Evidências para o tratamento de feridas em recém-nascidos: revisão integrativa

Introdução: Diante das particularidades e desafios no manejo e tratamento de feridas em recém-nascidos torna-se importante para o enfermeiro conhecer, indicar e avaliar a eficácia e segurança das coberturas e produtos, inclusive na análise dos produtos para o público neonatal. Objetivo: Identificar na literatura as principais coberturas e produtos utilizados no tratamento de feridas em recém-nascidos. Metodologia: Trata-se de uma revisão integrativa de literatura, com artigos publicados entre os anos de 2018 a 2022, que abordaram os temas de coberturas e produtos utilizados no tratamento de feridas em recém-nascidos. A coleta de dados foi realizada por meio de consulta na Biblioteca Virtual de Saúde e Scientific Eletronic Library Online. Foram utilizados os descritores "newborn", "wounds" e "bandage". A análise foi realizada conforme a estratégia PICO e estruturados pelo PRISMA. Resultados: Diante dos achados foi possível identificar 13 artigos que abordavam produtos e coberturas destinados ao tratamento de feridas em neonatos. Foram encontrados 14 tipos de coberturas/produtos e dispositivos que utilizam a terapia por pressão negativa. Considerações finais: A literatura indica o uso de produtos e cobertura com princípios passivos, ativos e biológicos para o tratamento de feridas em neonatos, inclusive no prematuro, valendo destacar a importância em considerar o uso seguro de coberturas adequadas a esse público.

Introducción: Dadas las particularidades y desafíos en el manejo y tratamiento de heridas en recién nacidos, es importante que los enfermeros conozcan, indiquen y evalúen la efectividad y seguridad de apósitos y productos, incluido el análisis de productos para el público neonatal. Objetivo: Identificar en la literatura los principales apósitos y productos utilizados para el tratamiento de heridas en recién nacidos. Metodología: Se trata de una revisión integrativa de la literatura, con artículos publicados entre 2018 y 2022, que abordaron los temas de apósitos y productos utilizados en el tratamiento de heridas en recién nacidos. La recolección de datos se realizó mediante consulta en la Biblioteca Virtual en Salud y Biblioteca Científica Electrónica en Línea. Se utilizaron los descriptores "newborn", "wounds" y "bandage". El análisis se realizó según la estrategia PICO y estructurado por PRISMA. Resultados: Teniendo en cuenta los hallazgos, fue posible identificar 13 artículos que abordaron productos y apósitos destinados al tratamiento de heridas en recién nacidos. Se encontraron 14 tipos de revestimientos/productos y dispositivos que utilizan terapia de presión negativa. Consideraciones finales: La literatura indica el uso de productos y coberturas con principios pasivos, activos y biológicos para el tratamiento de heridas en recién nacidos, incluidos los prematuros, y cabe resaltar la importancia de considerar el uso seguro de coberturas adecuadas para esta población.

Introduction: Given the particularities and challenges in the management and treatment of wounds in newborns, it becomes important for nurses to know, indicate and evaluate the efficacy and safety of dressings and products, even in the analysis of products for the neonatal population. Objective: To identify in the literature the main dressings and products used to treat wounds in newborns. Methodology: This is an integrative literature review, with articles published between 2018 and 2022, which addressed the topics of dressings and products used in the treatment of wounds in newborns. Data collection was carried out through consultation in Biblioteca Virtual de Saúde and in the Scientific Electronic Library Online. The "newborn", "wounds" and "bandage" descriptors were used. The analysis was carried out according to the PICO strategy and structured following PRISMA. Results: Given the findings, it was possible to identify 13 articles that addressed products and dressings intended for treating wounds in newborns. Fourteen types of dressings/products and devices that use negative pressure therapy were found. Final considerations: The literature indicates the use of products and dressings with passive, active and biological principles for the treatment of wounds in newborns, including premature neonates, and it is worth highlighting the importance of considering the safe use of dressings that are suitable for this population.

Perfil clínico e epidemiológico de pacientes vítimas de queimaduras, um estudo retrospectivo / Clinical and epidemiological profile of burn victims, a retrospective study

Introdução: No Brasil, queimaduras acometem cerca de um milhão de pessoas/ano, a maioria do sexo masculino. Além de prejuízos físicos e emocionais, há impacto econômico, com gastos para o sistema de saúde, indenizações e incapacidades laborais. Por estas razões, estudos epidemiológicos são importantes para traçar o perfil da população mais acometida, orientando a prevenção dessa afecção. Método: Revisão dos prontuários de 398 vítimas de queimaduras, internados na Santa Casa de Santos, de janeiro de 2016 até dezembro de 2019. Resultados: Os principais acometidos são homens, jovens, em ambiente doméstico, por líquidos aquecidos, causando em sua maioria queimaduras de segundo grau, atendidos em até 24 horas, considerados grandes queimados e internados em enfermaria por até duas semanas. Aproximadamente 90% recebeu alta com melhora, necessitando apenas de desbridamento e curativos. Conclusão: Nosso trabalho concorda com maioria das revisões em relação à prevalência do sexo masculino, jovens, economicamente ativos, em suas residências, com líquidos aquecidos, acidentalmente. Outros estudos apontaram crianças como as mais afetadas, mostrando necessidade de políticas voltadas a ambas as faixas etárias. Com relação à internação, a maioria permaneceu em enfermaria, com queimaduras de segundo grau, prevalecendo os grandes queimados, o que acarreta maior gravidade e custos. Esse dado vai contra alguns trabalhos, que apontam queimadura de segundo grau como principal, porém com menos de 10% da superfície corporal queimada. A maior parte dos pacientes, tanto neste quanto na maioria dos estudos, apresentou bom desfecho, sem necessidade de Unidade de Terapia Intensiva ou procedimentos cirúrgicos, mostrando a importância do desbridamento precoce e cuidados com curativos.

Introduction: In Brazil, burns affect around one million people/year, the majority of whom are male. In addition to physical and emotional losses, there is an economic impact, with costs for the health system, compensation, and work disabilities. For these reasons, epidemiological studies are important to outline the profile of the most affected population, guiding the prevention of this condition. Method: Review the medical records of 398 burn victims admitted to Santa Casa de Santos from January 2016 to December 2019. Results: The main victims were young men in a domestic environment, by heated liquids, mostly causing second degree burns, treated within 24 hours, considered major burns, and admitted to the infirmary for up to two weeks. Approximately 90% were discharged with improvement, requiring only debridement and dressings. Conclusion: Our work agrees with most reviews regarding the prevalence of young, economically active males with accidentally heated liquids in their homes. Other studies highlighted children as the most affected, showing the need for policies for both age groups. Regarding hospitalization, the majority remained in the ward, with second-degree burns, with major burns prevailing, which leads to greater severity and costs. This data goes against some studies, which indicate second-degree burns as the main burn, with less than 10% of the body surface burned. In both this and most studies, most patients had a good outcome, without needing an Intensive Care Unit or surgical procedures, showing the importance of early debridement and care with dressings.

Membranas amnióticas y su aplicación en el tratamiento de quemaduras: una revisión sistemática exploratoria

Las quemaduras son un problema de interés en salud pública ya que generan un alto índice de morbimortalidad a nivel mundial, las quemaduras térmicas son las más prevalentes y pueden alterar la integridad anatómica, funcional y estética de la piel, aspectos fundamentales para la autoestima del paciente y su capacidad para reintegrarse a la sociedad. Al revisar la literatura sobre el tratamiento de estas afecciones encontramos diversos tratamientos, entre ellos el uso de membrana amniótica humana, la cual ha tenido un impacto importante en el manejo de quemaduras al funcionar como andamio biológico con cualidades regenerativas y antiinflamatorias. El presente artículo tiene como objetivo sintetizar la información actual que describe las aplicaciones de membranas amnióticas humanas en quemaduras, realizamos una revisión exploratoria sistemática de la literatura desde 2010 hasta 2021.

Burns are a problem of interest in public health since they generate a high rate of morbidity and mortality worldwide, thermal burns are the most prevalent and can alter the anatomical, functional and aesthetic integrity of the skin, fundamental aspects for the patient's self-esteem and their ability to reintegrate into society. At review literature about the treatment of these conditions, we find various treatments, including the use of human amniotic membrane, which has had a significant impact on burn management by functioning as a biological scaffold with regenerative and anti-inflammatory qualities. The present article aims to synthesize the current information that describes the applications of human amniotic membranes in burns. We carry out a systematic exploratory review of the literature from 2010 to 2021.

Linha do tempo da pele de tilápia (Oreochromis niloticus) na medicina regenerativa moderna: Da bancada ao paciente / Timeline of tilapia skin (Oreochromis niloticus) in modern regenerative medicine: From bench to patient

OBJETIVO: Descrever a trajetória de desenvolvimento dos curativos biológicos oriundos de pele de tilápia (Oreochromis niloticus) em glicerol e liofilizada para uso em cirurgias externas e, posteriormente, uma matriz proteica acelular (scaffold) para uso interno. RESULTADOS: A pele de tilapia no glicerol e liofilizada foi aplicada com sucesso em mais de 550 pacientes queimados. A pele de tilápia liofilizada obteve sucesso no tratamento de 53 mulheres em vaginoplastias, em 160 pacientes na redesignação sexual e na preparação do leito da ferida na autoenxertia em 15 portadores da Síndrome de Apert. O scaffold está sendo empregado na oftalmologia na medicina veterinária na reconstrução de córnea em 420 cães, nas duroplastias na neurocirurgia nos testes em animais, e em estudos para uso cirúrgico em 10 especialidades médicas. CONCLUSÕES: O curativo de pele de tilápia supera desafios do tratamento de queimados do Brasil. É barato, biossustentável, efetivo e reduz a dor do paciente, propiciando melhores resultados com potencial redução de custos, contribuindo para a qualidade de vida dos pacientes. O sucesso da pesquisa confirma a pele de tilápia como um novo biomaterial de grande potencial em medicina regenerativa.

OBJECTIVE: To describe the development trajectory of biological dressings made from tilapia (Oreochromis niloticus) skin in glycerol and freeze-dried for use in external surgeries and, subsequently, an acellular protein matrix (scaffold) for internal use. RESULTS: Tilapia skin in glycerol and freeze-dried was successfully applied to more than 550 burn patients. Freeze-dried tilapia skin was successful in the treatment of 53 women undergoing vaginoplasty, in 160 patients in sexual reassignment and in preparing the wound bed in self-grafting in 15 patients with Apert Syndrome. The scaffold is being used in ophthalmology, veterinary medicine in corneal reconstruction in 420 dogs, in duraplasty in neurosurgery in animal tests, and in studies for surgical use in 10 medical specialties. CONCLUSIONS: The tilapia skin dressing overcomes challenges in treating burns in Brazil. It is cheap, biosustainable, effective and reduces patient pain, providing better results with potential cost reduction, contributing to patients' quality of life. The success of the research confirms tilapia skin as a new biomaterial with great potential in regenerative medicine.

Peripheral ulcerative keratitis as presenting manifestation of systemic microscopic polyangiitis: a case report / Ceratite ulcerativa periférica como manifestação de poliangiíte microscópica sistêmica: relato de caso

ABSTRACT Microscopic polyangiitis is a rare autoimmune disease of unknown etiology, characterized by inflammation and necrosis of blood vessels. It forms a part of the antineutrophil cytoplasmic antibody-associated vasculitides-a heterogeneous group of disorders characterized by vasculitis. It is a systemic disease affecting multiple organs. The patients may present with a wide variety of symptoms. Ocular manifestations may present as its initial clinical symptoms, necessitating a multidisciplinary approach for reducing the morbidity and mortality. Early diagnosis aids in the formulation of appropriate treatment and prevention of further complications. Aggressive treatment, including surgery, is often necessary to limit structural damage and preserve visual function. We present the case of an 82-year-old woman who initially presented with peripheral ulcerative keratitis that led to the diagnosis of microscopic polyangiitis.

RESUMO A poliangeíte microscópica é uma doença autoimune rara de etiologia desconhecida, caracterizada por inflamação e necrose dos vasos sanguíneos. Faz parte das vasculites associadas a anticorpos citoplasmáticos antineutrófilos - um grupo heterogêneo de doenças caracterizadas por vasculite. É uma doença sistêmica que afeta vários órgãos. Os pacientes podem apresentar uma grande variedade de sintomas. As manifestações oculares podem apresentar-se como seus sintomas clínicos iniciais, necessitando de abordagem multidisciplinar para redução da morbimortalidade. O diagnóstico precoce ajuda na formulação do tratamento adequado e na prevenção de complicações futuras. O tratamento agressivo, incluindo cirurgia, muitas vezes é necessário para limitar o dano estrutural e preservar a função visual. Apresentamos o caso de uma mulher de 82 anos que inicialmente apresentou ceratite ulcerativa periférica que levou ao diagnóstico de poliangite microscópica.

Procuramiento y uso de aloinjertos cutáneos de piel total criopreservados obtenidos de pacientes sometidas a abdominoplastía / Procurement and use of cryopreserved whole skin cutaneous allografts obtained from patients undergoing abdominoplasty

Resumen Introducción: Los aloinjerto cutáneos (AC) son excelentes sustitutos cutáneos temporales, sin embargo, la donación y procura de piel cadavérica, fuente habitual de AC, es baja. Objetivo: Evaluar la factibilidad de utilizar la piel proveniente de abdominoplastías como fuente de AC y su eficacia clínica. Materiales y Método: Entre el 17 de agosto de 2020 al 28 de febrero de 2021 se analizó una cohorte prospectiva de 14 pacientes femeninas sometidas a abdominoplastía por motivos estéticos, que aceptaron donar la piel del colgajo cutáneo abdominal redundante, la cual fue criopreservada. Se utilizaron los AC de piel total criopreservados (ACPTC) en 10 pacientes con diagnósticos de: pie diabético (4), laparostomía contenida (2) herida compleja extremidad inferior (2), sarcoma de cuero cabelludo recidivado (1) y melanoma (1). Resultados: Se obtuvieron 14 colgajos de piel total, los cuales fueron procesados obteniendo una superficie promedio de 302 cm2 y 8,3 láminas de distintos tamaños de utilidad clínica por paciente. En todos los pacientes en que se utilizó ACPTC hubo un prendimiento inicial del AC para posteriormente, en promedio 21 días, presentar una escara necrótica que al ser retirada presentaba un tejido vital adherido al receptor rico en fibroblastos, siendo algunos pacientes auto injertados y otros manejados con cicatrización por segunda intención como tratamiento definitivo. Discusión: Los ACPTC proporcionan una cobertura intermedia, pues una parte se integra en forma definitiva, actuando como un andamiaje biológico para la formación de una interfase sobre la cual se puede autoinjertar o dejar evolucionar con cicatrización por segunda intención y una parte es rechazada. Conclusión: La procura de piel de donante vivo, en pacientes sometidos a cirugías de contorno corporal es un proceso factible, fuente de ACPTC, los cuales permiten una nueva cobertura intermedia con múltiples aplicaciones clínicas.

Introduction: Skin allografts (SA) are outstanding temporary skin substitutes; however, cadaveric skin donation and procurement, a common source of SA, remains low. Aim: To evaluate the feasibility and clinical efficacy of using skin from abdominoplasties as a source of SA. Materials and Method: A prospective cohort was analyzed from August 17th, 2020 and February 28th, 2021, with 14 female patients submitted to abdominoplasty surgeries for aesthetic motives, who authorized skin donation from the redundant abdominal flap which was posteriorly cryopreserved. Cryopreserved total skin allografts (CTSA) was used in 10 patients with the following diagnoses: diabetic foot (4), contained laparostomy (2) complex wound of the lower limb (2), relapsing sarcoma of the scalp (1), and melanoma (1). Results: 14 CTSA were obtained, which were processed, obtaining an average area of 302 cm2 and 8.3 sheets of different sizes and clinical applications from each patient. In all patients who received CTSA, an initial attachment was observed, followed by the appearance of a necrotic scar in an average of21 days. The peeling of the latter revealed a vital tissue tightly adhered to the receptor and rich in fibroblasts. Some of the patients received autografts, and others were managed with secondary intention scarring as a definite treatment. Discussion: CTSA provide an intermediate coverage since one part is definitely adhered to, acting as a biologic scaffolding for the formation of an interface that can be autografted or left for a secondary intention scarring, and the host rejects the other portion. Conclusión: skin procurement from a living donor in patients submitted to body contour surgeries is a feasible process and significant source of CTSA, which permits a new intermediate coverage with multiple clinical uses.

Simplified vacuum dressing system: effectiveness and safety in wounds management

Purpose: Negative pressure wound therapy (NPWT) has revolutionized wound care, but its high cost reduces the procedure's availability. To solve the problem, streamlined vacuum dressings systems have been proposed, but the utility of these devices has been poorly studied. The objective of this study was to evaluate a simplified vacuum dressing system model (SVDM). Methods: Randomized clinical trial in which wounds were treated with SVDM compared to a complex occlusive dressing (silver hydrofiber, SHF). The analyzed outcomes were cleaning, presence of granulation tissue, clinical appearance, and indication for surgical closure of wounds. Results: Fifty injuries were treated (25 in each group), most located on lower limbs. SVDM proved to be more effective than SHF in the evaluated outcomes. Wound recalcitrance reduced the effectiveness of the equipment used. Despite its efficacy, complications occurred, the most frequent related to dressing changes: minor bleeding, foam adherence to a wound bed, and pain. Only for bleeding no favorable risk-benefit ratio was found. There were no severe complications, worsening conditions of injuries, or deaths. Conclusions: SVDM proved to be an effective and acceptably safe device for managing studied wounds.

Research progress of protective dressing on prevention of pressure injury of sacrum / 中国实用护理杂志

The sacrum is a common site of stress injury. The occurrence of pressure ulcers not only leads to the aggravation of the patient′s condition, the prolongation of hospital stay, the increase of medical costs, the decline of life quality, but also aggravates the burden of society, family and medical staff. Early reasonable and effective application of sacral dressing can prevent the occurrence of pressure injury. In this study, the characteristics and effectiveness of different types of sacral dressings were reviewed by reviewing relevant literatures at home and abroad and summarizing the existing relevant studies, so as to provide guidance for clinical application.

Effect of alpha-humulene incorporation on the properties of experimental light-cured periodontal dressings

Abstract The objective of this study was to formulate an experimental light-cured periodontal dressing containing alpha-humulene and to compare its physical, antimicrobial, and cytotoxicity properties with commercial gold standards (Barricaid® and Periobond®). Two periodontal dressing formulations were developed (a and b). The formulations were divided into 5 groups according to the alpha-humulene concentration as follows: Ea - control group, Ea1 - 1%, Ea5 - 5%, Ea10 - 10%, and Ea20 - 20%; Eb - control group, Eb1 - 1%, Eb5 - 5%, Eb10 - 10%, and Eb20 - 20%. Materials characterization was performed using the degree of conversion, cohesive strength, sorption, and solubility assays. Antimicrobial assay was performed using the modified direct contact test against E. faecalis and S. aureus. Cytotoxicity was assessed by the cell viability experiment using L929 fibroblasts. In general, the cohesive strength values of materials decreased as the alpha-humulene concentration increased. All the experimental dressings showed antimicrobial activity against both bacteria tested. Cell viability results for the Ea, Ea1, Eb, and Eb1 groups showed moderate cytotoxic effect. The formulations containing alpha-humulene showed similar behavior to the commercial references. Thus, formulations containing alpha-humulene have potential to be used as periodontal dressing.

Utilidad del apósito liofilizado de piel de cerdo en el manejo de cicatrización de úlcera de pie diabético / Usefulness of lyophilized pig skin dressings in wound healing as treatment for diabetic foot ulcer

Resumen Objetivo: Mostrar la utilidad del apósito liofilizado de piel de cerdo comparado con el manejo conservador con sulfadiazina de plata en el proceso de cicatrización de la úlcera de pie diabético. Materiales y Método: Estudio cuasiexperimental en pacientes con diagnóstico de pie diabético, se establecieron 2 grupos de estudio utilizando una relación 2:1, el grupo de exposición (10 pacientes) tratado con apósito liofilizado de piel de cerdo y el grupo de control (5 pacientes) manejado con sulfadiazina de plata. La utilidad se midió con la cicatrización en semanas de tratamiento. El análisis estadístico incluyó prueba de t, prueba de z, regresión logística simple y cálculo de la probabilidad del evento. Resultados: El tiempo de cicatrización fue más corto en el grupo manejado con apósito liofilizado de piel de cerdo (10,20 semanas) que en el grupo con manejo a base de sulfadiazina de plata (13,8 semanas). A las 9 semanas de iniciado el tratamiento, la mitad de las pacientes con apósito de piel de cerdo ya habían cicatrizado comparado con la cicatrización en el grupo manejado con sulfadiazina de plata (20%). La probabilidad de cicatrización a las 11 semanas en paciente manejados con sulfadiazina de plata es 20% y con apósito liofilizado de piel de cerdo 80%. Conclusión: El apósito liofilizado de piel de cerdo tuvo mejores resultados en el estudio, comparado con el manejo estándar con sulfadiazina de plata. Es necesario realizar un estudio aleatorizado para determinar la efectividad de este material como herramienta terapéutica.

Aim: To demonstrate the usefulness of lyophilized pig skin dressings versus usual management with silver sulfadiazine in wound healing treatment for diabetic foot ulcers. Materials and Method: In this quasi-experimental study, we included patients diagnosed with diabetic foot. We established two groups with a distribution (2:1), the exposure group treated with lyophilized pig skin dressings (10 patients) and the control group (5 patients), the standard of care with silver sulfadiazine. Usefulness was measured with wound healing in treatment weeks. Statistical analysis included t-test, z-test, simple logistic regression, and calculation of probability of an event. Results: Wound healing time was shorter in the group treated with lyophilized pig skin dressing (10.20 weeks) than in the group treated with silver sulfadiazine (13.8 weeks). At 9 weeks after treatment started, 50% of patients treated with lyophilized pig skin dressings had complete wound healing compared with the patients in the group managed with silver sulfadiazine. (20%). The probability of wound healing been completed at 11 weeks in a patient managed with silver sulfadiazine is 20%, compared to lyophilized pig skin dressings is 80%. Conclusion: Lyophilized pig skin dressings had better outcomes than silver sulfadiazine in wound healing treatment for diabetic foot ulcers inside the study. Is mandatory develop another study with a randomized design to determinate the effectiveness as a therapeutic alternative.

Cobertura profilática para lesões por pressão na face dos profissionais de saúde durante a COVID-19 / Cobertura profiláctica para lesiones por presión en la cara de los profesionales de la salud durante COVID-19 / Prophylactic dressing for pressure injuries in the face of health professionals during COVID-19

Objetivo: propor a elaboração de cobertura profilática para prevenção de lesão por pressão na face de profissionais de saúde pelo uso de máscara durante a pandemia provocada pela Covid-19. Método: trata-se de um estudo metodológico dividido em 2 etapas: revisão narrativa de literatura e elaboração da cobertura profilática, utilizando critérios pré-estabelecidos pelos pesquisadores. Resultados: a cobertura profilática, proposta neste estudo, tem apresentação em rolo, não estéril e deverá ser utilizada somente em pele íntegra. Será composta por uma fita de silicone macio, perfurado, com micro aderência, de 2,5 cm de largura; camada central de espuma extrafina de poliuretano, com 1cm de largura; e parte externa de filme de poliuretano. Conclusão: a proposta da cobertura profilática promoverá a absorção da umidade, reduzirá a pressão e o cisalhamento e, consequentemente, as lesões por pressão na face de profissionais de saúde pelo uso de máscaras de proteção individual. (AU)

Objective: To propose the development of prophylactic dressing to prevent pressure injuries on the face of health professionals by the use of a mask during the pandemic caused by Covid-19. Methods: This a methodological study divided into two stages: narrative review of the literature and elaboration of prophylactic dressing, using pre-established criteria by the researchers. Results: The prophylactic dressing, proposed in this study, has a roll presentation, not sterile and should be used only on intact skin. It will be composed of a soft silicone tape, perforated, with micro-adherence, 2.5 cm wide; central layer of extra-fine polyurethane foam, with 1 cm wide; and external polyurethane film. Conclusions: The prophylactic dressing proposal will promote moisture absorption, will reduce pressure and shear and, consequently, pressure injuries on the face of health professionals through the use of individual protection masks.(AU)

Objetivo: proponer el desarrollo de coberturas profilácticas para prevenir lesiones por presión en el rostro de los profesionales de la salud mediante el uso de mascarilla durante la pandemia causada por Covid-19. Métodos: se trata de un estudio metodológico dividido en 2 etapas: revisión narrativa de la literatura y elaboración de la cobertura profiláctica, utilizando criterios preestablecidos por los investigadores. Resultados: la cobertura profiláctica, propuesta en este estudio, tiene presentación en rollo, no es estéril y debe usarse solo sobre piel intacta. Consistirá en una cinta de silicona microadhesiva perforada, suave y de 2,5 cm de ancho; capa central de espuma de poliuretano extrafina de 1 cm de ancho; y parte exterior de película de poliuretano. Conclusión: la propuesta de cobertura profiláctica promoverá la absorción de humedad, reducirá la presión y el cizallamiento y, en consecuencia, las lesiones por presión en el rostro de los profesionales de la salud mediante el uso de máscaras de protección individual.(AU)

Research progress in amniotic membrane transplantation for diabetic foot management / 中国基层医药

The purpose of this review is to evaluate the promoting effects of amniotic membrane tissue on ulcer healing and investigate the underlying mechanism, providing new ideas for diabetic foot management. A computer-based online search of CNKI, PubMed and other databases to screen multi-center, randomized controlled trials published in high-impact journals using biological dressings, diabetic foot and other search terms. The retrieved data were analyzed and summarized. Amniotic membrane tissue and its derivatives can greatly shorten the time taken for healing of ulcer surface. This occurs possibly because they can promote angiogenesis and neural repair and prevent against infection. Moreover, the new derivatives provide great ease in use. Therefore, amniotic membrane and its derivatives provide a new tool for diabetic foot management.

Application of alginate based hydrogels/dressings in wound healing: Sustained, dynamic and sequential release / 中国组织工程研究

BACKGROUND: Alginate can improve the hydrophilic quality of wound dressing, create moist wound microenvironment, and remove wound exudate. Currently, alginate bimolecular materials have been used in the design and development of various wound dressings to improve the efficiency of wound healing. OBJECTIVE: To summarize the research and progress of alginate based hydrogels/dressings in skin wound healing. METHODS: We searched PubMed, Science Direct and CNKI databases from 2000 to 2020 with the English terms of “alginate hydrogel, wound healing, wound dressing, mesenchymal stem cell, growth factor, nanoparticles, diabetic wound, antibiotics, bioactive peptide, three-dimensional printing” and the Chinese terms of “alginate, wound healing”. Based on the inclusion and exclusion criteria, 60 articles were finally reserved for review. RESULTS AND CONCLUSION: (1) The cross-linking of alginate with other organic or inorganic materials can improve the mechanical properties and biodegradability of composite materials, and create a moist and mild wound microenvironment. (2) Alginate based hydrogel/dressing can be used as a delivery platform to load seed cells, growth factors or other bioactive substances to speed up wound healing. (3) It still need to be further explored by researchers to make alginate materials have better cell recognition sites, improve the mechanical properties of composite scaffold materials, control the microstructure of alginate biomaterials and control the dynamic, sustained and sequential release of drugs or cells.

Curativo na ferida operatória para prevenção da infecção de sítio cirúrgico em pacientes adultos oncológicos: revisão sistemática / Surgical wound dressing to prevent surgical site infection in adult oncological patients: a systematic review

Introdução: O manejo da ferida operatória limpa no pós-operatório é uma importante intervenção para prevenção da infecção do sítio cirúrgico. O uso de curativo estéril na ferida operatória, aproximada por primeira intenção, deve ser utilizado de forma asséptica e tem como principal objetivo impedir a contaminação por microrganismo. No entanto, para as diretrizes clínicas para prevenção de infecção do sítio cirúrgico, não existe consenso sobre a escolha do curativo ideal. Objetivo: Sintetizar as evidências sobre o curativo efetivo para prevenção da infecção de sítio cirúrgico aplicado na ferida operatória, aproximada por primeira intenção, em pacientes oncológicos adultos submetidos a cirurgia eletiva. Materiais e Método: Trata-se de uma revisão sistemática pautada no Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), registrada sob o número CRD42020156908, constituída das etapas: 1) Elaboração e registro do protocolo da revisão; 2) Delimitação da pergunta da revisão; 3) Definição dos critérios de elegibilidade; 4) Busca e seleção dos estudos; 5) Coleta de dados; e 6) Síntese e apresentação dos resultados da revisão sistemática. A estratégia de busca foi realizada nas bases de dados: Cochrane Central, Cinahl, Embase, Lilacs, Livivo, PubMed, Scopus e Web of Science. A estratégia de busca foi fundamentada no objetivo da revisão e adaptada para cada base de dados consultada. Utilizaram-se descritores controlados e palavras-chave, a saber: Neoplasms AND Bandages AND Surgical Wound Infection AND prevention and control. A literatura cinzenta consultada foi o Google Acadêmico e a ProQuest Dissertations and Theses Database. As etapas foram realizadas de forma independente e mascarada por dois revisores, e um terceiro para resolução de conflitos. Ao término da seleção dos estudos primários, realizou-se a busca manual nas listas de referências dos estudos primários incluídos. Resultados: A amostra compôs-se de sete ensaios clínicos aleatorizados. Os curativos absorventes foram comparados em cinco estudos incluídos. A mupirocina foi avaliada em dois estudos. Os curativos com prata foram avaliados em três estudos. O mel, a parafina, o tempo de retirada do curativo e a terapia por pressão negativa aparecem em um único ensaio cada. Em relação ao risco de viés, foram avaliados os sete estudos incluídos pela ferramenta da Cochrane Risk of Bias (RoB 2), sendo seis de baixo risco e um estudo avaliado como risco incerto. A metanálise foi realizada com três ensaios que testaram curativo de prata versus o curativo absorvente, não demonstrando diferenças estatisticamente significantes (p= 0.77) na prevenção da infecção do sítio cirúrgico. O Intervalo de Confiança (IC) do diamante metanalítico varia de 0,41 a 1,06, assim não demonstra diferença estatisticamente significante na efetividade entre os tipos de curativo. A certeza da evidência foi avaliada pelo sistema GRADE e foi considerada forte em todos os domínios. Conclusões: A ausência de padronização em relação ao tipo e tempo de curativo utilizados nos estudos pode ser um dificultador para as recomendações do curativo ideal. E apesar dos resultados promissores com curativo impregnado com prata, ainda não é possível concluir qual é o curativo mais efetivo aplicado na ferida operatória, para prevenção de infecção de sítio cirúrgico, com fechamento primário, em pacientes oncológicos adultos submetidos a cirurgia eletiva

Introduction: The management of clean surgical wounds in the postoperative period is an important intervention to prevent surgical site infections. The use of sterile dressings in operative wounds, held together by primary intention, should be used aseptically, with the main objective of preventing microbiological contamination. However, clinical guidelines for the prevention of surgical site infection do not provide a consensus about the choice of the optimal dressing. Objective: The aim of this review was to summarize the existing evidence about effective surgical site dressings for the prevention of operative wound infections, held together by primary intention in adult oncological patients submitted to elective surgery. Materials and Method: This was a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), registered under number CRD42020156908. It was developed according to the following phases: 1) preparing and registering the review protocol; 2) defining the review question; 3) defining the eligibility criteria; 4) searching and selecting the studies; 5) data collection; and 6) summarizing and presenting the results of the systematic review. The search strategy was carried out in the following databases: Cochrane Central, Cinahl, Embase, Lilacs, Livivo, PubMed, Scopus, and Web of Science. The search strategy was based on the objective of the review and adapted for each of the consulted databases. Controlled descriptors and keywords were used, namely: Neoplasms AND Bandages AND Surgical Wound Infection AND prevention and control. The grey literature consulted was Google Scholar, ProQuest Dissertations and Theses Database. The stages were carried out independently and blindly by two reviewers, while a third reviewer was used to settle any conflicts. After selecting the primary studies, the researchers manually searched the reference lists of the included primary studies. Results: The sample consisted of seven randomized clinical trials. Absorbent dressings were compared in five included studies. Mupirocin was evaluated in two studies. Silver dressings were evaluated in three studies. Honey, paraffin, dressing removal time, and negative pressure therapy all appeared in a single trial each. Regarding the risk of bias, the seven studies were assessed using the Cochrane Risk of Bias tool (RoB 2); six presented a low risk of bias and one study presented uncertain risk. The meta-analysis was performed with three trials that tested silver dressings versus absorbent dressings, with no statistically significant differences (p= 0.77) in the prevention of surgical site infection. The confidence interval (CI) of the diamond ratio varied between 0.41 and 1.06, thus it did not demonstrate a statistically significant difference in effectiveness between the types of dressing. Certainty of the evidence was evaluated using the GRADE system, which considered it strong in all categories. Conclusions: The lack of standardization regarding the type and duration of dressing used in the studies can make it difficult to recommend the ideal dressing. And despite the promising results with dressings impregnated with silver, it is still not possible to conclude which is the most effective dressing applied to the surgical wound, to prevent surgical site infection, with primary closure, in adult cancer patients undergoing elective surgery

Biological and mechanical characterization of commercial and experimental periodontal surgical dressings

Abstract The objective of this study was to evaluate the biocompatibility and mechanical properties of two commercially available and one experimental periodontal dressing materials. The cytotoxicity of Periobond ® , Barricaid ® and one experimental periodontal dressing based on Exothane ® 8 monomer was tested on 3T3/NIH mouse fibroblast. Genotoxicity was assessed by micronuclei formation, and cell alterations were analyzed using light microscopy. Both biological assays were performed using the eluate obtained from specimens after 24, 72, or 168 hours of incubation. Mechanical characterization was assessed through the ultimate tensile strength and the water sorption and solubility tests. The significance level of α = 0.05 was used for all statistical analyses. All the materials promoted a cell viability lower than 60% in all evaluated times. In general, the cell viability was significantly reduced after 72 and 168h of specimens' incubation. Considering the factor material, there were not statistical differences in the cell viability (p = 0.156). The genotoxicity was not statistically significant among the groups in the different periods of time (p > 0.05). Differences in the ultimate tensile strength values were not statistically significant different among the groups (p = 0.125). Periobond ® showed the higher water sorption values (p < 0.001). Regarding solubility, there were no statistical differences between the groups (p = 0.098). All the periodontal dressing materials evaluated in this study exerted a cytotoxic effect against mouse fibroblasts, and their toxicity became more evident over time. Among the materials evaluated, the experimental light-cure type has shown overall similar properties to the commercial references.

Products and technologies for treating patients with evidence-based pressure ulcers / Productos y tecnologías para el tratamiento de pacientes con lesiones por presión basadas en evidencias / Produtos e tecnologias para o tratamento de pacientes com lesões por pressão baseadas em evidências

ABSTRACT Objective: to identify products/technologies for treating patients with pressure ulcers with an evidence level 1. Method: this is an integrative literature review. A survey of studies was carried out using the United States National Library of Medicine Portal, Scientific Electronic Library Online, Virtual Health Library, National Library of Medicine(®), The Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean in Health Sciences, Nursing Database. Results: sixteen articles were selected with level of evidence 1. The findings were categorized into five categories: Topical therapy to promote healing; Alternative therapy to promote healing; Topical therapy to promote debridement; Topical therapy to minimize lesion contamination; Topical therapy to reduce lesion size. Final considerations: the 17 products/technologies identified favor/fast healing, debridement, minimize contamination and reduce lesion size to accelerate healing.

RESUMEN Objetivo: identificar productos/tecnologías para el tratamiento de pacientes con úlceras por presión con nivel de evidencia 1. Método: revisión integradora de la literatura. Los estudios se realizaron utilizando bibliotecas virtuales: Portal de la Biblioteca Nacional de Medicina de los Estados Unidos, Biblioteca Electrónica Científica en Línea, Biblioteca Virtual en Salud y bases de datos: Biblioteca Nacional de Medicina(®), The Cumulative Index to Nursing and Allied Health Literature, Latinoamericano y Literatura del Caribe en Ciencias de la Salud, Base de datos de enfermería. Resultados: se seleccionaron 16 artículos con nivel de evidencia 1. Los hallazgos se categorizaron en cinco categorías: Terapia tópica para promover la curación; Terapia alternativa para promover la curación; Terapia tópica para promover el desbridamiento; Terapia tópica para minimizar la contaminación de la úlcera; Terapia tópica para reducir el tamaño de las úlceras. Consideraciones finales: los 17 productos/tecnologías identificados favorecen/aceleran la curación, el desbridamiento, minimizan la contaminación y reducen el tamaño de las lesiones para acelerar la curación.

RESUMO Objetivo: identificar produtos/tecnologias para tratamento de pacientes com lesões por pressão com nível de evidência 1. Método: revisão integrativa da literatura. Realizou-se levantamento de estudos, utilizando bibliotecas virtuais: Portal da Biblioteca Nacional de Medicina dos Estados Unidos, Scientific Eletronic Library Online, Biblioteca Virtual em Saúde, e bases de dados: National Library of Medicine (®), The Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados de Enfermagem. Resultados: selecionaram-se 16 artigos com nível de evidência 1. Os achados foram categorizados em cinco categorias: Terapia tópica para promoção da cicatrização; Terapia alternativa para promover a cicatrização; Terapia tópica para promover o desbridamento; Terapia tópica para minimizar a contaminação da lesão; Terapia tópica para redução do tamanho das lesões. Considerações finais: os 17 produtos/tecnologias identificados favorecem/agilizam a cicatrização, o desbridamento, minimizam a contaminação e reduzem o tamanho das lesões para acelerar a cicatrização.

Cuidados de enfermagem a recém-nascido com infecção de sítio cirúrgico incisional profunda: relato de caso / Cuidados de enfermería a un recién nacido con infección del sitio quirúrgico incisional profunda: informe de un caso / Nursing care of a newborn with deep incisional surgical site infection: a case report

RESUMO Objetivo Descrever um caso de infecção de sítio cirúrgico do tipo incisional profunda ocorrido em um hospital infantil do Sul do Brasil, evidenciando os cuidados de enfermagem com o recém-nascido. Método Estudo de caso com coleta de dados em prontuário, aprovado pela Instituição e pelo Comitê de Ética em Pesquisa com Seres Humanos. Resultados A partir do diagnóstico de infecção de sítio cirúrgico, foi estabelecido um plano de cuidados específicos com a lesão, utilizando curativos oclusivos compostos por tecnologias especiais para acelerar o processo de cicatrização por segunda intenção. Conclusão Apesar da gravidade das lesões, o conhecimento científico e a habilidade dos enfermeiros assistenciais no tratamento da infecção de sítio cirúrgico proporcionaram ao neonato a cicatrização completa da ferida operatória e alta hospitalar previamente ao tempo estimado.

RESUMEN Objetivo Describir un caso de infección del sitio quirúrgico incisional profunda ocurrido en un hospital infantil del sur de Brasil, destacando los cuidados de enfermería con el recién nacido. Método Estudio de caso con coleta de datos del expediente, aprobado por la Institución y por el Comité de Ética en Investigación con Seres Humanos. Resultados A partir del diagnóstico de infección del sitio quirúrgico, se estableció un plan de cuidados específicos con la lesión, utilizando apósitos oclusivos compuestos por tecnologías especiales para acelerar el proceso de curación por segunda intención. Conclusión A pesar de la gravedad de las lesiones, el conocimiento científico y la habilidad de los enfermeros en el tratamiento de la infección de sitio quirúrgico proporcionaron al neonato una cicatrización completa de la herida operatoria y alta hospitalaria antes del tiempo estimado.

ABSTRACT Objective To describe a case of deep incisional surgical site infection in a children's hospital in South Brazil, emphasizing the nursing care measures provided to the newborn. Method Case study with data collection from medical record, approved by the institution and the Human Research Ethics Committee. Results From the diagnosis of surgical site infection, a plan was established for specific care of the lesion using occlusive dressings made with technologies aimed at accelerating the second-intention healing process. Conclusion Despite the severity of the lesions, the scientific knowledge and the skill of the nurses during treatment of the surgical site infection provided the newborn with full surgical wound healing and hospital discharge before the estimated moment.

Amniotic membrane transplantation in ocular surface diseases / Transplante de membrana amniótica em doenças da superfície ocular

Abstract Objective: To evaluate the clinical effectiveness of amniotic membrane transplantation for ocular surface reconstruction. Methods: Prospective study including 23 eyes of 21 patients who underwent amniotic membrane transplantation at Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) and at Cirurgia e Diagnose em Oftalmologia do Paraná (CDOP) clinic, located in Curitiba, PR, Brazil, from may 2015 to july 2019. The amniotic membrane was collected from elective and term cesarean delivery, and conserved in preservation medium and glycerol 1:1, stored at -80° Celsius. The membrane was fixed on the ocular surface with 10-0 nylon, 8-0 vicryl, biological glue or a combination of these materials. Results: The ocular surface reconstruction was successful in 22 eyes (95.6%). Failure was observed only in 1 case (bullous keratopathy) in which the condition was maintained postoperatively. Patients' age ranged from 11-82 years, with a mean age of 37.4 years. There was a higher incidence in males (66.6%). A difference was perceived in the distribution of the affected eye (which was greater in the right eye - 65.2%). As for the previous ophthalmic surgery history, 12 of the 23 eyes had a positive history (52.2%). It was observed that all patients who had preoperative visual acuity assessed showed improvement or maintenance of corrected visual acuity. In the postoperative period, complications associated with the underlying disease were observed, although not particularly related to the amniotic membrane transplantation. There were not any cases of postoperative infection. Conclusions: There was an improvement in the general state of the ocular surface in almost all of the cases in which the transplant was performed. Therefore, the amniotic membrane can be considered a good alternative for reconstructing the ocular surface, as a single or supporting treatment.

Resumo Objetivo: Avaliar a eficácia clínica do transplante de membrana amniótica na reconstrução da superfície ocular. Métodos: Estudo prospectivo incluiu 23 olhos de 21 pacientes que realizaram transplante de membrana amniótica no Hospital de Clínicas da Universidade Federal do Paraná (UFPR) e na clínica de Cirurgia e Diagnose em Oftalmologia do Paraná (CDOP), localizados em Curitiba, PR, Brasil, no período de maio de 2015 a julho de 2019. A membrana amniótica foi captada a partir de parto cesárea eletivo e a termo, conservada em meio de preservação e glicerol 1:1 e armazenada a -80° Celsius. A membrana foi fixada na superfície ocular com fio nylon 10-0 ou vicryl 8-0 e/ou cola biológica. Resultados: A idade dos pacientes variou de 11-82 anos, com média de 37,4 anos. Houve maior incidência no sexo masculino (66,6%). Ocorreu diferença na distribuição do olho acometido (maior no olho direito - 65,2%). Quanto à história de cirurgia oftalmológica prévia, 12 dos 23 olhos tinham história positiva (52,2%). Observamos que nos pacientes em que foi possível a avaliação da acuidade visual pré-operatória, todos apresentaram melhora ou manutenção da acuidade visual. No pós-operatório foi observado complicações associadas à doença de base e não propriamente ao transplante de membrana amniótica. Não foram registrados casos de infecção pós-operatória. Conclusão: Houve melhora do estado geral da superfície ocular em quase totalidade dos casos em que o transplante foi realizado. Portanto, a membrana amniótica pode ser considerada uma boa alternativa para reconstrução da superfície ocular, como tratamento único ou coadjuvante.

In search of ideal donor site wound dressings

Background: Split skin grafting (SSG) is a commonly used reconstructive technique for wound cover. Donor site wounds (DSW) after split-skin graft harvesting are rather clean wounds. Depending on the thickness of the SSG, the DSW should re-epithelialize completely in 7 to 21 days. This study was initiated with a background to look for an ideal dressing for the management of DSW. Aim of the study was to compare efficacy of Cellulose acetate mesh, Collagen sheet, Hydrocolloid dressings and chlorhexidine tulle for donor site wound management after harvesting split thickness skin graft.Methods: 100 patients with 100 donor site wounds were included in the study. Patients were randomized into four different groups of 25 each, depending upon the type of dressings used to cover the wound. Data regarding time to complete wound healing and pain at the donor site were recorded on visual analogue scale (VAS). Requirement of pain killers during post-operative period were recorded. Complications like infection or hyper-granulation were also recorded.Results: The study included 72 males and 28 females. The primary objective was to observe the effectiveness of wound dressings in the treatment of DSWs and time to complete wound healing. In this context, collagen dressing was found to be the most effective in current study (p<0.07) and also the least pain was experienced by the patients where collagen dressings were used.Conclusions: The study concluded that collagen dressings was best amongst the various dressings studied with average healing time of 9 days with least pain score over DSW.

Análisis del potencial de innovación en apósitos para tratar heridas crónicas en la ciudad de Lima, Perú / Analysis Of The Potential Of Innovation In Dressings To Treat Chronic Wounds In The City Of Lima, Peru

Objetivo: Analizar el potencial de innovación en apósitos para tratar heridas crónicas en la Ciudad de Lima. Métodos: Se realizó un estudio cualitativo mediante una encuesta y análisis de las entrevistas realizadas a expertos médicos y gestores de compras en insumos para el tratamiento de heridas de difícil resolución en 8 instituciones representativas de salud pública con categorías 1 ­ 4 dentro de las 54 existentes solo en Lima Metropolitana, Perú - 2018. Resultados: Se determinó que en las instituciones de salud pública son atendidos un promedio 17 pacientes mensualmente (60% provenientes de hospitalización y 40% de consultorio externo). Equivale decir que 11,016 pacientes presentan heridas crónicas de difícil resolución al año, los cuales requerirán de tratamiento especializado y una demanda anual promedio de 110,160 apósitos en stock. Los apósitos con mayor demanda corresponden a los Hidrogeles e Hidrocoloides, respectivamente que son utilizados por los resultados positivos que ofrecen en la curación de las heridas, aunque en ocasiones la limitante es el aspecto económico. En el mercado, el precio unitario oscila entre los 20 y 90 soles, esto representa una inversión económica de 1500 soles en promedio por paciente, produciendo en algunos casos complicaciones o abandono del tratamiento cuando los recursos son escasos. Conclusiones: La demanda de pacientes con heridas crónicas de difícil resolución en las instituciones de salud públicas de Lima metropolitana es alta. Es importante promover e incentivar la investigación de nuevas alternativas terapéuticas y/o dispositivos biomédicos que favorezcan su curación.

Objective: To analyze the potential for innovation in dressings to treat chronic wounds in the City of Lima. Methods: A qualitative study was carried out by means of interviews to medical experts and purchasing managers of medical supplies for the treatment of difficult-to-resolve wounds in 8 representative public health institutions with categories 1-4 within the only 54 of Lima, Peru - 2018. Results: It was determined that an average of 17 patients is treated in public health institutions on a monthly basis (60% from hospitalization and 40% from an outpatient office). It is equivalent to say that 11,016 patients present chronic wounds of difficult resolution each year, which will require specialized treatment and an average annual demand of 110,160 dressings in stock. The dressings with the highest demand correspond to the Hydrogels and Hydrocolloids, respectively; used because of the positive results they offer in wound healing, despite economic limitations. The market price per unit ranges between 20 and 90 soles (S/.), representing an economic investment of 1500 soles on average per patient, in some cases causing complications or abandonment of treatment when resources are scarce. Conclusions: There is a high demand for patients with chronic wounds of difficult resolution in the public health institutions of Lima. It is important to promote and incentivize the investigation of new therapeutic alternatives and / or biomedical devices that favor its treatment.