Bacterial infection transmitted by human tissue allograft transplantation

Eastlund, Ted

doi:10.1007/s10561-006-0003-z

Cited by 122 publications

(59 citation statements)

References 79 publications

(68 reference statements)

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“…Concerns, however, exist regarding the efficacy of frozen or freeze dried allograft, the potential of immunogenicity, and the hazard of microbial contamination, though the rate of disease transmission has proven to be low [1,13,24,26,47]. In addition, the use of allograft is associated with considerable expense, and patients' reservations towards allograft implantation may play an important role as well [23].…”

Section: Introductionmentioning

confidence: 99%

A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis

et al. 2008

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The objective of this study is to compare the clinical and radiographic results of ultraporous b-tricalcium phosphate (b-TCP) versus autogenous iliac crest bone graft (ICBG), through prospective randomized pilot study (EBM-Level 1), as graft extenders in scoliosis surgery. In the posterior correction of scoliosis, local bone resected as part of the procedure is used as the base bone graft material. Supplemental grafting from the iliac crest is considered the gold-standard in posterior spinal fusion. However, autograft is not available in unlimited quantities, and bone harvesting is a source of significant morbidity. Ultraporous b-TCP might be a substitute for ICBG in these patients and thus eliminate donor site morbidity. A total of 40 patients with adolescent idiopathic scoliosis (AIS) were randomized into two treatment groups and underwent corrective posterior instrumentation. In 20 patients, ICBG harvesting was performed whereas the other half received b-TCP (VITOSS Ò ) to augment the local bone graft. If thoracoplasty was performed, the resected rib bone was added in both groups. Patients were observed clinically and radiographically for a minimum of 20 months postoperatively, with a mean follow-up of 4 years. Overall pain and pain specific to the back and donor site were assessed using a visual analog scale (VAS). As a result, both groups were comparable with respect to the age at the time of surgery, gender ratio, preoperative deformity, and hence length of instrumentation. There was no significant difference in blood loss and operative time. In nine patients of the b-TCP group and eight patients of the ICBG group, thoracoplasty was performed resulting in a rib graft of on average 7.9 g in both groups. Average curve correction was 61.7% in the b-TCP group and 61.2% in the ICBG group at hospital discharge (P = 0.313) and 57.2 and 54.3%, respectively, at follow-up (P = 0.109). Loss of curve correction amounted on average 2.6°in the b-TCP group and 4.2°in the comparison group (P = 0.033). In the ICBG group, four patients still reported donor site pain of on average 2/10 on the VAS at last follow-up. One patient in the b-TCP group was diagnosed with a pseudarthrosis at the caudal end of the instrumentation. Revision surgery demonstrated solid bone formation directly above the pseudarthrosis with no histological evidence of b-TCP in the biopsy taken. In conclusion, the use of b-TCP instead of ICBG as extenders of local bone graft yielded equivalent results in the posterior correction of AIS. The promising early results of this pilot study support that b-TCP appears to be an effective bone substitute in scoliosis surgery avoiding harvesting of pelvic bone and the associated morbidity.

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Section: Introductionmentioning

confidence: 99%

A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis

et al. 2008

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“…An extensor lag can be partially prevented by tensioning the graft and by keeping the limb in full extension while securing the quadriceps [24]. Concerns with the use of allograft include tissue availability, cost, immune reaction, and disease transmission [35].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Mazza

Vaienti

Mazzola

et al. 2016

Injury

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Introduction: Latest advances made in joint replacement implants allows reconstruction of entire limbs. These special prostheses or megaprostheses were originally designed for the treatment of severe oncological bone loss. Nowadays, however, the indications and applications of these devices are expanding to other orthopaedic and trauma clinical conditions. Since 2008 we have implanted 152 megaprostheses in non-oncological conditions: 87 were implanted for post-traumatic failures aseptic/septic (represented by complex non-unions and critical size bone defects); 26 total femur, 52 distal femur and 9 proximal tibia. In this group of patients bone and soft tissues conditions are completely different compared to patients with oncological back ground. The presence of infection and previous surgeries can lead to adhesion, scar interference, muscular and tendon impairment and skin problems that lead to reduced function and severe joint stiffness. The purpose of this study is to evaluate the results of treatment of reconstruction of patellar tendon during implantation of proximal tibia megaprosthesis for the treatment of septic post traumatic critical bone defects. Patients and methods: In this retrospective study, we evaluated 9 patients treated with proximal tibia megaprosthesis who underwent patellar tendon reconstruction. All patients presented a complete patellar tendon disruption at the time of prosthesis implantation. Procedures of reconstruction included a tendon-plasty of quadriceps and/or patellar tendons, a pie crusting of quadriceps fascia, a reinforcement of the apparatus with synthetic tendon graft substitutes (LARS) and a medial gastrocnemius muscular flap to reconstruct the extensor mechanism and obtain skin coverage when needed. The average follow up was 18 months (9-36). For each of the cases, we analysed the complications occurred regarding septic recurrence, patellar fracture, quadriceps and patellar tendon rupture and number of reinterventions. The clinical outcome was assessed by the WOMAC Score. Results: In all cases there was no infection recurrence or skin related problems. None of the patients require prosthesis revision due to loosening or device failure. No patellar fracture or quadriceps tendon failure was recorded. One patient presented a rupture of the reconstructed patellar tendon due to a trauma incident 18 months after the implantation and he required revision surgery. From a clinical point of view the average WOMAC score was 62.4 at 1 month rising to 72.6 at 3 months, 78.2 at 6 months, 76.4 at 1 year and 74.8 at 18 months. Conclusion: When proximal tibia megaprosthesis is implanted and there are soft tissue and patellar tendon deficiency, soft tissue reconstruction can be achieved by appropriate lengthening of the tendon and a gastrocnemius flap reinforced by LARS. Such an approach allows restoration of the extensor mechanism and coverage of the prosthesis in an area where skin problems are frequently very common.

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“…It has been well-documented that despite meticulously designed sterilization techniques during removal, processing and marketing of the allografts, life-threatening infectious complications from allogenic materials still exist. 11,12 Bacterial infections are particularly associated with bone, tendon, cartilage, cornea, dura, heart valve, skin and pericardium. 13 Apart from bacterial infections, allograft-related virus and fungal infections have also been reported.…”

Section: Discussionmentioning

confidence: 99%

Central Nervous System Tuberculosis Subsequent to Dural Grafting

Sanuş

Tanrıverdi

Tutunculer

et al. 2008

Can. j. neurol. sci.

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Despite modern diagnostic and treatment modalities, tuberculosis (TB) still remains a major worldwide health problem. Resurgence in developed countries is due mainly to infection with the human immunodeficiency virus, immigration from developing and/or underdeveloped countries, transmissions in hospitals and prisons and development of multidrug-resistant strains of TB.1 According to the estimates of World Health Organization, TB accounts for 7-8 million new cases every year and is responsible for 2.9 million deaths worldwide annually. 2Tuberculosis infection is encountered mainly in underdeveloped or developing countries, but increasing infection rate has recently been reported even in developed countries.3 As a developing country, it has been estimated that TB is increasing rather than decreasing since the 1970s in Turkey and is still a serious problem in this country. 4 It has been estimated that neurological involvement of TB infection constitutes approximately 5-15 % of the cases, with a high predominance in children. 5,6 Central nervous system (CNS) involvement including atypical forms have been reported and reviewed extensively in the literature. [7][8][9] The bacteria are transmitted through inhalation of aerosolized droplets and CNS involvement occurs mainly by hematogenous route. Although iatrogenic CNS infections have been reported, such as after lumbar puncture, 10 there has been no report of CNS TB after allogenic dural grafting.This report concerns allogenic dura mater graft-related lumbar and cerebellar TB in a 20-year old male who underwent on operation to correct Chiari type-I malformation in which posterior fossa decompression followed by allograft dural grafting had been performed. As far as we know, this is the first report of CNS TB following the use of allograft dura mater. CASE REPORTA 20-year-old male was referred to the Neurosurgical Department, Cerrahpasa Medical Faculty, Istanbul University, for further diagnosis and treatment. The patient complained of lumbar pain radiating to both lower extremities, which was accompanied by recent headache. Physical examination disclosed nothing abnormal. However, neurological examination revealed lower extremity weakness (1/5) and neck stiffness. Medical history showed that he had an operation to correct a Chiari type-I malformation, in which posterior decompression plus C1 laminectomy and dural grafting with cadaveric allograft was performed six months prior to the admission to us ( Figure 1) PEER REVIEWED LETTERsevere headache and neck pain four months after the surgical intervention. He was evaluated by his primary neurosurgeon and radiological examination at that time disclosed the syrinx had resolved completely and so it was decided to follow the patient clinically. Two months after his last visit, he developed severe

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Bacterial infection transmitted by human tissue allograft transplantation

Cited by 122 publications

References 79 publications

A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis

A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Central Nervous System Tuberculosis Subsequent to Dural Grafting

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