Buriram Hospital

BACKGROUND:Platelet-rich fibrin (PRF) is an autologous biomaterial that promotes tissue regeneration through sustained release of growth factors. Its role in accelerating bone healing in mandibular fractures, however, remains incompletely defined. This study evaluated the effect of PRF on bone regeneration following open reduction and internal fixation (ORIF) of bilateral mandibular fractures. METHODS:A prospective split-mouth clinical trial was conducted at a single center between December 2023 and September 2025. Twenty patients with bilateral mandibular fractures were enrolled; each patient received PRF on one fracture side and conventional ORIF on the contralateral side. Bone density was quantified using Hounsfield units (HU) from preoperative and postoperative computed tomography scans at 2 weeks, 1 month, and 3 months. Statistical analysis employed a two-way repeated-measures analysis of variance with post hoc comparisons. RESULTS:Eighteen patients completed the 3-month follow-up and were included in the final analysis. Bone density increased significantly over time in both sides (p< 0.001), with a significant side by time interaction (p< 0.001). At 3 months, PRF-treated sites demonstrated higher HU values (700.0± 152.1) than controls (567.8± 135.7), yielding a mean difference of 132.2 HU (p< 0.001, Cohen's d= 0.94). No early intergroup differences or postoperative complications were observed. CONCLUSION:Adjunctive use of PRF significantly enhanced bone density at 3 months without increasing complications. PRF appears to promote late-stage bone mineralization; however, larger multicenter studies with longer follow-up are required before recommending routine clinical implementation.

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.