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.

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.

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.

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].

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)

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.

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

Hematological change parameters in patients with pressure ulcer at long-term care hospital / Alterações dos parâmetros hematológicos em pacientes portadores de úlcera por pressão em um hospital de longa permanência

Objective To assess factors associated with the development of pressure ulcers, and to compare the effectiveness of pharmacological treatments. Methods The factors associated with the development of pressure ulcers were compared in lesion-carrying patients (n=14) and non-carriers (n=16). Lesion-carrying patients were treated with 1% silver sulfadiazine or 0.6IU/g collagenase and were observed for 8 weeks. The data collected was analyzed with p<0.05 being statistically relevant. Results The prevalence of pressure ulcers was about 6%. The comparison of carrier and non-carrier groups of pressure ulcers revealed no statistically significant difference in its occurrence with respect to age, sex, skin color, mobility, or the use of diapers. However, levels of hemoglobin, hematocrit, and red blood cells were found to be statistically different between groups, being lower in lesion-carrying patients. There was no significant difference found in lesion area between patients treated with collagenase or silver sulfadiazine, although both groups showed an overall reduction in lesion area through the treatment course. Conclusion Hematologic parameters showed a statistically significant difference between the two groups. Regarding the treatment of ulcers, there was no difference in the area of the lesion found between the groups treated with collagenase and silver sulfadiazine. .

Objetivo Avaliar os fatores associados ao desenvolvimento da úlcera por pressão e comparar a efetividade de tratamentos farmacológicos. Métodos Os fatores associados ao desenvolvimento de úlcera por pressão foram comparados entre pacientes portadores (n=14) e não portadores (n=16) da lesão. Os pacientes com a ferida foram tratados com sulfadiazina de prata 1% ou colagenase 0,6UI/g, sendo acompanhados durante 8 semanas. Os dados coletados foram analisados considerando-se estatisticamente significativo se p<0,05. Resultados A prevalência de úlcera por pressão foi de cerca de 6%. A comparação entre os grupos de portadores e não portadores de úlcera por pressão não revelou diferença estatística significativa entre ocorrência desta segundo idade, sexo, cor da pele, mobilidade e uso de fralda. Por outro lado, os valores de hemoglobina, hematócrito e hemácias foram estatisticamente diferentes entre os grupos, sendo menor naqueles pacientes portadores da lesão. Não houve diferença significativa na área da lesão entre aqueles pacientes tratados com colagenase ou sulfadiazina de prata, embora ambos os tratamentos tenham evidenciado uma redução média da área da lesão. Conclusão Os parâmetros hematológicos apresentaram diferença estatística entre os dois grupos avaliados, ao contrário das demais variáveis analisadas. Em relação ao tratamento das úlceras, não houve diferença na área da lesão na comparação entre a colagenase e a sulfadiazina. .

O efeito da sulfadiazina de prata, extrato de ipê-roxo e extrato de barbatimão na cicatrização de feridas cutâneas em ratos / Effects of silver sulfadiazine, ipê roxo (Tabebuia avellanedae) extract and barbatimão (Stryphnodendron adstringens) extract on cutaneous wound healing in rats

OBJETIVO: Estudo morfológico do efeito da sulfadiazina de prata, extrato de ipê-roxo e extrato de barbatimão na cicatrização de feridas cutâneas. MÉTODOS: Utilizou-se 96 ratos Wistar. Todos foram submetidos à ligadura da veia femoral direita para produzir hipertensão venosa. Após 30 dias foi confeccionada a ferida cutânea. Dividiu-se os animais em quatro grupos. O grupo S recebeu aplicação tópica de sulfadiazina de prata; o grupo IR, extrato de ipê-roxo; o grupo B, extrato de barbatimão e o grupo C, aplicação de solução salina a 0,9 por cento, diariamente, nas feridas por um período de sete, 14 e 30 dias. A análise histológica avaliou: proliferação vascular, neutrófilos, linfócitos, fibroblastos, fibras colágenas e epitelização. RESULTADOS: Os achados macroscópicos mostraram epitelização completa aos 14 dias em todos os animais dos grupos S, IR e B. Na análise histológica aos 14 dias, apenas o grupo C ainda apresentava epitelização incompleta em seis animais; neste mesmo período houve diferença estatisticamente significativa entre o grupo controle e os demais grupos quanto ao processo inflamatório e neovascularização. Em relação à presença de fibroblastos e colágeno, houve diferença estatisticamente significativa entre o grupo controle e os demais grupos aos 30 dias. CONCLUSÃO: A análise dos resultados morfológicos permite inferir que o grupo S, IR e B foram favorecidos no processo de cicatrização das feridas cutâneas, quando comparados com o controle.

OBJECTIVE: Morphological study of effects of silver sulfadiazine, Tabebuia avellanedae (ipê-roxo) extract and Stryphnodendron adstringens (barbatimão) extract on cutaneous wound healing was done. METHODS: Ninety six Wistar rats were used. All animals underwent a femoral right vein ligation to induce a venous hypertension. Thirty days after the cutaneous wound was done, they were divided into groups of four animals. Group S received silver sulfadiazine topical application; group IR, Tabebuia avellanedae extract topical application; group B received Stryphnodendron adstringens extract topical application and group C received physiological solution topical application, every day for a period of seven, 14 and 30 days. Histology analyzed the presence vascular proliferation, neutrophil and lymphocite, fibroblast, collagen fiber and epithelization. RESULTS: The macroscopic analysis showed complete epithelization at 14 days in group S, IR e B. The histological data at 14 days of observation only group C still showed incomplete epithelization in six animals. At the same period there was a statistic significant difference between the control group and the others groups as inflammation process and neovascularization. About the presence fibroblasts and collagen, there was statistic significant difference between the control group and the others groups at the 30 days because at this period the control group still showed fibroblasts and collagen lower when compared to the others groups. CONCLUSION: The morphological analysis of the results permits to infer that the group S, IR and B had a better healing of skin wounds, when compared with the control.

Comparison of the Efficacies of Silver-Containing Dressing Materials for Treating a Full-Thickness Rodent Wound Infected by Methicillin-resistant Staphylococcus aureus / 대한진단검사의학회지

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) may cause infections during wound dressing. We aimed to compare the antibacterial activities and wound-healing effects of commercially available silver-coated or silver-impregnated wound dressings on MRSA-infected wounds. METHODS: Full-thickness skin defects were made on the back of rats (N=108) and were infected with MRSA. The rats were divided into the following 6 groups according to the dressing used for the wounds: nanocrystalline silver (Acticoat(R)), silver carboxymethylcellulose (Aquacel(R)-Ag), silver sulfadiazine (Medifoam silver(R)), nanocrystalline silver (PolyMem silver(R)), silver sulfadiazine (Ilvadon(R)), and 10% povidone iodide (Betadine(R)). We analyzed the wound sizes, histological findings, and bacterial colony counts for the groups. We also inoculated the silver materials on Mueller-Hinton agar plates containing MRSA and compared the inhibition zones in the agar plates. RESULTS: The order of the rate of wound-size decrease was Acticoat(R)>Aquacel(R)-Ag>PolyMem silver(R)>Medifoam silver(R)>Ilvadon(R)>Betadine(R). The histological findings revealed that the Acticoat(R) showed more reepithelialization and granulation tissue formation and less inflammatory cell infiltration than the other materials. The order of the time required for wound healing was Acticoat(R)>Aquacel (R)-Ag>PolyMem silver(R)>Ilvadon(R)>Medifoam silver(R)>Betadine(R). The bacterial colony counts reduced in all the groups, except in the Medifoam silver(R) group. The order of the size of the inhibition zone was Acticoat(R)>Aquacel(R)-Ag>Ilvadon(R)>PolyMem silver(R)>Betadine(R)>Medifoam silver(R). CONCLUSIONS: Silver-coated or silver-impregnated wound dressings can be used for treating MRSAinfected wounds. Considering its superior efficacy in comparison to the efficacies of other silver-coated or silver-impregnated wound dressings, Acticoat(R) should be preferentially used for the treatment of MRSA-infected skin wounds.

Fototerapia (LEDs 660/890nm) no tratamento de úlceras de perna em pacientes diabéticos: estudo de caso / Phototherapy (LEDs 660/890nm) in the treatment of leg ulcers in diabetic patients: case study

Avaliou-se a fototerapia na cicatrização de úlceras de perna (UP) mistas em dois pacientes diabéticos (tipo 2), hipertensos. O aparelho apresentava sonda 1 (S1) (1 LED de 660nm, 5mW) aplicado em 3 UP e sonda 2 (S2) (32 LEDs de 890nm e 4 LEDs de 660nm, 500mW) em 6 UP. Após antissepsia,úlceras foram tratadas com sondas a 3J/cm2, 30seg, 2x/semana seguido pelo curativo diário com sulfadiazina de prata a 1 por cento por 12 semanas. Pela análise com software Image J®, as UP com S2 tiveram índices de cicatrização médios de 0,6; 0,7 e 0,9 enquanto S1 foi de 0,2; 0,4 e 0,6 no 30º, 60º e 90º dias, respectivamente. A fototerapia acelerou a cicatrização das úlceras de perna em pacientes diabéticos.

This study evaluated the use of phototherapy in the healing of mixed leg ulcers in two diabetic patients (type 2) with arterial hypertension. The device had probe 1 (one 660nm LED, 5mW) applied in 3 ulcers and probe 2 (32 890nm LEDs associated with 4 660nm LEDs, 500mW) in 6 ulcers. After asepsis, ulcers were treated with probes to 3 J/cm2, 30sec per point, twice a week, followed by topical daily dressing with 1 percent silver sulphadiazine during 12 weeks. The following analyses of ulcers with software Image J showed that probe 2 presented mean healing rates of 0.6; 0.7 and 0.9, whereas probe 1 had 0.2;0.4 and 0.6 at 30, 60 and 90 days, espectively. Phototherapy accelerated wound healing of leg ulcers in diabetic patients.

Antibióticos tópicos en infecciones bacterianas / Topical antibiotics in bacterial infections

Los antibióticos tópicos ofrecen varias ventajas sobre los antibióticos sistémicos, tales como una menor capacidad de generar resistencia bacteriana, una concentración alta de la droga en el sitio de la infección, ausencia de efectos adversos y toxicidad sistémica y bajo costo. Los antibióticos locales son útiles en el tratamiento de las infecciones bacterianas superficiales menores, dermatosis o heridas secundariamente infectadas, eliminación del estado de portador nasal de S. aureus y tratamiento adyuvante de la antibiotioterapia sistémica en infecciones bacterianas superficiales más extensas. La dematitis de contacto alérgica y la resistencia bacteriana son los dos problemas principales en la antibioticoterapia tópica. El desarrollo de nuevos antibióticos con mecanismos de acción únicos es de importancia para la práctica diaria dermatológica

Topical antibiotics offer several advantages, such as decreased induction of bacterial resistance, high concentration of the drug in the site of infection, avoidance of systemic adverse effects or toxicity and low cost. Local antibiotics are useful in the treatment of minor superficial bacterial infections, secondarily infected dermatosis or wounds, elimination of S. Aureus from nasal mucosa, and adjuvant therapy when associated with systemic antibiotics for more extensive superficial bacterial infections. Contact allergic dermatitis and bacterial resistance are the two main problems in topical antibacterial treatment. Development of new antibiotics, with unique mode of action is crucial for dermatologists

Comparison of efficacy of 1% silver sulfadiazine and Acticoat for treatment of partial-thickness burn wounds.

BACKGROUND: Acticoat (Smith & Nephew, Hull, UK) is a silver-coated dressing reported to reduce infection and exhibit antimicrobial activity in wounds. OBJECTIVE: The purpose of the present study was to compare the efficacy ofacticoat and 1% silver sulfadiazine (1% AgSD) for treatment of partial thickness burn wounds. MATERIAL AND METHOD: The authors reviewed 50 patients who had partial thickness burn wounds less than 25% admitted to Siriraj Burn Unit from May 2002 to September 2005. All patients were divided into 2 groups: the acticoat treated group (25 patients) and the 1% silver sulfadiazine treated group (25 patients). The 2 groups were compared for the etiology of burn wound, demographic data including age, sex, % Total Body Surface Area burn (TBSA%), cultured organisms, wound infection and outcome of Length Of hospital Stay (LOS) and level of pain. RESULTS: The authors found no significant differences in age, TBSA (%) between both groups. 7 patients (28%) developed wound infection. There were no differences in wound infection and LOS between both groups (p > 0.05). All of the patients who developed wound infection responded well to targeted topical and systemic antibiotic treatment. The 1% AgSD treated group (6 of 25, 24%) obtained more split thickness skin graft to close the granulation defects compared to patients who were treated with acticoat (4 of 25, 16%) but no statistical significance, p = 0.32). Average pain scores in the acticoat treated groups were significantly lower than the 1% AgSD treated group (4 +/- 0.6 versus 5 +/- 0.7, respectively). CONCLUSION: The present study confirms the efficacy of acticoat treatment in partial thickness burn wound. The authors conclude that acticoat has an advantage of limiting the frequency of replacement of the dressing and provides a less painful alternative to wound care with 1% AgSD with comparable incidence of burn wound infection. This is due to its long wear time and the ease of application and removal.

Bacterial and fungal colonization of burn wounds

A prospective study of fungal and bacterial flora of burn wounds was carried out from February 2004 to February 2005 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 203 patients were treated at the Burns Unit. Wound swab cultures were assessed at weekly intervals for four weeks. Three hundred and fifty four sampling procedures (surface swabs) were performed from the burn wounds. The study revealed that bacterial colonization reached 86.6 percent within the first week. Although the gram-negative organisms, as a group, were more predominant, Staphylococcus aureus (28.4 percent) was the most prevalent organism in the first week. It was however surpassed by Pseudomonas aeruginosa form third week onwards. For S. aureus and P. aeruginosa vancomycin and polymyxin were found to be the most effective drugs. Most of the isolates showed high level resistance to antimicrobial agents. Fungi were found to colonize the burn wound late during the second week postburn, with a peak incidence during the third and fourth weeks. Species identification of fungi revealed that Candida tropicalis was the most predominant, followed by Candida parapsilosis. It is crucial for every burn institution to determine the specific pattern of burn wound microbial colonization, the time-related changes in the dominant flora, and the antimicrobial sensitivity profiles. This would enable early treatment of imminent septic episodes with proper empirical systemic antibiotics, without waiting for culture results, thus improving the overall infection-related morbidity and mortality.

Aplasia cutis congênita / Aplasia cutis

A aplasia cutis é uma doença rara, caracterizada pela ausência congênita da epiderme e da derme. Os autores relatam o caso de R.L.M., nascida em29.05.97, sexo feminino, com 2.970g, perímetro cefálico de 31 cm,apresentando falha no couro cabeludo, na região parietal posterior, estendendose bilateralmente, com cerca de 8 cm x 4 cm, de consistência amolecida, coloração avermelhada, aspecto de membrana meníngea bem vascularizada, caracterizando a aplasia cutis. Aparentemente, nenhuma outra anomalia congênita estava presente. Foram aplicadas sulfadiazina de prata e solução salina local, com vestimento da lesão. Após 25 dias, houve fechamento quase completo da lesão. Após um ano de terapêutica, a lesão encontrava-se completamente fechada. Conclui-se que o tratamento proposto parece eficaz. Entretanto, mesmo com boa evolução, tais pacientes necessitam de acompanhamento rigoroso, tendo em vista as possíveis complicações, a existência de anomalias associadas e a eventual necessidade de realização de cranioplastia.

The authors present a case of aplasia cutis of the scalp. This case wasassociated with cranium malformation. The patient was treated conservativelywith the use of Silvadene cream dressing. Healing was obtained about the 30th day of the treatment. We conclude that Silvadene should be considered as apossible treatment to aplasia cutis.

Study of burn sepsis with special reference to Pseudomonas aeruginosa.

Fifty cases of burn of different degrees were subjected to clinical and microbiological studies. A total of 60 isolates were obtained. Of these, 40 (80.0% incidences) were Ps aeruginosa, 8 (16.0 incidences) Staph pyogenes, 6 (12.0% incidences) Kl pneumoniae, 4 (80.0% incidences) Esch coli and 2 (4.0% incidences) C albicans. Monobacterial cultures showed isolations in 41 cases (82.0%) and 34 (68.0%) of them were Ps aeruginosa. At the time to admission 42 cases (84.0%) were infected and during one week of hospitalisation another 8 cases (16.0%) were infected yielding an overall infection rate of 100%. The commonest organism on admission and after hospitalisation was Ps aeruginosa with isolation rates of 60.0% (30) and 20.0% (10) respectively. Gram-negative bacilli, predominantly Ps aeruginosa were found in the lower part of the body with an incidence of 74.0% (37). Staph pyogenes was found in the upper half showing an incidence of 12.0% (6) next to 20.0% (10) incidence of Ps aeruginosa. The incidence of burn infection was high in patients with deep and major burn wounds, the bacterial isolates being 76.0% (38) and 80.0% (40) respectively. Silver sulphadiazine exhibited antimicrobial action in the range of 14 to 390 microM/ml, while cerium sulphadiazine had no inhibitory effect even up to 667 microM/ml on pseudomonas isolates. Zinc sulphadiazine was effective in inhibiting the growth of 10 isolates tested in 40 to 297 microM/ml range.

Sulfadiazina de prata e outros fármacos utilizados no tratamento de queimados / Silver sulfadiazine and other drugs used in burns treatment

O uso de antibactérianos tópicos tem papel decisivo no controle de infecçoes em queimaduras.A presente revisao discute vantagens e desvantagens dos fármacos disponíveis para o tratamento de queimados:nitrato de prata,iodopovidona, mafenida,acido acetico,nitrofurazona,hipoclorito de sodio,clorexidina,gentamicina,sulfadiazida de prata.Para esse último,atualmente o mais utilizado no tratamento tópico sao apresentados dados relativos ao estectro de açao,farmacocinética,reaçoes adversas e precauçoes no emprego terapêutico.