Treatment of experimentally induced partial-thickness burns in rats with different silver-impregnated dressings

Purpose: To evaluate the morphometric, macroscopic and microscopic aspects of experimentally induced partial-thickness burns in rats treated with different silver-based dressings. Methods: Wistar rats were used, divided into six treatments: saline (NaCl 0.9%); silver sulfadiazine 1%; Silvercel; Mepilex Ag; Aquacel Ag and Acticoat. The animals were monitored daily and euthanized at 7, 14 and 30 days after injury induction (DAI). Results: At 7 DAI, necrosis/crust was greater in control, silver sulfadiazine and Mepilex Ag treatments, granulation tissue was induced by Aquacel Ag, polymorphonuclear infiltrate (PMN) infiltration was intensified by Mepilex Ag; mononuclear infiltrate (MN) infiltration and angiogenesis were increased by Silvercel. At 14 DAI, hemorrhage was decreased by Silvercel and Mepilex Ag, PMN infiltration increased by Acticoat. At 30 DAI, angiogenesis was greater in the Acticoat treatment and fibroblasts were increased by Acticoat and Mepilex Ag. Collagen was induced at 14 DAI by silver sulfadiazine and Aquacel Ag and, at 30 DAI, by silver sulfadiazine and Silvercel treatments. Conclusions: Silvercel and Acticoat presented better results than the other products. However, all the dressings were better than the control at some point during the process, and may contribute to the healing of partial thickness burns. Silvercel and Aquacel Ag treatments induced better cosmetic outcomes regarding wound closure and scarring.

Development and Characterization of a Hydrogel Containing Silver Sulfadiazine for Antimicrobial Topical Applications. Part II: Stability, Cytotoxicity and Silver Release Patterns

Abstract Hydrogels are interesting for use in the treatment of topical wounds due to their virtually zero toxicity, and capacity for extended release of pharmaceuticals. Silver sulfadiazine (SSDZ) is the drug of choice in the treatment of skin burns. The aim of the study was to determine cytotoxicity, antimicrobial activity and stability of a PVA hydrogel with integrated silver sulfadiazine. SSDZ-hydrogels were prepared using 10% (w/w) PVA (either 89% or 99% hydrolyzed) and 1% (w/w) silver sulfadiazine. Cellular viability was assessed via MTS assays, antimicrobial activity via disk-diffusion and accelerated stability tests were carried out with analysis at 0, 30, 60, 90 and 180 days of storage at 40 ± 2 °C and a relative humidity of 75 ± 5%. The parameters evaluated included organoleptic characteristics, moisture, swelling ability, mechanical strength, FTIR, XRD, TGA and DSC, and silver release patterns via XRD and potentiometry. Cell viability tests indicated some cytotoxicity, although within acceptable levels. After 90 days of storage, SSDZ hydrogel samples exhibited a brown coloration, probably due to the formation of Ag or Ag2O nanoparticles. The SSDZ-loaded hydrogels suffered visual and physical changes; however, these changes did not compromise its use as occlusive wound dressings or its antimicrobial properties.

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.

Wound healing activity of Allium cepaL. bulbs in a second-degree burn wound model in Holtzman rats / Actividad cicatrizante de los bulbos de Allium cepa L. en un modelo de quemadura de segundo grado en ratas Holtzman

Background: The bulb of Allium cepa Linnaeus (onion) is used in traditional medicine as an antidiabetic, antioxidant, antihypertensive, anti-inflammatory, and antihyperlipidemic, among others. The lack of information or little knowledge about the effects of Allium cepa L. on skin lesions, specifically burn wounds, arouses interest in studying its effects on these skin disorders. Objective: This study assessed the wound healing activity of Allium cepa L. on second-degree burns induced in Holtzman rats. Method: Thirty-two albino rats were randomly distributed into four groups of 8 rats each, including the Healthy group, the Control group, the Experimental group (Alliumcepa L.), and the Standard group (1% silver sulfadiazine). Burn wounds were induced, and topical treatments were performed daily for 21 days. The reduction of the burned body area (mm2) was determined during the experimental time. Albino rats were sacrificed with an excess of surgical anesthesia to obtain tissue samples for histopathological analysis. Results: Standard and experimental groups significantly reduced burned body area (p<0.01) compared to the control group. Histopathological studies showed hyperemic chorion in the Control group, fibroblasts, and collagen in the Standard group, and dermis composed of a reticular stratum of fibroblasts, collagen, and few blood vessels in the Experimental group. Conclusion: Allium cepa L. revealed wound-healing activity on burns induced in Holtzman rats and reduced the damage produced by burns

Antecedentes: El bulbo de Alliumcepa L. (cebolla) se utiliza en medicina tradicional como antidiabético, antioxidante, antihipertensivo, antiinflamatorio, anti hiperlipidémico entre otros. La falta de información o muy poco conocimiento acerca de los efectos de Allium. cepa L. en lesiones cutáneas, específicamente en las heridas por quemaduras, despierta el interés por estudiar sus efectos en estas afectaciones cutáneas. Objetivo: El objetivo de este estudio fue evaluar la actividad cicatrizante de Allium. cepa L. en quemaduras de segundo grado inducidas en ratas Holtzman. Método: Se utilizaron treinta y dos ratas albinas distribuidas al azar en cuatro grupos de ocho ratas cada uno, incluyendo el Grupo sano, el Grupo Control, el Grupo Experimental (Allium cepa L.) y el Grupo Estándar (Sulfadiazina de plata al 1%). Se indujo la herida por quemadura, y los tratamientos tópicos se realizaron diariamente durante 21 días. La reducción del área corporal quemada (mm2) se determinó durante el tiempo de experimentación, luego los animales fueron sacrificados con exceso de anestesia quirúrgica para obtener las muestras de tejidos para el estudio histopatológico. Resultados: Los grupos estándar y experimental mostraron reducción significativa en el área corporal quemada (p<0,01) comparadas al grupo control. El estudio histopatológico evidenció corion hiperémico en el grupo control; fibroblastos y colágeno en el grupo estándar y dermis integrada por un estrato reticular de fibroblastos, colágeno y pocos vasos sanguíneos en el grupo experimental. Conclusión: Alliumcepa L. reveló actividad cicatrizante en quemaduras inducidas en ratas Holtzman, y disminuyó el daño producido por las quemaduras

Curativos em queimaduras: Revisão da prática brasileira / Burns dressing: Review of Brazilian practice

OBJETIVO: Identificar quais os curativos e coberturas mais utilizados no tratamento de feridas por queimaduras no Brasil. MÉTODO: Trata-se de uma revisão narrativa, com artigos publicados no período de 2011 a 2020. A busca foi realizada na Biblioteca Virtual em Saúde a partir dos descritores: curativo, cobertura, queimadura e enfermagem, no mês de maio de 2021. RESULTADOS: Foram selecionados oito estudos para análise e, a partir da leitura desses artigos, as coberturas citadas foram: sulfadiazina de prata, ácido hialurônico e película de biocelulose, assim como gaze não aderente, hidrogel e hidrofibra de carboximetilcelulose sódica. CONSIDERAÇÕES FINAIS: Conhecer as coberturas utilizadas no tratamento de queimadura permite melhor e mais rápido resultado para o paciente, diminui os custos da instituição e favorece a equipe assistencial, que não sofre desgaste emocional, pois observa resultados positivos no tratamento das lesões.

OBJECTIVE: To identify which dressings are most used in the treatment of burn wounds in Brazil. METHODS: This is a narrative review, with articles published from 2011 to 2020. The search was carried out in the Virtual Health Library using the descriptors: dressing, coverage, burns, and nursing, in May 2021. RESULTS: Eight studies were selected for analysis, and from the reading of these articles, the coatings cited were: silver sulfadiazine, hyaluronic acid, and biocellulose film, as well as non-adherent gauze, hydrogel, and sodium carboxymethylcellulose hydrofiber. FINAL CONSIDERATIONS: Knowing the dressings used in the treatment of burns allows for better and faster results for the patient, reduces the institution's costs, and favors the care team, which does not suffer emotional distress, as it observes positive results in the treatment of injuries.

O uso de alta frequência como recurso para cicatrização de queimaduras: Um estudo de caso / The use of high frequency as a resource for burn healing: A case study

OBJETIVO: Avaliar a eficácia da alta frequência na cicatrização de feridas por queimadura durante internação hospitalar. MÉTODO: Trata-se de um estudo de caso, realizado com uma voluntária do sexo feminino, 19 anos, em um hospital de pronto-socorro. Foram aplicados a alta frequência e curativos convencionais, com a amostra única sendo dividida em área de intervenção e área controle. Foram avaliados dados clínicos e sociodemográficos, registros fotográficos pré e pós as intervenções, dimensão da área da ferida por meio de planimetria digitalizada, aspecto da cicatriz através da Escala Vancouver e a qualidade de vida por meio do questionário Burn Specific Health Scale. RESULTADOS: A área da ferida teve redução de 54% na área de intervenção e 26% na área controle. Aspectos como vascularização e flexibilidade também apresentaram discreta melhora. O questionário de qualidade de vida reduziu dois pontos, relacionados à melhora da sensibilidade da pele e aos cuidados com a queimadura. CONCLUSÃO: A utilização de alta frequência combinada com uso de curativos durante a internação hospitalar mostrou resultados favoráveis em comparação a apenas o uso de curativos na cicatrização de feridas. Contudo, mais estudos são necessários.

OBJECTIVE: To evaluate the effectiveness of the high frequency in the healing of burn wounds during hospitalization. METHODS: This is a case study, conducted with a 19-year-old female volunteer, in an emergency room. The high frequency and conventional dressings were applied, with the single sample being divided into the intervention area and the control area. Clinical and sociodemographic data, photographic records before and after the interventions, dimension of the wound area through digitalized planimetry, the aspect of the scar through the Vancouver Scale and quality of life through the Burn Specific Health Scale questionnaire were evaluated. RESULTS: The wound area decreased 54% in the intervention area and 26% in the control area. Aspects such as vascularity and flexibility also showed a slight improvement. The quality of life questionnaire reduced two points, related to the improvement of skin sensitivity and care for burns. CONCLUSION: The use of the high frequency combined with the use of dressings during hospitalization showed favorable results compared to only the use of dressings in wound healing. However, more studies are needed.

Therapy for patients with burns - an integrating review

SUMMARY OBJECTIVE: to identify, through an integrative review, national studies published over the last ten years highlighting products and therapies used in burns. METHODS: integrative research with studies published in the last ten years. Including clinical studies describing the use of the already established or innovative therapies in burns and the results obtained, published in national journals in the last ten years. Excluding articles published before 2007 and those that did not present results regarding the use of products in burns. RESULTS: ten articles that met the inclusion criteria were selected. Collagenase, 1% silver sulfadiazine, and porous cellulose membrane were some of the therapies cited. CONCLUSION: the casuistry was low; however, the good results obtained with porous cellulose membrane and silver nanocrystalline dressing are highlighted, since they were used in a larger number of patients in the studies evaluated.

RESUMO OBJETIVO: Identificar, por meio de revisão integrativa, estudos nacionais publicados nos últimos dez anos que destaquem produtos e terapêuticas utilizados nas queimaduras. MÉTODOS: Pesquisa integrativa com estudos publicados nos últimos dez anos. Incluídos os estudos clínicos que descreveram a utilização de terapias já consagradas ou inovadoras em queimaduras e os resultados obtidos e publicados em periódicos nacionais nos últimos dez anos. Excluídos os artigos publicados antes de 2007 e os que não apresentaram resultados quanto ao uso de produtos nas queimaduras. RESULTADOS: Selecionados dez artigos que atenderam aos critérios de inclusão, sendo colagenase, sulfadiazina de prata 1% e membrana celulósica porosa algumas das terapias descritas. CONCLUSÕES: A casuística foi baixa, porém, ressaltam-se os bons resultados obtidos com a membrana celulósica porosa e o curativo com prata nanocristalina, em virtude de terem sido utilizados em um maior número de pacientes nos estudos avaliados.

Tissue healing efficacy in burn patients treated with 1% silver sulfadiazine versus other treatments: a systematic review and meta-analysis of randomized controlled trials

Abstract This study aims to evaluate tissue healing efficacy in burn patients treated with 1% silver sulfadiazine versus other treatments. This is a systematic literature review and meta-analysis of randomized clinical trials performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) and PICO strategy, registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42017081057. The review found 71 studies in MEDLINE/Pubmed, 1 in Clinical Trials, 19 in the Cochrane Library, and 4 in LILACS in five manual searches. Of these, 81 studies were pre-selected. After independent analysis by two reviewers, only 11 studies met the inclusion criteria for the review. All studies (n = 11) using alternative treatments to silver sulfadiazine were shown to be superior in the mean time for complete wound healing, with statistically significant differences between experimental and control groups (p <0.00001); mean difference (- 4.26), 95% CI [- 5.96, - 2.56].

U-net based metal segmentation on projection domain for metal artifact reduction in dental CT

Unlike medical computed tomography (CT), dental CT often suffers from severe metal artifacts stemming from high-density materials employed for dental prostheses. Despite the many metal artifact reduction (MAR) methods available for medical CT, those methods do not sufficiently reduce metal artifacts in dental CT images because MAR performance is often compromised by the enamel layer of teeth, whose X-ray attenuation coefficient is not so different from that of prosthetic materials. We propose a deep learning-based metal segmentation method on the projection domain to improve MAR performance in dental CT. We adopted a simplified U-net for metal segmentation on the projection domain without using any information from the metal-artifacts-corrupted CT images. After training the network with the projection data of five patients, we segmented the metal objects on the projection data of other patients using the trained network parameters. With the segmentation results, we corrected the projection data by applying region filling inside the segmented region. We fused two CT images, one from the corrected projection data and the other from the original raw projection data, and then we forward-projected the fused CT image to get the fused projection data. To get the final corrected projection data, we replaced the metal regions in the original projection data with the ones in the fused projection data. To evaluate the efficacy of the proposed segmentation method on MAR, we compared the MAR performance of the proposed segmentation method with a conventional MAR method based on metal segmentation on the CT image domain. For the MAR performance evaluation, we considered the three primary MAR performance metrics: the relative error (REL), the sum of square difference (SSD), and the normalized absolute difference (NAD). The proposed segmentation method improved MAR performances by around 5.7% for REL, 6.8% for SSD, and 8.2% for NAD. The proposed metal segmentation method on the projection domain showed better MAR performance than the conventional segmentation on the CT image domain. We expect that the proposed segmentation method can improve the performance of the existing MAR methods that are based on metal segmentation on the CT image domain.

Speech Perception and Gap Detection Performance of Single-Sided Deafness under Noisy Conditions

BACKGROUND AND OBJECTIVES: Many studies have reported no benefit of sound localization, but improved speech understanding in noise after treating patients with single-sided deafness (SSD). Furthermore, their performances provided a large individual difference. The present study aimed to measure the ability of speech perception and gap detection in noise for the SSD patients to better understand their hearing nature.

Segmental Spinal Dysgenesis–“Redefined”

STUDY DESIGN: Retrospective single institutional observational study. PURPOSE: Segmental spinal dysgenesis (SSD), a complex spinal dysraphic state caused by notochord malformation disorders, is named after its morphological presentation where a spine segment is dysgenetic, malformed or absent. This study’s objective was to examine and reassess SSD imaging findings and correlate them with an embryological explanation. OVERVIEW OF LITERATURE: Scott and his colleagues defined SSD as segmental agenesis or dysgenesis of the lumbar or thoracolumbar vertebrae and underlying spinal cord. Tortori-Donati and his colleagues defined it as a morphologic continuum ranging from hypoplasia to an absent spinal cord segment. METHODS: Fifteen children, whose imaging findings and clinical features were consistent with SSD, were included in the study. Magnetic resonance imaging (MRI) was performed per institutional spine protocol. RESULTS: Five children (33.3%) presented with a high-ending bulbous cord with no caudal segment, six (40%) presented with a dorsal or lumbar segmental dysgenetic cord with a low-lying, bulky caudal cord but without significant spinal canal narrowing, and four (26.6%) presented with segmental caudal dysgenesis with severe kyphoscoliosis, gibbus deformity, and spinal canal narrowing with a normal distal segment (normal or low-lying). CONCLUSIONS: SSD is a complex spinal anomaly in children requiring clinical-radiological assessment followed by multidisciplinary management based on the extent and severity of the dysgenetic cord and the type of SSD. MRI plays a crucial role in both diagnosing and classifying SSD prior to surgical treatment to prevent further impairment.

Aplicação de membranas de colágeno contendo ácido úsnico incorporado em lipossomas no processo de cicatrização de queimaduras em áreas especiais / Application of collagen membranes containing usnic acid incorporated into liposomes in the burns healing process in special areas / Aplicación de membranas de colágeno que contienen ácido usínico incrustado en liposomas en el proceso de cicatrización de quemaduras en áreas especiales

Objetivo: Verificar a cicatrização de queimaduras em áreas especiais através da aplicação da membrana bioativa de colágeno contendo ácido úsnico incorporado em lipossomas. Método: Trata-se de um estudo de intervenção, descritivo e de campo, de comparação intraindividual, com abordagem quantitativa. A coleta de dados foi realizada na Unidade de Tratamento de Queimados (UTQ) do Hospital de Urgência de Sergipe (HUSE) durante três meses. A amostra foi composta por nove pacientes adultos, de ambos os sexos, apresentando duas áreas queimadas, selecionadas aleatoriamente em dois grupos: teste, no qual foram aplicadas as membranas bioativas; e controle, áreas submetidas à aplicação de óleo à base de ácido graxo essencial ou sulfadiazina de prata, padrão-ouro no tratamento de queimaduras. As imagens foram captadas por registro fotográfico padronizado e, em seguida, foi realizada a análise descritiva da queimadura, bem como o cálculo da área queimada, através do programa Image J®, antes e após intervenção. Resultados: Notou-se maior presença de tecido de granulação na área teste, bem como maior vascularização, com cicatrização mais homogênea e mais avançada, enquanto a área controle (C14) ainda se apresentava com mais exsudato e deposição de fibrina. Houve padrão de redução da área das queimaduras nos dois grupos analisados, com área mais reduzida no grupo teste (de 2,769 cm2 para 1,258 cm2) em relação ao controle (de 2,882 cm2 para 2,091 cm2). Conclusão: Observou-se melhora no aspecto clínico das lesões, com cicatrização mais acelerada e fisiológica nas áreas teste, em relação à área controle.

Objective: To verify the burns healing in special areas through the application of the bioactive membrane of collagen containing usnic acid incorporated into liposomes. Methods: This is an interventional, descriptive and field study, of individual comparison, with a quantitative approach. Data collection was performed at the Burn Treatment Unit of Sergipe Urgency Hospital during three months. The sample consisted of nine adult patients, of both sexes, presenting two burned areas, randomly selected in two groups: test, where the bioactive membranes were applied; and control, areas subject to the application of oil based on essential fatty acid or silver sulfadiazine, gold standard in burns treatment. The images were captured by the standardized photographic record and then the descriptive analysis of the burn was carried out, as well as the calculation of the burn area, through the Image J® program, before and after intervention. Results: There was a greater presence of granulation tissue in test area, as well as greater vascularization, with more homogeneous and more advanced healing, whereas the control area still presented with more exudate and fibrin deposition. There was reduction of burn area between groups, with lower area in test group (2.769 cm2 to 1.258 cm2) in relation to control group (from 2.882 cm2 to 2.091 cm2). Conclusion: It was observed an improvement in the clinical aspect of the lesions, with a faster and physiological repair of scar in test areas in relation to control area.

Objetivo: Verificar la curación de quemaduras en áreas especiales mediante la aplicación de la membrana de colágeno bioactivo que contenía ácido usínico incorporado en los liposomas. Método: Se trata de una intervención, un estudio descriptivo y de campo, con una comparación intra-individual, con un enfoque cuantitativo. La recolección de datos se realizó en la unidad de tratamiento de quemaduras del hospital de emergencia de Sergipe durante tres meses. La muestra consistió en nueve pacientes adultos de ambos sexos, presentando dos áreas quemadas, seleccionadas aleatoriamente en dos grupos: test, donde se aplicaron las membranas bioactivas; y control, áreas sometidas a la aplicación de aceites esenciales a base de ácidos grasos o sulfadiazina de plata, estándar de oro en el tratamiento de quemaduras. Las imágenes fueron capturadas por registros fotográficos estandarizados y luego se realizó el análisis descriptivo de la quemadura, así como el cálculo del área quemada, a través del programa Image J®, antes y después de la intervención. Resultados: La mayor presencia de granulación de tejido en el área de prueba, así como la vascularización, con más homogeneous y más avanzado curativo, el seguimiento del área de control con más exudación y fibrin deposición. (2,769 cm2 a 1,258 cm2) en relación al grupo de control (de 2,882 cm2 a 2,091 cm2). Conclusión: Este estudio demostró una mejora en el aspecto clínico de las lesiones, con un patrón más acelerado y fisiológico de la reparación del tejido en las áreas de la prueba.

Comparación de dos técnicas de curación en pacientes quemados pediátricos / Comparison of two healing techniques in pediatric burned patients

Introducción: Existen varias curaciones para quemaduras. La sulfadiazina de plata se ha usado por años pero las membranas microporosas son cada vez más preferidas. Objetivos: Comparar la eficiencia de las membrana microporosa (Telfa Clear®) versus sulfadiazina de plata (Platsul®) en menores de 15 años hospitalizados por quemadura. Pacientes y Métodos: Estudio de cohorte retrospectivo de 87 pacientes, dividido en 2 grupos comparables en extensión y profundidad de la quemadura, edad y sexo. Durante enero a diciembre 2007 se curaron 52 pacientes con Platsul® y desde enero a octubre 2008 se curaron 35 con Telfa Clear®. Se evalúa tiempos y extensión de reepitelización, porcentaje de injertos, costos, días de hospitalización, número de curaciones, complicaciones, almacenamiento-estabilidad y costos. Estadística no paramétrica para el análisis univariado y regresión logística multivariado en Stata 11.2. Resultados: Los pacientes curados con Platsul® se injertaron más tardíamente y presentan más curaciones. Platsul® es peor evaluado por su almacenamiento-estabilidad y mayores costos. No hay diferencia en la incidencia de infección. Conclusiones: Ambas Técnicas son eficientes en permitir reepitelización, pero Platsul® puede demorar el injerto. La Telfa Clear® es mejor evaluado por el equipo de salud en cuanto a almacenamiento y estabilidad. El menor costo de Telfa Clear® es una ventaja.

Introduction: There are several dressings for burns. Silver sulfadiazine has been used for years but microporous membranes are increasingly preferred. Objectives: To compare the efficiency of microporous membrane (Telfa Clear®) versus silver sulfadiazine (Platsul®) in children younger than 15 years old hospitalized for burns. Patients and Methodology: Retrospective cohort study of 87 patients, divided into 2 comparable groups in extent and depth of the burn, age and sex. During January to December 2007, in 52 patients Platsul® were use and in 35 patients Telfa Clear® were use from January to October 2008. The time and extent of re-epithelialization, percentage of grafts, costs, length of stay, number of dressing change, complications, storage-stability and costs are evaluated. Non-parametric statistics were used for univariate analysis and logistic regression for multivariate analysis en Stata 11.2. Results: Platsul® was associate to a later graft and had a greater number of dressing changes. Platsul® is worst rated for its storage-stability and higher costs. No difference in infection rate was observed. Conclusions: Both techniques are efficient in allowing re-epithelialization, but burns treated with Platsul® were grafted later than when Telfa Clear® was used. Telfa Clear® is best evaluated by the health team in terms of storage and stability. The cost of Telfa Clear® is presented as an advantage.

Ação cicatrizante da nanopartícula de prata com norbixina em queimaduras / Healing action of silver nanoparticle with norbixin on burns

Introdução: A queimadura é uma injúria que altera a integridade da pele, decorrente de traumas térmicos. Dentre os compostos não convencionais utilizados na cicatrização de feridas estão a norbixina e as preparações com prata. Objetivo: avaliar a ação cicatrizante da nanopartícula de prata associada à norbixina em queimaduras de Mus musculus. Métodos: Inicialmente, preparou-se uma solução nanoprata/norbixina e a partir desta obteve-se o gel teste. Posteriormente dividiu-se os animais em 3 grupos, sendo negativo (sem tratamento), positivo (sulfadiazina de prata) e teste (gel teste). Nestes animais houve a indução das queimaduras. No 7º e 14º dia realizou-se a eutanásia e os tecidos lesionados foram coletados para análise microscópica. Resultado: Verificou-se potencial vantagem do grupo teste em relação ao negativo e igualdade comparada ao positivo. Conclusão: A nanopartícula de prata associada à norbixina representa uma fonte alternativa para a cicatrização de queimaduras. (AU)

Introduction: Burning is an injury that alters the integrity of the skin, due to thermal trauma. Among the non-conventional compounds used in wound healing are norbixin and silver preparations. Objective: to evaluate the cicatrizing action of silver nanoparticle associated with norbixina in Mus musculus burns. Methods: Initially, a nanoprata / norbixin solution was prepared and from this solution the test gel was obtained. Afterwards the animals were divided into 3 groups, being negative (without treatment), positive (silver sulfadiazine) and test (gel test). In these animals, there was the induction of burns. On the 7th and 14th day, euthanasia was performed and the injured tissues were collected for microscopic analysis. Result: There was a potential advantage of the test group in relation to negative and equality compared to positive. Conclusion: The silver nanoparticle associated with norbixin represents an alternative source for the healing of burns. (AU)

Dermoabrasión como alternativa de tratamiento en quemaduras tipo AB en pacientes pediátricos. Experiencia del Servicio de Cirugía Plástica, Unidad de Quemados del Hospital Pediátrico Fernando Bareyro / Dermoabrasion for treatment in pediatric burns

La dermoabrasión en combinación con sulfadiazina de plata y lidocaína, como tratamiento para las quemaduras AB en pacientes pediátricos, presenta ventajas en cuanto a los resultados que ofrece, ya que es un método sencillo y reproducible. Como desventaja presenta que se requieren varias sesiones de tratamiento y en algunos casos, donde se produjo profundización de la lesión, se requirió cobertura con injerto de pie

Curativos de prata iônica como substitutos da sulfadiazina para feridas de queimaduras profundas: relato de caso / Ionic silver dressings as substitute for sulfadiazine for deep burn wounds: case report / Apósitos de plata iónica como sustitutos de sulfadiazina en las heridas por quemaduras profundas: reporte de caso

OBJETIVO: Este artigo tem por objetivo relatar as possíveis vantagens de curativos na forma de lâminas impregnadas com prata iônica (Atrauman®, Mepilex border Ag®, Mepilex-Ag® e Silvercel não aderente®) como agentes tópicos substitutos do creme de sulfadiazina de prata 1% nas queimaduras profundas. RELATO DOS CASOS: Foram tratados 31 pacientes. O Atrauman-Ag® foi empregado em 15 pacientes, o Mepilex border Ag® em três, Mepilex-Ag® em quatro e o Silvercel não aderente® em nove pacientes. Do total, relatamos a utilização destes novos curativos em dois pacientes do estudo com diagnóstico inicial de queimadura profunda. Em nenhum caso foram observados sinais de infecção nas feridas, apesar das trocas de curativos terem sido realizadas entre 4 a 7 dias, mesmo nas queimaduras de espessura total. O conforto propiciado por estes curativos foi evidente, minimizando o estresse e dor e as feridas de espessura parcial se apresentaram com sinais evidentes de rápida epitelização. CONCLUSÃO: Neste estudo preliminar, notamos que todos pacientes se beneficiaram de modo significativo do uso de curativos modernos com lâminas impregnadas por prata iônica quando comparados ao curativo convencional de sulfadiazina. Além da proteção contra infecção, mesmo nas queimaduras de espessura total, eles oferecem a enorme vantagem de as trocas serem espaçadas entre 4 a 7 dias, quando comparados à sulfadiazina, que exige a troca diária dos curativos, minimizando dor e desconforto aos pacientes e também o estresse da equipe de saúde envolvida nos Centros de Tratamento de Queimados.(AU)

OBJECTIVES: This article aims to evaluate the efficacy, and possible advantages of dressings in the form of ionic silver impregnated sheets (Atrauman Ag®, Mepilex Border Ag®, Mepilex - Ag® and Silvercel non - adherent®) as a local substitute agents for the cream of silver sulfadiazine-1% on deep burns. CASE REPORTS: 31 patients were treated. Atrauman-Ag® was used in 15 patients, Mepilex Border Ag® in three, Mepilex-Ag® in four and Silvercel non-adherent® in nine patients. Of the total, we report the use of these new dressings in two patients. In no case were signs of wound infection, even though dressing changes were performed between 4 and 7 days, also in total thickness burns. The comfort provided by these dressings was evident, minimizing stress and pain and partial thickness wounds presented with clear signs of rapid epithelization. CONCLUSION: In this preliminary study, we noticed that all patients benefited significantly from the use of new dressings with ionic silver impregnated sheets when compared to the conventional dressing of sulfadiazine cream. In addition to protection against infection, even in full-thickness burns, they offer the significant advantage that the changes of dressings are spaced between 4 and 7 days. Compared to sulfadiazine, which requires the daily exchange of dressings, they minimize pain and discomfort to patients, and also the stress to the health team involved in the treatment of the Burn Treatment Centers.(AU)

Objetivos: Este artículo tiene como objetivo evaluar la eficacia preliminar y los beneficios potenciales de la curación en forma de láminas impregnadas con plata iónica (Atrauman®, Mepilex Border Ag®, Mepilex-Ag® y Silvercel no aderente®) como sustitutos de crema de sulfadiazina de plata al 1% en quemaduras profundas. Casos Clínicos: Se han tratado 31 pacientes. El Atrauman-Ag® se utilizó en 15 pacientes, Mepilex Border Ag® en tres, Mepilex Ag® en cuatro y Silvercel no adherente® en nueve pacientes. Del total, se presenta la utilización de estos nuevos apósitos en dos pacientes. En ningún caso se observaron signos de infección en las heridas, a pesar de los cambios de apósito se llevaron a cabo entre los 4 y 7 días, incluso en quemaduras de espesor total. La comodidad ofrecida por éstos curación era evidente, lo que minimiza el estrés y el dolor y las heridas de espesor parcial se presentan con signos claros de una rápida epitelización. Conclusión: En este estudio preliminar, se observó que todos los pacientes se beneficiaron significativamente del uso de apósitos impregnados con plata iónica en comparación con sulfadiazina. Además de la protección contra la infección, incluso en quemaduras de espesor total, ofrecen la gran ventaja de las cambios están separadas de 4 a 7 días en comparación con sulfadiazina, que requiere el cambio diario de vendajes, minimizando dolor y malestar a los pacientes, e también el estrés del personal de salud de los centros de tratamiento de Queimados.(AU)

Efeitos do tratamento tópico com ácido hialurônico 0, 2% em queimadura de segundo grau: um relato de experiência / Effects of topical treatment with hyaluronic acid 0, 2% in second-degree burn: an experience report / Efectos del tratamiento tópico con ácido hialurónico 0, 2% quemadura de segundo grado: un relato de experiencia

OBJETIVO: Testar o uso tópico diário e prolongado na cicatrização de queimaduras em idoso, observando-se os parâmetros: tempo de cicatrização, presença ou ausência de cicatrizes hipertróficas e o efeito estético final resultante do tratamento. RELATO DE CASO: Trata-se de um relato de caso realizado em clínicaescola de uma Faculdade de Enfermagem do interior paulista. O estudo descreve o tratamento empregado em lesão por queimadura de segundo grau em uma paciente de 64 anos, que sofreu queimadura de espessura parcial por escaldadura. Foi realizado registro fotográfico e a avaliação da ferida. Inicialmente, a paciente recebeu o tratamento convencional com sulfadiazina de prata 1% durante sete dias. Como não houve resolução, iniciou-se o tratamento com ácido hialurônico (AH) 0,2% diariamente. Com 14 dias de tratamento, observou-se completa reepitelização. Após 27 dias do início do tratamento, a cicatriz apresentou-se com melhora de hiperpigmentação e não havia sinais de hipertrofia. Não foram observados eventos adversos locais ou sistêmicos durante o período de estudo da lesão. CONCLUSÃO: Os dados permitem concluir que a aplicação tópica de AH 0,2% em queimaduras de paciente idoso contribuiu para acelerar a cicatrização, melhorou a evolução do tratamento e o resultado estético.

OBJECTIVE: To test daily and prolonged topical use in the healing of burns in the elderly, considering the parameters: time of healing, presence or absence of hypertrophic scars and the final aesthetic effect resulting from the treatment. CASE REPORT: This is a case report carried out in the clinical school of a School of Nursing at São Paulo state. The study describes the treatment used in second-degree burn injury in a 64-year-old patient who suffered partial thickness burn by scald. Photographic recording and wound evaluation were performed. Initially, the patient received conventional treatment with 1% silver sulfadiazine for seven days. As there was no resolution, treatment with 0.2% hyaluronic acid (HA) was started daily. At 14 days of treatment, complete re-epithelization was observed. After 27 days, the scar presented with improvement of hyperpigmentation and there were no signs of hypertrophy. No local or systemic adverse events were observed during the study period of the lesion. CONCLUSION: The data allow us to conclude that the topical application of AH 0.2% in burns of elderly patients contributed to accelerate healing, improved treatment evolution and aesthetic result.

Experimental burns: Comparison between silver sulfadiazine and photobiomodulation / Queimadura experimental: comparativo entre sulfadiazina de prata e fotobiomodulação

Summary Objective: To analyze morphological characteristics and organization of the collagen fibers of third degree burns from scalding compared to laser therapy and silver sulfadiazine, the latter considered as the gold standard. Method: Were selected 12 animals (Rattus norvegicus) also divided into three groups (control group [CG] - untreated burns; sulfadiazine group [SG] - burns were treated with silver sulfadiazine at 1%; laser group [LG] - burns were treated with photobiomodulation). The scald burns were carried out by using PVC mold, and the material collected on the 14th day after burn was prepared for morphological and optical retardation analysis for evaluation of inflammatory infiltrates and collagen organization, respectively. Results: On the 14th day, the laser and sulfadiazine groups had mild inflammatory response, while the control group showed an intense inflammatory process, with statistical significance between laser and control groups, but not between sulfadiazine and control groups. Laser and sulfadiazine groups no longer had granulation tissue, opposite to what was seen in the control group. The presence of hair follicles and ulcer did not significantly differ between groups. The optical retardation of collagen fibers was higher in sulfadiazine group, followed by laser and control groups. As for systemic effect, we were able to identify it by simply analyzing the presence or absence of granulation tissue. Conclusion: Morphologically, the laser or silver sulfadiazine treatments were similar and both provided better organization of collagen fibers in relation to the untreated group. However, the sulfadiazine group modulated the deposition of collagen fibers more efficiently than the laser group.

Resumo Objetivo: Analisar características morfológicas e organização das fibras colágenas de queimaduras de terceiro grau provocadas por escaldo em relação à terapia com laser e àquela considerada padrão-ouro, a sulfadiazina de prata. Método: Foram selecionados 12 animais (Rattus norvegicus), divididos igualmente em três grupos (grupo controle [GC] - queimaduras não tratadas; grupo sulfadiazina [GS] - queimaduras tratadas com sulfadiazina de prata 1%; grupo laser [GL] - queimaduras tratadas com fotobiomodulação). As queimaduras foram realizadas por escaldo com a utilização de molde de PVC, e o material coletado no 14º dia pós-queimadura foi preparado para análise morfológica e de retardo óptico, para avaliação do infiltrado inflamatório e da organização do colágeno, respectivamente. Resultados: No 14º dia, os grupos laser e sulfadiazina apresentaram resposta inflamatória leve, enquanto o grupo controle apresentou processo inflamatório intenso, havendo significância estatística entre os grupos laser e controle, mas não entre os grupos sulfadiazina e controle. Enquanto os grupos laser e sulfadiazina não apresentavam mais tecido de granulação, o grupo controle ainda apresentava. A presença de folículo piloso e de úlcera não diferiu significantemente entre os grupos. O retardo óptico das fibras colágenas foi maior no grupo sulfadiazina, seguido dos grupos laser e controle. Apenas a análise da presença ou ausência de tecido de granulação permitiu identificar o efeito sistêmico. Conclusão: Morfologicamente, os tratamentos com laser ou sulfadiazina de prata foram similares e ambos proporcionaram maior organização das fibras colágenas em relação ao grupo não tratado. Entretanto, o grupo sulfadiazina modulou a deposição das fibras colágenas mais eficientemente que o grupo laser.

One-Year Serial Follow-up Magnetic Resonance Imaging Study of RigidFix for Femoral Fixation in Anterior Cruciate Ligament Reconstruction

PURPOSE: To assess graft slippage at the site of femoral fixation by follow-up magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) reconstruction with a four-strand autogenous hamstring tendon using RigidFix (DePuy Mitek). MATERIALS AND METHODS: Twenty-one subjects diagnosed with ACL rupture underwent ACL reconstruction using hamstring autograft with the transtibial technique. RigidFix was used for femoral fixation and Intrafix and washer screw were used for tibial fixation. Follow-up MRIs were taken immediately after surgery and at 1, 3, 6, and 12 months after surgery. Slippage of the graft and breakage of the RigidFix cross-pin were assessed. Side-to-side difference (SSD) on stress radiographs was measured to assess residual laxity. RESULTS: Mean slippage of the graft was 0.21±0.31 mm at one year after surgery. Cross-pin breakage was noted in two subjects: in one subject, immediately after surgery and in the other subject, at 6 months after surgery. Mean SSD was 1.32±1.07 mm at the last follow-up. The correlation coefficient between graft slippage and SSD was 0.131 (p=0.571). CONCLUSIONS: RigidFix is a stable fixation device for hamstring autograft with minimally statistically significant but clinically insignificant graft slippage. Cross-pin breakage did not affect the clinical outcomes. Careful preparation of the graft is needed for performing the technique correctly.

Adipose tissue stromal vascular fraction in the treatment of full thickness burns in rats

ABSTRACT PURPOSE: To analyze the healing effects of stromal vascular fraction (SVF) application compared to wound dressing with 2% silver sulfadiazine in full thickness burn wounds in rats. METHODS: Animals were divided into two groups: 2% silver sulfadiazine group and SVF group. Both groups received occlusive bandages while the first one was treated with 2% silver sulfadiazine and the latter was treated with injections of SVF prepared from adipose tissue extracted from an animal donor. The animals were accompanied through 3, 7 and 30 days for evaluation of macroscopic, microscopic and morphometric aspects. RESULTS: On day three, a significant increase (p<0.05) of infiltration of polymorphonuclear, fibrin formation and fibroblasts migration in SVF group was observed. On the 7th day the mononuclear infiltrate, angiogenesis, collagen and fibroblasts were significantly increased in the SVF group (p<0.05). At 30 days significantly increased collagen deposition was observed in the SVF group (p<0.05) . CONCLUSION: Adipose tissue derived stromal vascular fraction injections promotes better wound repair than 2% silver sulfadiazine in the treatment of full thickness burn in rats during the evaluated experimental period.