ABSTRACT
Deep burn injuries necessitate effective debridement to promote healing and reduce complications. Traditional surgical debridement is the standard of care; however, it can lead to significant tissue loss, excessive bleeding and delayed healing. Bromelain-based enzymatic debridement offers a potential less invasive alternative that aims to selectively remove necrotic tissue while preserving viable ones. Therefore, this systematic review and meta-analysis comprehensively compares bromelain debridement versus standard care in the management of partial and full-thickness burns. Cochrane Library, Embase, and Medline were searched until May 30th, 2024 for studies comparing bromelain debridement versus standard care. R version 4.4.0 was used to pooled risk ratio and mean difference in a random-effects model. We included seven studies, comprising 484 participants, of whom 238 (49%) were treated with enzymatic debridement. Bromelain significantly reduced time to eschar removal (MD - 7.60 days 95% CI [-9.76, -5.44]; I² = 70%) in comparison with standard care. Additionally, bromelain group presented a significant reduction in the risk of surgical excision (RR 0.17; 95% CI [0.06, 0.47]; I² = 79%) and need for autografts (RR 0.40; 95% CI [0.18, 0.93]; I² = 76%) in comparison with standard group. No differences were found in behalf of time to wound closure (MD -7.64; 95% CI [-18.46]-[3.18]; I2 = 86%), nor in Modified Vancouver Scar Scale (MD -0.36; 95% CI [-0.96]-[0.23]; I2 = 0%). Bromelain-based enzymatic debridement may accelerate eschar removal and reduce the need for surgical excision and autografts, without adversely affecting wound closure time or long-term scar quality.
ABSTRACT
Nos últimos anos, as células-tronco, devido a sua capacidade de originar diversos tecidos corporais e pelo poder de auto-renovação, impulsionaram os estudos de engenharia tecidual, sobretudo em medicina regenerativa. Nesse aspecto, o tecido adiposo vem se mostrando como fonte ideal para obtenção de tais células, devido à facilidade de captação, à baixa morbidade associada ao procedimento e ao elevado rendimento celular. Com o objetivo de estabelecer um modelo experimental versátil e que satisfizesse várias áreas de interesse, propôs-se o coelho Oryctolagus cuniculus como fonte de tecido adiposo. Esse animal apresenta bolsa adiposa interescapular com peso médio de 17,2g, o que corresponde a cerca de 6,6 g/Kg em machos adultos (peso corporal médio de 2590g). A coleta do material foi por meio de lipoaspiração a seco, com cânula de 3,5mm; levou-se em média, 11 minutos para o procedimento, obtendo-se aproximadamente 10 ml de gordura. Após o processamento pela técnica enzimática, em cada mililitro de gordura encontrou-se em média 1x105 células-tronco. O estudo constatou ainda que, por meio da criopreservação em nitrogênio líquido, as células mantinham suas características citométricas após períodos de congelamento que variaram de uma semana a 13 meses. As células apresentaram características de sua indiferenciação, como a expressão dos marcadores de superfície: CD90, 80,6%; HLA-DR, 2,8% e caspase 3, 10,5%. A análise do ciclo celular com 100% de confluência mostrou que 70,8% das células encontravam-se quiescentes; 22,1% apoptóticas. As células com alta capacidade replicativa, que corresponde à fase S do ciclo celular, 1,4% e 0,9% encontravam-se em replicação, mostrando que as células-tronco do tecido adiposo, em cultura, não apresentam uma proliferação descontrolada, tendendo a se estabilizar, principalmente quando atingem confluência máxima em monocamada. Todas essas vantagens fazem com que o modelo proposto possa ser facilmente reprodutível, contribuindo...
In the latest years, the study on tissue engineering, mainly in the area of regenerative medicine, has advanced because the medical community is highly interested in stem cells. This is due to both the potential of these cells to originate any body tissue and their power of self-renewal. Adipose tissue has been used as an ideal source of such cells, due to the simplicity of their collection, high cellular yield, and low morbidity associated with the procedure. In order to establish a versatile experimental model, which could meet the needs of researchers from various areas, the rabbit Oryctolagus cuniculus was proposed as a source of adipose tissue. This animal has an adipose pad in the interscapular region with an average weight of 17.2g, which corresponds to about 6.6g of fat material per kilogram of an adult male animal (mean body weight = 2.6kg). The material was collected by means of a liposuction procedure. Using a 3.5- mm diameter tube, a volume of nearly 10ml of fat material was obtained in a mean time of 11min. After processing the fat tissue by enzymatic technique, about 1x105 stem cells were found per milliliter of fat material. Using cryopreservation of the cells by freezing them in liquid nitrogen, it was observed that the cytometric characteristics were maintained after a period of time ranging from 1 week to 13 months. The cells presented evident characteristics of undifferentiation, such as expression of the surface markers CD90, HLA-DR, and Caspase-3 (80.6, 2.8, and 10.5 %, respectively). Analysis of the cellular cycle with 100% confluence allowed us to show that 70.8% of the cells were quiescent, 22.1% were apoptotic, 1.4% had high replication capacity (phase S of the cellular cycle) and 0.9% were already in replication (phase G2/M), indicating that stem cells from adipose tissue did not show uncontrolled proliferation, tending to stabilize, mainly when they reach maximal confluence in monolayer. These advantages make this model easily...
Subject(s)
Animals , Rabbits , Models, Animal , Regenerative Medicine , Stem Cells , Animal ExperimentationABSTRACT
Stem cells, because of their pluripotentiality and unlimited capacity for self-renewal, project great promise for tissue engineering and are expected to allow significant advances for distinct reconstructive procedures. This study aimed to establish a versatile experimental model with potential application to distinct lines of research in plastic surgery. The search was guided by the need for mesenchymal stem cells that can be easily obtained for laboratory research. The authors studied the anatomy of a number of animals as potential donors and indicated the white New Zealand rabbit (Oryctolagus cuniculus) for this purpose. The animals of this species present definite areas of lipid tissue on their back, allowing easy access to the tissue by either exeresis or liposuction.