Curcumin nanoliposomes mitigate wound tissue inflammatory response caused by tooth extraction

Abstract Curcumin is a plant-derived compound with polypharmacological properties that are hampered by its poor solubility, fast degradation, etc. Wound closure complications that follow tooth extraction are numerous, and relatively frequently additional treatment is needed to prevent unwanted process chronification. The present study aims to compare the effects of free and the nanoliposome-encapsulated curcumin on tooth extraction wound closure. The experiments were performed on Wistar rats where both forms of curcumin were applied topically on a tooth extraction wound for seven days. Changes in tissue oxidative stress (malondialdehyde and oxidized proteins concentrations, and catalase activity) and inflammation (nitric oxide levels and myeloperoxidase activity) related parameters were studied three and seven days following the tooth extraction. Also, the extent of pathohistological changes and osteopontin immunohistochemical expression were studied. The obtained results indicate that both forms of curcumin prevent an increase in oxidative stress and inflammation-related parameters in the studied samples at 3-and 7-day time points. Additionally, we found that curcumin diminished tissue inflammatory response and osteopontin expression, while at the same time it caused faster granulation tissue maturation. The encapsulation of curcumin in nanoliposomes proved to be better in improving the extraction wound healing process than the free curcumin, giving this formulation a potential in the pharmaceutical industry.

Comparación entre suturas para cierre profundo y superficial en reemplazo total de rodilla: seguimiento a un año / A comparison of sutures for deep and superficial wound closure in total knee arthroplasty: One-year follow-up

Introducción Aunque diferentes materiales y técnicas se han desarrollado para el cierre superficial y profundo en reemplazo total de rodilla (RTR), no hay evidencia que permita dar recomendaciones respecto a una técnica especifica que disminuya complicaciones postoperatorias de la herida. El propósito de este estudio es comparar el uso de dos técnicas de cierre profundo (Sutura barbada vs. Sutura absorbible trenzada) y superficial (grapas vs. sutura de polipropileno) en RTR. Materiales y métodos Estudio observacional retrospectivo en 240 pacientes. Se excluyeron pacientes con antecedente de cirugía abierta previa de rodilla, RTR previo por lesiones tumorales o artrofibrosis. Seguimiento mínimo de 1 año. Resultados Se usaron grapas en 176 pacientes y Prolene® en 64 pacientes. El cierre profundo se realizó con Stratafix® en 164 pacientes y con Vicryl® en 75 pacientes. Encontramos complicaciones relacionadas con la herida y la funcionalidad al año de seguimiento. La infección superficial para el cierre con prolene presento un HR de 2.6 con un intervalo de confianza (IC) de 95%=1.1-6.2; p=0.029 y en el cierre profundo encontramos un HR a favor del Vicryl® de 0.22, IC 95%=0.96-5.8; p=0.05. Conclusiones Este estudio demostró un incremento significativo de la incidencia de infección superficial después de un RTR cuando el cierre profundo se realiza con suturas barbadas y el cierre superficial se realiza con sutura de polipropileno. Sin embargo, no se presentaron diferencias significativas en otras complicaciones relacionadas con la herida y en la funcionalidad postoperatoria con las diferentes técnicas de cierre superficial y profundo evaluadas.

Introduction Different materials and techniques have been developed for superficial and deep closure in total knee replacement (TKR), but there is no solid evidence that allows to recommend a specific technique that decreases the surgical post-operative complications. The purpose of this study is to compare the use of two deep closure techniques (barbed suture vs. braided absorbable suture) and superficial (staples vs. polypropylene suture) in TKR. Materials and methods An observational retrospective study was carried out in 240 patients. Those individuals were excluded with previous open knee surgery, arthrofibrosis, patients who underwent TKR due to tumor lesions or a follow up for less than one year. Results The skin was closed in 176 patients with staples and in 64 patients with Prolene®. Deep closure was performed with Stratafix® in 164 patients and with Vicryl® in 75 patients. Also, complications related to the wound and functionality were recorded in the first postoperative year. Superficial infection for closure with prolene presented an HR in favor of 2.6 with a confidence interval (CI) of 95%=1.1­6.2; p=0.029 and in deep closure a HR in favor of Vicryl® of 0.22, 95% CI=0.96­5.8; p=0.05 Conclusions This study demonstrated a significant increase in the incidence of superficial infection after TKR when deep closure is performed with barbed sutures and superficial closure with polypropylene suture. However, there were no significant differences in other complications related with the wound neither postoperative functionality with the different superficial and deep closure techniques that were evaluated.

Manejo quirúrgico de heridas por mordeduras de perro en pacientes pediátricos: nuestra experiencia en 8 años / Surgical management of dog bite wounds in pediatric patients: our experience in 8 years

Introducción. Hasta un 90% de las mordeduras de animales son producidas por perros. Los niños son la población más vulnerable frente a las mordeduras ya que suelen afectar una mayor proporción de superficie corporal. Objetivo. Analizar la casuística de mordeduras de perro y su repercusión en nuestro entorno. Métodos. Estudio observacional, descriptivo, retrospectivo de un período de 8 años, que incluyó a todos los pacientes de 0 a 18 años con diagnóstico de mordedura de perro. Resultados. Se incluyeron 183 pacientes con diagnóstico de mordedura de perro. El promedio de edad fue de 6,1 años, y el grupo etario más afectado fue el de los niños de 3 a 5 años (38,3%). El tratamiento quirúrgico fue dividido en pacientes que requirieron rafia por planos (84,6%), colgajos (11,4%), injertos (3,4%) y puntos de aproximación (1%). Se reportaron 8 pacientes con complicaciones (4,4%). Conclusión. Los niños de 3 a 5 años son los más afectados por mordeduras de perro y la zona de cabeza y cuello es la más común. Un porcentaje importante de pacientes requirieron colgajos e injertos con buenos resultados.

Introduction. Up to 90% of animal bites are produced by dogs. Children are the most vulnerable population because bites tend to affect greater body surface area. Outcome. Analyze dog bites cases and their impact on our environment. Methods. An observational, descriptive, retrospective study during an 8 year period was carried out, which included all patients from 0 to 18 years with a diagnosis of dog bite. Results. A total of 183 patients with a diagnosis of dog bite were found. The average age was 6.1 years, and the age group most affected was children from 3 to 5 years old (38.3%). Surgical treatment was divided into: patients who required suture by planes (84.6%), flaps (11.4%) and grafts (3.4%) and approximation stitches (1%). Complications were reported in 8 patients (4.4%). Conclusion. Children from 3 to 5 years old are the most affected by dog bites, the head and neck area is the most common. A significant percentage of patients required flaps and grafts with good results.

Uso de VAC en neonatos / Use of VAC in neonates

El objetivo de este trabajo es normatizar el uso de la terapia de presión negativa de heridas complejas en neonatos. La iniciativa surge a partir de la negativa de nuestros proveedores locales de proporcionarnos el material del sistema VAC (cicatrización asistida por vacío), por temor a las posibles complicaciones por su uso en neonatos y escasa bibliografía al respecto. Se presentan 2 casos tratados en neonatos entre 2018 y 2021, y se acompaña de revisión bibliográfica encontrada, de diferente etiología. Con las conclusiones obtenidas, se pretende establecer al VAC como una herramienta terapéutica eficaz en neonatos, de igual manera que se aplica, en toda herida compleja que lo requiera, sin importar la edad del paciente

The goal of this work is to standardize the use of negative pressure therapy for complex wounds in newborns. The initiative arises from the refusal of our local suppliers to provide us with the VAC (vacuum-assisted healing) system material, for fear of possible complications from its use in newborns and little literature about it. There are 2 cases treated in neonates between 2018 and 2021, and it is accompanied by found bibliographic review of different etiology. With the conclusions obtained, it is intended to establish the VAC as an effective therapeutic tool in neonates, just as it is applied, in any complex wound that requires it, regardless of the age of the patient

Effect of closure of anterior abdominal wall layers on early postoperative findings at cesarean section: A prospective cross-sectional study

Abstract Objective To investigate the effect of closure types of the anterior abdominal wall layers in cesarean section (CS) surgery on early postoperative findings. Methods The present study was designed as a prospective cross-sectional study and was conducted at a university hospital between October 2018 and February 2019. A total of 180 patients who underwent CS for various reasons were enrolled in the study. Each patient was randomly assigned to one of three groups: Both parietal peritoneum and rectus abdominis muscle left open (group 1), parietal peritoneum closure only (group 2), and closure of the parietal peritoneum and reapproximation of rectus muscle (group 3). All patients were compared in terms of postoperative pain scores (while lying down and duringmobilization), analgesia requirement, and return of bowel motility. Results The postoperative pain scores were similar at the 2nd, 6th, 12th, and 18th hours while lying down. During mobilization, the postoperative pain scores at 6 and 12 hours were significantly higher in group 2 than in group 3. Diclofenac use was significantly higher in patients in group 1 than in those in group 2. Meperidine requirements were similar among the groups. There was no difference between the groups' first flatus and stool passage times. Conclusion In the group with only parietal peritoneum closure, the pain scores at the 6th and 12th hours were higher. Rectus abdominismuscle reapproximations were found not to increase the pain score. The closure of the anterior abdominal wall had no effect on the return of bowel motility.

Comparison Between Primary and Secondary Method of Closing Surgical Wound After Tooth Extraction: A Split-Mouth Study

ABSTRACT Objective: To compare and assess the primary and secondary closure techniques following extraction of impacted third molars for post-operative complications. Material and Methods: In total, 30 patients ranging between 18-30 years of age and of either sex who had bilaterally impacted mandibular third molars were randomly selected. Split mouth study method was used so that the participants served as their own control. Group 1 consisted of primary closure of left mandibular impacted third molars and Group 2 consisted of secondary closure of right mandibular impacted third molars. Basement evaluations were recorded for each patient along with subjective and objective evaluations for postoperative 7 days. Data analysis was carried out by SPSS 17.0 software using Mann-Whitney U test, Wilcoxon matched-pairs test and t-test. A p-value ≤ 0.05 was assigned as statistically significant. Results: When compared to group 1, group 2 revealed statistically less pain and swelling following the secondary closure of wound from day 1 to 7. There was a significant improvement in mouth opening in Group 2 at day 1 (p=0.0005) and at day 7 (p=0.00001). Conclusion: Secondary wound closure after disimpaction of mandibular third molar results in better postoperative recovery than primary closure.

Avaliação das prescrições de enfermagem e médicas para curativos em um hospital universitário: implicações éticas / Evaluation of nursing and medical prescriptions for dressings in a university hospital: ethical implications

Objetivo: Analisar as prescrições de curativo realizadas por enfermeiros e médicos quanto a clareza e a adequabilidade do produto prescrito as características da ferida, bem como analisar as implicações éticas desse contexto. Metodologia: Estudo descritivo quantitativo, realizado em um hospital universitário do Centro-Oeste brasileiro. Compuseram a amostra 180 prescrições de curativos obtidas em prontuários de pacientes com feridas, e as características das feridas foram coletadas por meio de instrumento tipo checklist. Resultados: 92,2% dos registros apresentavam prescrições para a realização dos curativos. Em 7,8% dos registros não havia prescrição de curativos. 93,9% das prescrições estavam incompletas, sendo que em 31,4% foi encontrado divergência entre prescrições de enfermagem e médica no mesmo registro diário. Em 32,3% não havia especificação do produto a ser utilizado no curativo. Em 38,3% a prescrição do produto foi inadequada às características das feridas. Conclusão: Foram evidenciadas fragilidades nas prescrições de curativo que implicam infrações éticas. Os achados reforçam a necessidade de capacitação da equipe e maiores investimentos na formação do profissional em tratamento de feridas. (AU)

Objective: To analyze the dressing prescriptions made by nurses and doctors regarding the clarity and suitability of the prescribed product to the characteristics of the wound, as well as to analyze the ethical implications of this context. Methods: Quantitative descriptive study, carried out in a university hospital in the Brazilian Midwest. The sample comprised 180 dressing prescriptions obtained from medical records of patients with wounds, and the characteristics of the wounds were collected using a checklist-type instrument. Results: 92.2% of the records had prescriptions for dressing. In 7.8% of the records there was no prescription for dressings. 93.9% of prescriptions were incomplete, and in 31.4% there was a divergence between nursing and medical prescriptions in the same daily record. In 32.3% there was no specification of the product to be used in the dressing. In 38.3% the prescription of the product was inadequate to the characteristics of the wounds. Conclusion: Weaknesses in dressing prescriptions that imply ethical infractions were evidenced. The findings reinforce the need for staff training and greater investments in training professionals in wound care. (AU)

Objetivo: Analizar las prescripciones de apósitos realizadas por enfermeras y médicos sobre la claridad e idoneidad del producto prescrito a las características de la herida, así como analizar las implicaciones éticas de este contexto. Métodos: Estudio descriptivo cuantitativo, realizado en un hospital universitario del Medio Oeste brasileño. La muestra estuvo fue compuesta por 180 prescripciones de apósitos obtenidas de historias clínicas de pacientes con heridas, y las características de las heridas se recolectaron mediante un instrumento tipo checklist. Resultados: el 92,2% de los registros tenía prescripción de aposito. En el 7,8% de los registros no había prescripción de apósitos. El 93,9% de las prescripciones estaban incompletas y en el 31,4% había divergencia entre las prescripciones médicas y de enfermería en un mismo registro diario. En el 32,3% no se especificó el producto a utilizar en el apósito. En el 38,3% la prescripción del producto fue inadecuada a las características de las heridas. Conclusión: Se evidenciaron debilidades en la preparación de prescripciones que implican infracciones éticas. Los hallazgos refuerzan la necesidad de capacitación del personal y mayores inversiones en la capacitación de profesionales en el cuidado de heridas. (AU)

Desbridamiento apropiado y técnica de "pie crusting" en el manejo de herida traumática / Adequate debridement and pie-crusting technique in the management of traumatic injuries

Las heridas crónicas de origen traumático, con exposición de tejidos, requieren de un desbridamiento adecuado, lavado y una pronta cubierta para evitar la infección y la desecación. A veces, incluso deben ser ampliadas para realizar un adecuado desbridamiento quirúrgico; por lo que, al intentar una cobertura completa, el resultado es una herida a tensión, que se complica con inflamación, infección y la dehiscencia que se acentúa aún más si está en una zona de flexión, como la rodilla. Se presenta el caso de una paciente de 28 años, que acudió a emergencias con un antecedente de herida traumática en la rodilla derecha, signos de retraso de la cicatrización, tejido de granulación friable, exposición de la rótula, abundante secreción serosa y dolor al movimiento con rango limitado. Se la trató en un solo tiempo quirúrgico con desbridamiento, irrigación y cobertura completa de la herida mediante la técnica de "pie-crusting". Nivel de Evidencia: IV

Chronic wounds of traumatic origin, with tissue exposure, require adequate debridement, lavage and prompt coverage to prevent infection and desiccation. Wounds may even require to be enlarged in order to perform an adequate surgical debridement. Enlarged wound attempts to perform a complete coverage may result in tension wound closures, which are complicated by inflammation, infection, and dehiscence and aggravated when located on flexure areas, such as on the knee. We report the case of a 28-year female patient, who presented to the Emergency Department with a history of traumatic wound in the right knee and signs of delayed healing, friable granulation tissue, exposed patella, increased serous drainage, and painful limited range of motion. She underwent a single surgical time procedure with debridement, irrigation, and complete coverage of the wound with the help of the pie-crusting technique. Level of Evidence: IV

Comparing intra-oral wound healing after alveoloplasty using silk sutures and n-butyl-2-cyanoacrylate

OBJECTIVES: The need for proper wound closure is of paramount importance after any intra-oral surgery. Various wound closure techniques have been described in literature using traditional non-absorbable suture materials. These include like synthetic absorbable sutures, surgical staples and tissue adhesives. Cyanoacrylates are among the most commonly used biocompatible tissue adhesives. To evaluate and compare intraoral wound healing using 3-0 silk sutures and n-butyl-2-cyanoacrylate after alveoloplasty.MATERIALS AND METHODS: A total of 20 patients requiring bilateral alveoloplasty in the same arch (upper or lower) were included in this study. Patients with any pre-existing pathology or systemic disease were excluded. After alveoloplasty was performed, the wound was closed using 3-0 braided silk sutures on one side, and using n-butyl-2-cyanoacrylate bio adhesive on the other side. Patients were evaluated based on the following parameters: time required to achieve wound closure; the incidence of immediate and postoperative hemostasis; the time to the use of the first rescue medication; the side where pain first arises; and the side where wound healing begins first.RESULTS: Compared to 3-0 silk sutures, cyanoacrylate demonstrated better hemostatic properties, reduced operative time, reduced postoperative pain and better wound healing.CONCLUSION: These data suggest that cyanoacrylate glue is an adequate alternative to conventional sutures to close the surgical wound after alveoloplasty, and better than are 3-0 silk sutures.

Comparación entre suturas convencional coadyuvada con ulmoplus® y sin ulmoplus® en el cierre de incisiones de piel de conejo ( Oryctolagus cuniculus ) / Comparison between conventional sutures with ulmoplus® and without ulmoplus® in the incision closure of rabbit skin ( Oryctolagus cuniculus )

Considerando los avances en las investigaciones que relacionan los efectos terapéuticos de la miel en el proceso de cicatrización de heridas, la presente investigación tuvo como objetivo evaluar y comparar cualitativamente, a través de una análisis morfológico, la respuesta tisular local entre sutura convencional coadyuvada con Ulmoplus® y sin Ulmoplus® en el cierre de la incisión de piel de conejo. Se utilizaron 10 conejos adultos, divididos en grupo S (sutura) y grupo S+U (sutura más Ulmoplus®). Se les realizó una incisión de 10 mm de largo, en la región anterior de la pierna, a través de la epidermis y dermis, hasta llegar a la fascia profunda que cubría al músculo tibial anterior. Posteriormente, solo al grupo S+U se le aplicó Ulmoplus®. Luego, en ambos grupos, la incisión fue suturada con dos puntos intradérmicos de ácido poliglicólico (vicryl 2/0). Después de 10 días post incisión fueron tomadas las biopsias de la piel y procesadas para su observación en microscopio de luz. El estudio se llevó a cabo considerando las recomendaciones de la Guía para el Cuidado y Uso de Animales de Laboratorio. Ambos grupos presentaron una incisión cerrada al día 10, con características microscópicas propias de una fase proliferativa. No obstante, el grupo S+U mostró una cicatriz de menor longitud y de aspecto más plano, cuya epidermis estaba mejor organizada y era de menor grosor, con células basales diferenciadas. A nivel dérmico se observó contracción de la herida, evidenciándose una zona cicatrizal de menor tamaño. Ulmoplus®, es una buena alternativa como coadyuvante en el proceso de cierre de heridas quirúrgicas utilizando sutura convencional, ya que acelera el proceso de cicatrización y permite mejores resultados estéticos de la cicatriz.

Considering the advances in research that relate honey therapeutic effects in wound healing process, the present investigation aimed to evaluate and compare qualitatively, through morphological analysis, the local tissue response between conventional suture with Ulmoplus ® and without Ulmoplus ® in the closure of the rabbit skin incision. We used 10 adult rabbits, divided into group S (suture) and group S + U (suture plus Ulmoplus®). An 10 mm long incision was made in the anterior region of the leg, passing through epidermis and dermis, until reaching the deep fascia that covered the anterior tibial muscle. Subsequently, only the S + U group was given Ulmoplus®. Then, in both groups, the incision was sutured with two intradermal points of polyglycolic acid (vicryl 2/0). After 10 days post incision, biopsies of the skin were taken and processed for observation in a light microscope. The study was carried out considering the recommendations of the Guide for the Care and Use of Laboratory Animals. Both groups had a closed incision at day 10 with microscopic characteristics of a proliferative phase. However, the S + U group showed a scar of shorter length and flatter appearance, whose epidermis was more organized and thinner, with differentiated basal cells. At the dermal level, wound contraction was observed, evidencing a smaller scar area. Ulmoplus®, as a coadjuvant in closing surgical wounds process using conventional suture is a good alternative, since it accelerates the healing process and allows better aesthetic results of the scar.

Retalho interósseo posterior reverso do antebraço para o tratamento cirúrgico do trauma elétrico da mão: relato de caso / Reverse posterior interosseous flap of the forearm for the surgical treatment of electric hand trauma: Case report

Introdução: Lesões que acometem as mãos com importante perda cutânea frequentemente requerem retalhos para cobertura precoce, visto que permitem melhor reabilitação. Dentre as opções, o retalho interósseo posterior reverso do antebraço é o mais utilizado para defeitos no dorso da mão e punho, com baixas taxas de complicações. Normalmente, esse retalho não é utilizado para a reconstrução de defeitos em região palmar, já que geralmente não alcança esse local. Relato de caso: Apresentamos o caso de um paciente com queimadura elétrica de terceiro grau, em palma da mão direita, cuja reconstrução foi realizada com o uso do retalho interósseo posterior reverso do antebraço, após debridamentos conservadores, no 14o dia após a queimadura. O paciente apresentou boa evolução pós-operatória, sem complicações ou sequelas funcionais a longo prazo. Conclusão: O retalho interósseo posterior reverso do antebraço permite cobertura adequada de lesões em palma da mão, preservando sua funcionalidade.

Introduction: Lesions affecting the hands with significant skin loss often require flaps for early coverage, as these permit faster healing. Among the various options, the reverse posterior interosseous flap of the forearm is most commonly used for defects involving the back of the hand and wrist due to low complication rates. Normally, this flap is not used for the reconstruction of defects in the palmar region since its distal reach is insufficient. Case report: We present the case of a male patient with third-degree electrical burns on his right palm, whose reconstruction was performed on the 14th day postinjury using the reverse posterior interosseous flap of the forearm after conservative debridement. The patient presented good postoperative evolution, without long-term complications or functional sequelae. Conclusion: The reverse posterior interosseous flap of the forearm permits adequate coverage of palm injuries, preserving its functionality.

Fio de sutura elástico / Elastic suture thread

Introdução: O tratamento de grandes e médias feridas é um desafio para os cirurgiões quando precisam fechálas e, normalmente, são utilizadas técnicas cirúrgicas de enxertias ou retalhos, que podem deixar sequelas e até mesmo mutilações. Ao longo do tempo desenvolveu-se a técnica de "sutura elástica" que promove a cicatrização em curto espaço de tempo com sequelas menores, entretanto o procedimento tem sido realizado com material improvisado. Objetivo: Desenvolver um fio de sutura elástico cirúrgico que possa ser esterilizado e confeccionado nos moldes dos produtos médicos cirúrgicos. Métodos: Revisão das patentes existentes por meio da busca de anterioridade e comparação com o dispositivo do estudo. Pesquisa de materiais com as características necessárias como elasticidade e tensão. Teste destas características em laboratórios especializados. Resultados: O produto desenvolvido é um fio elástico com duplo agulhamento para suturas, com matéria prima de silicone que apresenta elasticidade e resistência a tensão. Conclusão: O fio de sutura elástico, com duplo agulhamento, para feridas de médio e grande porte foi desenvolvido.

Introduction: Closing large and medium wounds is challenging for surgeons and often leads to the use of graft or flap surgical techniques. These procedures can leave sequelae and even mutilations. An "elastic suture" technique was developed to promote wound healing in a short time span with minor sequelae; however, improvised materials have been used in this procedure. Objective: To develop a surgical elastic suture thread that can be manufactured and sterilized following the standards of surgical medical products. Methods: We conducted a patent search, compared the findings with the study device, and researched materials with necessary characteristics such as elasticity and tension. Testing these characteristics in specialized laboratories. Results: The developed device is a double-needled elastic suture made of silicone that presents tensile strength. Conclusion: Here, we developed a double-needled elastic suture for medium and large wounds.

A simple modification of the conventional figure-of-eight sternal closure technique

Abstract Objective: To describe a new technique of sternal closure, modified from the conventional figure-of-eight approach, which can provide a secure closure and prevent sternal complications. Methods: The modified technique is based on the intercalation of the caudal portion of each steel wire passed along the sternum. This is a retrospective analysis of patients operated with this modified technique at our institution between January 2014 and December 2016. Results: One hundred and forty-three patients underwent sternal closure with the modified technique. In-hospital mortality rate was 1.4% (n=2). No sternal instability was observed at 30 days postoperatively. Two patients developed mediastinitis that required extraction of the wires. Conclusion: Short-term results have shown that the modified sternal closure technique can be used safely and effectively, with complications rates being consistent with worldwide experience.

Cicatrização e tratamento de feridas: a interface do conhecimento à prática do Enfermeiro / Wound healing and treatment: the interface of knowledge to the practice of the Nurse

Objetivos: determinar o nível de conhecimento de enfermeiros sobre cicatrização e tratamento de feridas e avaliar a indicação e o tempo de permanência dos produtos utilizados no curativo. Materiais e Métodos: Trata-se de um estudo transversal, realizado em um hospital universitário, com a aplicação de questionário para verificação do nível de conhecimento e observação da prática de curativo realizado pelo enfermeiro, quanto a indicação e o tempo de permanência dos produtos. Resultados: Constatou-se baixo conhecimento nos parâmetros: debridamento, exsudato, biofilme e sinais de infecção e em 48,5% das feridas avaliadas a indicação inadequada de produtos ou coberturas. Também foi inadequado, o tempo de permanência dos produtos com recomendação de troca entre 5 e 7 dias. Conclusões: O artigo destaca que os temas debridamento, exsudato, biofilmes e indicação e permanência de produtos devem ser reforçados nos centros formadores e na qualificação em serviço. (AU)

Objectives: To determine the level of knowledge of nurses about wound healing and treatment and to evaluate the indication and the residence time of the products used in the dressing. Methodology: This was a cross-sectional study, carried out in a university hospital, with the application of a questionnaire to verify the level of knowledge (N = 18 nurses) and observation of the dressing practice performed by the nurse, regarding the indication and length of stay (N = 110 dressing observations). Results: Low knowledge on the parameters: debridement, exudate, biofilm and signs of infection were observed, and from the observations, inadequate indication of products was found in 48.5%, as well as the time of permanence of those products was inadequate. exchange recommendation between five and seven days. Conclusion: It should be emphasized that the debridement, exudate, biofilms, and indication and length of stay of products should be reinforced in the training centers and in-service qualification. (AU)

Objetivos: determinar el nivel de conocimiento de enfermeros sobre cicatrización y tratamiento de heridas y evaluar la indicación y el tiempo de permanencia de los productos utilizados en el vendaje. En el presente trabajo se analizaron los resultados obtenidos en el estudio de los resultados obtenidos en el estudio de los resultados obtenidos, tiempo de permanencia de los productos (N = 110 observaciones de curativos). Resultados: Se constató bajo conocimiento en los parámetros: debridamiento, exudado, biofilm y signos de infección y, a partir de las observaciones, se encontró una indicación inadecuada de productos en el 48,5%, así como fue inadecuado el tiempo de permanencia de aquellos productos con recomendación de intercambio entre cinco y siete días. Conclusión: Se destaca que los temas debridamiento, exudado, biopelículas y indicación y tiempo de permanencia de productos deben ser reforzados en los centros formadores y en la calificación en servicio. (AU)

Risk factors for major adverse events after surgical closure of ventricular septal defect in patients less than 1 year of age: a single-center retrospective

Abstract Objective: To reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure. Methods: We reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as "prolonged". Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE). Results: VSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) (P-value<0.001) and prolonged cardiopulmonary bypass time (P=0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE (P=0.03). Conclusion: Higher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.

Resolución de úlcera trocantérea mediante colgajo musculocutáneo de fascia lata en isla con cierre en V-Y / Trochanteric ulcer reconstruction by tensor fascia lata musculocutaneous island flap with a V toY closure

Introducción. La úlcera trocantérea es una de las lesiones por presión más frecuente y está asociada generalmente a bursitis, por lo que su tratamiento es complejo. Materiales y Métodos. Se presenta el caso de un paciente masculino de 29 años, con antecedente de lesión medular asociada a paraplejía fláccida con desarrollo de úlcera trocantérea derecha elíptica vertical. Fue abordado de forma multidisciplinaria y resuelto con resección de la patología y reconstrucción con colgajo musculocutáneo de fascia lata. Resultado. El paciente fue dado de alta al 21 día posoperatorio. No presentó dehiscencias, infecciones de la herida ni recidiva al cumplirse 6 meses de la cirugía y el resultado estético y funcional fue satisfactorio. Conclusión. El colgajo musculocutáneo de fascia lata ascendido y con cierre de V en Y es una opción segura, versátil y reproducible para la resolución de úlceras trocantéreas. Sin embargo, deben respetarse todos los pasos de la técnica para evitar así complicaciones y recidivas.

Background. Trochanteric ulcer is one of the most frequent pressure sore and is usually related with bursitis, therefore its treatment is complex. Material and Methods. We present a case of a 29 year-old male patient with medical history of spinalcord injury (SCI) related to flaccid paraplegia and the development of right trochanteric vertical elliptical sore. He was treated by a multidisciplinary team and solved by the resection of the pathology and immediate reconstruction with tensor fascia lata (TFL) musculo cutaneous flap. Results. The patient was discharged from the institution on the 21st postoperative day. With a follow-up of a 6 months period, complications such as wound infection, suture dehiscense or recurrence were not observed. Aesthetic and functional results were satisfactory. Conclusion. Ascended TFL flap with a V-Y closure is a reproducible, reliable and versatile procedure for the coverage of trochanteric pressure sore defects. However all surgical techniques tages must be considered in order to avoid complications and recurrence of the disease

Secondary healing strategy for difficult wound closure in invasive vulvar cancer: a pilot case-control study

OBJECTIVES: Despite the number of surgical advances and innovations in techniques over time, radical vulvectomy frequently results in substantial loss of tissue that cannot be primarily closed without tension, the mobilization of surrounding tissues or even the rotation of myocutaneous flaps. The aim of this study was to evaluate the feasibility of leaving the surgical vulvar open wound for secondary healing in situations where primary closure of the vulvar wound is not possible. METHODS: This case-control pilot study analyzed 16 women with a diagnosis of squamous cell carcinoma of the vulva who first underwent inguinofemoral lymphadenectomy, 6-week sessions of chemotherapy and 25 daily sessions of radiotherapy. Afterward, excision of the vulvar lesion with free margins was performed between January 2011 and July 2017. Twelve patients underwent primary closure of the wound (control), and in 4 patients, the surgical wound was left open for secondary healing by means of a hydrofiber (case). The inclusion criteria were a) FIGO-2009 stage II up to IIIC; b) squamous cell carcinoma; and c) no evidence of pelvic or extrapelvic disease or pelvic nodal involvement. The exclusion criteria were extrapelvic disease or pelvic nodal involvement, another primary cancer, or a poor clinical condition. ClinicalTrials.gov: NCT02067052. RESULTS: The mean age of the patients at the time of the intervention was 62.1. The distribution of the stages was as follows: II, n=6 (37 %); IIIA, n=1 (6%), IIIB, n=1 (6%) and IIIC, n=8 (51%). The mean operative time was 45 minutes. The hospital stay duration was 2 days. Full vulvar healing occurred after an average of 30 days in the control group and after an average of 50 days in the case group. CONCLUSION: A secondary healing strategy may be an option for the treatment of vulvar cancer in situations of non-extensive surgical wounds when primary closure of the wound is not possible.

O plasma rico em fatores de crescimento no tratamento de pacientes com úlceras venosas / Plasma rich in growth factors in the treatment of patients with venous ulcers

Objetivo geral: Analisar as propriedades do plasma rico em fatores de crescimento (PRGF) autólogo, para tratar pacientes com úlceras venosas. Método: Trata-se de um estudo quase- experimental realizado em um Hospital Universitário, cuja coleta de dados ocorreu no período de maio de 2016 a dezembro de 2017. Amostra composta por 18 pacientes com úlcera venosa, que atenderam aos critérios de inclusão. Os participantes compareceram por 12 semanas consecutivas, ao ambulatório para consulta de enfermagem e troca do curativo, com aplicação do PRGF a cada 15 dias. O preparo do PRGF utilizou a técnica de uma centrifugação e o gluconato de cálcio como ativador plaquetário. Realização da contagem de plaquetas e identificação dos fatores de crescimento no PRGF usado no tratamento. Resultados: Amostra homogênea quanto às variáveis socioeconômicas e clínicas, com predomínio de idosos, sexo masculino, ensino fundamental incompleto e renda entre um e dois salários mínimos. Obtenção de um PRGF com contagem baixa de plaquetas, mediana de 122 x 103 mm3 plaquetas, mas com principais fatores de crescimento plaquetários envolvidos na cicatrização (PDGF-AB, PDGF-BB, TGF-ß, VEGF, EGF e FGF2). Houve alta variabilidade na contagem de plaquetas e na concentração de fatores de crescimento, com correlação forte e significativa entre a quantidade de plaquetas e os fatores de crescimento PDGF-AB e PDGF-BB. As médias de cada fator de crescimento foram 1,52 ng/ml para o PDGF-AB, 1,38 ng/ml para o PDGF-BB, 1,40 ng/ml para o TGF-ß, 0,99 ng/ml para VEGF, 1,57 ng/ml para o EGF e 1.04 ng/ml para o FGF2. O tamanho inicial médio das úlceras neste estudo foi de 29,6 ± 23,9 /cm2 e o percentual médio de redução da área após 12 semanas de tratamento foi de 46,2%. O tamanho das úlceras após tratamento era significativamente menor do que o tamanho inicial das úlceras (p-valor do teste de Wilcoxon igual a 0,001). Entretanto, a redução da área das úlceras, no período das 12 semanas, não apresentou correlação com as concentrações dos fatores de crescimento no PRGF. A percentagem de tecido de epitalização apresentou crescimento em todo período do estudo com aumento significativo ao final de 12 tratamento (média = 58,1%) e o tecido desvitalizado apresentou decrescimento durante todo o período do estudo com redução significativa ao final de 12 semanas (média = 11%). Ao final de 12 semanas observou-se uma melhora significativa do tipo de exsudato nas úlceras e uma diminuição significativa da quantidade de exsudato nas úlceras. Conclusão: Neste estudo, foi confirmada a hipótese nula em que a concentração dos fatores de crescimento presentes no PRGF não apresentou relação estatisticamente significativa com a redução da área das úlceras venosas.

Objective: To analyze the properties of autologous plasma rich in growth factors (PRGF), to treat patients with venous ulcers. Method: It is a quasi-experimental clinical study performed in a University Hospital, the data collection occurred from May 2016 to December 2017. Sample of 18 patients with venous ulcer, who met the inclusion criteria. The participants attended weekly for 12 weeks to the outpatient clinic for nursing consultation and dressing change, with application of the plasma rich in growth factors (PRGF) for each 15 days. The PRGF preparation used the single- centrifugation technique and calcium gluconate as a platelet activator. Realization of platelet count and identification of growth factors in PRGF used in treatment. Platelet counting and identification of growth factors in the PRGF used in the treatment. Results: Homogeneous sample regarding socioeconomic and clinical variables, with predominance of the elderly, male gender, incomplete primary education and income between 1 and 2 minimum wages. A PRGF with a low platelet count, median of 122 x 103 mm3 platelets, but with the main platelet growth factors involved in the healing (PDGF-AB, PDGF-BB, TGF-ß, VEGF, EGF and FGF2). There was a high variability in platelet counts and in the concentration of growth factors, with a strong and significant correlation between the amount of platelets and the growth factors PDGF-AB and PDGF-BB. The means of each growth factor were 1.52 ng / ml for PDGF-AB, 1.38 ng / ml for PDGF-BB, 1.40 ng / ml for TGF-ß, 0.99 ng / ml for VEGF, 1.57 ng / ml for EGF and 1.04 ng / ml for FGF2. The initial mean size of the ulcers in this study was 29.6 ± 23.9 / cm2 and the percentage mean reduction in area after 12 weeks of treatment was 46.2%. The ulcer size after treatment was significantly smaller than the initial ulcer size (Wilcoxon p-value = 0.001). However, the area of ulcer reduction over the 12-week period did not correlate with growth factor concentrations in PRGF. The percentage of epitalization tissue increased throughout the study period with a significant increase at the end of 12 treatments (mean = 58.1%) and devitalized tissue decreased throughout the study period with a significant reduction at the end of 12 weeks (mean = 11%). At the end of 12 weeks there was a significant improvement in the type of exudate in the ulcers and a significant decrease in the amount of exudate in the ulcers. Conclusion: In this study, the null hypothesis was confirmed that the concentration of growth factors present in PRGF did not present statistically significant relationship with the reduction of venous ulcers area.

Objetivo general: Analizar las propiedades del plasma rico en factor de crecimiento autólogo (PRGF) para tratar pacientes con úlcera venosa. Método: Estudio cuasi experimental realizado en un hospital universitario. Datos recolectados entre mayo de 2016 y diciembre de 2017. Muestra compuesta por 18 pacientes con úlcera venosa que cumplieron los criterios de inclusión. Los participantes asistieron semanalmente, durante 12 semanas, a la clínica ambulatoria para consulta de enfermería y cambio de apósito, con aplicación de plasma rico en factor de crecimiento (PRGF) en frecuencia bisemanal. La preparación de PRGF utilizó la técnica de centrifugación; se empleó gluconato de calcio como activador plaquetario. Se efectuó recuento de plaquetas e identificación de los factores de crecimiento en el PRGF utilizado en el tratamiento. Resultados: Muestra homogénea en sus variables socioeconómicas y clínicas, con predominio de ancianos, varones, estudios primarios incompletos, con ingresos de entre 1 y 2 salarios mínimos. Se obtuvo un PRGF con bajo recuento de plaquetas, con mediana de 122 x 103 mm3 de plaquetas, aunque con importantes factores de crecimiento plaquetario involucrados en la curación (PDGF-AB, PDGF-BB, TGF-ß, VEGF, EGF y FGF2). Existió marcada variabilidad en el recuento plaquetario y en la concentración del factor de crecimiento, con marcada y significativa correlación entre la cantidad de plaquetas y factores de crecimiento PDGF-AB y PDGF-BB. Los promedios de cada factor de crecimiento fueron 1.52 ng / ml para PDGF-AB, 1.38 ng / ml para PDGF-BB, 1.40 ng / ml para TGF-ß, 0.99 ng / ml para VEGF, 1,57 ng / ml para EGF y 1,04 ng / ml para FGF2. El tamaño inicial promedio de las úlceras observadas en este estudio fue de 29,6 ± 23,9 / cm2, y la reducción porcentual media en el área luego de 12 semanas de tratamiento fue del 46,2%. El tamaño de las úlceras luego del tratamiento resultó ser significativamente inferior a su tamaño inicial (p-valor del test de Wilcoxon igual a 0,001). Sin embargo, la reducción del área de las úlceras, durante el período de 12 semanas, no se correlacionó con las concentraciones de los factores de crecimiento en el PRGF. El porcentaje de tejido epitelial aumentó durante todo el período del estudio, con un aumento significativo final en 12 tratamientos (media = 58,1%). El tejido desvitalizado disminuyó a lo largo del estudio, con reducción significativa luego de 12 semanas (promedio = 11%). Finalizadas las 12 semanas, hubo mejora significativa en el tipo de exudado de las úlceras y disminución significativa de la cantidad de exudado de las úlceras. Conclusión: En este estudio, se confirmó la hipótesis nula en que la concentración de los factores de crecimiento presentes en el PRGF no presentaba una relación estadísticamente significativa con la reducción del área de las úlceras venosas.

Cierre primario diferido en las amputaciones parciales del pie diabético / Primary deferred closure in partial amputations of diabetic foot

Introducción: Las amputaciones parciales del pie diabético requieren un prolongado período de cicatrización. La presencia de angiopatía y neuropatía periférica y la ausencia de actividad del factor de crecimiento epidérmico entorpecen dicho proceso. Objetivos: Evaluar la evolución de las amputaciones parciales del pie diabético con el uso del Heberprot-P® mediante un procedimiento quirúrgico de cierre total diferido a un segundo tiempo. Métodos: Se realizó un estudio descriptivo, longitudinal y retrospectivo, en 52 pacientes operados de amputación de los artejos del pie atendidos en el Hospital Provincial Universitario Manuel Ascunce Domenech de la provincia de Camagüey, en el período comprendido desde enero 2015 hasta septiembre de 2016 y en los que fue factible realizar este procedimiento. Resultados: El sexo femenino representó el 59,6 por ciento, con mayor número de casos en el intervalo de 61-70 años. Se realizaron 30 operaciones los artejos centrales y 22 entre el primero y el quinto. El 94,6 por ciento cicatrizó entre los 16 y los 20 días. Ninguno fue reintervenido. Conclusiones: La terapia con Heberprot-P® abre nuevos caminos para lograr mayor efectividad en el tratamiento y cicatrización del pie diabético. El procedimiento empleado mejoró el resultado funcional y estético de los pies operados(AU)

Introduction: Partial amputation of diabetic foot requires a long cicatrization period. The presence of angiopathy and peripheral neuropathy, and the lack of epidermal growth factor activity dull the process. Objective: To evaluate the evolution of partial amputations of diabetic foot using Heberprot-P® through a surgical procedure based in a total deffered closure to a second time. Methods: A descriptive, longitudinal and retrospective study was in a total of 52 patients operated on foot knuckles amputations in Manuel Ascunce Domenech University Provincial Hospital of Camagüey Province, from January 2015 to September 2016. In this patients was feasible to carry out the so above mentioned surgical procedure. Results: The female gender represented the 59, 6 percent with major number of cases from 61 to 70 years old. 30 surgeries were performed on the central knuckle and 22 between the first and fifth knuckle. 94,6 percent healed within 16 to 20 days. None of the patients was reoperated. Conclusions: Heberprot-P® therapy opens new ways to achieve better effectiveness in the treatment and cicatrization of diabetic foot. The procedure used improved the functional and aesthetical results in the operated feet(AU)

Retalho anterolateral da coxa reverso: uma opção de reconstrução para os membros inferiores / Reverse anterolateral thigh flap: a reconstruction option for the lower limbs

Introdução: A reconstrução cutânea e de tecidos moles na região ao redor do joelho é frequentemente desafiadora para o cirurgião plástico e tem como objetivo fornecer uma boa função articular do joelho com aparência estética aceitável. O planejamento cirúrgico requer considerar a técnica mais simples que leve ao fechamento da ferida, com mínima morbidade na área doadora. Há poucos relatos do uso do retalho anterolateral (ALT) reverso na literatura, em se tratando de defeitos na fossa poplítea, joelho e porção proximal da perna. O objetivo é descrever uma serie de casos de pacientes submetidos à reconstrução de ferida em fossa poplítea, joelho e terço superior da perna com retalho ALT reverso. Métodos: Quatro pacientes, dos quais 3 eram reconstruções de fossa poplítea e 1 reconstrução de joelho e terço proximal da perna. Todos submetidos à ressecção ampla da ferida/ tumor, dissecção do retalho ALT reverso, e transposição para o defeito. Resultados: Follow-up de 2 a 18 meses, evidenciando-se morbidade mínima para área doadora, com cobertura total do defeito e ótimo resultado funcional do membro afetado, com bom resultado estético. Apenas em um dos casos evidenciou-se sofrimento e necrose parcial (15%) do retalho devido a hematoma e compressão do pedículo, nos demais não foi evidenciado sofrimento dos retalhos, deiscência, seroma ou infecção. Conclusão: O retalho ALT da coxa reverso mostrou-se uma opção viável, apresentando bom resultado funcional e estético para a reconstrução cutânea e de tecidos moles na região de fossa poplítea, joelho e terço superior da perna.

Introduction: Cutaneous and soft tissue reconstruction in the region around the knee is often challenging for the plastic surgeon and aimed at providing good knee joint function with acceptable aesthetic appearance. Surgical planning requires considering the simplest technique that leads to wound closure, with minimal morbidity in the donor area. The literature has reported only few cases of the use of the reverse anterolateral (ALT) flap for defects in the popliteal fossa, knee, and leg proximal portion. The objective is to describe a series of cases of patients who underwent reconstruction with a reverse ALT flap for wounds in the popliteal fossa, knee, and upper third of the leg. Methods: Among four patients, three received popliteal fossa reconstructions and one received knee and leg proximal third reconstructions. All the patients underwent wound/tumor extensive resection, dissection of the reverse ALT flap, and transposition to the defect. Results: During follow-up for 2 to 18 months, minimal morbidity was observed in the donor area, with a total coverage of the defect, optimal functional result of the affected limb, and good aesthetic result. Only one case had a partial necrosis (15%) of the flap due to hematoma and pedicle compression. In the other patients, no evidence of flap failure, dehiscence, seroma, or infection were found. Conclusion: The reverse ALT flap was a viable option, presenting good functional and aesthetic results for cutaneous and soft tissue reconstructions in the popliteal fossa, knee, and upper third of the leg.