fibrin and Pain--Postoperative

Pelvic adhesions can form secondary to inflammation, endometriosis, or surgical trauma. Strategies to reduce pelvic adhesion formation include placing barrier agents such as oxidised regenerated cellulose, polytetrafluoroethylene, and fibrin or collagen sheets between pelvic structures.. To evaluate the effects of barrier agents used during pelvic surgery on rates of pain, live birth, and postoperative adhesions in women of reproductive age.. We searched the following databases in August 2019: the Cochrane Gynaecology and Fertility (CGF) Specialised Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), Epistemonikos, and trial registries. We searched reference lists of relevant papers, conference proceedings, and grey literature sources. We contacted pharmaceutical companies for information and handsearched relevant journals and conference abstracts.. Randomised controlled trials (RCTs) on the use of barrier agents compared with other barrier agents, placebo, or no treatment for prevention of adhesions in women undergoing gynaecological surgery.. Three review authors independently assessed trials for eligibility and risk of bias and extracted data. We calculated odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) using a fixed-effect model. We assessed the overall quality of the evidence using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods.. We included 19 RCTs (1316 women). Seven RCTs randomised women; the remainder randomised pelvic organs. Laparoscopy (eight RCTs) and laparotomy (11 RCTs) were the primary surgical techniques. Indications for surgery included myomectomy (seven RCTs), ovarian surgery (five RCTs), pelvic adhesions (five RCTs), endometriosis (one RCT), and mixed gynaecological surgery (one RCT). The sole indication for surgery in three of the RCTs was infertility. Thirteen RCTs reported commercial funding; the rest did not state their source of funding. No studies reported our primary outcomes of pelvic pain and live birth rate. Oxidised regenerated cellulose versus no treatment at laparoscopy or laparotomy (13 RCTs) At second-look laparoscopy, we are uncertain whether oxidised regenerated cellulose at laparoscopy reduced the incidence of de novo adhesions (OR 0.50, 95% CI 0.30 to 0.83, 3 RCTs, 360 participants; I² = 75%; very low-quality evidence) or of re-formed adhesions (OR 0.17, 95% CI 0.07 to 0.41, 3 RCTs, 100 participants; I² = 36%; very low-quality evidence). At second-look laparoscopy, we are uncertain whether oxidised regenerated cellulose affected the incidence of de novo adhesions after laparotomy (OR 0.72, 95% CI 0.42 to 1.25, 1 RCT, 271 participants; very low-quality evidence). However, the incidence of re-formed adhesions may have been reduced in the intervention group (OR 0.38, 95% CI 0.27 to 0.55, 6 RCTs, 554 participants; I² = 41%; low-quality evidence). No studies reported results on pelvic pain, live birth rate, adhesion score, or clinical pregnancy rate. Expanded polytetrafluoroethylene versus oxidised regenerated cellulose at gynaecological surgery (two RCTs) We are uncertain whether expanded polytetrafluoroethylene reduced the incidence of de novo adhesions at second-look laparoscopy (OR 0.93, 95% CI 0.26 to 3.41, 38 participants; very low-quality evidence). We are also uncertain whether expanded polytetrafluoroethylene resulted in a lower adhesion score (out of 11) (MD -3.79, 95% CI -5.12 to -2.46, 62 participants; very low-quality evidence) or a lower risk of re-formed adhesions (OR 0.13, 95% CI 0.02 to 0.80, 23 participants; very low-quality evidence) when compared with oxidised regenerated cellulose. No studies reported results regarding pelvic pain, live birth rate, or clinical pregnancy rate. Collagen membrane with polyethylene glycol and glycerol versus no treatment at gynaecological surgery (one RCT) Evidence suggests that collagen membrane with. We found no evidence on the effects of barrier agents used during pelvic surgery on pelvic pain or live birth rate in women of reproductive age because no trial reported these outcomes. It is difficult to draw credible conclusions due to lack of evidence and the low quality of included studies. Given this caveat, low-quality evidence suggests that collagen membrane with polyethylene glycol plus glycerol may be more effective than no treatment in reducing the incidence of adhesion formation following pelvic surgery. Low-quality evidence also shows that oxidised regenerated cellulose may reduce the incidence of re-formation of adhesions when compared with no treatment at laparotomy. It is not possible to draw conclusions on the relative effectiveness of these interventions due to lack of evidence. No adverse events directly attributed to the adhesion agents were reported. The quality of the evidence ranged from very low to moderate. Common limitations were imprecision and poor reporting of study methods. Most studies were commercially funded, and publication bias could not be ruled out.

Topics: Cellulose, Oxidized; Cervix Uteri; Collagen; Female; Fibrin; Glycerol; Humans; Hyaluronic Acid; Incidence; Infertility, Female; Laparoscopy; Laparotomy; Membranes, Artificial; Pain, Postoperative; Pelvis; Polyethylene Glycols; Polytetrafluoroethylene; Postoperative Complications; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic; Second-Look Surgery; Tissue Adhesions; Viscosupplements

The benefits of high-quality postoperative analgesia are well documented and include earlier mobilization, fewer respiratory and cardiovascular complications, and shorter hospital stay. Local anesthesia-based acute pain regimens are at worst equal to and at best superior to opiate-based regimens from the perspective of analgesia. A multimodal approach limiting opioids by combining with local anesthetics has additional beneficial effect on outcomes such as nausea and vomiting, pruritus, gastrointestinal function, respiratory complications, and neutrophil function. Wound catheters providing continuous infiltration of local anesthetics offer a rational approach to effective perioperative analgesia, but their use is limited by a short duration of action. There is an identified need for further methods to optimize longer-acting delivery of these agents. This article reviews current and evolving longer-acting techniques and their limitations with particular focus on the potential advantages of a fibrin hydrogel-based system.

Topics: Analgesia, Epidural; Analgesics, Opioid; Anesthesia, Local; Anesthetics, Local; Drug Delivery Systems; Fibrin; Humans; Hydrogels; Liposomes; Pain Management; Pain, Postoperative; Perioperative Care; Postoperative Period

Pelvic adhesions can form as a result of inflammation, endometriosis or surgical trauma. During pelvic surgery, strategies to reduce pelvic adhesion formation include placing barrier agents such as oxidised regenerated cellulose, polytetrafluoroethylene or fibrin sheets between the pelvic structures.. To evaluate the effects of barrier agents used during pelvic surgery on rates of pain, live birth and postoperative adhesions in women of reproductive age.. We searched the following databases in February 2015: the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL) and trial registries. We handsearched relevant journals, conference proceedings and grey literature sources and we contacted pharmaceutical companies for information.. Randomised controlled trials (RCTs) of the use of barrier agents compared with other barrier agents, placebo or no treatment for the prevention of adhesions in women undergoing gynaecological surgery.. Two review authors independently assessed trials for eligibility and risk of bias and extracted the data. We calculated odds ratios (ORs) or mean differences (MD) with 95% confidence intervals (CIs) using a fixed effect model. The overall quality of the evidence was assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods.. Eighteen RCTs (1262 women) were included. Six RCTs randomised women; the remainder randomised pelvic organs. Laparoscopy (eight RCTs) and laparotomy (10 RCTs) were the primary surgical techniques. Indications for surgery included myomectomy (six RCTs), ovarian surgery (five RCTs), pelvic adhesions (five RCTs), endometriosis (one RCT) and mixed (one RCT). The sole indication for surgery in three of the RCTs was infertility. Twelve RCTs reported commercial funding; the rest did not state their source of funding.No studies reported either of our primary outcomes of pelvic pain and live birth. Oxidised regenerated cellulose (Interceed) versus no treatment at laparoscopy or laparotomy (13 RCTs)At second-look laparoscopy oxidised regenerated cellulose at laparoscopy was associated with reduced incidence of de novo adhesions (OR 0.50, 95% CI 0.30 to 0.83, three RCTs, 360 participants, I(2) = 75%, very low-quality evidence) and of re-formed adhesions (OR 0.17, 95% CI 0.07 to 0.41, three RCTs, 100 participants, I(2) = 36%, low quality evidence).At second-look laparoscopy no evidence was found of any difference between the groups in the incidence of de novo adhesions after laparotomy (OR 0.72, 95% CI 0.42 to 1.25, one RCT, 271 participants, I(2) = 41%, low-quality evidence). However, the incidence of re-formed adhesions was lower in the intervention group (OR 0.38, 95% CI 0.27 to 0.55, six RCTs, 554 participants, moderate-quality evidence). Expanded polytetrafluoroethylene (Gore-Tex) versus no treatment at gynaecological surgery (one RCT) The evidence suggested that at second-look laparoscopy expanded polytetrafluoroethylene was associated with a reduction in new adhesion formation (OR 0.17, 95% CI 0.03 to 0.94, one RCT, 42 participants, low-quality evidence). Expanded polytetrafluoroethylene (Gore-Tex) versus oxidised regenerated cellulose (Interceed) at gynaecological surgery (two RCTs)One RCT found no difference between the groups at second-look laparoscopy in the incidence of de novo adhesions (OR 0.93, 95% CI 0.26 to 3.41, 38 participants, very low-quality evidence). A second RCT suggested that the expanded polytetrafluoroethylene group had a lower adhesion score (out of 11) (MD -3.79, 95% CI -5.12 to -2.46, 62 participants, very low-quality evidence) and a lower risk of re-formed adhesions (OR 0.13, 95% CI 0.02 to 0.80, 23 participants, very low-quality evidence). This last finding was sensitive to choice of effect estimate and no longer suggested a differenc. We found no evidence on the effects of barrier agents used during pelvic surgery on either pain or fertility outcomes in women of reproductive age.Low quality evidence suggests that oxidised regenerated cellulose (Interceed), expanded polytetrafluoroethylene (Gore-Tex) and sodium hyaluronate with carboxymethylcellulose (Seprafilm) may all be more effective than no treatment in reducing the incidence of adhesion formation following pelvic surgery. There is no conclusive evidence on the relative effectiveness of these interventions. There is no evidence to suggest that fibrin sheet is more effective than no treatment. No adverse events directly attributed to the adhesion agents were reported. The quality of the evidence ranged from very low to moderate. The most common limitations were imprecision and poor reporting of study methods. Most studies were commercially funded, and publication bias could not be ruled out.

Topics: Cellulose, Oxidized; Cervix Uteri; Female; Fibrin; Humans; Hyaluronic Acid; Infertility, Female; Pain, Postoperative; Pelvis; Polytetrafluoroethylene; Postoperative Complications; Randomized Controlled Trials as Topic; Second-Look Surgery; Tissue Adhesions; Viscosupplements

Pelvic adhesion can form as a result of inflammation, endometriosis or surgical trauma. Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that may cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. An increasing number of adhesion reduction agents, in the form of site-specific and broad-coverage barriers and solutions, are becoming available to surgical teams. The most widely studied strategies include placing synthetic barrier agents between the pelvic structures. Most of the adhesions in the barrier-treated patients develop in uncovered areas in the abdomen. This fact suggests that the application of liquid or gel anti-adhesive agents to cover all potential peritoneal lesions, together with the use of barrier agents, may reduce the formation of postoperative adhesions. This article introduces the topical choices available for adhesion prevention mentioned in preliminary clinical applications and animal models. To date there is no substantial evidence that their use reduces the incidence of postoperative adhesions. In combination with good surgical techniques, these non-barrier agents may play an important role in adhesion reduction.

Topics: Acetamides; Antioxidants; Collagen Type I; Female; Fibrin; Glucans; Glucose; Honey; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Icodextrin; Inflammation; Linezolid; Melatonin; Oxazolidinones; Pain, Postoperative; Pelvic Pain; Pelvis; Peritoneal Diseases; Phosphatidylcholines; Postoperative Complications; Tissue Adhesions; Treatment Outcome

The objective of this randomized clinical trial was to investigate the effects of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome (2D and 3D) of apicomarginal defects. Patients presenting with endodontic lesions and concomitant periodontal communication were randomly allocated to PRF High and PRF Medium groups. The treatment protocol in each group included a periapical surgical procedure with placement of PRF clot and membrane in the bony defect and on the denuded root surface, respectively. Quality of life was assessed for 1 week after surgery following a modified version of the patient's perception questionnaire. Postoperative pain was assessed using a visual analog scale. Clinical and radiographic evaluations were performed using Rud and Molven 2D criteria and Modified PENN 3D criteria. Buccal bone formation was assessed using sagittal and corresponding axial sections in CBCT. Histological analysis was performed using hematoxylin and eosin (H and E) staining and attaching primary antibodies to tissue sections. In total, 40 patients were enrolled in the trial (N = 20 per group). PRF Medium group patients reported significantly less swelling on the 1st (p = 0.036), 2nd (p = 0.034), and 3rd (p = 0.023) days, and average pain on the 2nd (p = 0.031), 3rd (p = 0.03), and 4th (p = 0.04) days postoperatively. The difference in success rate for periapical healing was non-significant between the PRF Medium group (89.5%) and PRF High group (90%), in both 2D and 3D imaging (p = 0.957). The formation of buccal bone was observed in five cases (26.3%) and four cases (20%) in the PRF Medium and PRF High groups, respectively, with a non-significant difference (p = 0.575). PRF Medium clots had a loose fibrin structure with a significantly higher number of neutrophils (473.79 ± 82.89 per mm

Topics: Fibrin; Humans; Pain, Postoperative; Platelet-Rich Fibrin; Quality of Life; Wound Healing

To investigate the efficacy and safety of concentrated growth factor fibrin (CGF) for the extraction of mandibular third molars.. This was a randomized, double-blind, and controlled clinical study. Patients who underwent mandibular impacted tooth extraction were randomly divided into 2 groups. In the CGF group, the tooth extraction fossa was utilized to place CGF gel. In the control group, the fossa was filled with serum. The visual analogue scale (VAS), reductions in swelling and trismus, incidence of postoperative dry socket, distal periodontal depth and bone regeneration of the second molar, and bone density (BMD) of the extraction fossa at 24 weeks were evaluated.. One hundred eighteen patients were enrolled in this study. There was no significant difference in baseline clinical characteristics between the 2 groups. The pain score of the CGF group was significantly lower than that of the control group at 2, 24, and 48 hours after operation. There was no significant difference in the reduction in swelling or trismus between the 2 groups. There were no cases of dry socket in the CGF group and 3 cases of dry socket in the control group. The periodontal probing depth and bone regeneration of the second molar when the socket was implanted with CGF were better than those that healed naturally (P < .05). The bone mineral density of each group was significantly increased at 24 weeks but was significantly different between groups (P < .05).. CGF can effectively reduce reactive tooth extraction pain and help avoid dry sockets. It can promote periodontal tissue and bone healing in distal and extracted sockets.

Topics: Fibrin; Humans; Intercellular Signaling Peptides and Proteins; Molar; Molar, Third; Pain, Postoperative; Prospective Studies; Tooth Extraction; Tooth, Impacted

The aim of this study was to investigate the effects of concentrated growth factors (CGF) and advanced platelet-rich fibrin (A-PRF) on edema, pain, and trismus after mandibular third molar surgery.. Patients were randomly divided into A-PRF, CGF and control groups. After extraction of the third molars, A-PRF and CGF were prepared and applied to the extraction sockets in study groups, while nothing was applied to the control group. Edema was measured from 5 reference points, including tragus, labial commissure, soft tissue pogonion, lateral corner of the eye/lateral canthus and angulus mandible. Trismus measured as the distance between the right lower and upper central incisors. Trismus and edema were measured preoperatively, and on postoperative 2nd and 7th days. Pain evaluated using the visual analogue scale (VAS) between 6th hour and 7th day after surgery.. A total of 75 patients, 25 in each group, were included in the study. The change in tragus to labial commissure measurements showed a significant difference between baseline-7th days among control and CGF groups (P=0.038). Significant differences observed between the tragus to pogonion measurements at baseline-7th days among the control-CGF groups (P=0.014), and A-PRF-CGF groups (P=0.038). Secondary outcome variables trismus, pain, and analgesic consumption showed no significant differences among the groups (P>0.05).. Based on the results of this study, it can be concluded that A-PRF and CGF seem to have no positive effects on pain, edema, and trismus after third molar surgery.

Topics: Edema; Fibrin; Humans; Molar, Third; Pain, Postoperative; Platelet-Rich Fibrin; Tooth, Impacted; Trismus

In this study, it was aimed to investigate and compare the postoperative effects of leukocyte- and platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) in terms of pain, swelling, and trismus after mandibular third molar surgery.. The study included a total of 27 patients with bilateral impacted mandibular third molar, which surgically operated at different times. Patients were evaluated in two randomly separated groups. For the first and second group, A-PRF and L-PRF were applied into the tooth socket, respectively. The outcome variables were pain, swelling, the number of analgesics taken, and trismus. These variables were also assessed based on first, second, third, and seventh days following the operation.. The data were collected and analyzed with unpaired Student's t-test and Mann-Whitney U test.. The study was conducted with 27 patients, consisting of 15 females and 12 males between ages of 18-26. The visual analog scale pain scores of the L-PRF group during first (P < 0.05), second, and third days and total values (P < 0.01); the number of analgesics on days 2 (P < 0.01) and 3; and their total values (P < 0.05) were significantly higher than the A-PRF group. There was no significant difference between swelling, trismus, and the duration of operation (P > 0.05).. The results of this study showed that the use of A-PRF after mandibular third molar extraction significantly reduces postoperative pain and the patients need to take analgesics of A-PRF group compared to L-PRF group.

Topics: Adult; Edema; Female; Fibrin; Humans; Leukocytes; Male; Mandible; Molar, Third; Pain Measurement; Pain, Postoperative; Platelet-Rich Fibrin; Postoperative Period; Tooth Extraction; Tooth, Impacted; Treatment Outcome; Trismus; Turkey; Young Adult

We aimed to determine the clinical effects of titanium-prepared, platelet-rich fibrin (T-PRF) on human palatal mucosal wound healing (PMWH) and to identify its effect on time-dependent changes in palatal soft-tissue thickness (PSTT) in terms of histoconduction, which is a new concept.. Free gingival graft (FGG) donor sites were treated with T-PRF and compared with an untreated control group. The results of colour match and H. Colour match scores of the test group were significantly higher than those of the control group at 7 and 14 days. CWE was observed at a higher frequency in the test group than in the control group on day 14. Post-operative bleeding prevalence was lower in the test group than in the control group for the first 2 days. A time-dependent decrease in PSTT was observed at 1 and 6 months in the control group compared with baseline (baseline, 4.23 ± 0.62 mm; 1 month, 4.01 ± 0.68 mm; and 6 months, 3.93 ± 0.69 mm). However, no significant difference was found in the test group (baseline, 4.29 ± 0.64 mm; 1 month, 4.61 ± 0.51 mm; and 6 months, 4.51 ± 0.58 mm).. The T-PRF membrane exhibited positive effects on PMWH. T-PRF, which is a promising autogenous matrix for histoconduction, may also be preferred as an autogenous alternative to connective tissue grafts in the treatment of gingival recessions and peri-implant mucosal recessions.

Topics: Analgesics; Biocompatible Materials; Blood Platelets; Color; Connective Tissue; Fibrin; Follow-Up Studies; Gingiva; Gingival Recession; Humans; Hydrogen Peroxide; Oral Hemorrhage; Oxidants; Pain Measurement; Pain, Postoperative; Palate; Postoperative Hemorrhage; Prospective Studies; Re-Epithelialization; Titanium; Transplant Donor Site; Wound Healing

To assess the effect of platelet-rich fibrin (PRF) on postoperative pain, swelling, trismus, periodontal healing on the distal aspect of the second molar, and progress of bone regeneration in mandibular third molar extraction sockets.. Over a 2-year period, 31 patients (mean age, 26.1 yr) who required surgical extraction of a single impacted third molar and met the inclusion criteria were recruited. After surgical extraction of the third molar, only primary closure was performed in the control group, whereas PRF was placed in the socket followed by primary closure in the case group (16 patients). The outcome variables were pain, swelling, maximum mouth opening, periodontal pocket depth, and bone formation, with a follow-up period of 3 months. Quantitative data are presented as mean. Statistical significance was inferred at a P value less than .05.. Pain (P = .017), swelling (P = .022), and interincisal distance (P = .040) were less in the case group compared with the control group on the first postoperative day. Periodontal pocket depth decreased at 3 months postoperatively in the case (P < .001) and control (P = .014) groups, and this decrease was statistically significant. Bone density scores at 3 months postoperatively were higher in the case group than in the control group, but this difference was not statistically important.. The application of PRF lessens the severity of immediate postoperative sequelae, decreases preoperative pocket depth, and hastens bone formation.

Topics: Adult; Autografts; Blood Platelets; Bone Density; Bone Regeneration; Edema; Female; Fibrin; Follow-Up Studies; Humans; Male; Mandible; Molar; Molar, Third; Osteogenesis; Pain, Postoperative; Periodontal Pocket; Postoperative Complications; Tooth Extraction; Tooth Socket; Tooth, Impacted; Treatment Outcome; Trismus

Impacted third molar removal is a routine procedure in oral and maxillofacial surgery. Platelet-rich fibrin (PRF) is a second generation platelet concentration which is produced by simplified protocol. The aim of this study was to assess the effectiveness of PRF in the healing process by evaluating the changes in pain and swelling after third molar surgery.. Fifty-six patients (23 male, 33 female) who provide the inclusion criteria were selected to participate in this study. The evaluation of the facial swelling was performed by using a horizontal and vertical guide. The pain was evaluated in the postoperative period using a visual analog scale (VAS) of 100 mm.. Horizontal and vertical measurements showed more swelling at the control side (without PRF) in 3th day postoperatively (p < 0.05). There were no statistically significant differences regarding pain among the groups.. As a conclusion, PRF seems to be effectiveness on postoperative horizontal swelling after third molar surgery. PRF could be used on a routine basis after third molar extraction surgery.

Topics: Adolescent; Adult; Blood Platelets; Edema; Female; Fibrin; Humans; Male; Pain Measurement; Pain, Postoperative; Tooth Extraction; Tooth, Impacted; Treatment Outcome; Young Adult

This 6-month randomized controlled clinical study primarily aimed to compare the results achieved by the use of a platelet-rich fibrin (PRF) membrane or connective tissue graft (CTG) in the treatment of gingival recession and to evaluate the clinical impact of PRF on early wound healing and subjective patient discomfort. Use of a PRF membrane in gingival recession treatment provided acceptable clinical results, followed by enhanced wound healing and decreased subjective patient discomfort compared to CTG-treated gingival recessions. No difference could be found between PRF and CTG procedures in gingival recession therapy, except for a greater gain in keratinized tissue width obtained in the CTG group and enhanced wound healing associated with the PRF group.

Topics: Adult; Blood Platelets; Connective Tissue; Epithelium; Female; Fibrin; Follow-Up Studies; Gingiva; Gingival Hemorrhage; Gingival Recession; Granulation Tissue; Humans; Male; Membranes, Artificial; Middle Aged; Pain Measurement; Pain, Postoperative; Periodontal Attachment Loss; Periodontal Pocket; Pilot Projects; Postoperative Complications; Surgical Flaps; Wound Healing; Young Adult

Application of platelet concentrates to wounds could speed healing. Leukocyte- and platelet-rich fibrin, a relatively recent development, stands out from the other preparations. This prospective, randomized, controlled clinical trial studied the rate of healing of postoperative hand wounds after a single application of leukocyte- and platelet-rich fibrin.. Eligible patients were healthy individuals older than 18 years who had been scheduled for elective McCash (open palm) surgery for Dupuytren disease at the Plastic and Hand Surgery Department of Nice's University Hospital between August of 2007 and February of 2010. The control group received the reference care of petroleum jelly mesh (Vaselitulle), and test patients had leukocyte- and platelet-rich fibrin applied. The primary endpoint was healing delay measured in postoperative days. Secondary endpoints included pain, bleeding, and wound exudate. The trial was carried out as a single-blind trial.. Among the 68 randomized patients, 33 patients in the leukocyte- and platelet-rich fibrin group and 31 in the Vaselitulle group were analyzed. Primary endpoint analysis showed a median healing delay of 24 days (interquartile range, 18 to 28 days) for the fibrin group and 29 days (interquartile range, 26 to 35 days) for the Vaselitulle group (p = 0.014, log-rank test). Postoperative pain assessment, bleeding, and exudate were always lower for the fibrin group, but not significantly so.. The authors trial demonstrates that a single leukocyte- and platelet-rich fibrin application on fresh postoperative hand wounds shows a median improvement of 5 days in comparison with the standard treatment.. Therapeutic, II.

Topics: Aged; Bandages; Blood Platelets; Dupuytren Contracture; Exudates and Transudates; Female; Fibrin; Follow-Up Studies; Hand; Humans; Kaplan-Meier Estimate; Leukocytes; Male; Middle Aged; Pain, Postoperative; Postoperative Hemorrhage; Prospective Studies; Single-Blind Method; Time Factors; Treatment Outcome; Wound Healing

The main objective of this study was to evaluate the clinical effectiveness of platelet-rich fibrin membrane used in combination with a coronally advanced flap (CAF) and to compare it with the use of an enamel matrix derivative (EMD) in combination with a coronally advanced flap in gingival recession treatment.. 20 split-mouth cases of maxillary anterior teeth or bicuspids presenting with Miller Class I or II gingival recession were treated with a CAF combined with a platelet-rich fibrin membrane (PRF group) or with EMD (EMD group) placed under a CAF. The following parameters were measured at baseline and at 12 months post treatment: gingival recession (GR), apicocoronal width of the keratinized tissue (WKT), and probing depth (PD).. Complete rot coverage in the PRF group was 65% (13 out of 20 recessions) and 60% in the EMD group (12 out of 20 recessions). GR was 4.10 ± 1.05 mm in the PRF group and 3.90 ± 1.00 mm in the EMD group at baseline, and 1.05 ± 0.45 mm in the PRF group and 1.15 ± 0.65 mm in the EMD group at 12 months. The difference observed between the tow groups at 12 months was statistically significant. Average root coverage was 70.5% in the EMD group and 72.1% in the PRF group. WKT was 1.30 ± 0.56 mm in the EMD group and 1.45 ± 0.86 mm in the PRF group at baseline, and 1.90 ± 0.81 mm in the EMD group and 1.62 ± 0.28 mm in the PRF group at 12 months. The difference observed between the two groups at 12 months was not statistically significant. Twelve-month changes in PD were not significantly different between the two groups. The pain intensity was statistically different between the two groups. The pain intensity was statistically different between groups for the first 5 days, favoring the PRF group.. The present study did not succeed in demonstrating any clinical advantage of the use of PRF compared to EMD in the coverage of gingival recession with the CAF procedure. The EMD group showed a higher success rate in increasing WKT than did the PRF group.

Topics: Adult; Bicuspid; Blood Platelets; Chelating Agents; Cuspid; Dental Enamel Proteins; Edetic Acid; Female; Fibrin; Follow-Up Studies; Gingiva; Gingival Pocket; Gingival Recession; Humans; Incisor; Male; Maxilla; Middle Aged; Pain Measurement; Pain, Postoperative; Surgical Flaps; Tooth Root; Treatment Outcome; Young Adult

The use of fibrin for mesh fixation in laparascopic hernioplasty has theoretical advantages in that it could result in reducing postoperative pain. The objective of this study is to demonstrate this improvement in postoperative pain with the highest level of evidence possible.. Unicenter single surgeon prospective randomized double-blind study of transabdominal preperitoneal (TAPP) bilateral hernioplasties comparing autologous fibrin sealant (FG) used for mesh fixation on one side and staples (SG) on the other. Data were collected regarding anthropometric measures, costs, complications and pain evaluation at postoperative days 7, 30 and 180 using a visual analogue scale. The patients were also asked to answer the following simple question: "On which side do you have more pain?". Twenty-two eligible patients were included in the study. Both groups were comparable. The operating time was significantly longer (30 min more) in the FG. The incidence of seroma was similar in both groups, and that of hematoma was higher in the SG (0 vs. 9.1%). At 1 week, the visual analogue scale scores were significantly lower in the FG (median: 1.7 vs. 4.5; MWU:103.5, p < 0.05). At 1 month, this difference became clinical and statistically insignificant. 72.7% of the patients referred more pain on the side with staples at 1 week, 38% at 1 month, and 0% at 6 months (after patients with hernia recurrence were excluded). The recurrence rate was higher in the FG (9.9 vs. 13.6%). A hernia in the FG cost 200 Euros more than that in the SG, or even more if a complete economic study is considered.. The use of fibrin produces less postoperative pain in the first week, but prolongs operating time and increases costs. Moreover, there appears to be a higher recurrence rate and a lower incidence of hematoma, while the incidence of seroma remains unchanged.

Topics: Adult; Aged; Double-Blind Method; Fibrin; Health Care Costs; Hernia, Inguinal; Humans; Laparoscopy; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies; Recurrence; Seroma; Surgical Mesh; Surgical Stapling; Tissue Adhesives; Treatment Outcome

Compared to knees, hips have more bony constraint and soft tissue coverage. Thus, repair of focal cartilage defects in hips requires more invasive and technically complex surgeries than simple arthroscopy or arthrotomy. Autologous matrix-induced chondrogenesis (AMIC) is a second-generation bone marrow stimulation technique. Improvement in Tegner, Lysholm, International Cartilage Repair Society (ICRS), and Cincinnati scores has been reported at 1 and 2 years after AMIC in knees. AMIC is potentially useful to repair defects in hips, but it is unknown whether it relieves symptoms or results in a durable construct.. A surgical hip dislocation is used to access the defect. This is débrided to stable cartilage shoulders, necrotic bone is removed, and the lesion base is drilled. Autogenous bone graft is used for lesions with bony defects to create a level surface. Fibrin gel and a collagen membrane are placed to stabilize the superclot for fibrocartilage formation.. We treated six patients with AMIC in the hip between 2009 and 2010. We obtained Oxford Hip and UCLA Activity Scores. Repair quality was assessed on 6-month postoperative MRI using the modified magnetic resonance observation of cartilage repair tissue (MOCART) system. Minimum 1-year followup data were available for four patients (range, 1-2.5 years).. Postoperative Oxford Hip Scores ranged from 13 to 17, UCLA Activity Scores ranged from 5 to 10, and MOCART scores ranged from 55 to 75. No complications occurred.. We describe AMIC in the hip. Although these patients had pain relief and improved function, long-term followup is necessary to assess the duration of improvement, durability of repair, and potential for arthrosis.. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Topics: Adolescent; Adult; Biomechanical Phenomena; Bone Marrow; Bone Transplantation; Cartilage, Articular; Chondrogenesis; Collagen; Debridement; Female; Femoracetabular Impingement; Fibrin; Gels; Hip Joint; Humans; Magnetic Resonance Imaging; Male; Membranes, Artificial; Osteotomy; Pain, Postoperative; Radiography; Recovery of Function; Retrospective Studies; Time Factors; Transplantation, Autologous; Treatment Outcome; Young Adult