group. There were no differences in the occurrence of implant loss (p = 0.558), bleeding-on-probing (p = 0.087), peri-implantitis (p = 0.999) and peri-implant mucositis (p = 0.797) between the severely atrophic alveolar ridge group and the reference group. CONCLUSIONS: Even in severely atrophic maxillae with < 3 mm residual bone height, a one-stage maxillary sinus lift and immediate implant placement can be carried out safely.

FDA-approved deep learning software application versus radiologists with different levels of expertise: detection of intracranial hemorrhage in a retrospective single-center study.

PURPOSE: To assess an FDA-approved and CE-certified deep learning (DL) software application compared to the performance of human radiologists in detecting intracranial hemorrhages (ICH). METHODS: Within a 20-week trial from January to May 2020, 2210 adult non-contrast head CT scans were performed in a single center and automatically analyzed by an artificial intelligence (AI) solution with workflow integration. After excluding 22 scans due to severe motion artifacts, images were retrospectively assessed for the presence of ICHs by a second-year resident and a certified radiologist under simulated time pressure. Disagreements were resolved by a subspecialized neuroradiologist serving as the reference standard. We calculated interrater agreement and diagnostic performance parameters, including the Breslow-Day and Cochran-Mantel-Haenszel tests. RESULTS: An ICH was present in 214 out of 2188 scans. The interrater agreement between the resident and the certified radiologist was very high (κ = 0.89) and even higher (κ = 0.93) between the resident and the reference standard. The software has delivered 64 false-positive and 68 false-negative results giving an overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 68.2%, 96.8%, 69.5%, 96.6%, and 94.0%, respectively. Corresponding values for the resident were 94.9%, 99.2%, 93.1%, 99.4%, and 98.8%. The accuracy of the DL application was inferior (p < 0.001) to that of both the resident and the certified neuroradiologist. CONCLUSION: A resident under time pressure outperformed an FDA-approved DL program in detecting ICH in CT scans. Our results underline the importance of thoughtful workflow integration and post-approval validation of AI applications in various clinical environments.

Continuous Multidisciplinary Care for Patients With Orofacial Clefts-Should the Follow-up Interval Depend on the Cleft Entity?

OBJECTIVE: The multidisciplinary follow-up of patients with cleft lip with or without palate (CL/P) is organized differently in specialized centers worldwide. The aim of this study was to evaluate the different treatment needs of patients with different manifestations of CL/P and to potentially adapt the frequency and timing of checkup examinations accordingly. DESIGN: We retrospectively analyzed the data of all patients attending the CL/P consultation hour at a tertiary care center between June 2005 and August 2020 (n = 1126). We defined 3 groups of cleft entities: (1) isolated clefts of lip or lip and alveolus (CL/A), (2) isolated clefts of the hard and/or soft palate, and (3) complete clefts of lip, alveolus and palate (CLP). Timing and type of therapy recommendations given by the specialists of different disciplines were analyzed for statistical differences. RESULTS: Patients with CLP made up the largest group (n = 537), followed by patients with cleft of the soft palate (n = 371) and CL ± A (n = 218). There were significant differences between the groups with regard to type and frequency of treatment recommendations. A therapy was recommended in a high proportion of examinations in all groups at all ages. CONCLUSION: Although there are differences between cleft entities, the treatment need of patients with orofacial clefts is generally high during the growth period. Patients with CL/A showed a similarly high treatment demand and should be monitored closely. A close follow-up for patients with diagnosis of CL/P is crucial and measures should be taken to increase participation in follow-up appointments.

Risk Factors for Complications Following Staged Alveolar Ridge Augmentation and Dental Implantation: A Retrospective Evaluation of 151 Cases with Allogeneic and 70 Cases with Autogenous Bone Blocks.

Purpose: the aim of this study was to identify potential risk factors favoring complications by assessing the number and types of complications associated with allogeneic or autogenous bone blocks applied as onlay grafts for alveolar ridge augmentation prior to implantation. Methods: A retrospective chart review on the success of 151 allogeneic and 70 autogenous bone blocks in a cohort of 164 consecutive patients, who were treated over a period of 6 years by the same surgeon, was conducted. Statistical conclusions were based on ROC curves and multiple logistic regression models. Results: Complications were observed more frequently with autogenous bone blocks (14 out of 70 cases; 20%) compared to allogeneic bone blocks (12 out of 151 cases; 7.9%; p = 0.013). However, these complications were minor and did not impact the successful dental rehabilitation. In a multiple logistic regression model, the risk of a complication was increased by the use of an autogenous bone block (OR = 3.2; p = 0.027), smoking (OR = 4.8; p = 0.007), vertical augmentation above a threshold of 2.55 mm (OR = 5.0; p = 0.002), and over-contouring (OR = 15.3; p < 0.001). Conclusions: Overall, the complication rate of ridge augmentations carried out with autogenous or allogeneic bone blocks was low. Despite previous recommendations, over-contouring and a vertical augmentation above a threshold of 2.55 mm should be avoided.

Survival Rates of Dental Implants in Autogenous and Allogeneic Bone Blocks: A Systematic Review.

Background and Objectives: Preliminary studies emphasize the similar performance of autogenous bone blocks (AUBBs) and allogeneic bone blocks (ALBBs) in pre-implant surgery; however, most of these studies include limited subjects or hold a low level of evidence. The purpose of this review is to test the hypothesis of indifferent implant survival rates (ISRs) in AUBB and ALBB and determine the impact of various material-, surgery- and patient-related confounders and predictors. Materials and Methods: The national library of medicine (MEDLINE), Excerpta Medica database (EMBASE) and Cochrane Central Register of Controlled Trials (CENTRAL) were screened for studies reporting the ISRs of implants placed in AUBB and ALBB with ≥10 participants followed for ≥12 months from January 1995 to November 2021. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed via several scoring tools, dependent on the study design. Means of sub-entities were presented as violin plots. Results: An electronic data search resulted in the identification of 9233 articles, of which 100 were included in the quantitative analysis. No significant difference (p = 0.54) was found between the ISR of AUBB (96.23 ± 5.27%; range: 75% to 100%; 2195 subjects, 6861 implants) and that of ALBB (97.66 ± 2.68%; range: 90.1% to 100%; 1202 subjects, 3434 implants). The ISR in AUBB was increased in blocks from intraoral as compared to extraoral donor sites (p = 0.0003), partially edentulous as compared to totally edentulous (p = 0.0002), as well as in patients younger than 45 as compared to those older (p = 0.044), cortical as compared to cortico-cancellous blocks (p = 0.005) and in delayed implantations within three months as compared to immediate implantations (p = 0.018). The ISR of ALBB was significantly increased in processed as compared to fresh-frozen ALBB (p = 0.004), but also in horizontal as compared to vertical augmentations (p = 0.009). Conclusions: The present findings widely emphasize the feasibility of achieving similar ISRs with AUBB and ALBB applied for pre-implant bone grafting. ISRs were negatively affected in sub-entities linked to more extensive augmentation procedures such as bone donor site and dentition status. The inclusion and pooling of literature with a low level of evidence, the absence of randomized controlled clinical trials (RCTs) comparing AUBB and ALBB and the limited count of comparative studies with short follow-ups increases the risk of bias and complicates data interpretation. Consequently, further long-term comparative studies are needed.

An in-depth analysis of the mitochondrial phylogenetic landscape of Cambodia.

Cambodia harbours a variety of human aboriginal populations that have scarcely been studied in terms of genetic diversity of entire mitochondrial genomes. Here we present the matrilineal gene pool of 299 Cambodian refugees from three different ethnic groups (Cham, Khmer, and Khmer Loeu) deriving from 16 Cambodian districts. After establishing a DNA-saving high-throughput strategy for mitochondrial whole-genome Sanger sequencing, a HaploGrep based workflow was used for quality control, haplogroup classification and phylogenetic reconstruction. The application of diverse phylogenetic algorithms revealed an exciting picture of the genetic diversity of Cambodia, especially in relation to populations from Southeast Asia and from the whole world. A total of 224 unique haplotypes were identified, which were mostly classified under haplogroups B5a1, F1a1, or categorized as newly defined basal haplogroups or basal sub-branches of R, N and M clades. The presence of autochthonous maternal lineages could be confirmed as reported in previous studies. The exceptional homogeneity observed between and within the three investigated Cambodian ethnic groups indicates genetic isolation of the whole population. Between ethnicities, genetic barriers were not detected. The mtDNA data presented here increases the phylogenetic resolution in Cambodia significantly, thereby highlighting the need for an update of the current human mtDNA phylogeny.

Clinical Follow-Up in Orofacial Clefts-Why Multidisciplinary Care Is the Key.

(1) Background: Although most clinicians involved in the treatment of cleft patients agree upon the major importance of interdisciplinary cooperation and many protocols and concepts have been discussed in the literature, there is little evidence of the relevance of continuous interdisciplinary care. We aimed to objectify the type and number of therapeutic decisions resulting from an annual multidisciplinary follow-up. (2) Methods: We retrospectively analyzed the data of all 1126 patients followed up in the weekly consultation hours for cleft patients at university clinics in Leipzig for the years 2005-2020. We assessed the clinical data of every patient and specifically evaluated the treatment decisions taken at different points in time by the participating experts of different specialties. (3) Results: In total, 3470 consultations were included in the evaluation, and in 70% of those, a therapeutic recommendation was given. Each specialty showed certain time frames with intense treatment demand, which partially overlapped. Nearly all therapy recommendations were statistically attached to a certain age (p < 0.001). (4) Conclusions: There is an exceptionally high need for the interdisciplinary assessment of patients with cleft formation. Some developmental phases are of particular importance with regard to regular follow-up and initiation of different treatment protocols. The therapy and checkup of cleft patients should be concentrated in specialized centers.

Patients referred to a German TMD-specialized consultation hour-a retrospective on patients without a diagnosis according to RDC/TMD decision trees.

OBJECTIVES: The objective was to describe the physical and psychosocial features of patients attending a specialized consultation hour for temporomandibular disorders (TMD). This investigation focused on those patients who did not receive a diagnosis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). MATERIALS AND METHODS: From 2004 to 2017, patients seeking care during a TMD-specialized consultation hour were consecutively recruited. Each patient completed a TMD-related questionnaire, psychosocial questionnaires (Graded Chronic Pain Scale, Hospital Anxiety and Depression Scale, Beschwerden-Liste), and the Oral Health Impact Profile-49. The clinical examination was performed according to the RDC/TMD. RESULTS: The mean age of the 1020 patients was 43.3 years (75.3% female). According to the RDC/TMD decision trees, 351 patients were categorized without a TMD diagnosis (NoTMDdx). The most frequent reasons for seeking care were orofacial pain/TMJ pain or headaches revealing an OR of 1.89 (for TMDdx group). A relevant proportion of patients was categorized as positive for anxiety (NoTMDdx/TMDdx 30.8/41.2%; p = 0.072), depression (20.8/23.9%; p = 0.433), non-specific physical symptoms (31.4/44.1%; p < 0.001), or dysfunctional chronic pain (11.5/18.2%; p < 0.001). In both patient groups, the oral health-related quality of life was impaired (42.9/52.7 points; p < 0.001), and the frequency of therapy measures prior to the consultation hour was high. CONCLUSIONS: Patients seeking care from TMD specialists were usually referred with TMD-associated symptoms. Of those, a relevant proportion did not receive a diagnosis according to RDC/TMD decision trees. CLINICAL RELEVANCE: Psychosocial screening and the avoidance of overtreatment are recommended for patients with TMD-related symptoms.

Alveolar ridge augmentation using the shell technique with allogeneic and autogenous bone plates in a split-mouth design-A retrospective case report from five patients.

Atrophic alveolar ridges of five patients were augmented with allografts and autografts on opposite sites, followed by dental implantation. Both augmentation materials led to equivalent bone gains. Allografts did not compromise the clinical outcome.

Analyzing Low-Level mtDNA Heteroplasmy-Pitfalls and Challenges from Bench to Benchmarking.

Massive parallel sequencing technologies are promising a highly sensitive detection of low-level mutations, especially in mitochondrial DNA (mtDNA) studies. However, processes from DNA extraction and library construction to bioinformatic analysis include several varying tasks. Further, there is no validated recommendation for the comprehensive procedure. In this study, we examined potential pitfalls on the sequencing results based on two-person mtDNA mixtures. Therefore, we compared three DNA polymerases, six different variant callers in five mixtures between 50% and 0.5% variant allele frequencies generated with two different amplification protocols. In total, 48 samples were sequenced on Illumina MiSeq. Low-level variant calling at the 1% variant level and below was performed by comparing trimming and PCR duplicate removal as well as six different variant callers. The results indicate that sensitivity, specificity, and precision highly depend on the investigated polymerase but also vary based on the analysis tools. Our data highlight the advantage of prior standardization and validation of the individual laboratory setup with a DNA mixture model. Finally, we provide an artificial heteroplasmy benchmark dataset that can help improve somatic variant callers or pipelines, which may be of great interest for research related to cancer and aging.

Quality of life in patients with oral hard or soft tissue defects after reconstructive microsurgery.

With current advances in medicine, many surgical methods have emerged for the reconstruction of soft and hard tissue defects of the head and neck. Current literature provides only a limited amount of evidence in studies addressing differences in quality of life for specific therapeutic measures in microvascular reconstruction. The validated University of Washington quality of life questionnaire version 4 (UW-QoL v4), a distress thermometer, and two questions addressing donor-site morbidity were sent to 134 patients at a tertiary care centre. All participants had undergone a type of microvascular reconstructive surgery of the head and neck. They were distributed into three groups according to the defect and type of treatment: defects reconstructed by soft-tissue microvascular tissue transfer, defects involving the hard tissue and treated by alloplastic reconstruction, and hard tissue defects receiving microvascular osseous reconstruction. A total of 82 patients completed the questionnaire in full and returned it. Patients from all the groups showed improved distress thermometer values postoperatively. Those who underwent osseous microvascular reconstruction had better functional items than those who had alloplastic reconstruction plates. Donor-site morbidity was rated low in all groups. Microvascular osseous reconstructive surgery might help to improve functional outcomes in patients with osseous defects more than alloplastic reconstruction.

Flow Chart for Reconstructive Head and Neck Surgery in Composite Soft and Hard Tissue Defects.

INTRODUCTION: Virtual planning of reconstructive surgical procedures in patients with osseous and composite defects in the head and neck region is becoming increasingly a state of the art modality. However, computational algorithms lack the capability of planning the involved soft tissue and vascular pedicle position. The authors present a flow-chart to solve this problem in the reconstruction of defects of the upper and lower jaw. MATERIAL AND METHODS: Clinical records from 2013 to 2018 from a tertiary care center were screened for patients undergoing osseous reconstruction in the head and neck region. A flow-chart considering soft tissue positioning and the anatomical course of the vascular pedicle was assessed in consideration of the defect and donor-site. RESULTS: A total of 81 osseous and composite microvascular reconstructive procedures have been conducted. Defects of the lower jaw were the most common (n = 61). The free fibula flap was the most common reconstructive measure and showed a wide versatility of surgical options to reconstruct these defects. The flow charts were assessed accordingly in these procedures. CONCLUSION: Soft tissue and vascular pedicle positioning can be planned pre-operatively by the use of virtual planning and should be considered as an enhancement tool to the already existing computational algorithms of planning hard tissue reconstruction.

Profiling of Mitochondrial DNA Heteroplasmy in a Prospective Oral Squamous Cell Carcinoma Study.

While a shift in energy metabolism is essential to cancers, the knowledge about the involvement of the mitochondrial genome in tumorigenesis and progression in oral squamous cell carcinoma (OSCC) is still very limited. In this study, we evaluated 37 OSCC tumors and the corresponding benign mucosa tissue pairs by deep sequencing of the complete mitochondrial DNA (mtDNA). After extensive quality control, we identified 287 variants, 137 in tumor and 150 in benign samples exceeding the 1% threshold. Variant heteroplasmy levels were significantly increased in cancer compared to benign tissues (p = 0.0002). Furthermore, pairwise high heteroplasmy frequency difference variants (∆HF% > 20) with potential functional impact were increased in the cancer tissues (p = 0.024). Fourteen mutations were identified in the protein-coding region, out of which thirteen were detected in cancer and only one in benign tissue. After eight years of follow-up, the risk of mortality was higher for patients who harbored at least one ∆HF% > 20 variant in mtDNA protein-coding regions relative to those with no mutations (HR = 4.6, (95%CI = 1.3-17); p = 0.019 in primary tumor carriers). Haplogroup affiliation showed an impact on survival time, which however needs confirmation in a larger study. In conclusion, we observed a significantly higher accumulation of somatic mutations in the cancer tissues associated with a worse prognosis.

Customized allogeneic bone grafts for maxillary horizontal augmentation: A 5-year follow-up radiographic and histologic evaluation.

We report the histological evaluation of an individualized allogeneic bone block 5 years after alveolar ridge augmentation. The biopsy showed a well-vascularized lamellar bone with fatty incorporations without any avital allograft remnants. The presence of osteocytes, lining cells, macrophages, and blood vessels indicated a healthy and vital bone tissue.

A randomized clinical trial on the efficacy of a patient-adapted autonomous exercise regime for patients with head and neck cancer.

Patients undergoing surgical therapy of head and neck malignancies are known to exhibit a high number of comorbidities and frequently present a high nosocomial morbidity. Physiotherapy (PT) improves the clinical course of patients after extensive surgery. The aim of this study was to establish and then compare an additional individualized autonomous exercise plan with standard physiotherapy. 69 consecutive patients undergoing surgical treatment of head and neck cancer were randomized into two groups. The control group received standard clinical physiotherapy, the intervention group an additional autonomous exercise plan, adapted to the patient's performance profile. The patients randomized to the intervention group showed significantly fewer signs of fatigue (5.5 ± 3.5 vs. 3.7 ± 2.7, p = 0.048) and fewer digestive problems (4.7 ± 3.3 vs. 2.3 ± 2.7; p = 0.009) compared with the patients of the control group. In addition, a significantly shorter hospital stay was observed (17.7 ± 6.3 vs. 13.4 ± 3.4 days, p = 0.005), which was positively influenced by the early start of the exercises (r = 0.623, p = 0.001) and frequent practice (r = 0.432, p = 0.031). Patients with head and neck cancer therapy can benefit from an autonomous, individualized exercise plan. In coordination with the physiotherapists, mobilization should be as early and intensive as possible.

Ankle Brachial Index Predicts for Difficulties in Performing Microvascular Anastomosis.

PURPOSE: In reconstructive microsurgery, severe arteriosclerosis is a known predictor for free flap failure because of problems with the vascular anastomosis. We investigated whether the ankle brachial index (ABI) could be a suitable preoperative measurement for the prediction of compromise regarding vascular anastomosis in patients undergoing microsurgical reconstruction. MATERIAL AND METHODS: We conducted a prospective cohort study of patients who had undergone reconstructive microvascular surgery in a tertiary care center from 2015 to 2017. The ABI was preoperatively assessed by dividing the systolic blood pressure measured at the ankle by the brachial systolic blood pressure. Results from 0.9 to 1.3 are within the physiologic range. Values less than 0.9 indicate moderate to severe arteriosclerosis, and those greater than 1.3 indicate the major form of arteriosclerosis with complete calcification of the tunica media. The ABI value correlated with the ease of the anastomosis (rated from 1 [very straightforward] through 5 [very difficult]), gross examination findings (intraluminal plaque [yes vs no]), and the necessity of plaque removal before anastomosis (yes vs no). In addition, cross-sectional specimens were obtained from the arteries and veins of the donor and recipient sites intraoperatively. The specimens were rated histologically for the arteries and veins using an ordinal scale. Histologic evaluation was performed to confirm and objectify the results from the ABI. Statistical analysis was performed using SPSS software, version 24.0 (IBM Corp, Armonk, NY) and t tests, analysis of variance, and χ2 tests. RESULTS: The sample included 41 patients with a mean age of 56.7 years; 59% were men. The mean ABI was 1.06. The mean ease of anastomosis was 1.8. The mean ABI was associated with the ease of anastomosis. A pathologic ABI was significantly related to problems with the arterial anastomosis (P = .004) and increased arteriosclerosis in the arteries from the donor (P = .047) and recipient (P = .036) sites. CONCLUSIONS: A pathologic ABI was associated with increased difficulty with the microvascular anastomosis.

Hand Perfusion in Patients with Physiological or Pathological Allen's Tests.

BACKGROUND: The Allen test (AT) is a widely used clinical tool for the preoperative assessment of sufficient dual vessel hand perfusion although the impact of a pathological AT on tissue perfusion of the hand is not entirely clear. This study reveals perfusion changes of the hand in patients with pathological and physiological AT after terminating the dual blood supply. METHODS: Patients were distributed into 2 groups (physiological and pathological AT) that each contained 25 members. Perfusion of the thumb, middle, and small fingers was measured with a laser Doppler based ("oxygen-to-see" [O2C]) device. A steady state was measured and also values at 1, 3, 5, and 10 minutes after radial occlusion were measured. RESULTS: In patients with a physiological AT, only 1 out of 18 values differed significantly from the steady state measurements after 10 minutes, whereas patients with a pathological AT showed significant alterations in 8 out of 18 values. Oxygen saturation of the superficial and deep tissues appeared to be significantly worse in patients with a pathological AT. CONCLUSION: Patients with a pathological AT suffered significantly more from the loss of dual hand perfusion than patients with a physiological AT. Patients with a pathological AT need more time to compensate for the altered perfusion pattern.