***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AlloDerm RTU ® and AlloMaxTM are two acellular dermal matrices ( ADMs ) used in implant-based breast reconstruction . In this study , we examined whether different processing methods for the ADMs lead to a disparity in histologic , clinical , and financial outcomes after breast reconstruction . Thirty patients undergoing implant-based breast reconstruction were r and omized into AlloMax or AlloDerm arms ( n = 15 , each ) . ADM was placed at the time of immediate reconstruction . Patients were evaluated for complications on postoperative days 7 , 14 , and 30 . During implant exchange , ADM biopsies were taken and compared histologically for vascular and cellular infiltration . Patient satisfaction was evaluated using the BRECON-31 question naire 1 year after implant exchange . A cost analysis was performed comparing the two ADMs . Patient demographics and complication rates  were similar between the two groups ( p > 0.05 ) . Histologically , vessel density and fibroblast/inflammatory cell infiltrate were greater on the dermal side than on the implant side ( p < 0.01 ) in both ADMs , suggesting greater vascular and cellular in-growth from the dermal side . Vessel density in the middle portion of the Allomax biopsies was significantly higher than the same site in the Alloderm biopsies ( p < 0.05 ) . The extent of fibroblast/inflammatory cell infiltration was similar in both arms ( p > 0.05 ) . The BRECON-31 satisfaction question naire yielded similar responses across all metrics between the two study arms . The negotiated price was slightly different when comparing the two ADMs , with no significant difference in ADM reimbursement . In this study , AlloDerm RTU and AlloMax were successfully used for implant-based breast reconstruction with comparable outcomes INTRODUCTION A m and ibular condyle fracture can be treated conservatively by intermaxillary fixation ( IMF ) or by open reposition and internal fixation ( ORIF ) . Many IMF-modalities can be chosen , including IMF-screws ( IMFS ) . This prospect i ve multi-centre r and omised clinical trial compared the use of IMFS with the use of arch bars in the treatment of m and ibular condyle fractures . RESULTS The study population consisted of 50 patients ( mean age : 31.8 years ) . Twenty-four ( 48 % ) patients were allocated in the IMFS group . Twenty-six ( 52 % ) patients were assigned to the arch bars group . In total 188  IMF-screws  were used ( 5 - 12 screws per patient , mean 7.83 screws per patient ) . All pain scores were lower in the IMFS group . Three patients developed a malocclusion ( IFMS-group : one patient , arch bars-group : two patients ) . Mean surgical time was significantly shorter in the IMFS group ( 59 vs. 126 min ; p<0.001 ) . There were no needlestick injuries ( 0 % ) in the IMFS group and eight ( 30.7 % ) in the arch bars group ( p=0.003 ) . One  IMF-screw fractured on insertion ( 0.53 % ) , one ( 0.53 % ) screw was inserted into a root . Six ( 3.2 % ) screws loosened spontaneously in four patients . Mucosal disturbances were seen in 22 patients , equally divided over both groups . CONCLUSION Considering the advantages and the disadvantages of IMFS , and observing the results of this study , the authors conclude that IMFS provide a superior method for IMF . IMFS are safer for the patients and surgeons The objective of this prospect i ve , r and omized , controlled trial was to compare the results of two operative techniques used for the treatment of unstable distal radius fractures in elderly patients classified as AO types A2 , A3 , and C1 . Patients were treated with either fixed-angle volar plates or K-wires using a combined Kap and ji and Willenegger technique . The functional results were determined after 3 , 6 , and 12 months . We included 40 patients aged over 65 years . Twenty-one patients were treated with plate fixation and 19 with K-wire fixation . The functional results , after 1 year , were nearly the same in both treatment groups , suggesting that either method is suitable for the treatment of unstable distal radius fractures of AO types A2 , A3 , and C1 in elderly patients . Sixteen of 21 patients with plate fixation and 17 of 19 patients with K-wire fixation present good results as assessed by the Castaing score . The median DASH score was three in both groups after 1 year . The patients with plate fixation were able to resume activities of daily living 4 weeks earlier . The most common complication was an intermediate post-traumatic median nerve irritation . Both methods are suitable for the treatment of elderly patients with unstable distal radius fractures of AO types A2 , A3 , and C1 . If early functional post-operative care is important , palmar fixed-angle plate fixation is an ideal treatment approach . Otherwise , K-wire fixation is an effective , minimally invasive method with comparable clinical results PURPOSE To compare minimally invasive intramedullary nails ( IMN ) and volar locking plates ( VLP ) for the treatment of unstable distal radius fractures by evaluating postoperative subjective , radiographic , and functional outcomes . The hypothesis was that IMN patients would have less pain and required less pain medication in the early postoperative period and returned to work earlier than VLP patients . METHODS Sixty patients with closed , displaced , unstable , extra-articular , metaphyseal fractures of the distal radius were r and omized to receive a VLP or an IMN for internal fixation . Functional outcomes ( Quick Disabilities of the Arm , Shoulder , and H and , Michigan H and Question naire ) , radiographic measurements ( ulnar variance , radial height , inclination , and volar tilt ) , and range of motion were assessed until final follow-up at 2 years after surgery . Narcotic pain medication use was documented for 5 weeks following surgery . RESULTS There were 2 groups of 30 patients with IMN ( mean age , 55 ± 14 y ) or VLP ( mean age , 55 ± 16 y ) with similar demographics and comorbidities . Patients with IMN  regained extension earlier but had similar range of motion to patients with VLP at final follow-up . There was similar improvement in Michigan H and Question naire , Quick Disabilities of the Arm , Shoulder , and H and , and strength between groups . Five weeks after surgery , fewer IMN patients required narcotic pain medication ( 13 % ) than VLP patients ( 33 % ) . Radiographic outcomes were similar at final follow-up . There were 3 failures with IMN versus 1 failure with VLP . All 10 employed patients with IMN  returned to previous work compared with 10 of the 12 employed patients with VLP . Time to return to work was similar for both groups . CONCLUSIONS In a cohort of similar patients , IMN and VLP provided comparable improvement in functional and radiographic outcomes . Patients with IMN required less narcotic pain medication after surgery than VLP patients . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic II INTRODUCTION Glycerol preserved acellular dermis ( Glyaderm ( ® ) ) consists of collagen and elastin fibers and is the first non-profit dermal substitute derived from glycerol-preserved , human allogeneic skin . It is indicated for bi-layered skin reconstruction of full thickness wounds . METHODS A protocol for clinical application and optimal interval before autografting with split thickness skin graft ( STSG ) was developed in a pilot study . A phase III r and omized , controlled , paired , intra-individual study compared full thickness defects engrafted with Glyaderm ( ® ) and STSG versus STSG alone . Outcome measures included percentage of Glyaderm ( ® ) take , STSG take , and scar quality assessment . RESULTS Pilot study ( 27 patients ):  Mean take rates equaled 91.55 % for Glyaderm ( ® ) and 96.67 % for STSG . The optimal autografting interval was 6 days ( ±1 day ) . R and omized trial ( 28 patients ):  Mean Glyaderm ( ® ) take rate was 88.17 % . STSG take rates were comparable for both research groups ( p=0.588 ) . One year after wound closure , Glyaderm( ® )+STSG was significantly more elastic ( p=0.003 ) than STSG alone . Blinded observers scored Glyaderm ( ® ) treated wounds better in terms of scar quality . DISCUSSION The efficacy of Glyaderm ( ® ) as a suitable dermal substitute for full thickness wounds is attested . Currently a procedure for simultaneous application of Glyaderm ( ® ) and STSG is adopted , allowing for further widespread use of Glyaderm ( ® ) Abstract The purpose of this study was to evaluate the efficacy of a new technique for uvular repair in patients with cleft palate . This is a prospect i ve , r and omized , double blind controlled trial study with Ethical Committee approval between two groups of 30 patients each with cleft palate who were operated on using the conventional and proposed method of uvular repair from 2005–2007 . Data was from the Outreach Surgical Center Program , Lima , Peru . Two groups of 30 patients each with cleft palate were operated on using the new technique by the Outreach Surgical Center Program Lima since 2007 . Data collection was accomplished by physical exam to evaluate the appearance of the constructed uvula , as well as the presence or absence of a fistula and by a speech therapist . This comparative study did not find a statistically significant association between the conventional and the proposed method for uvular repair or the presence of postoperative hypernasal speech determined at 1–5 years of age during follow-up ( p = 0.640 ) . This study observed no increase in the rate of fistulas and /or VPI between these two groups so it was concluded that the use of the proposed method for uvular reconstruction does not affect the closure of the velopharyngeal sphincter and , thus , the development of VPI is not increased UNLABELLED Distal half leg complex wounds are usually a formidable problem that necessitates either local or free flap coverage . The aim of this study was to compare cost billing charges in free Gracilis flap ( fGF ) and local fasciocutaneous perforator flap ( lFPF ) in reconstructing complex soft tissue leg and foot defects . PATIENTS AND METHODS Thirty consecutive adult ( > 15-year-old ) patients with soft tissue defects in the leg and /or foot requiring tissue coverage with a flap in the period between 2012 and 2015 were r and omly assigned ( block r and omization ) to either an fGF or lFPF procedure . The outcome measures addressed were total billed charges costs , perioperative billed charges cost , partial or complete flap loss , length of hospital stay , inpatient postsurgical care duration , complications , operating time and number of operative scrub staff . RESULTS One patient suffered from complete flap loss in each group . Reconstruction with lFPF showed total lower billed charges costs by 62 % ( 2509 USD ) ( p < 0.001 ) and perioperative billed charges cost by 54 % ( 779 USD ) ( p < 0.001 ) , and shorter total hospital stay ( 36.5 days ; p < 0.001 ) , inpatient postsurgical care duration ( 6.4 days ; p < 0.001 ) , operating time ( 4.3 h ; p < 0.001 ) and fewer scrub staff ( 2.2 persons ; p < 0.001 ) . CONCLUSION These results suggest that neither flap is totally superior to the other ; the choice should instead be based on the outcome sought and logistics . lFPF requires lower billed charges cost and re source use and saves operative time and personnel and reduces length of hospital stay . Our approach changed towards using perforator flaps in medium-sized defects , keeping the free flap option for larger defects Background Method ologists have proposed the formation of a good research question to initiate the process of developing a research protocol that will guide the design , conduct and analysis of r and omized controlled trials ( RCTs ) , and help improve the quality of reporting such studies . Five constituents of a good research question based on the PICOT framing include : Population , Intervention , Comparator , Outcome , and Time-frame of outcome assessment . The aim of this study was to analyze if the presence a structured research question , in PICOT format , in RCTs used within a 2010 meta- analysis investigating the effectiveness of femoral nerve blocks after total knee arthroplasty , is independently associated with improved quality of reporting . Methods Twenty-three RCT reports were assessed for the quality of reporting and then examined for the presence of the five constituents of a structured research question based on PICOT framing . We created a PICOT score  ( predictor variable ) , with a possible score between 0 and 5 ; one point for every constituent that was included . Our outcome variable was a 14 point overall reporting quality score ( OQRS ) and a 3 point key method ological items score ( KMIS ) based on the proper reporting of allocation concealment , blinding and numbers analysed using the intention-to-treat principle . Both scores , OQRS and KMIS , are based on the Consoli date d St and ards for Reporting Trials ( CONSORT ) statement . A multivariable regression analysis was conducted to determine if PICOT score was independently associated with OQRS and KMIS . Results A completely structured PICOT score question was found in 2 of the 23 RCTs evaluated . Although not statistically significant , higher PICOT was associated with higher OQRS [ IRR : 1.267 ; 95 % confidence interval ( CI ) : 0.984 , 1.63 
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Conclusions : Clinical investigators failed to justify their choice of time horizon in the majority of published r and omized controlled trials .