Okay, so we're going to start the anterior and posterior iliac crest bone marrow harvest. Before we start that, I'm going to show you kind of how to set up the machine. We're going to be using that Arthrex Angel here today. And so, sorry, I'm making sure this mic doesn't come off my ear. So when you start, when you set this up, I'm going to show everybody. Now, if you have a rep, they'll help you. Hey, by the way, I got to tell my rep joke. This probably won't go over well. What does an orthopedic surgeon say before sex? Is the rep here yet? Sorry. I didn't think that would go over very well. It goes over well with the reps though. All right, so you put your disposable kit in. You first place it in and you have to press firmly down and you lock it like that. Line it up. So, and if you have a rep who's here, they'll obviously help you with it. You firmly press this wheel down so it locks. And then you put your disposable on the machine and it just buttons right on here. It's super easy. In addition, I always close off these little clips just in case there's a cap on there, but just in case the cap's not working, you don't want product to fall all over the place. And then output syringe, you make sure there's no vacuum on it to start with. You place it here and then filter. Now, this will have been heparanized as well. So, this is one of the items you heparanize. I'm not going to go through that for time's sake. And you put it, there it is. Got it. And it's always red is to blood and white is to no blood. So, you put your... So, I always have, most important thing, the reason I'm doing this is bone marrow clots really quickly. So, you want to make sure you are ready to go and ready to spin as that bone marrow comes out so you can put it, your assistant can put it right in. All right, now I'm going to come over here and get my marrow. So, we're going to... Can I move? Okay, great. You see? All right, perfect. So, I have already marked this area. You can palpate that posterior iliac crest, use flora or use ultrasound. I used ultrasound and I marked this so we can practice in the lab. For demonstration's sake, we would take a little bit of lidocaine, marcaine. You would just go down to that level of the iliac crest. You would do a little periosteal block. Obviously, we don't need that today, but that's what you would do. Now, the good thing, important thing about this periosteal block is you don't want to fall immediately into the SI joint. So, during that period of time, you're double-checking you got your landmarks correct. You'll then go make a little stab incision and you're going to take your bone marrow, let me put it right here, your trocar. This has been heparanized as well and you're going to insert it into your incision. Can you see okay? Yeah. And then, you have your assistant hold firmly as you do kind of a corkscrew-like motion. You're going to head from PSIS towards ASIS and it's very important to have the patient positioned correctly. You're going to go in, go in about two to three centimeters, slowly remove your stylettes. Of course, this is not going to hurt. And then, you remove your aspirate. You then pull that, there's not going to be any bone marrow obviously for obvious reasons, but you're going to pull two to five cc's, two to five cc's, two to five cc's, two to five cc's and then you come back and you repeat. If for some reason you start to get towards the edge of the cortex and it gets loose, you can redirect through the same hole and then repeat that same process of two to five, rotate two to five, rotate two to five. Okay? So, that's how you do a posterior iliac crest harvest. Now, we're going to show you anterior. It's going live in here. Yeah, I hope not. All right. So, when you do anterior iliac crest, you can obviously palpate as well in this patient. If you can't palpate on anterior, you can use ultrasound as well. You really just want to avoid the, you know, medial portion of that ASIS so you don't get the lateral femoral cutaneous nerve. So, as long as you come out about two to three centimeters, you should be fine. Again, you can use local right on that iliac crest. You do your local block, periosteal block. I just fell off of it. Make a small stab incision. Lose your trocar. Seat it firmly on the iliac crest. I've got to find where I was. There we go. Hold on just a second. I fell right off of it. There we go. And you're going to insert your trocar. Again, you're going to do it in a fashion, corkscrew-like fashion. You're going to remove your stylet. And then you aspirate in the same fashion. Now, I don't go three centimeters deep. Usually, anterior, I'll only go about two and a half, and then I'll redirect. Do the same thing again, two to five, two to five, two to five. Pull back and continue that same process. Now, once you have your bone marrow aspirated, you're going to put it in your machine. Before you do that, you're going to program it. So, the reason I like this device is I can program it for whatever I want. I can hit the settings and go to protocols, and you can actually decide how much you're going to put in. So, let's say I'm going to do 50, and then you can put the hematocrit settings, so you can either get a leukocyte-rich or a leukocyte-poor product. So, in this case, at bone marrow, I'm going to run it at seven. And you can actually save these little guys and name them in here, so it's easy for your staff to just pre-program that protocol, and they just hit that button. I think it can save up to how many protocols? Twenty-five protocols. All right. Then you take your bone marrow aspirate, and you're going to filter it. So, this filtering process is really important. And you're going to filter it into your machine. And you always want to filter up with this device because this is the filter. If you go like this, you can clot easier. So, you want the filter to catch the clots. And you go slowly. So, one of the most important things about PRP and bone marrow is think about it like it's a living tissue. You don't want to, like, squirt it too fast, or you'll get hemolysis, and then it'll affect your outcome and your product. So, be nice to it. Awesome. So, once that's in there, get the cap. Recap it so you don't make a mess. All right. And then all you do is hit your button, and it does the rest. So, the way it works is, obviously, this machine has two ways of separating cells or measuring cells. The first thing it does is it does a density gradient centrifugation through the centrifuge itself. So, the heavy stuff is going to go to the bottom, and the light stuff is going to go to the top. And then as the product begins to return, and I'll show you this on the demo, this little dial, so there's a little light sensor here, and this light sensor senses the size of the cells as it comes through. So, what'll first happen as you, it'll first bring everything in, centrifuge it. Then when it's time to put the product back out, it starts to come back out. This light sensor will first sense the very light cells or the platelet pore plasma. This gate will turn to this output, and it will then go down into this little bag that says platelet pore plasma. So, it'll separate out your platelet pore plasma. Then once that light sensor sees the buffy coat coming through larger cells, the platelets, the layer, or stem cells, that layer you want, that gate will turn to here, and it'll fill your syringe up with your product, your PRP or your bone marrow concentrate. Then, once the light sensor sees the red cells coming, the large cells coming, it changes the gate to this RBC out bag, and it places all the RBCs here. So, it separates your PPP from your PRP or bone marrow concentrate from your RBCs. So, the machine will do it for you. Oh, yeah, and so this tells you exactly how much time is left on your cycle. So, if a patient's like, how long do I have to sit here? You'll say, well, we'll be ready in 15 minutes and 11 seconds. And the time it takes to process varies from 15 minutes to 20 based on bone marrow and volume. But it's pretty quick. All right, I think that's it. Thanks. We're all going to do that at our stations, so. That work?

Arthrex Angel machine

iliac crest bone marrow harvest

disposable kit

bone marrow harvesting technique

platelet-poor plasma separation