Platelet-rich fibrin along with a modified minimally invasive surgical technique for the treatment of intrabony defects: a randomized clinical trial

PURPOSE: The modified minimally invasive surgical technique (M-MIST) has been successfully employed to achieve periodontal regeneration. Platelet-rich fibrin (PRF) is known to enhance wound healing through the release of growth factors. This study aimed to observe the outcomes of periodontal surgery when M-MIST was used with or without PRF for the treatment of isolated intrabony defects.METHODS: This randomized clinical trial was conducted on 36 systemically healthy patients, who had chronic periodontitis associated with a single-site buccal probing pocket depth (PPD) and clinical attachment level of ≥5 mm. Patients were randomly divided into 2 groups: the test group treated with M-MIST and PRF, and the control group treated with M-MIST alone. The primary periodontal parameters analyzed were PPD, relative attachment level (RAL), and relative gingival margin level. The radiographic parameters analyzed were change in alveolar crest position (C-ACP), linear bone growth (LBG), and percentage bone fill (%BF). Patients were followed up to 6 months post-surgery.RESULTS: Intragroup comparisons at 3 and 6 months showed consistently significant improvements in PPD and RAL in both the groups. In intergroup comparisons, the improvement in PPD reduction, gain in RAL, and the level of the gingival margin was similar in both groups at 3 and 6 months of follow-up. Furthermore, an intergroup comparison of radiographic parameters also demonstrated similar improvements in C-ACP, LBG, and %BF at 6 months of follow-up.CONCLUSIONS: M-MIST with or without PRF yielded comparable periodontal tissue healing in terms of improvements in periodontal and radiographic parameters. Further investigation is required to confirm the beneficial effects of PRF with M-MIST.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03169920

Follicular unit transplantation for male pattern baldness: evaluation of first 250 cases

To restore hair, making the scalp look natural, by using follicular unit transplantation technique. Hair transplantation surgeries were performed on consecutive 250 patients between the ages of 24-69 years by 'follicular unit transplantation [PUT]' method from January, 2006. Patterns were classified according to the age group. All the procedures were done under local anesthesia as an outpatient procedure. A small strip of scalp containing hair with dimensions of 15-20cm x 1.5-2.1cm was excised from the occipital regions with the patient in prone position. The donor area was closed primarily using a non-absorbable 3-0 material with lower edge trichophytic closure technique. The hair-bearing strip was dissected into units containing clusters of one, two, three, and four follicles, under magnification. The anterior hairline was drawn preoperatively on each patient. Implantation of the follicular units was initiated immediately after the slits formation. A minimum of 1500 and maximum of 3235 follicular units were placed in one session. Transplanted areas were left open without any dressing. The donor area was covered with a small dressing which was removed the next morning. The first washing was started after 48 hours. The donor area stitches were removed after 10-12 days. The mean age of the patients was 36.6 years. Majority of the patients [65.2%] were in 21 -35 years age group. 28% of the patients belonged to type V of Norwood classification. The transplanted hair entered into the [telogen] phase and were lost within 2-4 weeks. The regrowth started in the third month, but it varied from patient to patient. The results were achieved in 8-9 months. No hematoma, infection or necrosis was observed in the early postoperative period. Mild periorbital edema was was observed in 9 patients only, however, it disappeared in the first week. Two patients displayed the inclusion cysts which were managed by drainage and, topical and oral antibiotics. Good planning, carefully prepared follicular units, and careful placement provide results that was satisfying for both the surgeon and the patient

Rejuvenating bad hair transplants

To share the experience of corrective surgery for bad hair transports. this study was carried out at the Aesthetic Plastic Surgery, Rawalpindi, from January 2007 to December 2008. All the male patients having unsatisfactory results after hair transplant surgeries were included. Patietns having problems with front hairline were included in group A. Patients having problems in mid-scalp were placed in group B, whereas patients with problems in donor area were placed in group C. In all patients, the corrective procedures were performed under local anesthesia, with a single dose of sedative [diazepam 10mg] and first generation cephalosporin. The donor area was infiltrated with a mixture of normal saline, lidocaine and epinephrine [1:100,00]. The strip was harvested in prone position. The donor area was closed with single 3-0 non-absorbable running suture. Undermining of the wound margins was performed in almost all the cases to avoid the stretch on the suture line. Slits were made according to the preoperative plan. Large hair plugs were removed/excised/extracted. The defects were closed using very fine sutures. Hair plugs were also removed in cases of very low hair line. Only single follicular unit grafts were used to reconstruct the anterior hairline. The remaining follicular unit grafts were distributed according to the preoperative plan. Transplanted areas were left open without any dressing. The first wash was started after 48 hours. The donor area stitches were removed on 12-14 days. A total of 26 patients were included who had pervious surgeries at other centers and were not satisfied with the results. The mean age of the patients was 30.8 years. Majority of the patients [42.5%] belonged to younger age group 20-30 years. 69.2% patients complained of a prominent 80.8% patients had unnatural angles of the hair. Donor scar problems were also seen including wide scar [69.2%] and poor positioning in 26.9% patients. Presented with significant cosmetic problems and severely limited donor reserves, the surgeon performing restorative transplantations faces distinct challenges. Meticulous surgical techniques and optional utilizations of a limited hair supply with enable the surgeon to achieve the best possible cosmetic results for patients requiring repairs

Experience of cross-finger flap

Objective: to evaluate the experience of cross-finger flap in patients presenting in a private Setup

Patients and Methods: the study was conducted in a private setup from January 2006 to December 2008. All the patients undergoing cross-finger flap were included. The cross-finger flap was raised under local anesthesia in adults and young children whereas in younger patients, general anesthesia was given. All the flaps were raised under the tourniquet control. The donor site was closed primarily with a full-thickness skin graft and a tie-over dressing was used to stabilize the graft. The pedicle was divided after 2 weeks and the flap was insetted. After the pedicle division, the flap portion was insetted at the donor site using non-absorbable monofilament sutures

Results: 31 patients underwent cross-finger flap. Majority of the patients were males [64.5% and with male to female ratio of 1.8:1. The average age in female patients was 19.5 years [range 3-36 years] and 28.7 years [range 11-39 yearsand in males. The post-burn contracture was the main cause [41 .9% and followed by road traffic accidents [35.5% and. Left hand was predominantly involved [61.3% and. Middle finger [35.5% and was the commonest to1be involved followed by index [29% and, ring [25.8% and, and thumb [6.5% and arid little finger [3.2% and. Hyper-pigmentation occurred in 22.6% and partial graft loss· in 6:5% . No case of hypertrophic scarring/keloid was seen. There was no loss of flap. The patients were followed up for 6 months and majority of the patients were satisfied with the functional and aesthetic outcome

Conclusion: the cross-finger flap is a useful and dependable means of resurfacing finger defects