Buriram Hospital (Thai: โรงพยาบาลบุรีรัมย์) is the main hospital of Buriram Province, Thailand and is classified under the Ministry of Public Health as a regional hospital. It has a CPIRD Medical Education Center which trains doctors for the Institute of Medicine of Suranaree University of Technology and is an affiliated hospital of the Faculty of Medicine Ramathibodi Hospital, Mahidol University.
Objective: Intermittent negative pressure wound therapy (NPWT) may enhance granulation, but commercial systems are costly. This study evaluated a low-cost, improvised intermittent NPWT system.Material and Methods: A randomized controlled trial was conducted with 32 patients having open wounds unsuitable for primary closure. Participants were allocated to intermittent NPWT (5 minutes on/-125 mmHg, 2 minutes off; n=16) or continuous NPWT (n=16) using an improvised system. The primary outcome was the percentage of granulation tissue coverage, assessed by blinded plastic surgeons on days 0, 3, 6, and 9. A linear mixed model was used for analysis.Results: The intermittent NPWT group demonstrated significantly greater granulation tissue formation than the continuous group (Group main effect: F(1)(1,30)=5.297, p-value=0.028). By day 9, the estimated marginal mean granulation coverage was 94.6% (95% CI: 88.0, 101.1) for intermittent NPWT versus 82.8% (95% CI: 76.3, 89.4) for continuous NPWT, with a significant between-group difference of 11.7% (p-value=0.029). Pain scores at day 9 did not differ between groups (p-value=0.876).Conclusion: An improvised intermittent NPWT system significantly improved granulation tissue formation compared to continuous NPWT, without increasing patient pain. Clinically, this accelerated granulation implies earlier readiness for definitive wound closure or skin grafting. This low-cost approach offers a practical and accessible solution for improving wound care in resource-constrained settings.
Objective: To compare 24-hour postoperative opioid consumption, converted to intravenous morphine equivalents, between patients receiving external oblique intercostal plane (EOI) block and those receiving incisional local infiltration (LA) in open cholecystectomy. Primary outcome: 24-h morphine equivalents. Secondary: pain intensity on a 0–10 numeric rating scale (NRS). The minimal clinically important difference (MCID) was defined as ≥30% opioid reduction and ≥1-point NRS decrease. Material and Methods: Forty-four patients undergoing open cholecystectomy were randomized to EOI or LA (22 each). The EOI group received 20 mL of 0.25% bupivacaine for EOI block after skin closure, and the LA group received the same dose for local infiltration before skin closure. Results: For the primary outcome, 24-h morphine equivalent consumption showed no significant difference between the groups (–4.09 mg; p-value=0.058). Ward opioid use (2–24 h) was lower in the EOI group (10.2±5.3 mg) than the LA group (14.1±6.9 mg); mean difference –3.96 mg, 95% CI (–7.69 to –0.22), p-value=0.038. This 28% reduction did not meet the 30% MCID. Median movement NRS in the ward was significantly lower with EOI (6 [IQR 5–6]) than LA (7 [IQR 5.75–8]); median difference –1, 95% CI (–2.00 to 0.00), p-value=0.022, meeting the 1-point MCID. Conclusion: Although the EOI block did not significantly reduce total 24-hour morphine consumption, it was associated with a clinically meaningful reduction in movement-evoked pain.
BACKGROUND:Lower lip reconstruction following cancer resection commonly employs the nasolabial flap (NLF) or modified neurovascular cheek flap (MNCF). Both techniques inadequately restore the orbicularis oris sphincter, theoretically predisposing patients to oral incompetence and drooling. However, direct comparative data on functional outcomes remain limited. To compare the incidence of postoperative drooling and wound complications between NLF and MNCF reconstruction for lower lip defects. METHODS:This retrospective cohort study included 125 patients with lower lip squamous cell carcinoma who underwent reconstruction with either NLF (n= 47) or MNCF (n= 78) between August 2012 and August 2025 at a single tertiary center. The primary outcome was drooling at the 3-month follow-up. Secondary outcomes included overall wound complications within 30 days. Multivariate logistic regression was performed to adjust for confounders. RESULTS:Baseline characteristics were comparable except for defect size, which was significantly larger in the MNCF group (75.0% vs. 60.0%; p= 0.007), and flap laterality, with bilateral procedures more common in the MNCF group (56.4% vs. 12.8%; p< 0.001). The overall drooling rate was 14.4%, with no significant difference between groups in univariate analysis (MNCF 11.5% vs. NLF 19.1%; p= 0.240). However, after adjusting for confounders, including flap laterality, the MNCF demonstrated a significantly lower risk of drooling (adjusted odds ratio [OR], 0.18; 95% confidence interval [CI], 0.04-0.82; p= 0.026). The MNCF group also showed significantly lower complication rates (1.3% vs. 14.9%, p= 0.003; adjusted OR, 0.06; 95% CI, 0.01-0.76; p= 0.030). CONCLUSION:The MNCF is associated with significantly lower rates of drooling and wound complications than the NLF, despite reconstructing larger defects. After controlling for flap laterality, the MNCF demonstrates superior functional outcomes, establishing it as the preferred technique for extensive lower lip reconstruction when surgical expertise is available.
