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PubMed2006

Racial and ethnic disparities in influenza vaccination coverage among adults during the 2004-2005 season.

During the 2004-2005 influenza season, the supply of vaccine to the United States was significantly reduced. In response, the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices issued interim recommendations for prioritizing vaccination. Given trends in racial/ethnic disparities in vaccination for influenza, the authors assessed the impact of the shortage on those historically less likely to be vaccinated. Using data from the Behavioral Risk Factor Surveillance System, they considered vaccination coverage among those non-Hispanic Whites, non-Hispanic Blacks, and Hispanics who had priority for being vaccinated during the 2004-2005 influenza season. The vaccine shortage had a significant negative effect on coverage among adults aged 65 years or older across the three racial/ethnic groups. Yet, the magnitude of the disparities in coverage did not change significantly from previous seasons. This finding may imply similar patterns of vaccine-seeking behavior during shortage and nonshortage years. No racial/ethnic differences were seen among adults aged 18-64 years, which likely reflects the higher percentage of health-care workers in this age group. Yearly monitoring of influenza vaccine coverage is important to assess the long-term impact of shortages on overall coverage and gaps in coverage between racial/ethnic groups.

Adult↗
PubMed1999

The immunization programme in Bangladesh: impressive gains in coverage, but gaps remain.

The paper reviews the achievements in tetanus immunization coverage and child immunization in Bangladesh. It uses data from the 1993-94 Bangladesh Demographic and Health Survey to identify and examine the programmatic and non-programmatic factors that influence the coverage of tetanus (TT) immunization during pregnancy, and full immunization among children 12-23 months old in rural Bangladesh. The purpose of this analysis is to identify the areas that need further programme attention. The logistic regression results show that the coverage of TT immunization was significantly associated with proximity to outreach clinics and the presence of a health worker in the community. Home visits by health/family planning fieldworkers and the proximity to outreach clinics had larger influences on TT coverage of poorer households compared to those better-off. The effect of distance to static clinics varied by regions. Among children, full immunization coverage (coverage of all of BCG, DPT1, DPT2, DPT3, Polio1 Polio2, Polio3) was significantly associated with distance to outreach clinics, the greater the distance to the clinics, the less the likelihood of immunization.

Adult↗
PubMed2005

The health service coverage of quality-certified primary health care units in Metro-Manila, the Philippines.

INTRODUCTION: In 1998, the Philippines' Department of Health implemented the Quality Assurance Programme, known as the Sentrong Sigla (Centre of Vitality) Movement, starting with primary health care units. The Department established the National Objectives for Health in 1999, which set targets for health status and service coverage by 2004. The Movement certifies primary health care facilities that comply with its list of quality standards. Three years after implementation of the Sentrong Sigla Movement, the present study assessed it as an intervention for the delivery of health care services. Specifically, it evaluated the 2001 service coverage among certified facilities and compared it with that of non-certified facilities in the National Capital Region (Metro-Manila) of the Philippines, and related service coverage to the targets of the National Objectives for Health for 2001. METHODS: For the intervention group, the study randomly selected 82 of the 143 certified facilities (57.3%), with 88 of the 223 non-certified facilities (39.5%) serving as the control group. Using reliable and valid measurement indicator tools, data were collected on preventive health services programmes, curative programmes and monitoring programmes. To compare service coverage of the intervention and control groups, the data were analyzed using chi-squared tests, prevalence ratios, clustered sampling analysis and linear regressions of the rates. RESULTS: The overall 2001 service coverage shows that certified facilities had significantly less success in the preventive and monitoring programmes than the non-certified facilities, but were not significantly different in the curative programmes. Neither type of facility reached the targets of the 2001 National Objectives for Health for preventive programmes. After adjusting for clustering, the certified facilities showed significantly lower service coverage, compared with non-certified facilities, only for enrolling new acceptors to the Family Planning Programme and for water-supply testing in the Environmental Sanitation Programme. CONCLUSION: Unlike previous studies, the results and analysis of the present study show that, generally, the Sentrong Sigla Movement had not improved the processes required to achieve better outcomes. Factors that could have contributed to the findings are described and strategies for improvement are recommended.

Humans↗
PubMed2001

Universal coverage in the United States: lessons from experience of the 20th century.

Both the rising numbers of uninsured Americans and the recent presidential election have put the issue of universal health insurance coverage back on the national agenda. Lack of health insurance is a major barrier to care for 44 million Americans, and lack of high-quality, comprehensive insurance is a barrier to millions more. Universal coverage is one of the best ways to ensure that all Americans have equitable access to quality care, and it also contributes to the financial stability of health care providers, especially those in the urban safety net. A wide variety of ideas to expand health care coverage were proposed, and in some cases enacted, during the last century. At the beginning of the 21st century, the American health care system is made up of varied elements, ranging from employer-sponsored health insurance for the majority of working-age adults to the public Medicare program for the elderly. While this patchwork system leaves many Americans without health insurance, it also creates many different ways to expand coverage, including various options in both the private and public sectors. By understanding how the current health care system developed, how the various proposals for universal health coverage gained and lost political and public support, and the pros and cons of the various alternatives available to expand coverage, we create a solid base from which to solve the problem of the uninsured in the 21st century.

Health Benefit Plans, Employee↗
PubMed2001

Moderate immunization coverage levels in East Delhi: implications for disease control programmes and introduction of new vaccines.

A vaccination coverage survey conducted in East Delhi in September 1999 showed that only 58.6 per cent of the children aged 12-23 months had received the full course of the vaccines recommended under the national immunization programme. Coverage with the third dose of DTP and oral polio vaccines was around 71 per cent, and with BCG and measles vaccines was 83 and 59 per cent, respectively. Drop-out rates between DTP1 and DTP3 and between DTP1 and measles immunization were 13.8 and 28.7 per cent, respectively. Nine per cent of the children had not received a single dose of any vaccine. The main reason for failure to immunize was lack of information. There was a marginal increase in DTP3 and OPV3 immunization coverage levels as recorded through a previous survey in 1996, a drop in coverage with measles vaccine from 64.3 to 59 per cent, and a significant increase in tetanus toxoid immunization coverage of pregnant women from 79.4 to 93 per cent. The percentage of children who had not received any vaccine declined from 13 to 9 per cent in the period between the two surveys. Coverage with hepatitis B vaccine at 14 per cent was only marginally higher than the baseline rate of 9 per cent before the vaccine was made available, free of cost, through government and municipal corporation health facilities.

Adjuvants, Immunologic↗
PubMed1993

Total versus partial musculofascial coverage for steroid-containing double-lumen breast implants in augmentation mammaplasty.

The use of intraluminal steroids in double-lumen breast implants is effective in preventing fibrous capsular contraction around the implant. This technique has not been accepted widely, however, and remains controversial primarily because steroid-related complications, including extrusion, late inferior migration, and atrophy of the skin, have been associated with their use. This nonrandomized retrospective study of 76 patients (146 breasts) who underwent submuscular augmentation of the breast through inframammary and periareolar incisions compares results after total musculofascial coverage of the implant with partial muscle coverage of the implant. In patients with partial muscle coverage of the implant, 7.8% steroid-related complications were observed. In the group with total musculofascial coverage of the implant, no steroid-related complications and no symptomatic contractions of the capsule were observed. Our study suggests that total musculofascial coverage provides a statistically significant margin of protection from steroid-related complications compared with techniques using only partial muscle coverage of the implant in patients who underwent cosmetic augmentation mammaplasty.

Contracture↗
PubMed1994

Elbow defect coverage with a one-staged, tunneled latissimus dorsi transposition flap.

Upper extremity reconstruction is very challenging due to the unavailability of expendable local muscles. A review of the literature reveals that the latissimus dorsi muscle has been used for functional restoration of elbow extension and flexion as well as soft-tissue coverage of upper arm and shoulder defects. In addition, the latissimus dorsi muscle has been used for forearm reconstruction. Although we have been unable to find any reports of the use of the latissimus dorsi muscle for pure coverage of complex elbow wounds, we have successfully used the latissimus dorsi transposition flap to cover complex elbow defects in a one-staged procedure for patients. In 3 of 4 patients, the latissimus dorsi transposition flap was the first choice. In the other patient, the latissimus dorsi flap was successfully used as an alternative choice for coverage of an open, comminuted elbow fracture after a failed rectus abdominis free tissue transfer. A technique is described for coverage of complex elbow defects by transferring a latissimus dorsi muscle on its vascular pedicle with or without an overlying skin island. This procedure is safe, one-staged, and results in minimal donor morbidity. The latissimus dorsi transposition flap provides reliable coverage of complex elbow defects and should be considered the flap of choice for coverage of the elbow.

Adult↗
PubMed1994

Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem.

OBJECTIVE: The authors review the historical basis for the provision of perioperative glucocorticoid coverage, and detail the evolution in the understanding of the role of the hypothalamic-pituitary-adrenal cortical (HPA) axis in response to physical stressors. New recommendations are proposed for glucocorticoid-dependent patients who require anesthesia and surgery. SUMMARY BACKGROUND DATA: In 1952, a patient developed surgery-associated adrenal insufficiency as a result of preoperative withdrawal from glucocorticoid therapy. That case report, and one other in the ensuing 12 months, prompted the publication of recommendations for perioperative glucocorticoid coverage, which became the standard of care. The understanding of the role of the HPA axis in the stress response has been subsequently refined; however, recommendations for perioperative glucocorticoid coverage have not been altered in parallel. METHODS: Studies were identified beginning with the first reports of the physiologic actions of the adrenal glands (1855) and the description and clinical use of cortisone (1930-1993). Studies were selected for review if they were related to or evaluated the provision of stress-related glucocorticoid administration. All clinical studies were evaluated to determine the basis for the provision of perioperative glucocorticoid coverage and the validity of the data used to justify these conclusions. CONCLUSIONS: Clinical and experimental evidence support the concept that the current amount of perioperative glucocorticoid coverage is excessive and has been based on anecdotal information. New recommendations are proposed which suggest that the amount and duration of glucocorticoid coverage should be determined by: a) the preoperative dose of glucocorticoid taken by the patient, b) the preoperative duration of glucocorticoid administration, and c) the nature and anticipated duration of surgery.

Glucocorticoids↗
PubMed1989

Coverage of acute vascular injuries of the axilla and groin with transposition muscle flaps: case reports.

Acute axillary or groin vascular injuries caused by farm machinery or shotgun blasts are often associated with extensive soft-tissue loss. Coverage of the repaired blood vessels with healthy tissue is necessary to avoid infection, desiccation, pseudoaneurysm, and rupture. Adjacent muscles are not always available to rotate for coverage, due to unacceptable functional loss, or injury to the principal vascular pedicle. We used proximally based trunk musculature with vascular pedicles out of the areas of injury to achieve coverage of four extensive axillary wounds and one extensive groin wound. Arterial repair only was performed in three axillary wounds. Combined arterial and venous repair were performed in one groin wound and one axillary wound. Followup ranging from 9 months to 5 years revealed no vascular failure or soft-tissue complications. We conclude that coverage of vascular repairs and soft-tissue defects with viable muscle is necessary in cases of extensive injury. Adjacent muscle is preferred for coverage, but when this is unavailable, coverage can still be achieved using more proximally pedicled muscles of the trunk.

Adolescent↗
PubMed1998

Type of health care coverage and the likelihood of being screened for cancer.

OBJECTIVES: This study explored whether type of outpatient health coverage affected the likelihood of men and women aged 20 to 64 years receiving recommended cancer screening procedures. METHODS: Data from the 1989 and 1990 California Behavioral Risk Factor Surveillance Surveys were used to compare Pap smear, mammogram, fecal occult blood test, and proctoscopic examination rates for adults with three different types of private health care coverage (Group/staff model health maintenance organization, Independent Practice Association Model health maintenance organization, indemnity plan) and no outpatient health insurance. Logistic regression models were used to control for sociodemographic and health characteristics and whether individuals had a usual health care provider. RESULTS: Individuals with Group Model health maintenance organization coverage were significantly more likely than those with indemnity plans to have had recent cervical, breast, and colorectal cancer screening, whereas screening likelihood for those with Independent Practice Association model health maintenance organization coverage did not differ substantially from those with indemnity plans. Individuals with no outpatient coverage were less likely to be screened than those with outpatient coverage. The most consistently significant predictor across cancer screening procedures for both men and women was having a usual doctor who knew their medical history. CONCLUSIONS: Adults who had private outpatient insurance were more likely to undergo recommended cancer detection procedures than those who did not. Adults who belonged to a health maintenance organization, which emphasizes and pays for a broader spectrum preventive care, were more likely to receive Pap smears, mammograms, and fecal occult blood tests than those covered by indemnity plans. Receiving care primarily from one doctor significantly increased the likelihood of having screening procedures, irrespective of type of health plan.

Adult↗
PubMed1995

Estimating immunization coverage from school-based childhood immunization records.

To determine the accuracy of school-based childhood immunization records and to describe the effects of their use on estimates of community-wide immunization coverage, we verified the immunizations to 72 months of age for children born in 1986 to residents in Dallas County, TX, and in Minnesota. Verified immunizations were compared with those documented in the school record. Major transcription errors accounted for fewer than 1% of discrepancies between school and provider records. For 99 subjects with 987 verified immunizations in Minnesota, age-appropriate immunization coverage estimated from the school records was within two percent of actual coverage. For 86 subjects with 981 verified immunizations in Dallas County, age-appropriate immunization coverage from the school records underestimated actual coverage by as much as 21%. The primary factor explaining the underestimate in Dallas was incomplete school immunization records for 33 (38%) subjects and 126 (13%) immunizations. Selective recording of immunizations related to the minimum state requirements in Texas contributed to incomplete school records in Dallas County. Verification of the completeness of records selected to estimate immunization coverage is essential if the estimates are used to monitor trends or to make public policy decisions.

Child↗
PubMed2002

Prostate-specific antigen screening coverage and prostate cancer incidence rates in the Belgian province of Limburg in 1996-1998.

According to the 1996-1998 cancer incidence report of the cancer registry of the Belgian province of Limburg (LIKAR), prostate cancer is the most common cancer in men with a crude invasive cancer incidence rate of 123.7 per 100000 person-years (125.4 and 81.8 after standardization for the European and the world standard population). In a study on geographical differences between the occurrence of cancers in municipalities, prostate cancer standardized incidence rates (SIRs) were significantly higher in a number of municipalities, with mean relative risks of 1.2 and 1.3 after full Bayesian smoothing. We hypothesized that prostate cancer incidence rates are largely influenced by the prostate-specific antigen (PSA) screening policy of local physicians and that differences between municipalities are more informative about local screening habits then about real differences in cancer occurrence. The aim of this study was to test this hypothesis by relating local prostate cancer SIRs to the PSA screening coverage of the population of men in each municipality. The SIRs of prostate cancer in 1996-1998 for each municipality were provided by LIKAR. They related to all histologically or cytologically proven new invasive prostate cancers during these years. For each municipality, PSA coverage data were provided by the largest sick fund of the region. Coverage was defined as the proportion of men above the age of 40 that was tested at least once within the registration period. The SIR of each municipality (dependent variable) was related to the age-standardized corresponding coverage (independent variable) by linear regression and was adjusted for the number of inhabitants per municipality: log (standardized incidence rate) = 164 + 602 * (standardized PSA coverage), = 0.12. The model explained 6% of the variance in incidence. In conclusion, in this study no statistically significant relationship was identified between PSA coverage and prostate cancer incidence rate per municipality. This could result from no such relationship existing or from low statistical power.

Adult↗
PubMed2005

Health care coverage and access to care: the status of Minnesota's veterans.

OBJECTIVES: The primary objective of this study was to examine veterans' reliance on health care services provided by the Veterans Health Administration (VHA) within Minnesota and estimate the potential effect on uninsurance rates if all eligible veterans relied on VHA coverage. Secondary objectives were to compare veterans and nonveterans' by geographic location, demographic characteristics, health status, and health insurance coverage and to compare insured and uninsured veterans especially with regard to access to care. RESEARCH DESIGN: Data are from the 2001 Minnesota Health Access Survey of a stratified random sample of more than 27,000 respondents, of whom 3,500 were self-identified veterans. Although all veterans were eligible to obtain health care services from the VHA in 2001, veterans not reporting VHA coverage and having no other source of insurance coverage were considered uninsured. Differences in weighted population characteristics are reported. Logistic regression analysis is used to identify factors associated with veterans' reliance on VHA coverage. RESULTS: Veterans represented 13.4% of the state's adult population and 9.3% of the state's uninsured nonelderly adult population in 2001. Uninsured veterans were more likely to be single, unemployed, living in rural areas, and reporting constrained access to services than insured veterans. Veterans with a non-VHA source of insurance were less reliant on VHA services. CONCLUSIONS: The state's uninsurance rate would significantly decrease if VHA capacity constraints were alleviated and veterans relied on the VHA safety net. If veterans' insurance status matters in states with low uninsurance rates, VHA coverage has broader implications for states with higher veteran concentrations and higher uninsurance rates.

Adult↗
PubMed2004

Clinical experience with linezolid in conjunction with wound coverage techniques for skin and soft-tissue infections and postoperative osteomyelitis.

Gram-positive organisms are emerging as possibly the most important nosocomial pathogens during the past decade. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infection in the postoperative patient. Burn victims are at high risk for developing vancomycin-resistant Enterococcus (VRE) and other multidrug-resistant microbial infections as a result of the immunocompromising effects of burn injury, prolonged intensive care unit stays, and broad-spectrum antibiotic therapy. To prevent serious and dreaded complications such as skin graft breakdown, delayed wound healing, loss of a limb, and even death, these infections require a combination of extensive antibiotic therapy and plastic surgical intervention. The objectives of this study were to report clinical experience with linezolid in addition to wound care, debridement, and wound coverage techniques for the treatment of S. aureus (including MRSA) and VRE infections. Forty patients received linezolid for infections of wound coverage such as an infected graft or flap, or received linezolid in conjunction with wound coverage techniques for a S. aureus or VRE infection. The median patient age was 53 years (range, 14-85 years), 55% were female, 28% of patients received intravenous (i.v.) linezolid only, 45% received i.v. with a switch to the oral formulation, and 28% received the oral formulation only. The clinical success rate of linezolid with adjuvant wound coverage techniques was 90.0% for osteomyelitis and was 100% for skin and soft-tissue infections. For infections of wound coverage, the clinical success rate was 83.3%. In conclusion, linezolid was an effective antibiotic for the treatment of S. aureus (including MRSA) and VRE infections in conjunction with wound coverage techniques. In addition, linezolid offers the option of treating these infections with an oral agent that is 100% bioavailable.

Acetamides↗
PubMed2006

A practical application of practice-based learning: development of an algorithm for empiric antibiotic coverage in ventilator-associated pneumonia.

BACKGROUND: Development of practice-based learning (PBL) is one of the core competencies required for resident education by the Accreditation Council for Graduate Medical Education, and specialty organizations including the American College of Surgeons have formed task forces to understand and disseminate information on this important concept. However, translating this concept into daily practice may be difficult. Our goal was to describe the successful application of PBL to patient care improvement with development of an algorithm for the empiric therapy of ventilator-associated pneumonia (VAP). METHODS: The algorithm development occurred in two phases. In phase 1, the microbiology and timing of VAP as diagnosed by bronchoalveolar lavage was reviewed over a 2-year period to allow for recognition of patterns of infection. In phase 2, based on these data, an algorithm for empiric antibiotic coverage that would ensure that the large majority of patients with VAP received adequate initial empiric therapy was developed and put into practice. The period of algorithm use was then examined to determine rate of adequate coverage and outcome. RESULTS: : In Phase 1, from January 1, 2000 to December 31 2001, 110 patients were diagnosed with VAP. Analysis of microbiology revealed a sharp increase in the recovery of nosocomial pathogens on postinjury day 7 (19% < day 7 versus 47% > or = day 7, p = 0.003). Adequate initial antibiotic coverage was seen in 74%. In Phase 2, an algorithm employing ampicillin- sulbactam for coverage of community- acquired pathogens before day 7 and cefipime for nosocomial coverage > or =day 7 was then employed from January 1, 2002 to December 31, 2003. Evaluation of 186 VAP cases during this interval revealed a similar distribution of nosocomial cases (13% < day 7 versus 64% > or = day 7, p < 0.0001). Empiric antibiotic therapy was adequate in 82% of cases or =day 7: overall accuracy improved to 83% (p = 0.05). Mortality from phase 1 to phase 2 trended toward a decrease (21% versus 13%, p = 0.1). CONCLUSIONS: Application of the concept of PBL allowed for identification of local patterns of infection and development of an institution specific treatment algorithm that resulted in >80% adequate initial empiric coverage for VAP with a trend toward decreased mortality. PBL allows for alteration in practice based on local patterns and outcomes and has the potential to improve patient care.

Algorithms↗
PubMed2003

Measles vaccination coverage among five-year-old children: implications for disease elimination in Australia.

OBJECTIVES: To (i) assess under-reporting of measles-mumps-rubella (MMR) vaccinations to the Australian Childhood Immunisation Register (ACIR); (ii) estimate MMR coverage among five-year-old children and the proportion immune to measles infection; (iii) identify factors related to non-uptake of MMR vaccination. METHODS: We analysed ACIR data for a birth cohort of approximately 64,000 children aged five years. The parents of a sample of 506 children with no ACIR record for the second MMR vaccination (MMR2), due at four years of age, were interviewed by telephone to assess under-reporting to the ACIR and reasons for non-uptake of MMR vaccination. RESULTS: Parents reported that 22% (n = 111) of the surveyed 506 children had received MMR2 before their fifth birthday, and 42% (n = 214) by approximately 5.5 years of age. After correcting for this level of under-reporting to the ACIR, MMR2 coverage for the entire cohort at five years of age was 52.9% (95% CI 52.3-53.4), and increased to 84.1% (95% CI 83.4-84.8) by approximately 5.5 years of age. This was 4.3% and 8.2%, respectively, higher than ACIR coverage estimates at the two ages. Based on the corrected MMR coverage estimates, 93% of the cohort was immune to measles due to vaccination. The most common parent-reported reason for incomplete vaccination was lack of knowledge about the MMR vaccination schedule. CONCLUSIONS: Measles elimination in Australia will require continued effort in vaccination coverage and timeliness among pre-school children. School-entry requirements are important for MMR2 uptake. Strategies are needed to improve reporting to the ACIR for more accurate measurement of coverage.

Attitude to Health↗
PubMed2003

Effects of variations in hysterectomy status on population coverage by cervical screening.

OBJECTIVES: To investigate geographic differences in hysterectomy rates and effects on estimated screening coverage in South Australia. METHODS: Hysterectomy data from South Australian hospitals for 1992-2000 were used to calculate age-specific hysterectomy rates for 20-69 year old women by residential subregion and postcode. Regional variations in rates were used to estimate variations in proportions of women with an intact uterus. Effects on estimates of screening coverage were investigated. RESULTS: About 66% of South Australian women were estimated to have an intact uterus at 70 years of age, based on hysterectomy rates for 1992-2000. The proportion was smaller in lower than upper socio-economic areas, and in country areas than the State capital (Adelaide). Estimates varied from 49% to 73% across 20 subregions. About 67% of 20-69 year olds with an intact uterus were estimated to have been screened in the 24-month period from 2000 to 2001. Similar estimates applied to Adelaide and country areas, irrespective of whether adjustments were made for differences in hysterectomy rates. A lower screening coverage applied to lower than upper socio-economic areas of Adelaide, irrespective of whether these adjustments were made. While adjusting for variations in hysterectomy rates generally had little effect on estimated screening coverage, there were notable exceptions. For example, in one subregion, coverage increased among 50-69 year olds from 53% to 66%. CONCLUSIONS: Adjustments for variations in hysterectomy rates can affect estimated screening coverage in some localities. Such adjustments should be undertaken to better define areas of under-screening for targeting in screening promotion.

Adult↗
PubMed2005

Coverage of localized gingival recessions: comparison of micro- and macrosurgical techniques.

BACKGROUND: In the presence of a thin and narrow zone of gingival tissue root recessions caused by trauma or inflammatory reactions seem to be a common feature of the buccal tissue morphology. The surgical coverage is mainly indicated for aesthetic reasons and may be accomplished with pedicled flaps in conjunction with or without the use of connective tissue grafts. AIM: The purpose of the present study was to evaluate the degree of vascularization of connective tissue grafts by applying a microsurgical approach. In addition, the clinical outcome was followed for 1 year. MATERIAL AND METHODS: The study population consisted of 10 patients with bilateral Class I and II recessions at maxillary canines. In split-mouth design, the defects were randomly selected for recession coverage either by a microsurgical (test) or macrosurgical (control) approach. Immediately after the surgical procedures, and after 3 and 7 days of healing, fluorescent angiograms were performed to evaluate graft vascularization. In addition, the clinical parameters were assessed before the surgical intervention, and 1, 3, 6 and 12 months postoperatively. RESULTS: The results of the angiographic evaluation at test sites revealed a vascularization of 8.9+/-1.9% immediately after the procedure. After 3 days and after 7 days, the vascularization rose to 53.3+/-10.5% and 84.8+/-13.5%, respectively. The corresponding vascularization at control sites were 7.95+/-1.8%/44.5+/-5.7% and 64.0+/-12.3%, respectively. All the differences between test and control sites were statistically significant. The clinical measurements revealed a mean recession coverage of 99.4+/-1.7% for the test and 90.8+/-12.1% for the control sites after the first month of healing. Again, this difference was statistically significant. The percentage of root coverage both test and control sites remained stable during the first year at 98% and 90%, respectively. CONCLUSIONS: The present controlled clinical study has demonstrated that in root surface coverage, a microsurgical approach substantially improved the vascularization of the grafts and the percentages of root coverage compared with applying a conventional macroscopic approach.

Adult↗