Sarcoma Size and Limb Dimensions Predict Complications, Recurrence, and Death in Patients with Soft Tissue Sarcoma in the Thigh: A Multidimensional Analysis.

BACKGROUND: Limb-sparing resections of thigh soft tissue sarcomas (STSs) can result in adverse outcomes. Identifying preoperative predictors for wound healing complications, tumor recurrence, and mortality is crucial for informed reconstructive decision-making. We hypothesized that preoperative measurements of thigh and tumor dimensions could serve as reliable indicators for postoperative complications, recurrence, and death. PATIENTS AND METHODS: In this retrospective cohort study conducted from March 2016 to December 2021, we analyzed patients undergoing thigh STS excisions followed by reconstruction. Preoperative magnetic resonance imaging or computed tomography scans provided necessary thigh and tumor dimensions. Univariate and multivariate regression assessed relationships between these dimensions and postoperative outcomes, including complications, recurrence, and death. RESULTS: Upon the analysis of 123 thighs, we found thigh width to be highly predictive of postoperative complications, even surpassing body mass index (BMI) and retaining significance in multivariate regression [odds ratio (OR) 1.19; 95% CI 1.03-1.39; p = 0.03]. Sarcoma-to-thigh width and thickness ratios predicted STS recurrence, with the thickness ratio retaining significance in multivariate regression (OR 1.03; 95% CI 1.001-1.05; p = 0.041). Notably, greater thigh thickness was independently protective against mortality in multivariate analysis (OR 0.80; 95% CI 0.65-0.98; p = 0.030). CONCLUSIONS: Thigh width outperformed BMI in association with postoperative complications. This may create an opportunity for intervention, where weight loss can play a role during the neoadjuvant therapy period to potentially reduce complications. Sarcoma-to-thigh width and thickness ratios, particularly the latter, hold substantial predictive value in terms of STS recurrence. Moreover, thigh thickness is an independent predictor of survival.

Trends of Medicare reimbursement rates for gender affirmation procedures.

BACKGROUND: While nearly 1 in 5 Americans receives health insurance coverage through Medicare, literature suggests that Medicare reimbursement is lagging behind inflation for many plastic surgery procedures. AIM: This article evaluates trends in Medicare reimbursement for gender affirmation procedures. METHODS: The most common gender affirmation procedures performed at an urban academic medical center were identified in this cross-sectional study (level 4 evidence). Five nongender surgery codes were evaluated for reference. A standardized formula utilizing relative value units (RVUs) was used to calculate monetary data. Differences in reimbursement between 2014 and 2021 were calculated for each procedure. OUTCOME: The main outcome was inflation-adjusted difference of charges from 2014 to 2021. RESULTS: Between 2014 and 2021, Medicare reimbursement for gender affirmation procedures had an inflation-unadjusted average change of -0.09% (vs +5.63% for the selected nongender codes) and an inflation-adjusted change of -10.03% (vs -5.54% for the selected nongender codes). Trends in reimbursement varied by category of gender-affirming procedure. The overall average compound annual growth rate had a change of -0.99% (vs -0.53% for the selected nongender codes). The average changes in work, facility, and malpractice RVUs were -1.05%, +9.52%, and -0.93%, respectively. CLINICAL IMPLICATIONS: Gender surgeons and patients should be aware that the decrease in reimbursement may affect access to gender-affirming care. STRENGTHS AND LIMITATIONS: Our study is one of the first evaluating the reimbursement rates associated with the full spectrum of gender affirmation surgery. However, our study is limited by its cross-sectional nature. CONCLUSIONS: From 2014 to 2021, Medicare reimbursement for gender affirmation procedures lagged inflation.

Utilizing Relative Citation Ratio to Compare Academic Productivity by Gender in Plastic Surgery.

INTRODUCTION: The relative citation ratio (RCR) is a bibliometric index utilized to assess research productivity. Mean relative citation ratio (m-RCR) and weighted relative citation ratio (w-RCR) can be utilized to assess individual research quality as well as career-long productivity, respectively. We sought to determine differences in academic productivity between genders and identify demographic variables associated with increased academic productivity. METHODS: A list of Plastic and Reconstructive Surgery residency programs was compiled utilizing the American Council of Academic Plastic Surgeons website. Each program department's website was utilized to generate a list of practicing surgeons and respective demographic information. Both mean and weighted RCR were obtained using the iCite, a National Institutes of Health bibliometric tool. Surgeons were excluded if any demographic or RCR data was not accessible. Chi-squared test, Mann-Whitney U test, Kruskal-Wallis test, and multivariable linear regressions were performed. RESULTS: A total of 785 academic plastic surgeons met the criteria and were included in the analysis, 186 of whom were women and 599 men. Both academic rank and model of residency training were significantly associated with gender in chi-squared analysis (P < 0.05). Mean relative citation ratio was higher among men in departments. Mean w-RCR was higher among men of assistant professor status, chief/chairperson status, integrated model of residency training, faculty size ≥six and in departments and divisions. Academic rank and faculty size were associated with higher w-RCR upon multivariable linear regression. CONCLUSIONS: Although differences exist in mean w-RCR between men and women in plastic surgery, gender is not a predictor of increased academic productivity. RCR is an accurate means of assessing gender differences in academic productivity as it comprehensively considers both quality and quantity of research and may be superior to other, older bibliometric indices.

"The Association of a Research Year With Matching Into an Integrated Plastic Surgery Residency".

INTRODUCTION: The relationship between pursuing a research year (RY) and plastic surgery match outcomes is unclear. The present study investigated the association between a dedicated RY and the odds of matching into an integrated Plastic and Reconstructive Surgery (PRS) residency program. METHODS: Electronic Residency Application Service applications to an integrated PRS residency program from 2017 to 2021 were evaluated. Match results were determined using online public sources. Students who had taken a RY were compared with those who had not (traditional). The relationship between pursuing a RY and matching was determined with logistic regression analyses. RESULTS: In total, 974 applicants were included, of which 191 (20%) completed an RY. The RY group had significantly higher match rates (83% versus 74%, P = 0.008), more presentations (13 versus 5, P < 0.001), and more publications (11 versus 4, P < 0.001) than the traditional group. The RY group was 80% more likely to match than the traditional group (adjusted odds ratio [OR] = 1.8, P = 0.016). However, this benefit was eliminated after controlling for the number of publications. Subgroup analysis revealed that applicants who completed an RY had increased odds of matching into a top 20 PRS residency program (OR = 2.2, P < 0.001), with the strongest association observed among applicants with 15+ (OR = 2.6, P < 0.001) or 20+ publications (OR = 4.1, P < 0.001). CONCLUSIONS: An RY is associated with 80% higher odds of matching and an increased number of publications. RYs seem to be most associated with benefits for applicants aiming to increase their publication numbers or to match into a top 20 residency program.

The Perceived Impact of COVID-19 on Graduate Medical Education and Recommendations for Bridging the Educational Gap.

INTRODUCTION: COVID-19 generated a system-wide shock causing an unbalanced equilibrium between producing adequately trained physicians and meeting extraordinary operational needs. Previous studies report the experience of surgical residents during COVID-19 at a regional level. This study measures the learning losses related with the redeployment of highly specialized medical professionals to the care of COVID-19 patients, while we systematically investigate proposed remedial strategies. METHODS: We administered an online cross-sectional survey in 67 countries capturing training inputs (i.e., surgeries and seminars residents participated in) before and during the pandemic and retrieved residents' expected learning outputs, career prospects and recommended remedial measures for learning losses. We compared responses of residents working in (treatment group) and out (control group) of hospitals with COVID-19 patients. RESULTS: The analysis included 432 plastic surgery residents who were in training during the pandemic. Most of the learning losses were found in COVID-19 hospitals with 37% and 16% loss of surgeries and seminars, respectively, per week. Moreover, 74%, 44%, and 55% of residents expected their surgical skill, scientific knowledge, and overall competence, respectively, to be lower than those of residents who graduated before COVID. Residents in COVID-19 hospitals reported participating in significantly (P < 0.001) fewer surgeries and having significantly (P < 0.001) lower surgical skill relative to those not in COVID-19 hospitals. CONCLUSIONS: The perceived lower competence and the fall-off in surgical skill and scientific knowledge among future surgeons suggest that health-care systems globally may have limited capacity to perform specialized and costly procedures in the future.

A Comparison of Plastic Surgery Authorship Trends Under Single Versus Double-Blinded Review.

INTRODUCTION: Research is key to academic advancement in plastic surgery. However, access to publication opportunities may be inequitable as seen in other fields. We compared authorship trends of plastic surgery manuscripts that underwent single-blinded review (SBR) versus double-blinded review (DBR) to identify potential disparities in publication opportunities. METHODS: Publications from two plastic surgery journals using SBR and two using DBR from September 2019 to September 2021 were evaluated. Name and institution of the article's first and senior author and journal's editor-in-chief (EIC) were recorded. Chi-squared and Fisher's exact analyses were used to compare author characteristics between SBR and DBR articles. RESULTS: Of 2500 manuscripts, 65.7% underwent SBR and 34.3% underwent DBR. SBR articles had higher percentages of women as first authors (31.9% versus 24.3%, P < 0.001) but lower percentages of first (50.7% versus 71.2%, P < 0.001) and senior (49.6% versus 70.3%, P < 0.001) authors from international institutions. First (26.0% versus 12.9%, P < 0.001) and senior (27.9% versus 18.0%, P = 0.007) authors of SBR articles tended to have more plastic surgery National Institutes of Health funding. Journals using SBR tended to have higher rates of authorship by EICs or authors sharing institutions with the EIC (P ≤ 0.005). CONCLUSIONS: While associated with greater female first authorship suggesting potential efforts toward gender equity in academia, SBR of plastic surgery articles tends to favor authors from institutions with higher National Institutes of Health funding and disadvantage authors from international or lower-resourced programs. Careful consideration of current peer-review proceedings may make publication opportunities more equitable.

Association of Metabolic Derangement and Postoperative Outcomes in Hernia Repair With Component Separation: A Propensity Score-Matched Nationwide Analysis.

INTRODUCTION: Metabolic syndrome (MetS) is characterized by cardiometabolic abnormalities such as hypertension, obesity, diabetes, or dyslipidemia. This study aims to evaluate the association of MetS on the postoperative outcomes of ventral, umbilical, and epigastric hernia repair using component separation. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent ventral, umbilical, and epigastric hernia repair with component separation between 2015 and 2021. MetS status was defined as patients receiving medical treatment for diabetes mellitus and hypertension, with a body mass index greater than 30 kg/m2. Propensity matching was performed to generate two balanced cohorts with and without MetS. T-tests and Fisher's Exact tests assessed group differences. Logistic regression models evaluated complications between the groups. RESULTS: After propensity score matching, 3930 patients were included in the analysis, with 1965 in each group (MetS versus non-MetS). Significant differences were observed in the severity and clinical presentation of hernias between the groups. The MetS cohort had higher rates of incarcerated hernia (39.1% versus 33.2%; P < 0.001), and recurrent ventral hernia (42.7% versus 36.5%; P < 0.001) compared to the non-MetS cohort. The MetS group demonstrated significantly increased rates of renal insufficiency (P = 0.026), unplanned intubation (P = 0.003), cardiac arrest (P = 0.005), and reoperation rates (P = 0.002) than the non-MetS cohort. Logistic regression models demonstrated higher likelihood of postoperative complications in the MetS group, including mild systemic complications (OR 1.25; 95%CI 1.030-1.518; P = 0.024), severe systemic complications (OR 1.63; 95%CI 1.248-2.120; P < 0.001), and reoperation (OR 1.47; 95%CI 1.158-1.866; P = 0.002). There were no significant differences in the rates of 30-d wound complications between groups. CONCLUSIONS: The presence of metabolic derangement appears to be associated with adverse postoperative medical outcomes and increased reoperation rates after hernia repair with component separation. These findings highlight the importance of optimizing preoperative comorbidities as surgeons counsel patients with MetS.

Beyond Accreditation Council for Graduate Medical Education Required Scholarship: The Academic Journey of Plastic Surgery Residents.

INTRODUCTION: Research productivity is an important part of required Accreditation Council for Graduate Medical Education scholarship during residency training and critical to trainees who intend to pursue careers in academia. This study aims to determine plastic surgery residents' experiences with and attitudes toward research. METHODS: Accredited independent (52) and integrated (86) plastic surgery program websites were manually searched for currently active residents' names and email addresses. Identified residents were emailed a survey consisting of 25 questions through Research Electronic Data Capture. RESULTS: A total of 45 plastic surgery residents responded to the survey request (14.6% response rate). Respondents were 57% female and 43% male, with an average age of 30.7 y. At the time of survey participation, 95% of surgery residents were involved in research endeavors, voluntarily or as part of their residency training. Of the respondents, 13 (32%) previously participated in a research fellowship compared to 28 (68%) respondents who did not. Interestingly, respondents who completed fellowships were 2.84 times (95% confidence interval: 0.52-15.38, P = 0.2269) more likely to intend continuing research endeavors after residency. Participants were most in agreement with statements suggesting their research fellowship benefitted their application in the plastic surgery match process (4 [interquartile range (IQR): 4, 4]), improved their ability to conduct research (4 [IQR: 4, 4]), and helped to better understand medical literature (4 [IQR: 3, 4]). CONCLUSIONS: Plastic surgery programs' robust research emphasis has a favorable translation into residents' self-perceived understanding of medical literature and clinical knowledge.

Resources on lymphedema surgery: How effective are they for patients?

Online patient education materials (PEMs) on lymphedema surgery were assessed for quality, readability, and content. A total of 37 PEMs were identified, primarily authored by academic/medical organizations. Readability scores indicated materials were difficult to read, with an average Flesch-Kincaid Grade Level of 10.4. PEM Assessment Tools showed acceptable understandability (72.3%) but poor actionability (28.5%). PEMs often lacked information on surgical risks, postoperative care, and long-term follow-up. Simplifying language and adding visual aids could improve PEM effectiveness.

Novel use of the rectus abdominus muscle flap for vaginal reconstruction in complex obstetric fistula repair: A case series.

OBJECTIVE: Globally, obstetric fistula is a tragic outcome following obstructed labour. Failure of complex repair and post-operative incontinence are common. We describe an innovative surgical technique incorporating the rectus abdominus flap at the time of fistula repair. DESIGN: Retrospective case series. SETTING: Malawi, Fistula Care Centre. METHODS: Patients were followed for 3 months after discharge to determine continence and healing. RESULTS: Five of six patients were continent at 3 months and one was lost to follow-up by dry at a one month post-operative phone call. There were no major complications. CONCLUSIONS: The rectus abdominus flap may be a useful adjunct to repair of complex obstetric fistula.

The Effect of Beautification Strategies on Mating Popularity Judged by Men from the People's Republic of China.

Contemporary women frequently employ beautification strategies. The impact of such strategies, such as plastic surgery, on mating popularity in different mate contexts remains unclear. To investigate this issue, the current study conducted two experiments. In Experiment 1, beautification strategies were manipulated using three images of the same female with different conditions (natural, makeup, and plastic surgery). The results indicated that when the beautification strategies were not informed, surgical-enhanced and makeup targets were perceived as significantly more attractive, loyal, and popular among potential mates than natural targets. However, when participants were informed of the beautification strategies, both natural and makeup targets showed a significant increase in perceived loyalty and mating popularity. In contrast, surgically enhanced targets saw a reduction in these dimensions. Experiment 2 aimed to reduce the confounding effect of facial attractiveness by using vignettes. The results indicated that the mating popularity of natural targets was significantly higher than that of makeup or surgically enhanced targets, with surgically enhanced targets being the least popular. Moreover, the results revealed the mediating role of perceived loyalty in the impact of beautification strategies on long-term mating popularity. This study sheds light on the potential stigmatization and negative bias toward beautification strategies in the mating market. Additionally, it provides guidance for women who intend to enhance their mate popularity through plastic surgery.

Exploring the landscape of extracellular vesicle application for skin and plastic surgery: A bibliometric analysis from 2003 to 2023.

BACKGROUND: Exosomes and other secretory membrane vesicles, collectively referred to as extracellular vesicles (EVs), have garnered increasing attention in research due to their biological characteristics. Notably, studies have shown promising results regarding the role of stem cell-derived extracellular vesicles (SC-EVs) in skin and plastic surgery applications. This study aims to elucidate current trends in SC-EVs within the context of skin and plastic surgery and offer insights for future research directions in advancing this critical field. METHODS: A comprehensive search was conducted for relevant studies on SC-EVs in skin and plastic surgery spanning from 2003 to 2023, utilizing the Web of Science database. Subsequently, data analysis was performed using VOSviewer and CiteSpace. RESULTS: A total of 1089 studies were identified, with a noticeable annual increase in publications on SC-EVs' application in skin and plastic surgery. China emerged as the leading contributor to this field, with Shanghai Jiao Tong University being a notable institution. Stem Cell Research & Therapy and the International Journal of Molecular Sciences were the top journals publishing relevant articles. Author Fu Xiaobing from the Chinese People's Liberation Army General Hospital had the highest publication count in this area. Keyword co-occurrence analysis revealed six distinct clusters, with "exosomes" being the most prevalent keyword in recent years. Wound healing and skin rejuvenation emerged as primary research focuses and hotspots in this field. CONCLUSION: This comprehensive review offers insights into global trends surrounding SC-EVs in skin and plastic surgery. Analysis of journals, institutions, references, and keywords provides valuable guidance for researchers in determining future research directions.

"Evaluating wound closure innovations in spinal surgery: impacts on efficiency and patient outcomes".

This study evaluates contemporary wound closure techniques in spinal surgery, focusing on the efficacy of barbed sutures, skin staples, and negative-pressure wound therapy (NPWT), compared to traditional methods. Barbed sutures, like STRATAFIX™ Symmetric, and skin staples demonstrate significant advantages, including reduced wound closure time, lower infection rates, and improved surgical outcomes, particularly in multilevel or revisional procedures. In contrast, plastic surgery closures do not show a substantial reduction in postoperative complications despite being used in more complex cases. NPWT is highlighted as an effective adjunct therapy for managing surgical site infections and reducing the need for hardware removal. The findings suggest that while modern techniques offer clear benefits, traditional methods remain valuable in specific contexts. The review advocates for further research through large-scale, long-term studies and emphasizes the need for personalized wound closure strategies based on individual patient risk factors.

Single-stage reconstruction of a large defect of the ear.

To reconstruct a large anterior skin and cartilage defect of the upper half of the external ear in an elderly patient after cancer surgery, different techniques are possible, but single-stage procedures should be advised. Combining flaps with reliable vascular supply, like the revolving door post-auricular flap and a mastoid advancement flap, is an attractive single-stage reconstructive option to rebuild a sturdy auricle.

Carbon footprint of a laser unit: a study of two centres in the UK.

PURPOSE: Climate change has serious consequences for our wellbeing. Healthcare systems themselves contribute significantly to our total carbon footprint, of which emissions from surgical practice are a major component. The primary sources of emissions identified are anaesthetic gases, disposal of single-use equipment, energy usage, and travel to and from clinical areas. We sought to quantify the waste generated by laser surgery which, to our knowledge, has not been previously reported. METHODS: The carbon footprint of two laser centres operating within the United Kingdom were measured. The internationally recognised Greenhouse Gas Protocol was used as a guiding framework to classify sources of waste and conversion factors issued by the UK government were used to quantify emissions. RESULTS: The total carbon footprints per day at each unit were 299.181 carbon dioxide equivalents (kgCo2eq) and 121.512 kgCO2eq, respectively. We found the carbon footprint of individual laser treatments to be approximately 15 kgCO2eq per procedure. The biggest overall contributor to the carbon footprint was found to be the emissions generated from staff, patient and visitor travel. This was followed by electricity usage, and indirect emissions from physical waste and laundry. CONCLUSIONS: The carbon footprint of laser procedures was considerably less than the average surgical operation in the UK. This initial study measures the carbon footprint of a laser center in a clinical setting and allows us to identify where improvements can be made to eventually achieve a net carbon zero health care system.

Changing practices in septorhinoplasty: the Irish experience.

PURPOSE: Septorhinoplasty (SR) is one of the most complex surgical procedures of the head and neck. As an elective procedure aiming to enhance patient quality of life, it can be difficult to perform in single-payer healthcare systems due to capacity pressures from acute and oncological surgical demand. We aimed to review national trends in the practice of SR to inform future healthcare planning. METHODS: This was a cross-sectional, population-based, longitudinal study of SR cases in Ireland's single-payer (public) healthcare system from 2005 to 2021. Time-series analysis using a linear regression model was performed to analyse trends by operation type, revision rates and length of stay. The impact of the COVID-19 pandemic and introduction of national surgical guidelines was analysed. RESULTS: 1952 SR were performed. Annual mean cases declined in both real (r = - 0.76, p < 0.01) and relative (r = - 0.87, p < 0.01) terms by 31% and 43%, respectively. Ambulatory SR, while initially rarely performed, increased to account for 55% of cases performed. The mean hospital length of stay declined significantly (r = - 0.84, p < 0.01) by 44%. CONCLUSIONS: SR increasingly struggles to find its place in Ireland's public healthcare system. New changes in SR practices including the rapid growth of ambulatory surgery and shorter lengths of hospital stay indicate positive responses to the mounting pressures faced by healthcare systems.

Functional tongue reconstruction after compartmental surgery: a schematic model for planning and insetting of the anterolateral thigh free flap.

PURPOSE: Anterolateral thigh free flap (ALTFF) is a versatile option for tongue reconstruction after cancer resection. Compartmental tongue surgery (CTS) is a surgical technique whose purpose is to remove the entire oncological compartment with the pathways of tumor spread. Extended glossectomies (EG) follow the same surgical steps and anatomical concepts as CTS but extend beyond hemiglossectomy. The surgical defect following such resections often necessitates the use of a large free flap, with the ALTFF being the most commonly used. METHODS: The CTS and EG are anatomically-based approaches tailored to the lesion rather than the tumor margins. Leaving a predictable defect, the reconstructive phase can, in most cases, be planned in a standardized way, assuming certain scenarios based on the surgical approach. RESULTS: After CTS and EG, the residual volumetric defect is large. Therefore, the reconstructive flap of choice is the ALTFF. The ALTFF offers sufficient tissue volume to cover the functional defect and is a versatile flap. It can be harvested as a simple fasciocutaneous flap, as a chimeric flap, or as a muscle-fasciocutaneous flap, depending on the reconstruction requirements. We demonstrated the constant design of ALTFF based on the predictable defect after CTS and EG, aiming for a more precise and standardized reconstruction. CONCLUSION: We propose a flap design based on the anatomy of the tongue and oral cavity after CTS or EG for a more precise and standardized reconstruction. Additionally, a standard template is particularly useful for less experienced surgeons who are approaching this technique for the first time.

Histological assessment of a novel de-epithelialization method for connective tissue grafts harvested from the palate. An experimental study in cadavers.

OBJECTIVES: This study aims to compare the histological outcomes of three distinct de-epithelialization methods used in (connective tissue grafts) CTG harvested from the palate. MATERIALS AND METHODS: An experimental study using nine cadaver head specimens was carried out to compare 3 different de-epithelialization techniques for CTG. Eighteen samples were randomly allocated to three study groups: bone scraper, diamond bur and extraoral removal with a scalpel. The main outcome variable was the graft surface percentage without epithelium remains. Additionally, the time employed, and the graft thickness were also measured. RESULTS: Sixteen CTGs were analyzed. The extraoral scalpel group presented a total surface area with no epithelium of 58.84% (22.68) and a mean de-epithelialization time of 3.7 min; the intraoral diamond bur group had 88.24% (41.3) of the surface with no epithelium and took 1.455 min, and the intraoral bone scraper showed 97.98% (5.99) of surface without epithelium and a mean time of 0.815 min (P < 0.05). Histological analysis showed significant differences between the bone scraper and the extraoral group (P = 0.009). CONCLUSION: The de-epithelialization technique with a bone scraper seems to be the most effective and fastest de-epithelialization technique for CTG. These findings need to be confirmed in future clinical studies with larger samples. CLINICAL RELEVANCE: The use of bone scrapers, could be a simple, effective and fast technique to de-epithelialize connective tissue grafts harvested from the palatal area for both novice and experienced surgeons.

Treatment of multiple adjacent gingival recessions using leucocyte- and platelet-rich fibrin with coronally advanced flap: a 12-month split-mouth controlled randomized clinical trial.

OBJECTIVE: This split-mouth randomized study aimed to assess efficacy of leucocyte-platelet-rich fibrin (L-PRF) versus connective tissue graft (CTG) in achieving root coverage (RC) for multiple adjacent gingival recessions (MAGRs) throughout 12-month period. MATERIALS AND METHODS: The study enrolled 59 teeth from 12 patients with Miller Class I MAGRs ≥ 2 mm on bilateral or contralateral sides. Patients were randomly assigned to receive coronally advanced flap (CAF) with either CTG (control) or L-PRF (test) treatment. Various parameters, including plaque and gingival index, clinical attachment level, recession depth, probing depth, recession width (RW), papilla width (PW), keratinized tissue width (KTW), gingival thickness (GT), percentage of RC, complete root coverage (CRC), and location of the relative gingival margin concerning the cemento-enamel junctions (GMCEJ) after CAF, were recorded at baseline, 3-, 6-, and 12-months post-surgery. On June 29, 2021 the study was registred to ClinicalTrials.gov (NCT04942821). RESULTS: Except KTW and GT gain, all clinical parameters, RC, and CRC were similar between the groups at all follow-up periods (p > 0.05). The higher GT and KTW gains were detected in the control group compared to test group at 12 months (p < 0.05). Both RC and CRC were positively associated with initial PW and GMCEJ, but negatively with initial RW (p < 0.05). CONCLUSIONS: The current study concludes that L-PRF were equally effective as CTG in treating MAGRs in terms of RC and CRC. Additionally, RC and CRC outcomes appeared to be influenced by GMCEJ, PW, and RW. CLINICAL RELEVANCE: L-PRF could represent a feasible substitute for CTG in treating MAGRs.

Analysis of the treatment of RT2 recessions with a xenogeneic collagen matrix vs. connective tissue graft combined with a coronally advanced flap. A double-blinded randomized clinical trial.

OBJECTIVES: To compare the clinical efficacy in terms of mean root coverage in RT2 recession treated with a coronally advanced flap combined with a xenogeneic collagen matrix versus a connective tissue graft. MATERIALS AND METHODS: A total of 20 patients were randomized to receive one of two treatments: coronally advanced flap + xenogeneic collagen matrix (test group) and coronally advanced flap + connective tissue graft (control group). Patient-related outcomes measures and professional aesthetic assessment by root esthetic score were performed. A descriptive and analytical statistical analysis of the variables was performed. RESULTS: At 12 months, the mean root coverage was 56.48% in the test group and 69.72% in the control group (p = 0.048), with a 35% and 40% complete root coverage in the xenogeneic collagen matrix and connective tissue graft, respectively. Test group presented less pain (3.65 vs. 5.2 VAS units) (p = 0.015) and less surgical time (45 vs. 49.15 min) (p = 0.004) than control group. CONCLUSION: The use of xenogeneic collagen matrix in RT2 recessions was effective for recession reduction to those obtained using autologous grafts; with the advantage that the duration of surgery and patient morbidity decreased. Therefore, xenogeneic collagen matrix in RT2 recessions could be an alternative to autologous grafts. CLINICAL RELEVANCE: The use of xenogeneic collagen matrix decreases the surgery time and patient morbidity but connective tissue graft results in significantly better mean root coverage and complete root coverage. Xenogeneic collagen matrix can be used in the treatment of RT2 gingival recessions. STUDY REGISTRATION: NCT03344315.