Low intensity ultrasound therapy induces angiogenesis and persistent inflammation in the chronic phase of the healing process of third degree burn wounds experimentally induced in diabetic and non-diabetic rats

ABSTRACT PURPOSE: To evaluate the effects of low intensity ultrasound on the healing process of third degree burn wounds in experimentally induced diabetic Wistar rats. METHODS: One hundred rats were divided into: control group; non-diabetic treated group; diabetic control group; diabetic treated group. The therapy was performed with a 3MHz ultrasound application, pulsed emission at 100Hz frequency, modulated at 20% with a dosage of 0.5W/cm2 during three minutes throughout 30 days. The surgical debridement of the wound was performed once at day 2. The wounds were morphometrically, macroscopically and microscopically evaluated at 3, 7, 14, 21 and 30 days. RESULTS: The wound contraction and collagen quantification were higher in all treated groups. Macroscopically, necrosis was higher in the diabetic control group. Granulation tissue was higher in treated groups during the proliferative and remodeling phase. Microscopically, there were greater mononuclear inflammatory infiltration, angiogenesis and fibroblast quantification in treated groups during the proliferative and remodeling phases. CONCLUSIONS: therapeutic ultrasound is beneficial in the inflammatory and proliferative phases of the healing process because it controlled the necrotic tissue, increased the granulation tissue and wound contraction. However in the remodeling phase it is not beneficial because of the continued angiogenesis and a mononuclear inflammatory infiltration.

Reconstrução de nariz após necrose por injeção de polimetilmetacrilato na face - relato de dois casos / Nose reconstruction after necrosis for injection of polimetilmetacrilate in the face - report of two cases

Introdução: além das causas mais freqüentes de perdasnasais-traumaecâncer-observamososurgimento de novas situações geradoras de mutilação do nariz, requerendo adaptações à abordagem do problema. Objetivo: apresentar dois casos de reconstrução nasal após injeção de polimetilmetacrilato para preenchimento estético na face. Método: Duas pacientes submetidas à reconstrução nasal por necrose conseqüente à injeção de polimetilmetacrilato. Resultados: visibilizados nas figuras 4, 5 e 6. Discussão: o polimetilmetacrilato é uma das substâncias utilizadas na bioplastia. A necrose conseqüente à injeção do polimetilmetacrilato para fins estéticos é uma nova entidade clínica, cuja incidência é desconhecida e a fisiopatologia sujeita à discussão. Modificações na rotina de reconstrução foram necessárias em virtude das condições locais. Retalhos septais, melhor escolha para a reparação do forro, foram contraindicados por comprometimento vascular. Utilizaram-se retalhos de pele previamente enxertada, associados a enxertos de cartilagem auricular e rotação de retalho frontal paramediano, procurando-seres peitar o princípio das subunidades anatômicas. Conclusão:a necrosedesegmentos da face após a injeção de polimetilmetecrilato é uma nova entidade clínica, cuja incidência é desconhecida, acrescentando nova etiologia às perdas nasais. Os fundamentos da reconstrução de nariz devem ser aplicados,buscando-se soluções individuais que adaptem- se às peculiaridades de cada situação.

Introduction: Inaddiction to the most frequentcauses of nasal tissue lost- cancer and trauma- new situations generating the mutilation ofthen osehavearrived, requiring adaptations to the problem-solving approach. Objective:To report two cases of nasal reconstruction after polimetilmetacrilate injection for aesthetic purposes on the face. Methods: Two female patients underwent nasal reconstruction after necrosis caused by injection of polimetilmetacrilate.Discussion:Polimetilmetacrilatehave been used as a substance for inclusion. The necrosis caused by the injection of polimetilmetacrilate is a new clinical entity, with unknown incidence and ongoing discussion of its phisiopathology. Changes in the routine of the nasal reconstruction were necessary due to local conditions. Septal flaps, the first choice for lining repair, were discarted because of previous vascular damage. Cutaneous flaps made of previously grafted skin were utilized in association with cartilage grafts and rotation of a paramedian frontal flap, following anatomical subunits principles. Conclusion: The necrosis of facial segments after injection of polimetilmetacrilate is a new clinical entity, with unknown incidence, that can be added as a new etiology of nasal tissue lost. The fundaments of nasal reconstruction should be applied, looking for individual solutions wich adapt to the peculiarities of each situation.