Análisis costo-efectividad del tratamiento con terapia compresiva en la cicatrización de úlceras venosas / Cost-effectiveness analysis of the treatment with compressive therapy in the healing of venous ulcers / Análise de custo-efetividade do tratamento com terapia compressiva na cicatrização de úlceras venosas

Objetivo: analizar el costo-efectividad y calcular la relación costoefectividad incremental del tratamiento multicapa compresivo con respecto al inelástico (bota de Unna y estiramiento corto) según la literatura actual. Método: estudio cuantitativo de costo-efectividad a través de un modelo con ayuda del software TreeAge® para la elaboración del árbol de decisión. Los supuestos anunciados se obtuvieron mediante el uso de datos secundarios de la literatura para estimar el costo y la efectividad de los parámetros asumidos. Para ello, se realizó una revisión sistemática de la literatura con metaanálisis. Resultados: el árbol de decisión, después del Roll Back, mostró que la terapia multicapa prevaleció sobre las alternativas en el caso base, presentó un costo intermedio por aplicación, pero obtuvo la mayor efectividad. El gráfico del análisis de costo-efectividad también demostró que había un dominio extendido de la bota de Unna sobre el vendaje de estiramiento corto. El análisis de sensibilidad reveló que el vendaje multicapa sigue siendo la alternativa con mayor costoefectividad, dentro del umbral de disposición a pagar. Conclusión: la alternativa con mayor costo-efectividad fue el vendaje multicapa, considerado estándar de oro en la literatura. La segunda alternativa con mayor costo-efectividad fue la bota de Unna, la terapia más utilizada en Brasil.

Objective: to analyze the cost-effectiveness and calculate the incremental cost-effectiveness ratio of multilayer compressive treatment in relation to inelastic (Unna boot and short stretch) therapy according to the current literature. Method: quantitative study about cost-effectiveness through modeling with the aid of TreeAge® software for construction of the decision tree. The anticipated assumptions were obtained by using secondary literature data to estimate the cost and effectiveness of the assumed parameters. A systematic literature review with meta-analysis was performed for this end. Results: the decision tree after Roll Back showed that the multilayer therapy dominated the alternatives in the base case, representing an intermediate cost per application, although with the highest effectiveness. The cost-effectiveness analysis graph also showed extended dominance of the Unna boot in relation to the short stretch bandage. The sensitivity analysis showed that multilayer bandage remains a more cost-effective alternative, within the threshold of willingness to pay. Conclusion: the most cost-effective alternative was multilayer bandage, considered the gold standard in the literature. The second most cost-effective alternative was the Unna boot, the most used therapy in Brazil.

Objetivo: analisar a custo-efetividade e calcular a razão de custoefetividade incremental do tratamento compressivo multicamadas em relação ao inelástico (bota de Unna e curto estiramento) de acordo com a literatura atual. Método: estudo quantitativo sobre custo-efetividade por meio de modelagem com auxílio do software TreeAge® para a construção da árvore de decisão. Os pressupostos anunciados foram obtidos pelo uso de dados secundários de literatura para estimativa do custo e efetividade dos parâmetros assumidos. Para tal, foi realizada uma revisão sistemática de literatura com metanálise. Resultados: a árvore de decisão, após Roll Back mostrou que a terapia multicamadas dominou as alternativas no caso-base, representando custo intermediário por aplicação, porém, com a maior efetividade. O gráfico da análise de custo-efetividade também mostrou uma dominância estendida da bota de Unna em relação à bandagem de curto estiramento. A análise de sensibilidade mostrou que a bandagem multicamadas permanece como alternativa mais custo-efetiva, dentro do limiar de disposição para pagar. Conclusão: a alternativa com maior custo-efetividade foi a bandagem multicamadas, considerada padrão ouro na literatura. A segunda alternativa mais custo-efetiva foi a bota de Unna, terapia mais utilizada no Brasil.

Preclinical study of experimental burns treated with photobiomodulation and Human Amniotic Membrane, both isolated and associated / Estudo pré-clínico de queimaduras experimentais tratadas com fotobiomodulação e membrana amniótica humana, isoladas e associadas / Estudio preclínico de quemaduras experimentales tratadas con fotobiomodulación y membrana amniótica humana, solas y combinadas

Abstract Objective: to evaluate the effect of photobiomodulation with low-level 660 nm laser alone or associated with Human Amniotic Membrane in the repair of partial-thickness burns in rats. Method: an experimental study conducted with 48 male Wistar rats, randomized into four groups: Control, Human Amniotic Membrane, Low-Level Laser Therapy, and Low-Level Laser Therapy associated with Human Amniotic Membrane. The histopathological characteristics of the skin samples were analyzed 7 and 14 days after the burn. The data obtained were submitted to the Kolmogorov-Smirnov and Mann-Whitney tests. Results: the histological analysis of the burn injuries showed a decrease in inflammation (p<0.0001) and an increase in proliferation of fibroblasts (p<0.0001) mainly at 7 days in all treatments related to the control group. At 14 days, the greater effectiveness in accelerating the healing process was significant (p<0.0001) in the Low-Level Laser Therapy group associated with the Human Amniotic Membrane. Conclusion: the association of photobiomodulation therapies with the Human Amniotic Membrane allowed verifying a reduction in the healing process time of the experimental lesions, stimulating its proposal as a treatment protocol in partial-thickness burns.

Resumo Objetivo: avaliar o efeito da fotobiomodulação com laser de baixa intensidade 660 nm isoladamente ou associada à membrana amniótica humana no reparo de queimaduras de espessura parcial em ratos. Método: estudo experimental com 48 ratos Wistar machos, randomizados em quatro grupos: Controle, Membrana Amniótica Humana, Terapia a Laser de Baixa Intensidade e Terapia a Laser de Baixa Intensidade associado à Membrana Amniótica Humana. As características histopatológicas das amostras de pele foram analisadas aos 7 e 14 dias após a queimadura. Os dados obtidos foram submetidos aos testes de Kolmogorov-Smirnov e Mann Whitney. Resultados: a análise histológica das lesões por queimadura mostrou a diminuição da inflamação (p <0,0001) e aumento da proliferação de fibroblastos (p <0,0001), principalmente nos 7 dias em todos os tratamentos relacionados ao grupo controle. Aos 14 dias, a maior efetividade na aceleração do processo cicatricial foi significativa (p<0,0001) no grupo Terapia a Laser de Baixa Intensidade associado à Membrana Amniótica Humana. Conclusão: a associação das terapias de fotobiomodulação à membrana amniótica humana permitiu comprovar redução no tempo do processo cicatricial das lesões experimentais, estimulando sua proposição como protocolo de tratamento em queimaduras de espessura parcial.

Resumen Objetivo: evaluar el efecto de la fotobiomodulación con láser de baja intensidad 660 nm de sola o combinada con la membrana amniótica humana en la reparación de quemaduras de espesor parcial en ratas. Método: estudio experimental con 48 ratas Wistar macho, aleatorizadas en cuatro grupos: Control, Membrana Amniótica Humana, Terapia con Láser de Baja Intensidad y Terapia con Láser de Baja Intensidad combinada con la Membrana Amniótica Humana. Las características histopatológicas de las muestras de piel fueron analizadas a los 7 y 14 días después de la quemadura. Los datos obtenidos fueron sometidos a las pruebas de Kolmogorov-Smirnov y Mann-Whitney. Resultados: el análisis histológico de las lesiones por quemadura mostró una disminución de la inflamación (p <0,0001) y un aumento de la proliferación de fibroblastos (p <0,0001) principalmente a los 7 días en todos los tratamientos en comparación con el grupo control; a los 14 días, en el grupo de Terapia con Láser de Baja Intensidad combinada con la Membrana Amniótica Humana la mayor efectividad en la aceleración del proceso de cicatrización fue significativa (p<0,0001). Conclusión: la asociación de terapias de fotobiomodulación con la membrana amniótica humana permitió comprobar que hubo una reducción en el tiempo del proceso de cicatrización de lesiones experimentales, lo cual favorece que se proponga como protocolo de tratamiento en quemaduras de espesor parcial.

An Experimental Study of Oral Mucosal Wound Healing following Scalpel and Diode Laser Incisions in Guinea Pigs: Clinical and Histological Observations

Introduction: The available data regarding scalpel and diode laser incisions wound healing is variable, scarce and needs more clarification especially in normal healthy tissues. Hence, this study was aimed to evaluate clinical and histologic parameters of wound healing with scalpel and diode laser on oral mucosa of Guinea pigs. Materials and Methods: This is an experimental study conducted on four male Guinea pigs. Laser and scalpel incisions were made on the right buccal mucosa of each guinea pig approximately 5mm deep and 10 mm in length and both the incisions were placed 10 mm apart using No#11Bard Parker blades and diode laser (640 wavelength) under general anesthesia. Punch biopsies of both the incisions were obtained and compared for clinical changes such as ease of working, intra-operative bleeding, color and approximation of wound edges and histological changes such as epithelial proliferation, inflammation, angiogenesis, and fibrosis on day 1, 3 and 7. Results: Clinically, scalpel wounds showed better healing than laser wounds although laser incisions provided bloodless surgical field. There was no significant difference in inflammation, angiogenesis and fibrosis between scalpel and diode laser incisions on both day 3 and 7 except for the epithelization which was comparatively early and better in scalpel wounds than the diode laser wounds. Conclusion: Diode lasers provide bloodless surgical field with better visibility than scalpel without any difference in oral mucosal wound healing. Considering the clinical benefits, the diode lasers could be a superior alternative to conventional scalpel technique.

Evaluation of wound healing activity of topical nicotine in an excision wound model in rats

Background: Wound can be defined as disruption of cellular, anatomical, or functional continuity of living tissues. Nicotine causes damage to the epithelial layer of blood vessel and delays wound healing. It plays an important pathogenic role in impaired wound healing. Although in the last millennium, topical use of nicotine has been reported. It promotes collagen synthesis and, in turn, promotes wound healing. The role of topical nicotine on wound healing is controversial. Therefore, it was planned to evaluate and compare wound healing activity of various doses topical nicotine in rats. Aim and Objectives: The objectives of this study were to evaluate the effect of topical nicotine on wound healing in an excision wound model in rats. Materials and Methods: For evaluation of the wound healing effects of the nicotine, excision wound model was used. Nicotine was applied topically in a dose of 1.5 g%, 3.0 g%, and 6.0 g% petroleum base. Petroleum jelly served as control for topical nicotine. Dressing done by applying topical nicotine until (20 days) complete wound healing was observed. Parameters evaluated were surface area of wound and percentage closure. Results: Findings of this show that, on day 4, nicotine 3.0 g% and 6 g% the wound surface area were more as compared to control. On day 12, nicotine 6.0 g% showed significantly more wound surface area than control (P < 0.05). Percentage wound contraction with topical nicotine (6.0 g%) was less as compared to control on day 4, 8, and 12 (P < 0.001). On day 16, percentage wound contracture with topical nicotine (6.0 g%) contraction was significantly less as compared to control (P < 0.05). Although percentage wound contraction with topical nicotine (all preparations) and control was similar on day 20. Conclusion: Finding shows that topical nicotine impairs wound healing in a dose related pattern during initial stages of healing in an excision wound model. However, there is no delay in wound healing with any dose of topical nicotine.

Funcionalidad del miembro inferior con exposición ósea con el uso de terapia con presión negativa VAC® vs. colgajo de gemelo medial

Objetivo: Comparar dos técnicas de cirugía reconstructiva para lesión en miembro inferior con exposición ósea y, a través de ella, diferenciar que la técnica de VAC® (Vacuum Assisted Closure, cierre asistido con presión negativa) es una alternativa con beneficio de recuperación potencial sin alteraciones significativas que pudieran llevar a un compromiso funcional. Materiales y métodos: Estudio de tipo analítico con corte prospectivo, cuantitativo y longitudinal, en el que se desarrolló la terapia con el uso del sistema de VAC® y de colgajo gemelar medial en todos los pacientes de la Clínica Stella Maris que presentaron heridas traumáticas de miembro inferior con exposición ósea de tercio medio tibial durante el periodo 2019. Resultados: Se evidenció que la medición con la escala funcional de la marcha (FAC, por sus siglas en inglés) fue mejor en los pacientes con la técnica de VAC® (dado que el 50 % tiene grado V) respecto a la técnica de colgajo (50 % en grado IV); las diferencias fueron estadísticamente significativas (p < 0,05). Se apreció que el tiempo de cierre fue mayor en la técnica de VAC® debido al proceso de regeneración progresiva hasta llenar o cubrir la zona completa de la lesión; por otro lado, se evidenció la diferencia de la intensidad del dolor posoperatorio entre las dos técnicas: de moderado a intenso con la técnica de colgajo y leve, en su mayoría, con la técnica de VAC®. Conclusiones: El sistema de aspiración VAC® es eficiente para la cobertura ósea en defectos traumáticos del tercio medio tibial anterior, por lo que constituye una alternativa con potencial beneficio de recuperación sin alteración de estructuras anatómicas, ya que brinda mejores resultados funcionales y menores complicaciones. Es una opción útil que actúa de forma segura porque estimula el cierre de la herida y minimiza las necesidades de un tratamiento quirúrgico.

Objective: To compare two reconstructive surgery techniques for lower limb injury with exposed bone and demonstrate that the VAC® (vacuum-assisted closure) negative pressure wound therapy is an alternative for potential recovery showing no significant changes that could lead to functional compromise. Materials and methods: An analytical, prospective, quantitative and longitudinal study conducted with all the patients of Clínica Stella Maris with traumatic injuries of the lower limb and exposure of the middle third of the tibia treated with the VAC® system and the medial calf flap in 2019. Results: The measurement obtained with the functional ambulation categories (FAC) scale showed better results among the patients treated with the VAC® technique (since 50 % got grade V) than those who underwent the flap technique (50 % got grade IV), being the differences statistically significant (p < 0.05). It was observed that the time to closure was longer with the VAC® technique due to the progressive regeneration process consisting of the complete filling or coverage of the lesion area. On the other hand, the difference in the postoperative pain intensity between the two techniques was evident, being moderate to intense with the flap technique and mild, for the most part, with the VAC® technique. Conclusions: The VAC® suction system is effective for bone coverage in traumatic defects of the anterior middle third of the tibia. It is an alternative for potential recovery that does not change the anatomical structures because it provides better functional results and fewer complications. It is a useful and safe option that stimulates wound closure and minimizes the need for surgical treatment.

Efectividad de diferentes métodos de planimetría aritmética para la mensuración de úlceras del pie diabético

Introducción: Uno de los aspectos más importantes de la evaluación de una úlcera del pie diabético lo constituye la medición de su tamaño, que permite predecir, a su vez, el tiempo de cicatrización. No hay consenso claro sobre cuál resulta el mejor método para esto, que sea rápido, práctico, barato y sencillo para la práctica habitual. Objetivo: Determinar la efectividad de diferentes métodos de planimetría aritmética para la mensuración de úlceras del pie diabético. Métodos: Estudio correlacional, longitudinal y prospectivo. Se trabajó con una muestra de 51 diabéticos con 53 úlceras a nivel de los pies, que fueron evaluados por los cuatro sistemas de medición propuestos en la misma fecha y lugar. Resultados: El análisis de las diferencias estableció que la menor dispersión se hallaba en el método de Kundin. Asimismo, las diferencias absolutas fueron menores en el referido procedimiento, mientras que las porcentuales establecieron que el 43,4 % de las mediciones realizadas a través de Kundin concordaban con las del sistema ImageJ, por lo que estas resultaron estadísticamente significativas. Conclusiones: La determinación de la superficie de la herida por el método de Kundin es el más efectivo entre todos los de planimetría sin contacto físico.

Introduction: One of the most important aspects of the evaluation of a diabetic foot ulcer is the measurement of its size, which in turn predicts healing time. There is no clear consensus on what is the best method for this; one which can be fast, practical, cheap and simple for regular practice. Objective: To determine the effectiveness of different methods of arithmetic planimetry for the measurement of diabetic foot ulcers. Methods: Correlational, longitudinal and prospective study. It was used a sample of 51 diabetic patients with 53 ulcers at foot level, who were evaluated by the four measurement systems proposed on the same date and place. Results: The analysis of the differences established that the lowest dispersion was found in the Kundin method. Likewise, the absolute differences were smaller in the aforementioned procedure, while the percentages established that 43.4% of the measurements made through Kundin agreed with those of the ImageJ system, so these were statistically significant. Conclusions: The determination of the wound surface by the Kundin method is the most effective without physical contact among all planimetry ones.

Investigation the Effect of Human Recombinant Epidermal Growth Factor on Rotator Cuff Healing: An Experimental Model / Investigação do efeito do fator de crescimento epidérmico recombinante humano na cicatrização do manguito rotador: Um modelo experimental

Abstract Objective To investigate the effectiveness of human recombinant epidermal growth factor in the healing of rotator cuff tear in the rabbit shoulder. Methods Rotator cuff tears (RCTs) were experimentally created on both shoulders of 20 New Zealand rabbits. The rabbits were divided into the following groups: RCT (sham group; n = 5), RCT + EGF (EGF group; n = 5), RCT + transosseous repair (repair group; n = 5), and RCT + EGF + transosseous repair (combined repair + EGF group; n = 5). All rabbits were then observed for 3 weeks, and biopsies were taken from the right shoulders in the third week. After three more weeks of observation, all rabbits were sacrificed, and a biopsy removed from their left shoulders. All biopsy material was stained with haematoxylin & eosin (H&E) and vascularity, cellularity, the proportion of fibers and the number of fibrocartilage cells were evaluated under light microscope. Results The highest collagen amount and the most regular collagen sequence was detected in the combined repair + EGF group. The repair group and the EGF group showed higher fibroblastic activity and capillary formation when compared with the sham group, but the highest fibroblastic activity and capillary formation with highest vascularity was detected in the combined repair + EGF group (p < 0.001). EGF seems to improve wound healing in the repair of RCT. The EGF application alone, even without repair surgery, seems to be beneficial to RCT healing. Conclusion In addition to rotator cuff tear repair, application of human recombinant epidermal growth factor has an effect on rotator cuff healing in rabbit shoulders.

Resumo Objetivo Investigar a eficácia do fator de crescimento epidérmico (EGF) recombinante humano na cicatrização da lesão do manguito rotador no ombro de coelhos. Métodos As rupturas do manguito rotador (RMRs) foram criadas experimentalmente em ambos os ombros de 20 coelhos Nova Zelândia. Os coelhos foram divididos nos seguintes grupos: RMR (grupo controle; n = 5), RMR + EGF (grupo EGF; n = 5), RMR + reparo transósseo (grupo reparo; n = 5) e RMR + EGF + reparo transósseo (grupo reparo combinado+ EGF; n = 5). Todos os coelhos foram observados por 3 semanas, e amostras de biópsias foram coletadas do ombro direito na 3ª semana. Após mais 3 semanas de observação, todos os coelhos foram submetidos à eutanásia, e uma amostra de biópsia foi coletada dos ombros esquerdos. Todo o material de biópsia foi corado com hematoxilina e eosina (H&E) para avaliação de vascularidade, celularidade, proporção de fibras e número de células fibrocartilaginosas à microscopia óptica. Resultados O grupo reparo combinado + EGF apresentou a maior quantidade e a sequência mais regular de colágeno. O grupo reparo e o grupo EGF apresentaram maior atividade fibroblástica e formação capilar em comparação ao grupo controle, mas a maior atividade fibroblástica e a formação capilar com maior vascularidade foram detectadas no grupo reparo combinado + EGF (p < 0,001). O EGF parece melhorar a cicatrização da ferida no reparo da RMR. A aplicação isolada de EGF, mesmo sem cirurgia reparadora, parece melhorar a cicatrização da RMR. Conclusão Além do reparo da RMR, a aplicação de EGF recombinante humano auxilia a cicatrização do manguito rotador dos ombros de coelhos.

Use of negative pressure therapy in closed surgical incisions of post-bariatric dermolipectomy / Uso da terapia de pressão negativa em incisões cirúrgicas fechadas de dermolipectomia pós-bariátrica

Introduction: Negative pressure therapy gains ground in surgical practice as an intervention to improve healing. Post-bariatric patients undergoing abdominal dermolipectomy are at increased risk of local complications. There is a notable dearth of current Brazilian studies on this. This study aims to analyze the presence of complications in patients undergoing post-bariatric dermolipectomy surgery with negative pressure dressing in closed surgical incisions. Method: Descriptive study that evaluated complications of surgical incisions in 20 patients undergoing post-bariatric dermolipectomy surgery with negative pressure therapy. Data tabulated in Windows Excel software and analyzed in the Statistical Package for the Social Sciences 18.0 program. Qualitative variables were presented in simple frequency and quantitative as mean, standard deviation, and amplitude. CEP-UNISUL approved the study. Results: 20 patients undergoing negative pressure therapy, 80% (n=16) female, mean age 39.55 years (±9.08). Anchor incision was chosen in 70% (n=14) of the surgeries, with an average tissue removal of 1940 grams (±710.37) and hospitalization time of 40.20 hours (±19.18), corresponding to 1,66 daily. Only 15% (n=3) of patients had complications (dehiscence, seroma, and hematoma, which occurred in the same proportion). There was no case of necrosis. Conclusion: The use of negative pressure therapy in closed surgical incisions of post-bariatric dermolipectomy seems to contribute to reducing postoperative complications.

Introdução: Terapia de pressão negativa ganha espaço na prática cirúrgica como intervenção para melhorar cicatrização. Pacientes pós-bariátricos submetidos a dermolipectomia abdominal apresentam maior risco de complicações locais. Há uma notável escassez de estudos brasileiros atuais acerca disso. O objetivo desse estudo é analisar a presença de complicações em pacientes submetidos a cirurgia de dermolipectomia pós-bariátrica com curativo de pressão negativa em incisões cirúrgicas fechadas. Método: Estudo descritivo que avaliou complicações de incisões cirúrgicas de 20 pacientes submetidos a cirurgia de dermolipectomia pós-bariátrica com terapia de pressão negativa. Dados tabulados no software Windows Excel e analisados no programa Statistical Package for the Social Sciences 18.0. Variáveis qualitativas foram apresentadas em frequência simples e quantitativas através de média, desvio padrão e amplitude. O estudo foi aprovado pelo CEP-UNISUL. Resultados: 20 pacientes submetidos a terapia de pressão negativa, sendo 80% (n=16) do sexo feminino, com idade média de 39,55 anos (±9,08). Incisão em âncora foi escolha em 70% (n=14) das cirurgias, com retirada média de tecido de 1940 gramas (±710,37) e tempo de hospitalização de 40,20 horas (±19,18), correspondendo a 1,66 diárias. Apenas 15% (n=3) dos pacientes apresentaram complicações (deiscência, seroma e hematoma, que aconteceram na mesma proporção). Não houve caso de necrose. Conclusão: Uso da terapia de pressão negativa em incisões cirúrgicas fechadas de dermolipectomia pós-bariátrica parece contribuir na redução das complicações pós-operatórias.

Laser de baixa potência na cicatrização e analgesia de lesões mamilares: ensaio clínico / Low lavel laser in the healinh and analgesia of nipples trauma: clinical trial / Láser de baja potencia en la curación y analgesia de pezones juveniles: un ensayo clínico

Objetivo: Analisar a eficácia do laser de baixa potência, modalidade local e sistêmico, para cicatrização e redução da dor ocasionadas por lesões mamilares. Métodos: Ensaio clínico, randomizado e controlado realizado com 54 lactantes atendidas em um Banco de Leite Humano, de dezembro de 2017 a junho de 2018. As lactantes, que somaram um total 101 lesões, receberam orientações referentes ao manejo clínico das mamas e foram alocadas em: Grupo Controle (GC), Grupo Laser Local (GLL), que receberam laser diretamente no mamilo lesionado e Grupo Irradiation Laser Intravascular of Blood (GILIB), que receberam a laserterapia sistêmica. Os dados foram analisados no SPSS para avaliação da homogeneidade dos grupos (Kruskal-Wallis) e regressão linear para identificação do efeito da intervenção no tamanho das lesões mamárias e intensidade da dor. Resultados: Os três grupos de análise se mostaram homogêneos antes do experimento (p=0,191). Após a intervenção, houve cicatrização das lesões nos três grupos, sendo significativamente maior no GLL e GILIB (p<0,050). Quanto à dor, houve redução em até 4.0 pontos no GLL e GILIB (p=0,002). Conclusão: A administração da laserterapia local e sistêmica foi mais eficaz para a cicatrização das lesões mamilares e redução da dor, quando comparadas ao grupo controle. (AU)

Objective: To analyze the effectiveness of the low-potency laser, local and systemic, for the healing and reduction of pain caused by nipple trauma. Methods: Clinical, randomized and controlled trial carried out with 54 lactating women assisted in a Human Milk Bank, from December 2017 to June 2018. The lactating women, which totaled 101 lesions, received guidance on the clinical management of their breasts and breasts designated in: Control Group (CG), Local Laser Group (GLL), which received laser directly on the injured nipple, and Intravascular Blood Laser Irradiation Group (GILIB), which received systemic laser therapy. Data were analyzed using the SPSS to assess the homogeneity of the groups (Kruskal-Wallis) and the linear regression to identify the effect of the intervention on the size of breast lesions and the intensity of pain. Results: The three analysis groups were homogeneous before the experiment (p=0.191). After the intervention, the healing of the lesions in the three groups was significantly higher in GLL and GILIB (p<0.050). As for the pain, there is a reduction of up to 4.0 points in GLL and GILIB (p=0.002). Conclusion: The administration of local and systemic laser therapy was more effective for the cure of nipple trauma and pain reduction, in comparison with the control group. (AU)

Objetivo: Analizar la efectividad del láser de baja potencia, local y sistémico, para la cicatrización y reducción del dolor causado por las lesiones del pezón. Métodos: Ensayo clínico, aleatorizado y controlado realizado con 54 mujeres lactantes atendidas en un Banco de Leche Humana, de diciembre de 2017 a junio de 2018. Las mujeres lactantes, que totalizaron 101 lesiones, recibieron orientación sobre el manejo clínico de las mamas y fueron asignadas en: Grupo de Control (CG), Grupo de Láser Local (GLL), que recibió láser directamente en el pezón lesionado, y Grupo de Irradiación de Láser Intravascular de Sangre (GILIB), que recibió terapia con láser sistémico. Los datos se analizaron mediante el SPSS para evaluar la homogeneidad de los grupos (Kruskal-Wallis) y la regresión lineal para identificar el efecto de la intervención sobre el tamaño de las lesiones mamarias y la intensidad del dolor. Resultados: Los tres grupos de análisis eran homogéneos antes del experimento (p=0,191). Tras la intervención, hubo curación de las lesiones en los tres grupos, siendo significativamente mayor en GLL y GILIB (p<0,050). En cuanto al dolor, hubo una reducción de hasta 4,0 puntos en GLL y GILIB (p=0,002). Conclusión: La administración de la terapia con láser local y sistémica fue más efectiva para la curación de las lesiones del pezón y la reducción del dolor, en comparación con el grupo de control. (AU)

Tratamiento quirúrgico de la enfermedad pilonidal sacrocoxígea. Experiencia de un centro en los últimos 4 años

Objetivo: Evaluar los resultados a largo plazo en el tratamiento quirúrgico de la enfermedad pilonidal sacrocoxígea (EPS), comparando las diferentes técnicas quirúrgicas utilizadas, complicaciones, tiempo de cicatrización y recidiva. Material y Método: Estudio trasversal retrospectivo. Se revisaron las fichas de los pacientes intervenidos por EPS entre enero 2017 hasta agosto 2021. Para el seguimiento se obtuvo la información desde los registros de los controles periódicos en nuestro centro y aquellos que no continuaron con estos controles se contactaron telefónicamente. Resultados: Se recopilaron 309 casos, con una media de seguimiento de 15,6 meses. Las técnicas más utilizadas para la fase crónica de EPS fueron marsupialización y Karydakis, con tiempo de cicatrización completa de 54,5 y 18,2 días, respectivamente. La presencia de complicaciones prolongó el tiempo de cicatrización en 46,5 días en Karydakis, con mínimo impacto en marsupialización. La tasa de recidiva fue menor en Karydakis y en etapa aguda cuando se realiza destechamiento y legrado. La profilaxis antibiótica no afectó el riesgo de complicaciones postoperatorias. Discusión: El desarrollo de complicaciones postoperatorias tiene mayor impacto en la cicatrización de la técnica cerrada que en la abierta, siendo esta última más tolerante en cuanto a la cicatrización frente a complicaciones. Conclusión: La intervención con técnica de Karydakis logra la cicatrización de la herida operatorio en menor tiempo que la marsupialización, sin embargo, al desarrollar complicaciones, este tiempo aumenta 3,5 veces más. La recurrencia fue menor en Karydakis. En absceso se recomienda el desteche y legrado por sobre el drenaje exclusivo

Aim: To evaluate long-term results in the surgical treatment of sacrococcygeal pilonidal disease (SPD) comparing the different surgical techniques used, complications, healing time and recurrence. Material and Method: Retrospective cross-sectional study. The files of the patients operated on for EPS between January 2017 and August 2021 were reviewed. For follow-up, information was obtained from the records of the periodic controls in our center; those who did not continue with these controls were contacted by telephone. Results: 309 cases were collected, with a mean follow-up of 15.6 months. The most used techniques for the chronic phase of EPS were marsupialization and Karydakis, achieving complete wound healing in 54.5 and 18.2 days, respectively. The presence of complications prolonged the healing time by 46.5 days in Karydakis, with minimal impact on marsupialization. The recurrence rate was lower in Karydakis and in the acute stage when unroofing and curettage were performed. Antibiotic prophylaxis did not increase the risk of postoperative complications. Discussion: The development of postoperative complications has a greater impact on the healing of the closed technique than in the open technique, the last one seems to be more tolerant in terms of healing in the presence of complications. Conclusion: The intervention with the Karydakis technique achieves healing of the surgical wound in less time than marsupialization, however, when complications develop, this time increases 3.5 times more. Recurrence was lower in Karydakis. In abscess weaning and curettage is recommended over the exclusive drainage.

Development and clinical application of hydrogel formulations containing papain and urea for wound healing

Abstract Hydrogels are used for wound treatment, as they may contain one or more active components and protect the wound bed. Papain is one of the active substances that have been used with this purpose, alongside urea. In this paper, carboxypolymethylene hydrogels containing papain (2% and 10% concentrations) and urea (5% concentration) were produced. Physical-chemical stability was performed at 0, 7, 15 and 30 days at 2-8ºC, 25ºC and 40ºC, as well as the rheological aspects and proteolytic activity of papain by gel electrophoresis. Clinical efficacy of the formulations in patients with lower limb ulcers was also evaluated in a prospective, single-center, randomized, double-blind and comparative clinical trial. The results showed 7-day stability for the formulations under 25ºC, in addition to approximately 100% and 15% of protein activity for 10% and 2% papain hydrogel, respectively. The rheological profile was non-Newtonian for the 10% papain hydrogel tested. There were no significant differences regarding the mean time for healing of the lesions, although 10% papain presented a better approach to be used in all types of tissue present in the wound bed.

Comparative evaluation of skin suture in rats with polyglycaprone 25 and nylon / Avaliação comparativa da sutura de pele com poliglicaprone 25 e nylon em ratos

ABSTRACT Currently, the market offers a wide variety of suture threads, made of materials with different structural and chemical properties. Among many other characteristics, they vary in origin, absorption or degradation, and structure. From this variety, the clinical doubt arises as to which material provides the patient with the best healing quality. Objective: This study aims to comparatively evaluate two different types of suture threads-Monocryl® (polyglycaprone 25) and Ethilon® (nylon)-regarding their ability to aid in tissue regeneration by a histological and immunohistochemical analysis of the skin of rats sutured with the aforementioned materials. Methods: This basic experimental study used 12 adult Wistar rats, randomly divided into three groups with four animals each and subjected to four longitudinal incisions under anesthesia. Each group corresponded to a postsurgical evaluation date (one, seven, and 14 days). Results: At 14 postoperative days, the studied groups had no histological difference. However, the use of nylon thread showed greater evidence of earlier fibrotic union. Conclusion: This study found no histological difference in healing 14 days after surgery among the techniques and the types of suture threads. Level of Evidence II, Therapeutic Studies.

RESUMO Atualmente, encontra-se disponível no mercado uma grande variedade de fios de sutura, compostos de materiais com diferentes propriedades estruturais e químicas, que variam quanto à origem, absorção ou degradação e estrutura, entre outras características. A partir dessa disponibilidade, emerge a dúvida clínica quanto ao material que propicia a melhor qualidade de cicatrização ao paciente. Objetivo: Avaliar comparativamente dois tipos de fios - Monocryl ® (poliglicaprone 25) e Ethilon ® (nylon) - quanto à sua capacidade de auxílio na regeneração tecidual, por meio da análise histológica e imuno-histoquímica da pele de ratos submetidos a suturas com esses materiais. Métodos: Neste estudo básico experimental, foram utilizados 12 ratos adultos da linhagem Wistar, randomicamente divididos em três grupos com quatros animais cada, que foram submetidos a quatro incisões longitudinais sob anestesia. Cada grupo correspondeu a uma data de avaliação pós-cirúrgica (1, 7 e 14 dias). Resultados: Passados 14 dias após a operação, não houve diferença histológica em relação aos grupos estudados. No entanto, o uso de fio de nylon apresentou evidência de união fibrótica mais precoce. Conclusão: Não há diferença histológica de cicatrização após 14 dias pós-operatórios entre as técnicas e os tipos de fio de sutura. Nível de Evidência II, Estudos Terapêuticos.

Soluble epoxide hydrolase inhibitor promotes the healing of oral ulcers

Abstract Objective Oral ulcers are a lesion in the oral mucosa that impacts chewing or drinking. Epoxyeicosatrienoic Acids (EETs) have enhanced angiogenic, regenerative, anti-inflammatory, and analgesic effects. The present study aims to evaluate the effects of 1-Trifluoromethoxyphenyl-3-(1-Propionylpiperidin-4-yl) Urea (TPPU), a soluble epoxide hydrolase inhibitor for increasing EETs level, on the healing of oral ulcers. Methods The chemically-induced oral ulcers were established in Sprague Dawley rats. The ulcer area was treated with TPPU to evaluate the healing time and pain threshold of ulcers. The expression of angiogenesis and cell proliferation-related protein in the ulcer area was detected using immunohistochemical staining. The effects of TPPU on migration and angiogenesis capability were measured with scratch assay and tube formation. Results Compared with the control group, TPPU promoted wound healing of oral ulcers with a shorter healing time, and raised pain thresholds. Immunohistochemical staining showed that TPPU increased the expression of angiogenesis and cell proliferation-related protein with reduced inflammatory cell infiltration in the ulcer area. TPPU enhanced cell migration and tube-forming potential in vitro. Conclusions The present results support the potential of TPPU with multiple biological effects for the treatment of oral ulcers by targeting soluble epoxide hydrolase.

LED phototherapy in tissue repair of chronic wounds in people with diabetes: a systematic review / Fototerapia LED en la reparación de tejidos de heridas crónicas en personas con diabetes: una revisión sistemática / Fototerapia com LED no reparo tecidual de feridas crônicas em pessoas com diabetes: revisão sistemática

ABSTRACT Objective: To identify scientific evidence of LED photobiomodulation in the treatment and tissue repair of chronic wounds in people with Diabetes Mellitus, types I and II. Method: Systematic review conducted from September/2021 to April/2022 in PubMed, LILACS, SCIELO, COHRANE, EMBASE and Web of Science. Randomized and observational clinical trials using LED in wound healing in diabetics, published between 2015 and 2022 were included. Data were descriptively analyzed with title/abstract screening, full text articles reading and definitive selection after meeting the predefined inclusion and exclusion criteria. Results: Fromthe total of 840 references, eight articles were selected, that evaluated the effectiveness of LED phototherapy in wounds of diabetic patients. Conclusion: LED light proved to be beneficial in tissue repair, with increased production in collagen and fibroblasts, angiogenesis, reduction of inflammation and, consequently, a decrease in lesion size.

RESUMEN Objetivo: Identificar evidencias científicas de fotobiomodulación con LED en el tratamiento y reparación de tejidos de heridas crónicas en personas con Diabetes Mellitus, tipos I y II. Método: Revisión sistemática realizada de septiembre/2021 a abril/2022 en PubMed, LILACS, SCIELO, COHRANE, EMBASE y Web of Science. Se incluyeron ensayos clínicos aleatorizados y observacionales con uso de LED en la cicatrización de heridas en diabéticos, publicados entre 2015 y 2022. Los datos fueron analizados descriptivamente con selección de título/resumen, lectura de artículos a texto completo y selección definitiva después de cumplir con la inclusión e inclusiones ex - predefinidas. Resultados: Del total de 840 referencias encontradas, se seleccionaron ocho artículos que evaluaron la efectividad de la fototerapia LED en heridas de pacientes diabéticos. Conclusión: La luz LED demostró ser beneficiosa en la reparación de tejidos, con aumento de la producción de colágeno y fibroblastos, angiogénesis, reducción de la inflamación y, en consecuencia, disminución del tamaño de la lesión.

RESUMO Objetivo: Identificar evidências científicas da fotobiomodulação com LED no tratamento e reparo tecidual em feridas crônicas de pessoas com Diabetes Mellitus, tipo I e II. Método: Revisão sistemática realizada de setembro/2021 a abril/2022 na PubMed, LILACS, SCIELO, COHRANE, EMBASE e Web of Science. Incluídos ensaios clínicos randomizados e observacionais utilizando LED na cicatrização de feridas em diabéticos, publicados entre 2015 a 2022. Os dados foram analisados descritivamente com triagem de título/resumo, leitura dos artigos em texto completo e seleção definitiva após atender aos critérios de inclusão e exclusão pré-definidos. Resultados: Do total de 840 referências encontradas, foram selecionados oito artigos que avaliaram a eficácia da fototerapia LED em feridas de pacientes diabéticos. Conclusão: A luz LED mostrou-se benéfica no reparo tecidual, com aumento na produção de colágeno e fibroblastos, angiogênese, redução da inflamação e consequentemente, diminuição no tamanho da lesão.

Hancornia speciosa serum latex fraction: a non-allergenic biomaterial / Fração soro do látex de Hancornia speciosa: um biomaterial não alergênico

Plant-derived products can assist in the healing process of dermal wounds. It has been demonstrated that Hancornia speciosa latex present angiogenic, osteogenic, anti-inflammatory, and antioxidant activities. Then, it could contribute to the wound healing process. However, natural products in contact with skin may cause dermatitis. The objective of this work was to evaluate the allergic and irritant potential of H. speciosa serum fraction latex using in vitro assays. The obtained results showed that the H. speciosa serum fraction latex has a slightly irritant potential and is not cytotoxic neither allergenic for human cells. Moreover, we identified a remarkable low amount of proteins in this material in comparison to Hevea brasiliensis latex. This result could explain the non-allergenic potential of H. speciosa serum fraction latex because proteins present in latex are the main responsible for allergy. This biomaterial could be used as a non-allergenic source for development of new medicines.

Produtos derivados de plantas podem auxiliar no processo de cicatrização de feridas cutâneas. Foi demonstrado que o látex de Hancornia speciosa apresenta atividades angiogênicas, osteogênicas, antiinflamatórias e antioxidantes. Então, este biomaterial pode contribuir para o processo de cicatrização de feridas. No entanto, produtos naturais em contato com a pele podem causar dermatites. O objetivo deste trabalho foi avaliar o potencial alérgico e irritante do látex da fração soro de H. speciosa por meio de ensaios in vitro. Os resultados obtidos mostraram que o látex da fração do soro de H. speciosa possui um potencial pouco irritante e não é citotóxico nem alergênico para células humanas. Além disso, foi identificado uma notável baixa quantidade de proteínas neste material em comparação ao látex de Hevea brasiliensis. Esse resultado poderia explicar o potencial não alergênico do látex da fração soro de H. speciosa, pois as proteínas presentes no látex são as principais responsáveis pela alergia. Este biomaterial pode ser utilizado como fonte não alergênica para desenvolvimento de novos medicamentos.

Hancornia speciosa serum latex fraction: a non-allergenic biomaterial

Abstract Plant-derived products can assist in the healing process of dermal wounds. It has been demonstrated that Hancornia speciosa latex present angiogenic, osteogenic, anti-inflammatory, and antioxidant activities. Then, it could contribute to the wound healing process. However, natural products in contact with skin may cause dermatitis. The objective of this work was to evaluate the allergic and irritant potential of H. speciosa serum fraction latex using in vitro assays. The obtained results showed that the H. speciosa serum fraction latex has a slightly irritant potential and is not cytotoxic neither allergenic for human cells. Moreover, we identified a remarkable low amount of proteins in this material in comparison to Hevea brasiliensis latex. This result could explain the non-allergenic potential of H. speciosa serum fraction latex because proteins present in latex are the main responsible for allergy. This biomaterial could be used as a non-allergenic source for development of new medicines.

Resumo Produtos derivados de plantas podem auxiliar no processo de cicatrização de feridas cutâneas. Foi demonstrado que o látex de Hancornia speciosa apresenta atividades angiogênicas, osteogênicas, antiinflamatórias e antioxidantes. Então, este biomaterial pode contribuir para o processo de cicatrização de feridas. No entanto, produtos naturais em contato com a pele podem causar dermatites. O objetivo deste trabalho foi avaliar o potencial alérgico e irritante do látex da fração soro de H. speciosa por meio de ensaios in vitro. Os resultados obtidos mostraram que o látex da fração do soro de H. speciosa possui um potencial pouco irritante e não é citotóxico nem alergênico para células humanas. Além disso, foi identificado uma notável baixa quantidade de proteínas neste material em comparação ao látex de Hevea brasiliensis. Esse resultado poderia explicar o potencial não alergênico do látex da fração soro de H. speciosa, pois as proteínas presentes no látex são as principais responsáveis pela alergia. Este biomaterial pode ser utilizado como fonte não alergênica para desenvolvimento de novos medicamentos.

Hancornia speciosa serum latex fraction: a non-allergenic biomaterial / Fração soro do látex de Hancornia speciosa: um biomaterial não alergênico

Abstract Plant-derived products can assist in the healing process of dermal wounds. It has been demonstrated that Hancornia speciosa latex present angiogenic, osteogenic, anti-inflammatory, and antioxidant activities. Then, it could contribute to the wound healing process. However, natural products in contact with skin may cause dermatitis. The objective of this work was to evaluate the allergic and irritant potential of H. speciosa serum fraction latex using in vitro assays. The obtained results showed that the H. speciosa serum fraction latex has a slightly irritant potential and is not cytotoxic neither allergenic for human cells. Moreover, we identified a remarkable low amount of proteins in this material in comparison to Hevea brasiliensis latex. This result could explain the non-allergenic potential of H. speciosa serum fraction latex because proteins present in latex are the main responsible for allergy. This biomaterial could be used as a non-allergenic source for development of new medicines.

Resumo Produtos derivados de plantas podem auxiliar no processo de cicatrização de feridas cutâneas. Foi demonstrado que o látex de Hancornia speciosa apresenta atividades angiogênicas, osteogênicas, antiinflamatórias e antioxidantes. Então, este biomaterial pode contribuir para o processo de cicatrização de feridas. No entanto, produtos naturais em contato com a pele podem causar dermatites. O objetivo deste trabalho foi avaliar o potencial alérgico e irritante do látex da fração soro de H. speciosa por meio de ensaios in vitro. Os resultados obtidos mostraram que o látex da fração do soro de H. speciosa possui um potencial pouco irritante e não é citotóxico nem alergênico para células humanas. Além disso, foi identificado uma notável baixa quantidade de proteínas neste material em comparação ao látex de Hevea brasiliensis. Esse resultado poderia explicar o potencial não alergênico do látex da fração soro de H. speciosa, pois as proteínas presentes no látex são as principais responsáveis ​​pela alergia. Este biomaterial pode ser utilizado como fonte não alergênica para desenvolvimento de novos medicamentos.

Conventional versus flap-protected free gingival graft: a multicenter randomized clinical trial

Abstract The purpose of this study was to compare the outcomes of a modified gingival graft technique, in which the released flap is positioned and sutured over the graft, with the conventional free gingival graft (FGG) procedure, when both are used for gingival augmentation. A 12-month, multicenter parallel randomized controlled trial was conducted. Subjects with buccal RT2 gingival recessions and keratinized tissue width (KTW) < 2 mm in at least one mandibular incisor were randomized to control group (n = 20; conventional FGG) or test group (n = 20; modified FGG; flap sutured over FGG using sling sutures). The primary outcome (KTW) was measured at baseline and after 3, 6 and 12 months, as was keratinized tissue thickness (KTT). Postoperative pain (POP) and analgesic intake were also recorded. Both techniques promoted a significant increase in KTW and KTT when compared to baseline (p < 0.05) with no significant differences between groups (KTW change of 6.1±1.5 mm and 5.4±1.6 mm, for control and test, respectively; p=0.16). However, test group patients reported less POP after 7 days and used less analgesic medication than control group patients (p < 0.05). We concluded that the modified FGG was comparable to conventional FGG in augmenting keratinized tissue width and thickness at mandibular incisors, but resulted in less patient morbidity.

The effect of BMP9 on inflammation in the early stage of pulpitis

Abstract Bone morphogenetic protein 9 (BMP9) tends to be associated with various inflammatory responses of diseases, but its relationship with pulpitis remains unknown. Objective This study aimed to evaluate the effects and mechanisms of BMP9 in pulpitis. Methodology A rat model of pulpitis was used to evaluate the expression of BMP9, which was also analysed in Porphyromonas gingivalis lipopolysaccharide (Pg-LPS)-stimulated human dental pulp cells (hDPCs). The effects and mechanism of BMP9 on the regulation of inflammatory factors and matrix metalloproteinase-2 (MMP2) were evaluated using real-time quantitative PCR, western blotting, and immunocytofluorescence. Moreover, the migration ability of THP-1 monocyte-macrophages, treated with inflammatory supernate inhibited by BMP9, was previously tested by a transwell migration assay. Finally, a direct rat pulp capping model was used to evaluate in vivo the influence of the overexpression of BMP9 in pulpitis. Results The expression of BMP9 decreased after 24 h and increased after 3 and 7 d in rat pulpitis and inflammatory hDPCs. The overexpression of BMP9 inhibited the gene expression of inflammatory factors (IL-6, IL-8, and CCL2) and the secretion of IL-6 and MMP2 in Pg-LPS-stimulated hDPCs. The level of phosphorylated Smad1/5 was upregulated and the levels of phosphorylated ERK and JNK were downregulated. The inflammatory supernate of hDPCs inhibited by BMP9 reduced the migration of THP-1 cells. In rat pulp capping models, overexpressed BMP9 could partially restrain the development of dental pulp inflammation. Conclusion This is the first study to confirm that BMP9 is involved in the occurrence and development of pulpitis and can partially inhibit its severity in the early stage. These findings provided a theoretical reference for future studies on the mechanism of pulpitis and application of bioactive molecules in vital pulp therapy.

Accelerating Wound Healing of Traumatic Ulcer with Topical Application of Dental Pulp Mesenchymal Stem Cell Secretome and Robusta Green Coffee Bean Extract Combination in vivo

ABSTRACT Objective: To investigate the ability of a combination dental pulp mesenchymal stem cell secretome (DPMSCS), robusta green coffee bean extract (RGCBE), and Carboxymethylcellulose-Natrium (CMC-Na) in a Wistar rats model of traumatic ulcers. Material and Methods: Twenty-eight young, male, healthy Wistar rats (Rattus norvegicus) were divided into seven groups randomly: Group K0, group K1-3 (traumatic ulcer rats that received CMC-Na gel for three days), group K1-7 (traumatic ulcer rats that received CMC-Na gel for seven days), group K2-3 (traumatic ulcer rats that received RGCBE for three days), group K2-7 (traumatic ulcer rats that received RGCBE for seven days), group K3-3 (traumatic ulcer rats that received DPMSCS for three days), and group K3-7 (traumatic ulcer rats that received DPMSCS for seven days). An ulcer was made with an amalgam stopper on the right buccal mucosa of the rats. DPMSCS 50% gel was applied to the ulcer on the left buccal mucosa. The ulcer diameter was measured on day 3 and day 7. Results: There was a significant difference in the diameter of the ulcer, the number of neutrophils, and fibroblasts in the treatment group compared to the control group on day 7. Conclusion: A combination of DPMSCS and RGCBE 50% accelerates traumatic ulcer wound healing by lowering ulcer diameter, decreasing neutrophil counts, and increasing fibroblast proliferation in vivo.