Large wounds resulting from severe injuries are generally treated with extended reconstructive operations (e.g., free flaps), which are accompanied by long hospitalizations and risks of infection, thrombosis, and flap loss. Integra is a collagen template that can be used for reconstruction of defects. The take rate and the rate of infection are essential for the successful use of Integra (Johnson and Johnson, Hamburg, Germany). Whether the take rate and integration of Integra could be improved with the use of fibrin glue and negative-pressure therapy was assessed. Between January of 2002 and December of 2002, patients with large defects who underwent Integra grafting for reconstruction were randomly divided into groups receiving either a new treatment with fibrin glue-anchored Integra and postoperative negative-pressure therapy or conventional treatment. Demographic features, cause of the wound, location of the wound, take rate, complications of Integra coverage, time from Integra coverage to skin transplantation, and functional and aesthetic results were assessed. Twelve patients (with similar group distributions with respect to sex, age, and location and cause of the injury) were included in the study. The take rate was 78 +/- 8 percent in the conventional treatment group and 98 +/- 2 percent in the fibrin/negative-pressure therapy group (p < 0.003). The mean period from Integra coverage to skin transplantation was 24 +/- 3 days in the conventional treatment group but only 10 +/- 1 days in the fibrin/negative-pressure therapy group (p < 0.002). The decrease in the interval between coverage with Integra and skin transplantation resulted in shorter hospital stays. The use of fibrin glue and negative-pressure therapy in combination with Integra could shorten the period from coverage to integration, which would be beneficial in terms of decreased risks of infection, thrombosis, and catabolism. Therefore, it is suggested that Integra be used in combination with fibrin glue and negative-pressure therapy to improve clinical outcomes and shorten hospital stays, with decreased risks of accompanying complications.
Interference screw fixation is frequently used in anterior cruciate ligament reconstruction with the bone-patellar tendon-bone graft. There have been no data available about the influence of screw diameter and insertion torque on primary stability. We designed a cadaveric study using paired knees to analyze the comparative effectiveness of 20-mm long screws of different diameters (9 mm versus 7 mm) and the significance of torque during screw insertion. Testing to failure was performed in a tensiometer with a crosshead speed of 200 mm/min. After slippage of a bone peg in the 7-mm screw specimens, the experiment was repeated in each specimen with a 9-mm screw fixation. Maximum tensile force was greater at the femoral insertion than at the tibial site. Results of refixations with 9-mm screws were only slightly inferior to the original 9-mm screw fixation specimens. Our results further showed that the torque can be used as a predictor of the stability of the bone block but cannot be used as an indicator for the strength of the reconstruction. The 7-mm screws are not recommended for tibial fixation. Failed 7-mm screw fixations can be replaced by 9-mm screws and refixations were successful in our study model.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.