Curativo da área doadora de enxerto de pele parcial com curativo de colágeno e alginato (Fibracol®): uma experiência de 35 pacientes / Wound management of partial-thickness skin-graft donor areas with a collagen and alginate dressing (Fibracol®): findings in 35 patients

INTRODUÇÃO: O objetivo deste estudo é relatar a nossa experiência com curativo de colágeno e alginato (Fibracol®) para cobrir áreas doadoras de enxerto de pele de espessura parcial. MÉTODO: Estudamos, retrospectivamente, 35 prontuários de pacientes que utilizaram o Fibracol® em áreas doadoras. Nossa rotina para cobrir a área doadora é a seguinte: cobertura da área com uma ou mais unidades de Fibracol® e, em seguida, com uma película à prova de água. Depois de três ou quatro dias, remover o curativo, limpar delicadamente com soro fisiológico e gaze e, quando julgava-se necessário, cobria-se novamente. A idade média foi de 25,52 anos (1-65). RESULTADOS: A coxa foi usada como área doadora em 29 pacientes, o braço em 2, a perna em 4 e tronco em 3 (2 pacientes tiveram mais de uma área doadora). O tempo médio necessário para epitelização foi de 4,51 dias (3-8). O valor de R do coeficiente de correlação de Pearson correlacionando a idade e tempo de epitelização foi -0,0755, com p = 0,6685. Nenhum dos pacientes teve infecção na área doadora. O curativo ideal para a área doadora do enxerto de pele de espessura parcial teria muitas características, incluindo: preço baixo, bom conforto do paciente, baixa taxa de infecção, período curto de tempo para epitelização, etc. CONCLUSÃO: Os autores relatam uma boa experiência usando Fibracol® em 35 pacientes, durante um período de 22 meses. O tempo para epitelização foi de 4,51 dias, mais curta do que a maioria dos trabalhos publicados, e não tinha correlação com a idade do paciente.

INTRODUCTION: The objective of this study was to report our findings with a collagen and alginate dressing (Fibracol®) used to cover donor areas of partial-thickness skin grafts. METHOD: We retrospectively evaluated the medical records of 35 patients in whom Fibracol® was used on donor areas. The routine used to manage the donor area is as follows: The area is covered with one or more units of Fibracol®, followed by application of a waterproof film. After three or four days, the dressing is removed and the area cleaned gently with saline and gauze; the area is dressed again if necessary. The mean patient age was 25.52 years (range, 1-65 years). RESULTS: The thigh was used as the donor area in 29 patients, the arm in 2, the leg in 4, and the trunk in 3. Two patients had more than one donor area. The mean time needed for epithelization was 4.51 days (range, 3-8 days). The Pearson correlation coefficient value correlating age and time of epithelization was -0.0755; p = 0.6685. None of the patients experienced an infection in the donor area. The ideal dressing for the donor area of split-thickness skin grafts would have multiple characteristics including low price, good patient comfort, low infection rate, and a short epithelization period. CONCLUSION: The authors report a positive experience with the use of Fibracol® in 35 patients over a period of 22 months. The mean epithelization period was 4.51 days, shorter than that in the majority of published studies, and had no correlation with the age of the patient.

A importância do resfriamento da queimadura no atendimento pré-hospitalar / The importance of cooling a burn injury in the pre hospital setting

Sabemos que o Atendimento Pré-Hospitalar (APH) à vítima queimada ainda é uma área bastante carente de informações precisas no Brasil. Os socorristas, muitas vezes, têm pouco conhecimento para fazer um atendimento rápido, eficiente e eficaz ou possuem material escasso - e às vezes inexistentes - em suas viaturas ou bases de atendimento. Além disso, o estresse que este tipo de evento causa faz com que as equipes de socorro nem sempre se sintam confortáveis e seguras em assumir um evento tão devastador, principalmente se os envolvidos forem crianças, idosos ou múltiplas vítimas. A publicação de Patrick Bourke, na revista Ambulance UK (Reino Unido), aponta a importância do resfriamento correto da queimadura no cenário pré-hospitalar, mostrando a história desta prática, o motivo e o modo correto de como este procedimento tão simples e importante pode ser realizado. O correto resfriamento da lesão, a proteção de infecções secundárias, a prevenção da hipotermia clínica e o alívio da dor ainda no APH irão influenciar diretamente na evolução destes pacientes, reduzindo custos com medicação, tempo de internação e prognóstico desta vítima.

It is known that Prehospital Emergency Care (PHEC) to burned victims is an area needing accurate information in Brazil. Quite often, PHEC responders have little knowledge to provide fast, efficient and effective care or count on little - sometimes, inexistent - material in their ambulances or care units. Besides, the stress caused by this kind of event makes rescue teams not always comfortable and confident to respond to a such devastating event, especially when children, elderly or multiple victims are involved. Patrick Bourke's article published in Ambulance UK (United Kingdom) points out the importance of burn fast cooling in prehospital care, showing the history of this practice, the reason for performing it and the correct way this simple and important procedure can be carried out. The injury correct cooling, protection against secondary infections, clinical and pain relief during PHEC will directly influence the patient's outcome, reducing medication costs and hospital stay and improving victim's prognosis.

Uso de espumas em áreas doadoras de enxertos / Use of polyurethane foam dressings on skin graft donor sites

Introdução: O sucesso de um enxerto de pele é avaliado não apenas pela integração do enxerto em si, mas também pela qualidade da recuperação da área doadora. A despeito de as áreas doadoras de enxertos representarem o melhor local para estudo de cicatrização de feridas, regimes de tratamento, de áreas doadoras, tem sido incompletamente estudados. Objetivo: Avaliação da eficácia de espumas de poliuretano como curativo de áreas doadoras de enxertos. Método: Estudo prospectivo no qual áreas doadoras de enxertos foram tratadas com espumas de poliuretano como alternativa a filmes de acetato de celulose. Resultados: Foram tratados 11 pacientes e catorze áreas doadoras de enxerto. Aderência prolongada (73%) e odor desagradável (45%) foram os problemas encontrados. Os resultados foram considerados insatisfatórios na grande maioria dos casos (73%). Conclusões: O uso de espumas de poliuretano mostrou-se ineficaz, nesse grupo de pacientes, devido à ocorrência de alto índice de complicações.

Introduction: The success of a skin graft is evaluated by not only the integration of the graft itself, but also the quality of the recovery of the donor site. Despite the fact that graft donor sites represent the best place to study wound healing, treatment regimens for donor sites have not been studied extensively. Method: To evaluate the efficiency of polyurethane foam as a dressing for graft donor sites. Methods: We conducted a prospective study in which graft donor sites were treated with polyurethane foam dressing, as an alternative to a cellulose acetate film. Results: We treated 11 patients and 14 donor graft sites. Problems associated with the use of polyurethane foam included prolonged adherence (73%) and an unpleasant odor (45%). The majority of patients reported that they found the dressing to be unsatisfactory (73%). Conclusions: The use of a polyurethane foam was shown to be ineffective as a graft donor site dressing, due to the high rate of associated complications.

Association of the background experience of nurses and their consideration for the standards of muscular injections and dressing in some selective hospitals in Esfahan

In the domain of performing care and cure affaires, one of the basic principles in most health centers is the muscle injections and dressing. As a psychomotor domain, after years and reaching the normality level of muscle injections and dressing, alterations may occur in the performance. So we attempted to investigate the relation between the background experience of the hospital staff and their consideration about the standards of muscle injections and dressing in different wards of selective hospitals in Esfahan. In this analytic cross-sectional study, data were obtained through different checklists to observe the importance of considering the standards of muscle injections and dressing, after certifying the validity and reliability. By random sampling, 38 cases of muscle injection and 31 cases of dressing were observed without notifying the practitioner. After completing the checklists, they were informed because of moral considerations; then those who agreed to take part in the research, the demographic questionnaire was also completed and obtained data were analyzed by SPSS software. Most cases were married women aged 29-31 for muscular injections and 22-30 for dressing. The nurses who did muscular injections had 10-19 years work experience and who did dressing had 1-9 years work experience. There was no significant association between the experience and considering the standards of muscle injections [NS], whereas this relation for considering the dressing standards were significant [p=0.02]. Most cases with considering the importance of standards of muscle injections and dressing did the care at medium degree [55.2% and 51.5%, respectively]. Professional experience was correlated with considering the dressing standards, while it showed no significant association with muscular injection

Management of wound infection after appendectomy: are parenteral antibiotics useful?

This study investigated the use of antibiotics in the treatment of wound infections after appendectomy. The subjects were 72 patients with post-operative wound infections at a district general hospital in Jordan. All patients received daily antiseptic dressings with povidone-iodine 10% in alcohol. The patients were randomized in a single-blind trial to receive either no antibiotics or parenteral antibiotics metronidazole and cefoxitin. There was no significant effect of antibiotic use in patients with early inflamed or severely inflamed appendicitis. However, for patients with perforated appendicitis the mean length of hospital stay and the mean frequency of change of dressings were significantly reduced. We conclude that antibiotics do not offer any advantage in post-appendectomy wound infections except for cases of perforated appendix

Bacterial flora of ulcers treated by three types of dressings.

Effect of three types of dressings on bacterial flora in ulcers is presented. Debrisan seemed to be more effective than Zinc tape and collagen sheet in reducing the number of bacterial pathogens.