Anterior cruciate ligament reconstruction utilizing a hamstring autograft is a surgical technique that has gained popularity among orthopedic surgeons caring for adolescent patients. While utilization of a hamstring autograft is a revered technique, harvest of the hamstring yields significant pain. Sciatic peripheral nerve blockade has proven to reliably provide analgesia at the hamstring donor site. Single-injection sciatic peripheral nerve blockade is considered a basic and effective technique, making its use following anterior cruciate ligament reconstruction standard practice in many institutions. The duration of action of a single-injection sciatic peripheral nerve blockade may fail to outlast the pain arising from the hamstring donor site, prompting some clinicians to employ continuous sciatic peripheral nerve blockade via an indwelling catheter. A lack of comparative effectiveness studies exists in the literature regarding the duration of action of peripheral nerve blockade necessary to adequately provide pain control following hamstring autograft harvest, resulting in disagreement among clinicians as to best pain control practices. Proponents of continuous sciatic peripheral nerve blockade assert that while more costly, the extended duration of analgesia afforded by this technique improves pain control postoperatively and decreases the use of other pain medications. Advocates of single-injection sciatic peripheral nerve blockade cite concerns associated with continuous sciatic peripheral nerve blockade known to be detrimental to rehabilitation, such as decreased active knee flexion and increased risk of falls. The purpose of this research is to compare the effect of single-injection sciatic PNB to continuous sciatic PNB on 1) postoperative pain control as measured by self-reported pain scores, pain medication use, and unplanned hospital admission due to poor pain control, 2) active knee flexion, and 3) patient satisfaction with pain control following ACL reconstruction with a hamstring autograft. The findings of this study have the potential to guide informed clinical reasoning and decision making regarding sciatic peripheral nerve blockade techniques following hamstring autograft harvest in adolescents undergoing anterior cruciate ligament reconstruction.

Hintergrund: Das Ziel der Studie war es, die Resultate nach arthroskopischer Rekonstruktion des vorderen Kreuzbandes (ACL)unter Verwendung der zentral-dritten Knochen-Patellarsehne-Knochen (LP) Autografts und der dreifachen/vierfachen Semitendinosus (ST) Autografts zu vergleichen. Hypothese: In der untersuchten Zeitdauer bietet die ACL-Rekonstruktion unter Verwendung der LP-Autografts mehr Stabilität aber zeigt auch mehr Entnahmestellenprobleme als ST-Autografts. Studienentwurf: Randomisierte kontrollierte Studie; Level of Study 1. Methoden: Eine randomisierte Reihe von 62 Patienten (17 Frauen und 45 Männer) mit einer einseitigen ACL-Ruptur, die rekonstrutive Chirurgie durchmachten, waren in der Studie eingeschlossen. Die LP-Transplantation (LP Gruppe) und die Semitensinosussehne Transplantation (ST-Gruppe) wurden gleichmäßig bei 31 Patienten durchgeführt. Die Patienten wurden in einer mittleren Zeitdauer von 67 Monaten (Range 62 bis 84 Monate) nach der Rekonstruktion nachuntersucht. Resultate: 44 von 62 Patienten (71%) konnten am Anschluss nachuntersucht werden. Die klinischen Untersuchungen zeigten keine signikanten Unterschiede zwischen der LP-Gruppe und der ST-Gruppe in der Lysholm-Score, Tegner-Aktivitätsniveau, IKDC-auswertungssystem, Einbeinsprungtest, KT-1000-Arthrometer, manueller Lachmantest auf. Eine bedeutende klinische Verbesserung wurde in beiden Gruppen gesehen. Zusammenfassung: Nach der Anwendung des zentralen Patellarsehnendrittels und des dreifachen/vierfachen ST-autografts fünf Jahre nach ACL-Rekonstruktion, waren die subjektiven und objektiven Resultate ähnlich. Außerdem wurde kein relevanter Unterschied in der Entnahmestellemorbidität zwischen den 2 Gruppen gefunden. / Background: The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third bone–patellar tendon–bone (BTB) autografts and triple/quadruple semitendinosus (ST) autografts. Hypothesis: In the long-term, ACL reconstruction using BTB autografts will show more stability but also render more donor-site problems than ST autografts. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A randomized series of 62 patients (17 women and 45 men) with a unilateral ACL rupture who underwent reconstrutive surgery were included in the study. The BTB graft (BTB group) and the ST-tendon graft (ST group) was equally used in 31 patients each. The patients were examined a median of 67 months (range, 62 to 84 months) after the reconstruction. Results: 44 of 62 patients (71%) were examined at follow-up. The clinical assessments at follow-up revealed no signicant differences between the BTB group and the ST group in terms of the Lysholm score, Tegner activity level, International Knee Documentation Committee evaluation system, 1-legged hop test, KT-1000 arthrometer laxity measurements, manual Lachmtest, and range of motion. A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessments. Donor-site morbidity in the form of knee-walking ability, kneeling ability, and area of disturbed anterior knee sensitivity revealed no significant differences between the groups. Conclusion: Five years after ACL reconstruction, the subjective and objective outcomes were similar after using the central third BTB autograft and triple/quadruple ST autograft. Furthermore, no difference in terms of donor-site morbidity was found between the 2 groups.

Traumatic injuries to peripheral nerves often leave gaps that cannot be repaired by direct suture methods. In such instances, repair with a tubular nerve guide, allows connection of the nerve ends, provides directional guidance, and concentrates endogenous trophic factors for regenerating axons. We hypothesized that collagen nerve guides containing longitudinally oriented channels would further improve the outcome of nerve repair by increasing the surface area available for cell migration. We restored the continuity of a 10mm peripheral nerve gap (rat sciatic nerve) by suturing the nerve stumps into a type I collagen nerve guide (1.5 mm ID), which contained longitudinal channels. Two different channel designs were tested. They were compared to empty nerve guides and autografts. One channel design contained five longitudinally-oriented collagen microtubes (0.4 mm ID) and the other contained 32 longitudinally-oriented collagen filaments (90 micro m diameter). Nerve regeneration was examined at 6 weeks and 12 weeks post repair by a determination of the number and diameter of myelinated axons in the middle sections of the nerve guides. Sciatic function Indices were calculated from walking tracks and static stance images, and electrophysiological assessments were performed. Compound muscle action potentials of the gastrocnemius and intrinsic muscles of the foot were recorded from animals in each group at 12 weeks, indicating that axons regenerated through the nerve repair site, into the distal nerve stump, and successfully reinnervated peripheral targets. At 6 weeks, there was no significant difference between the mean number of myelinated axons with the mid sections of the 3 types of nerve guides (P = 0.488). At 12 weeks, the nerve guide that contained 5 microtubes within its lumen had significantly more axons than the nerve guide that contained 32 filaments in its lumen (P = 0.008). The mean myelinated axon number in the microtube group is larger than the empty nerve guide group but this difference was not statistically significance (P < 0.05). Autografts at both 6 and 12 weeks had significantly more myelinated axons in the mid section of the repair site than either of the nerve guide repairs at the respective time points (P < 0.05).

No description available.

O objetivo deste estudo é avaliar a efetividade do enxerto ósseo em neoformação (EONF) no ganho de altura de tecido ósseo em procedimentos de levantamento de seio maxilar. Foram selecionados indivíduos de ambos os sexos com idade entre 25 e 60 anos apresentando perda de um dente na região de pré-molares ou molares superiores com remanescente ósseo de 2 a 9 mm entre a crista do rebordo alveolar e o assoalho do seio maxilar e existência de rebordo desdentado ou pelo menos um dente condenado à extração. Os seios foram tratados por meio de EONF misturado a osso bovino inorgânico OBI (teste; n= 7) ou OBI (controle; n= 6). O volume de tecido ósseo existente foi avaliado por meio de tomografias computadorizadas obtidas no exame inicial e 6 meses após a cirurgia. Após este período, biópsias de tecido duro foram obtidas para análise histológica e histomorfométrica durante a cirurgia de instalação dos implantes osseointegrados. A análise dos resultados das imagens tomográficas por meio do teste t demonstrou que os dois materiais são igualmente efetivos no ganho em altura óssea (teste: 11,22 ± 0,60 mm vs. controle: 11,82 ± 0,69 mm; p= 0,0664). A análise histológica da reação tecidual ao redor e entre as partículas de enxerto mostrou ausência de diferenças estatisticamente significantes entre os grupos, segundo teste de Mann Whitney. A análise histomorfométrica demonstrou maior percentual de osso vital (31,42% ± 11,13% vs. 16,38% ± 10,14%; p= 0,0002), menor percentual de partículas remanescentes (1,32% ± 2,34% vs. 3,15% ± 3,31%; p= 0,0306) e de tecido conjuntivo (27,65% ± 12,34% vs. 35,02 ± 13,16; p= 0,0257) no grupo teste do que no controle. O diâmetro médio das partículas remanescentes foi maior no grupo controle do que no grupo teste, segundo teste t (p= 0,0294), embora não houvesse diferenças estatisticamente significantes entre os grupos em relação à área de contado direto entre o tecido ósseo neoformado e a superfície das partículas. Esses resultados sugerem que EONF é efetivo para o ganho de altura óssea em procedimentos de levantamento de seio maxilar, resultando em formação de maior quantidade de osso vital do que aquela observada com o uso de OBI apenas. / The aim of this study is to evaluate the efficacy of newly forming bone graft (NFB) in the gain of bone height in sinus lift procedures. It were recruited for this study individuals 25- 60 years of age, both genders, presenting a missing tooth at an upper premolar or molar region with 2-9 mm of remaining bone between alveolar ridge crest and sinus floor and the existence of an edentulous ridge or at least one tooth condemned to extraction. Sinus were treated by NFB mixed to inorganic bovine bone IBB (test; n= 7) or IBB (control; n= 6). The volume of bone tissue was evaluated by computerized tomography obtained at baseline examination and 6 months after surgery. After this period, biopsies of hard tissue were obtained during implant installation for histologic and histomorphometric analysis. The analysis of data from tomographic images by t test showed that both materials were equally effective in the gain of bone height (test: 11.22 ± 0.60 mm vs. control: 11.82 ± 0.69 mm; p= 0.0664). The histologic analysis of tissue reaction around and between graft particles showed absence of significant differences between groups, according to Mann Whitney. Histomorphometric analysis showed greater percentage of vital bone (31.42% ± 11.13% vs. 16.38% ± 10.14%; p= 0.0002) and lower percentage of remaining particles (1.32% ± 2.34% vs. 3.15% ± 3.31%; p= 0.0306) and connective tissue (27.65% ± 12.34% vs. 35.02 ± 13.16; p= 0.0257) at test than control group. The mean diameter of remaining particles was greater at control than test group, according to t test (p= 0.0294), although no differences were observed between groups related to the area of direct contact between new bone and particles surface. These findings suggest that NFB is effective in the gain of bone height in sinus lift procedures, resulting in the formation of greater amount of vital bone with the use of IBB alone.

Πρόκειται για μια προοπτικη, συγκριτική, τυχαιοποιημένη, κλινική και ακτινολογική μελέτη της εξέλιξης της πώρωσης οπισθοπλάγιας σπονδυλοδεσίας με τη χρήση είτε αυτόλογου μοσχευματός είτε κοραλλιογενους υδροξυαπατίτη είτε μιγματος των δύο. Μελετήθηκαν 3 ομάδες ασθενών Α, Β και Γ με 18, 19 και 20 ασθενείς αντιστοιχά. Στην πρώτη ομάδα χρησιμοποιήθηκε μόνο αυτόλογο μόσχευμα, στη δεύτερη κοραλλιογενής υδροξυαπατίτης και αυτόλογο μόσχευμα και στην τρίτη ομάδα μόνο κοραλλιογενής υδροξυαπατίτης. Η εκτίμηση ήταν κλινική και ακτινολογική. Διαπιστώθηκε ότι η ενσωμάτωση του κοραλλιογενούς υδροξυαππατίτη χρειάζεται επααρκή αποφλοιωμένη οστική επιφάνεια και η τοποθετηση του στα οπισθοπλάγια σπονδυλικά στοιχεία δεν οδηγεί σε σπονδυλοδεσία. Όμως η τοποθετησή του κοραλλιογενούς υδροξυαπατίτη στα οπίσθια σπονδυλικά στοιχεία οδηγεί σε σπονδυλοδεσία στον αναμενόμενο χρόνο. / This prospective longitudinal randomized clinical and radiological study compared the evolution of instrumented posterolateral lumbar and lumbosacral fusion using either coralline hydroxyapatite or iliac bone graft or both. Three comparable groups A, B, and C were evaluated. In group A only autograft was used. In group B autograft and coralline hydroxyapatite were used and in group C only coralline hydroxyapatite was used as graft extender. The goups were evaluated clinically and radiologicalý It was found that coralline hydroxyapatite applied in the poserolateral spinal elements does not leed to a spinal fusion because of lack of bleeding osseous surfaces. However if coralline hydroxyapatite is applied in the laminae of the posterior spine it leeds to spinal fusion within the expected time.

O objetivo deste estudo é avaliar a efetividade do enxerto ósseo em neoformação (EONF) no ganho de altura de tecido ósseo em procedimentos de levantamento de seio maxilar. Foram selecionados indivíduos de ambos os sexos com idade entre 25 e 60 anos apresentando perda de um dente na região de pré-molares ou molares superiores com remanescente ósseo de 2 a 9 mm entre a crista do rebordo alveolar e o assoalho do seio maxilar e existência de rebordo desdentado ou pelo menos um dente condenado à extração. Os seios foram tratados por meio de EONF misturado a osso bovino inorgânico OBI (teste; n= 7) ou OBI (controle; n= 6). O volume de tecido ósseo existente foi avaliado por meio de tomografias computadorizadas obtidas no exame inicial e 6 meses após a cirurgia. Após este período, biópsias de tecido duro foram obtidas para análise histológica e histomorfométrica durante a cirurgia de instalação dos implantes osseointegrados. A análise dos resultados das imagens tomográficas por meio do teste t demonstrou que os dois materiais são igualmente efetivos no ganho em altura óssea (teste: 11,22 ± 0,60 mm vs. controle: 11,82 ± 0,69 mm; p= 0,0664). A análise histológica da reação tecidual ao redor e entre as partículas de enxerto mostrou ausência de diferenças estatisticamente significantes entre os grupos, segundo teste de Mann Whitney. A análise histomorfométrica demonstrou maior percentual de osso vital (31,42% ± 11,13% vs. 16,38% ± 10,14%; p= 0,0002), menor percentual de partículas remanescentes (1,32% ± 2,34% vs. 3,15% ± 3,31%; p= 0,0306) e de tecido conjuntivo (27,65% ± 12,34% vs. 35,02 ± 13,16; p= 0,0257) no grupo teste do que no controle. O diâmetro médio das partículas remanescentes foi maior no grupo controle do que no grupo teste, segundo teste t (p= 0,0294), embora não houvesse diferenças estatisticamente significantes entre os grupos em relação à área de contado direto entre o tecido ósseo neoformado e a superfície das partículas. Esses resultados sugerem que EONF é efetivo para o ganho de altura óssea em procedimentos de levantamento de seio maxilar, resultando em formação de maior quantidade de osso vital do que aquela observada com o uso de OBI apenas. / The aim of this study is to evaluate the efficacy of newly forming bone graft (NFB) in the gain of bone height in sinus lift procedures. It were recruited for this study individuals 25- 60 years of age, both genders, presenting a missing tooth at an upper premolar or molar region with 2-9 mm of remaining bone between alveolar ridge crest and sinus floor and the existence of an edentulous ridge or at least one tooth condemned to extraction. Sinus were treated by NFB mixed to inorganic bovine bone IBB (test; n= 7) or IBB (control; n= 6). The volume of bone tissue was evaluated by computerized tomography obtained at baseline examination and 6 months after surgery. After this period, biopsies of hard tissue were obtained during implant installation for histologic and histomorphometric analysis. The analysis of data from tomographic images by t test showed that both materials were equally effective in the gain of bone height (test: 11.22 ± 0.60 mm vs. control: 11.82 ± 0.69 mm; p= 0.0664). The histologic analysis of tissue reaction around and between graft particles showed absence of significant differences between groups, according to Mann Whitney. Histomorphometric analysis showed greater percentage of vital bone (31.42% ± 11.13% vs. 16.38% ± 10.14%; p= 0.0002) and lower percentage of remaining particles (1.32% ± 2.34% vs. 3.15% ± 3.31%; p= 0.0306) and connective tissue (27.65% ± 12.34% vs. 35.02 ± 13.16; p= 0.0257) at test than control group. The mean diameter of remaining particles was greater at control than test group, according to t test (p= 0.0294), although no differences were observed between groups related to the area of direct contact between new bone and particles surface. These findings suggest that NFB is effective in the gain of bone height in sinus lift procedures, resulting in the formation of greater amount of vital bone with the use of IBB alone.

Made available in DSpace on 2015-03-26T13:47:20Z (GMT). No. of bitstreams: 1 texto completo.pdf: 786382 bytes, checksum: 57cd0809363705fb0abb73b2bc5efd11 (MD5) Previous issue date: 2003-07-14 / In this study, two experiments were conducted in order to evaluate the iliac crest autograft and this association to fresh autogenous bone marrow in the lumbar dorsolateral vertebral union in rabbits. Thirty-three animals, separated in two groups, were used in each experiment. Nine animals in group 1 (G1), corresponding to the control group, where only L5-L6 transverses processes decortications were created and twenty-four animals in group 2 (G2) where, besides the decortication, the graft material was also deposited on L5-L6 transverses processes. The anesthetic protocol and surgical technique were the same in both works, difering the graft material used. In the first work, only the iliac crest autograft was associated to 2 millimeters of fresh autogenous bone graft. Manual palpations, radiographic, histological and biomechanical evaluations of the operated segments (L5-L6) and adjacents (L4-L5 and L6-L7); the solid segments were classified as solid union. The radiographics analysis was based on the presence of bone mass, bilaterally, without the interlaminar space was the object of study in histological analysis as the type of predominant tissue; and during the biomechanical test the force and resistence of vertebral union were evaluated. The manual palpation and radiographics evaluations demonstrated do not be the method of choice to determine the vertebral union level due to the great variation observed in the results comparing to histological and biomechanical analysis. In the histological analysis it was possible to observe the bone formation sequence from the reabsorption of bone fragments graft, the intense periosteal reaction over the decorticated transverse processes until the bone integration andconsequent vertebral union. In the biomechanical test, the force and rigidity of the operated segments were bigger than adjacents vertebras, although this diference was not significant throughout the analysis. In the first work, it was observed that the autogenous iliac crest bone graft when used in adequate amounts conduced to vertebral union in rabbits, which was intensified nine weeks after the surgical procedure. In the second work, the fresh autograft bone marrow associated to the iliac crest bone graft anticipate the bone formation which began at five weeks after surgery consisting an option for those patients whose sufficient bone graft amount can not be obtained to induce vertebral fusion. / Neste trabalho foram conduzidos dois experimentos para avaliação do autoenxerto da crista ilíaca e de sua união à medula óssea autógena fresca na união vertebral dorsolateral lombar em coelhos. Em cada experimento foram utilizados trinta e três animais, divididos em dois grupos, com nove animais no grupo 1 (G1), que correspondeu ao grupo controle, onde foi realizada somente a descortificação dos processos transversos de L5-L6 e vinte e quatro animais no grupo dois (G2), onde foi realizada além da descortificação, a enxertia entre os processos transversos de L5-L6. Os protocolos anestésicos e a técnica cirúrgica foram os mesmos em ambos os trabalhos, diferindo o material de enxertia utilizado. No primeiro trabalho utilizou-se apenas o autoenxerto da crista ilíaca, considerado material de escolha na união vertebral. No segundo trabalho foi associado ao autoenxerto da crista ilíaca dois mililitros de medula óssea autógena fresca. Foram realizadas análises por palpação, radiografias, histologia e teste biomecânico nos segmentos operados às cinco, sete e nove semanas após o procedimento cirúrgico. Na análise por palpação manual movimentos de flexão e extensão foram realizados nos segmentos operados (L5-L6) e adjacentes (L4-L5 e L6-L7); os segmentos sólidos foram classificados como união vertebral. As análises radiográficas foram baseadas na presença de massa óssea bilateralmente sem radioluscência; na análise histológica estudou-se os espaços interlaminares e o tipo de tecido predominante; e no teste biomecânico foram analisados força e resistência da união vertebral. As avaliações por palpação manual e radiografias demonstraram não ser métodos de escolha para a determinação do grau de união vertebral, devido à grande variação observada nos resultados comparados às análises histológicas e biomecânicas. Na histologia foi possível observar a seqüência da formação óssea, desde a reabsorção dos fragmentos ósseos enxertados, a intensa reação periosteal nos processos tranversos descortificados e a formação óssea endocondral proveniente do periósteo descortificado, culminando na osteointegração e conseqüente união vertebral. No teste biomecânico a força e a rigidez dos segmentos operados foram maiores que as vértebras adjacentes, porém essa diferença não foi significativa no decorrer das análises. No primeiro trabalho, foi observado que o osso autógeno da crista ilíaca utilizado em quantidades adequadas como material de enxertia em coelhos possibilitou a união vertebral, que se intensificou às nove semanas após o procedimento cirúrgico. No segundo trabalho, a medula óssea autógena fresca associada ao autoenxerto da crista ilíaca precipitou a formação óssea, que se iniciou às cinco semanas após a cirurgia, o que constitui uma opção nos pacientes que não se pode coletar enxerto ósseo suficiente para a obtenção de artrodese vertebral.

INTRODUÇÃO: A paratireoidectomia total com auto-enxerto imediato heterotópico (PTH+AE) é uma das técnicas cirúrgicas hoje usadas no tratamento do hiperparatireoidismo secundário à doença renal crônica e do hiperparatireoidismo persistente após o transplante renal. Os níveis adequados de paratormônio sistêmico (PTHs) no pós-operatório ainda são controversos e o perfil funcional do auto-enxerto de tecido paratireóideo, pouco esclarecido. No presente estudo, nós analisamos a função do tecido paratireóideo implantado pacientes com hiperparatireoidismo secundário e terciário. MÉTODO E CASUÍSTICA: Em um estudo prospectivo observacional, 19 pacientes portadores de doença renal crônica (PDRC) e quatro pacientes transplantados renais (PTR) foram submetidos à PTX+AE com e seguidos por um ano. Todos os pacientes apresentaram PTHs indetectável no pós-operatório imediato (POi). Os níveis séricos de PTH em ambos os membros superiores, cálcio, fósforo, fosfatase alcalina e reposição de cálcio elementar e calcitriol foram verificados com um mês, dois, três, quatro, seis, nove e 12 meses após a cirurgia. A 25-Hidroxivitamina D (25OHD) foi medida no POi, seis e 12 meses após a cirurgia. A função do auto-enxerto foi classificada em estados funcionais (EF) de acordo com os níveis de PTHs. RESULTADOS: A maioria dos PDRC e PTR mostraram níveis detectáveis de PTHs já no primeiro mês. No segundo mês pósoperatório, todos os pacientes apresentaram níveis detectáveis de PTHs quando também houve estabilização dos níveis séricos em ambos os grupos. Os gradientes de concentração de PTH não mostraram correlação com o PTHs. No pós-operatório, a hipercalcemia foi observada em 73,7% dos PDRC em pelo menos um episódio, reduzindo ou inibindo a secreção de paratormônio em oito pacientes. Não houve melhora dos níveis de 25OHD em ambos os grupos, permanecendo com níveis insuficientes. Oito PDRC regrediram de EF ao final do estudo. CONCLUSÃO: O perfil funcional do AE é semelhante entre os PDRC e PTR. A função do AE, inicia-se no primeiro mês pós-operatório, atingindo um maior EF até o quarto mês pós-operatório na maioria dos pacientes, porém pode haver declínio da função ao longo do tempo / BACKGROUND: Total parathyroidectomy with immediate forearm transplantation (PTX+AT) is employed in renal hyperparathyroidism. Appropriate postoperative systemic parathyroid hormone (sPTH) levels are still controversial and autograft functional behavior is unclear. In the present study, we analyzed the function of autotransplanted parathyroid tissue in secondary and tertiary hyperparathyroidism. METHODS: In a prospective observational study, 19 dialysis patients (DPs) and 4 kidney transplant patients (KTPs) who underwent PTX+AT were followed. All patients had undetectable PTH in the early postoperative period (ePO). Autograft function and the following biochemical variables were assessed at one, two, three, four, six, nine and 12 months following the operation: serum calcium, phosphorus, alkaline phosphatase, and intact PTH before and after the operation. 25-Hidroxyvitamin D levels (25OHD) were measured in the ePO, six and twelve months. Oral doses of calcium and calcitriol were recorded. Autograft function was stratified into four functional status (FS) according to sPTH. RESULTS: All functioning grafts presented sPTH until the second month. On the second postoperative month, all patients had sPTH detectable levels also when serum levels were steady in both groups. PTH gradients showed no significant correlation with sPTH levels. In at least one occasion in the postoperative period, hypercalcemia was observed in 73.7% of DPs, and it reduced or inhibited PTH secretion in 8 patients. There was no improvement in levels of 25OHD in both groups, resulting in insufficient levels. Eight DPs changed to a lower FS at the end of the study. CONCLUSION: The function of the autotransplanted parathyroid tissue usually initiates during the first month following operation and is similar in patients. The most of the patients reachs FS2 during the fourth month but autograft function can decrease over time

Les brûlures cutanées graves dont les lésions profondes et étendues des tissus ne permettent pas d’envisager un traitement classique par autogreffes, bénéficient aujourd’hui de substituts épidermiques autologues pour leur recouvrement. En effet l’ingénierie tissulaire permet l’obtention d’épiderme de culture autologue (CEA) par l’amplification in vitro de kératinocytes à partir d’une petite biopsie de peau saine. Si ces CEAs ont permis la survie de nombreux patients depuis les années 1980, ils n’en restent pas moins largement perfectibles du point de vue de l’esthétique et de la fonctionnalité de l’épiderme et de la jonction dermo-épidermique régénérés mais aussi en termes de coûts et de prévention des zoonoses.Ainsi, ce travail de thèse s’inscrit dans le cadre d’une recherche translationnelle et porte sur l’élaboration d’un épiderme de culture par ingénierie tissulaire en vue d’une application clinique chez les grands brûlés, afin de favoriser la cicatrisation et la régénération épidermique. Ce travail porte également sur l’évaluation non clinique de notre substitut épidermique sur un modèle animal de brûlure cutanée.Après avoir développé un nouveau substitut épidermique sur fibrine de plasma humain (hPBES : human Plasma-Based Epidermal Substitute), nous avons procédé à l’évaluation détaillée de ses caractéristiques phénotypiques et fonctionnelles en comparaison au substitut épidermique de référence Epicel® (Genzyme, US). Nous avons montré des propriétés plus intéressantes en termes de clonogénicité et de caractère souche, de prévention de la différenciation, de prolifération, de potentiel de migration, et de conservation des protéines de la membrane basale avec notre produit par rapport à Epicel®.L’apport de la matrice de fibrine de plasma sur la culture des kératinocytes en comparaison à une matrice de fibrine issue de fibrinogène purifié et à une culture sans matrice a été étudié notamment sous l’angle des facteurs libérés par les matrices. Nous avons observé une amélioration des propriétés des substituts épidermiques par la fibrine : diminution de la différenciation terminale, augmentation du potentiel migratoire et sécrétion de facteurs pro-cicatrisants (GM-CSF et PDGF-BB). En outre, la fibrine de plasma améliore spécifiquement la morphogénèse épidermique, la prolifération kératinocytaire et la clonogénicité.Le procédé de culture de ce nouveau substitut a été adapté aux exigences réglementaires sans altération du potentiel régénératif: remplacement des cellules nourricières murines par des fibroblastes dermiques humains, adaptation du milieu de culture et sécurisation du plasma par traitement à l’amotosalen.Toutes les étapes d’un modèle de brûlure chez le rat nude reproduisant la technique chirurgicale employée pour la greffe de CEA ont été mises au point, mais un rejet du greffon épidermique n’a pas permis l’évaluation d’hPBES sur ce modèle. Nous avons donc évalué le substitut épidermique développé hPBES chez la souris NOD-SCID après greffe au fascia et mis en évidence une bonne prise de greffe épidermique permettant la régénération d’un épiderme humain aux caractéristiques proches d’une peau saine avec une réorganisation de la jonction dermo-épidermique des 2 semaines après greffe. / The deep and large injuries caused by massive burns prevent the use of split-thickness skin autografts. Today, autologous epidermal substitutes constitute an alternative treatment for skin regeneration. In fact tissue engineering allows the production of Cultured Epithelial Autografts (CEA) by in vitro keratinocyte amplification from a small healthy skin biopsy. The clinical use of CEA since the 1980’s has allowed an increase in the survival rate of burnt patients. However, CEAs present numerous drawbacks, among them the high fragility of keratinocyte sheets, and the immaturity of the dermal-epidermal junction leading to heavy cosmetic and functional sequelae.This thesis focuses on the bioengineering of epidermal substitute for clinical burn treatment to enhance wound healing and skin regeneration, from a translational research point of view. This work also includes the development of an animal model of third degree burn for the evaluation of epidermal substitute.We first developed a new epidermal substitute cultured on a fibrin matrix from human plasma (hPBES: human Plasma-Based Epidermal Substitute). Then we characterized this new substitute with phenotypical and functional analyses, using as a reference the epidermal substitute Epicel® (Genzyme, US). We observed properties more favorable with hPBES than with Epicel® in terms of clonogenicity, stemness, differentiation level, proliferation, migration potential and basement membrane protein conservation.The influence of the plasma-based fibrin matrix on keratinocytes was studied in comparison with a culture on a fibrin from purified fibrinogen, and with a culture with no matrix. For this study we focused our analysis on the role of the released factors from fibrin matrices during epidermal substitute culture. Both fibrin matrices improved epidermal substitute properties: reduction of terminal differentiation, enhancement of migration potential, secretion of wound healing enhancing factors. Besides, plasma-based fibrin specifically promote epidermal morphogenesis, keratinocyte proliferation and clonogenicity.The culture process was adapted to European regulation requirements without diminishing its regenerative potential: substitution of murine feeder cells by human dermal fibroblasts, adaptation of culture medium and plasma viral inactivation using amotosalen treatment.A burn model including all the surgical steps used in clinics for CEA grating was developed on nude rats. However the evaluation of hPBES on this model could not be achieved due to graft rejection. Therefore we evaluated epidermal regeneration after hPBES graft on acute wounds on NOD-SCID mice. We showed a good graft rate, with the regeneration of a human epidermis close to healthy epidermis with a well-organized dermal-epidermal junction two weeks after hPBES grafting.