Use of surgical glue versus suture to repair perineal tears: a randomised controlled trial.

BACKGROUND: Surgical glue has been used in several body tissues, including perineal repair, and can benefit women. OBJECTIVES: To evaluate the effectiveness of n-butyl-2-cyanoacrylate surgical glue compared to the polyglactin 910 suture in repairing first- and second-degree perineal tears and episiotomy in vaginal births. DESIGN: A parallel randomised controlled open trial. SETTING: Birth centre in Itapecerica da Serra, São Paulo, Brazil. PARTICIPANTS AND METHODS: The participants were 140 postpartum women allocated into four groups: two experimental groups repaired with surgical glue (n = 35 women with a first-degree tear; n = 35 women with a second-degree tear or episiotomy); two control groups sutured with thread (n = 35 women with a first-degree tear; n = 35 women with a second-degree tear or episiotomy). The outcomes were perineal pain and the healing process. Data collection was conducted in six stages: (1) up to 2 h after perineal repair; (2) from 12 to 24 h postpartum; (3) from 36 to 48 h; (4) from 10 to 20 days; (5) from 50 to 70 days; and (6) from 6 to 8 months. ANOVA, Student's t, Monte Carlo, x-square and Wald tests were used for the statistical analysis. RESULTS: One hundred forty women participated in the first three stages, 110 in stage 4, 122 in stage 5, and 54 in stage 6. The women treated with surgical glue had less perineal pain (p ≤ 0.001). There was no difference in the healing process, but the CG obtained a better result in the coaptation item (p ≤ 0.001). CONCLUSIONS: Perineal repair with surgical glue has low pain intensity and results in a healing process similar to suture threads. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (UTN code: U1111-1184-2507; RBR-2q5wy8o); date of registration 01/25/2018; www.ensaiosclinicos.gov.br/rg/RBR-2q5wy8/.

Surgical adhesive glue to repair first-degree perineal tears in vaginal birth: A randomised controlled clinical trial.

Background: Perineal tears in vaginal birth are highly prevalent and may be related to physical and psychological trauma. Surgical glues are an alternative repair method to avoid the pain that may be caused by perineal repairs with sutures. Objective: To evaluate the effectiveness of surgical adhesive glue in reducing perineal pain when compared to sutures in first-degree perineal tears resulting from vaginal birth. Design: Open-label parallel-group randomised controlled trial. Setting: An alongside birth centre in Sao Paulo, Brazil. Participants: 84 intrapartum women with first-degree perineal tears needing repair. Methods: In the experimental group (n = 42), the perineal tears were repaired with Epiglu® surgical glue (ethyl-2-cyanoacrylate); in the control group (n = 42), the tears were repaired with Vicryl Rapide® (polyglactin 910) sutures. The primary outcome was the intensity of perineal pain after birth measured by a numeric pain rating scale ranging from 0 to 10 points. The secondary outcomes were healing, measured by the "Redness, Oedema, Ecchymosis, Discharge, and Approximation" scale; women's satisfaction with the perineal repair, measured by a visual analogue scale; and the time necessary to complete the repair. Data were collected during postpartum hospitalisation and 10-20 days after discharge, from December 2020 to May 2021. Data were analysed using bivariate analysis and linear models by intention-to-treat. Results: 36-48 h after birth, the mean of perineal pain was 0.2 (95% Confidence Interval [CI] 0.1-0.8) in the experimental group and 0.9 (95% CI 0.5-1.5) in the control group; the perineal healing score was 0.7 (95% CI 0.4-1.2) and 0.8 (95% CI 0.5-1.2), in the experimental and control groups, respectively; satisfaction was higher among women in the experimental group (88.1% versus 83.3% in the control group). After discharge, the mean of perineal pain was 0.1 (95% CI 0.0-0.5) in the experimental group and 1.4 (95% CI 0.8-2.2) in the control group; the perineal healing score was 0.0 (95% CI 0) and 1.0 (95% CI 0.7-1.3) in the experimental and control groups, respectively. Satisfaction was higher in the experimental group (94.9% versus 75.0%). The longitudinal analysis showed statistically significant differences between the groups regarding perineal pain and women's satisfaction. The average time necessary for perineal repair was 6.0 (95% CI 4.7-8.7) minutes in the experimental group and 9.7 (95% CI 8.3-11.5) in the control group (p < 0.001). Conclusions: Surgical glue resulted in less perineal pain, faster repair, and greater satisfaction than perineal sutures after birth. The healing process was similar in both cases. Tweetable abstract: Surgical glue was less painful and promoted greater satisfaction after birth compared to sutures in women with first-degree perineal tears. Registration: Registered on The Brazilian Clinical Trials Registry number RBR-52y5tq (http://www.ensaiosclinicos.gov.br/rg/RBR-52y5tq/), on July 16, 2020. The first recruitment was on December 17, 2020.

Efectividad del Tysuacril en la estomatitis aftosa / Effectiveness of Tysuacril in aphthous stomatitis

RESUMEN Introducción: el Tisuacryl es un biomaterial empleado en la cirugía general y bucal, así como en el tratamiento de la estomatitis aftosa, considerada un proceso multifactorial y actualmente la enfermedad ulcerosa más común de la cavidad oral. Objetivo: determinar la efectividad del Tisuacryl con respecto a la terapia convencional en el tratamiento de la estomatitis aftosa en Consolación del Sur, Pinar del Río, en el período comprendido entre septiembre 2018 y marzo 2020. Métodos: se realizó un estudio observacional analítico de casos y controles a 90 pacientes con estomatitis aftosa en Consolación del Sur, Pinar del Río, en el período comprendido entre septiembre 2018 y marzo 2020. La información se obtuvo de las historias clínicas individuales de Periodoncia al obtener el consentimiento oral y escrito de los pacientes o sus tutores. Los resultados se obtuvieron por análisis estadístico que incluyó el porciento y la prueba no paramétrica de Cochran Q. Resultados: predominó el sexo femenino y el grupo etario de 10 a 19 años para el 46,7 % en grupo estudio y el 42,2 % en grupo control; la disminución del dolor y la cicatrización iniciaron en el mayor número de pacientes a las 72 horas de tratamiento con Tisuacryl para el 91,1 % y el 55,6 % respectivamente; a los cinco días de aplicación del medicamento la totalidad de ellos estaban asintomáticos y casi todas las aftas bucales cicatrizadas. Conclusiones: las lesiones aftosas en la cavidad bucal evolucionaron satisfactoriamente con la aplicación del Tisuacryl al ser esta una alternativa efectiva de tratamiento en comparación con la terapia convencional.

ABSTRACT Introduction: Tisuacryl is a biomaterial used in general and oral surgery, as well as in the treatment of aphthous stomatitis, considered a multifactorial process and currently the most common ulcerative disease of the oral cavity. Objective: to determine the effectiveness of Tisuacryl with respect to conventional therapy in the treatment of aphthous stomatitis in Consolación del Sur, Pinar del Río, in the period from September 2018 to March 2020. Methods: an analytical observational case-control study was conducted on 90 patients with aphthous stomatitis in Consolación del Sur, Pinar del Río, in the period from September 2018 to March 2020. Information was obtained from individual Periodontics medical records by obtaining oral and written consent from patients or their guardians. Results were obtained by statistical analysis including percent and Cochran Q nonparametric test. Results: female sex and age group from 10 to 19 years old predominated for 46,7 % in the study group and 42,2 % in the control group; the decrease of pain and healing started in most patients 72 hours after treatment with Tisuacryl for 91,1 % and 55,6 % respectively; being five days after application of the drug all of them asymptomatic and almost all the oral aphthae healed. Conclusions: aphthous lesions in the oral cavity evolved satisfactorily with the application of Tisuacryl being an effective treatment alternative in comparison with conventional therapy.

Prevention of medical adhesive-related skin injury during patient care: A scoping review.

Background: : Medical adhesive-related skin injury can occur during health care. Professionals must adopt preventive measures to maintain the integrity of the skin and patient comfort and safety. Objective: : To map the existing scientific evidence on preventing medical adhesive-related skin injury in adults. Design: : Scoping Review. Methods: : Searches were conducted in PubMed/Medline, Cochrane Library, Embase®, Latin American and Caribbean Literature in Health Sciences, Cumulative Index for Nursing and Allied Health Literature, and Google Scholar, without period delimitation. Duplicate studies and those that didn´t answer the research question were excluded. Results: : Of the 209 studies identified in the search process, 30 made up the final sample. The prevention of injury by adhesives mainly involves identifying risk factors, proper adhesive selection, and correct application and removal. Health education and medical records about injuries related to medical adhesives are essential. Conclusions: : The prevention of medical adhesive-related skin injury should be done by adopting multifactorial measures, which range from identifying risk factors and correct handling of adhesives to the process of educating professionals, patients and communities about these injuries. Registration: : The research was registered on the Open Science Framework DOI 10.17605/OSF.IO/NSWP8.

Use of cyanoacrylate for the stabilization of tissues in root coverage procedures: A case series report with 5 years follow up

ABSTRACT: A variety of periodontal plastic surgery techniques have been proposed to correct aesthetic and functional problems caused by gingival recession, with root coverage using connective tissue grafts being the one most commonly performed. These surgeries, however, are partially dependent on tissue graft stability. In this case series, we describe the use of a tissue adhesive (cyanoacrylate) as a solution for graft stabilization. Two patients with Cairo's type 1 gingival recession were treated with an envelope technique using connective tissue graft stabilized with cyanoacrylate alone. The results were a faster procedure and complete root coverage, even after 5 years of follow-up. Our findings suggest that cyanoacrylates can be an alternative to standard graft stabilizing procedures, leading to a stable root coverage in RT1 recessions.

Uso de cola cirúrgica no reparo de lacerações perineais intraparto: estudo série de casos / Uso de pegamento quirúrgico para reparar desgarros perineales intraparto: estudio serie de casos / Use of surgical glue to repair intrapartum perineal lacerations: a case series study

Resumo Objetivo Descrever o uso da cola cirúrgica no reparo do trauma perineal no parto normal. Métodos Estudo série de casos realizado em três momentos (até 2 horas, 12-24 horas e 36-48 horas após o parto), em Itapecerica da Serra, SP. Foram incluídas mulheres que tiveram parto normal com trauma perineal com indicação de sutura (laceração de primeiro ou segundo graus e episiotomia). O trauma perineal foi reparado exclusivamente com cola cirúrgica Glubran-2®. Avaliou-se: intensidade da dor perineal (Escala Visual Numérica com 11 pontos), processo de cicatrização (escala REEDA de 15 pontos), satisfação com o reparo (escala Likert de 5 pontos). Os dados foram analisados de forma descritiva e inferencial comparando os três momentos. Resultados A técnica de aplicação da cola e a quantidade necessária foram definidas em uma amostra de 19 mulheres. Destas, 78,9% tiveram laceração de primeiro grau, 15,8% de segundo grau e 5,3% episiotomia. Os desfechos nos momentos 1, 2 e 3, foram respectivamente: ausência de dor (73,6%, 94,7% e 89,4%); escore ≤1 na escala REEDA (94,7%, 78,9% e 84,2%); 100% satisfeitas com o reparo em todos os momentos. Não houve diferença pelo teste de Friedman para dor e satisfação. O processo de cicatrização mostrou diferença, porém sem confirmação no pós-teste hoc. Conclusão A aplicação da cola mostrou-se viável para avaliação em uma amostra maior de mulheres, pois os resultados sugerem boa aceitação pelas mulheres e dor de baixa intensidade ou ausente, cicatrização adequada e alta satisfação com o reparo nas primeiras 48 horas após o parto.

Resumen Objetivo Describir el uso de pegamento quirúrgico para reparar traumas perineales en partos vaginales. Métodos Estudio serie de casos realizado en tres momentos (hasta 2 horas, de 12 a 24 horas y de 36 a 48 horas después de parto), en Itapecerica da Serra, estado de São Paulo. Se incluyeron mujeres que tuvieron parto vaginal con trauma perineal e indicación de sutura (desgarro de primer o segundo grado y episiotomía). El trauma perineal fue reparado exclusivamente con pegamento quirúrgico Glubran-2®. Se evaluó la intensidad del dolor perineal (Escala Visual Numérica de 11 puntos), el proceso de cicatrización (Escala REEDA de 15 puntos) y la satisfacción respecto a la reparación (Escala Likert de 5 puntos). Los datos fueron analizados de forma descriptiva e inferencial, comparando los tres momentos. Resultados La técnica de aplicación del pegamento y la cantidad necesaria fueron definidas en una muestra de 19 mujeres. De ellas, el 78,9 % tuvieron un desgarro de primer grado, el 15,8 % de segundo grado y el 5,3 % episiotomía. Los resultados de los momentos 1, 2 y 3 fueron, respectivamente: ausencia de dolor (73,6 %, 94,7 % y 89,4 %); puntuación ≤1 en la escala REEDA (94,7 %, 78,9 % y 84,2 %); 100 % satisfechas con la reparación en todos los momentos. No se observó diferencia de dolor y satisfacción con la prueba de Friedman. El proceso de cicatrización mostró diferencia, pero sin confirmación en la prueba post hoc. Conclusión La aplicación del pegamento demostró ser viable para un análisis con una muestra mayor de mujeres, ya que los resultados sugieren buena aceptación por parte de las mujeres, dolor de baja intensidad o ausente, cicatrización adecuada y alta satisfacción respecto a la reparación en las primeras 48 horas después del parto.

Abstract Objective To describe the use of surgical glue to repair perineal trauma during normal delivery. Methods This is a case series study, which was carried out in three moments (up to 2 hours, 12-24 hours and 36-48 hours after delivery) in Itapecerica da Serra, SP. Women who had a normal delivery with perineal trauma with a suture (first or second degree laceration and episiotomy) were included. Perineal trauma was repaired exclusively with Glubran-2® surgical glue. Perineal pain intensity (11-point Visual Numeric Scale), healing process (15-point REEDA scale), satisfaction with repair (5-point Likert scale) were assessed. Data were analyzed in a descriptive and inferential way comparing the three moments. Results The technique of applying the glue and the required amount were defined in a sample of 19 women. Of these, 78.9% had first-degree lacerations, 15.8%, second-degree lacerations and 5.3%, episiotomy. The outcomes at moments 1, 2 and 3 were absence of pain (73.6%, 94.7% and 89.4%), score ≤1 on the REEDA scale (94.7%, 78.9% and 84, two%); 100% were satisfied with the repair at all times. There was no difference by the Friedman test for pain and satisfaction. The healing process showed a difference, but without confirmation in the hoc post-test. Conclusion The glue application proved to be viable for assessment in a larger sample of women, as the results suggest good acceptance by women and low or no pain, adequate healing and high satisfaction with the repair in the first 48 hours after delivery.

Prevalence and associated factors of medical adhesive-related skin injury in cardiac critical care units / Prevalencia de lesiones de la piel relacionadas con adhesivos médicos y factores asociados en unidades críticas cardiológicas / Prevalência de lesão de pele relacionada a adesivos médicos e fatores associados em unidades críticas cardiológicas

ABSTRACT Objective: To identify and analyze the point prevalence of medical adhesive-related skin injury in patients hospitalized in cardiac Intensive Care Units and demographic and clinical factors associated to their occurrence. Method: Cross-sectional study conducted in Intensive Care Units of two public hospitals, reference centers for cardiology, located in São Paulo city, with 123 patients. Demographic and clinical data from patients' medical records were collected and lesions were identified through skin inspection. The data were analyzed through descriptive statistics and bivariate and multivariate analysis (Classification and Regression Tree). Results: Medical adhesive-related skin injury was presented by 28 patients, which amounts to a 22.7% prevalence. Its main causative agent was transparent polyurethane film (46.9%) and the cervical region was the most affected area (25.1%). From the multivariate analysis, the associated factors were found to be the presence of serum urea higher than or equal to 48.5 mg/dL and platelets lower than 193,500 mm3 or platelets higher than or equal to 193,500 mm3 and systolic blood pressure higher than or equal to 122 mmHg. Conclusion: This study has contributed to knowledge related to the epidemiology of this type of injury, favoring preventive care planning.

RESUMEN Objetivo: Identificar y analizar la prevalencia puntual de las lesiones de la piel relacionadas con adhesivos médicos en pacientes ingresados en Unidades de Cuidados Intensivos cardiológicos y los factores demográficos y clínicos asociados a su aparición. Método: Estudio transversal realizado en las Unidades de Cuidados Intensivos de dos hospitales públicos, de referencia en cardiología, ubicados en la ciudad de São Paulo, con 123 pacientes. Los datos demográficos y clínicos se recogieron de las historias clínicas de los pacientes y las lesiones se identificaron mediante la inspección de la piel. Los datos se analizaron mediante estadísticas descriptivas y análisis bivariado y multivariado (Classification and Regression Tree). Resultados: Hubo 28 pacientes con lesiones de la piel relacionadas con adhesivos médicos, con una prevalencia del 22,7%. El principal agente causante fue la película de poliuretano transparente (46,9%) y la región más afectada fue la cervical (25,1%). Mediante un análisis multivariado, los factores asociados fueron la presencia de urea sérica mayor o igual a 48,5 mg/dL y plaquetas menores de 193.500 mm3 o plaquetas mayores o iguales a 193.500 mm3 y presión arterial sistólica mayor o igual a 122 mmHg. Conclusión: El estudio contribuyó al conocimiento relacionado con la epidemiología de este tipo de lesión, favoreciendo la planificación de la atención preventiva.

RESUMO Objetivo: Identificar e analisar a prevalência pontual de lesão de pele relacionada a adesivos médicos em pacientes internados em Unidades de Terapia Intensiva cardiológicas e os fatores demográficos e clínicos associados à sua ocorrência. Método: Estudo transversal conduzido nas Unidades de Terapia Intensiva de dois hospitais públicos, referência em cardiologia, localizados no município de São Paulo, com 123 pacientes. Foram coletados dados demográficos e clínicos dos prontuários dos pacientes e as lesões foram identificadas por meio de inspeção da pele. Os dados foram analisados por meio de estatística descritiva e análises bivariada e multivariada (Classification and Regression Tree). Resultados: Apresentaram lesão de pele relacionada a adesivos médicos 28 pacientes, perfazendo prevalência de 22,7%. O principal agente causador foi o filme de poliuretano transparente (46,9%) e a região mais acometida foi a cervical (25,1%). Pela análise multivariada, os fatores associados foram presença de ureia sérica maior ou igual a 48,5 mg/dL e plaquetas menores que 193.500 mm3 ou plaquetas maiores ou iguais a 193.500 mm3 e pressão arterial sistólica maior ou igual a 122 mmHg. Conclusão: O estudo contribuiu para os conhecimentos relacionados à epidemiologia desse tipo de lesão, favorecendo o planejamento de cuidados preventivos.

Efectividad del Tisuacryl como apósito periodontal en técnicas quirúrgicas / Effectiveness of Tisuacryl as a periodontal dressing in surgical techniques

RESUMEN Introducción: el Tisuacryl es un biomaterial de gran efectividad como apósito periodontal en papilectomías, gingivectomías y gingivoplastias. Objetivo: determinar la efectividad del Tisuacryl con respecto al cemento quirúrgico o Quirucem, usados como apósito periodontal en cirugías periodontales. Métodos: estudio observacional analítico de casos y controles en 60 pacientes con diagnóstico de gingivitis crónica fibrosa y fibroedematosa desde septiembre de 2016 a junio de 2017. Se realizó examen físico, confección de historia clínica de periodoncia, tratamiento periodontal y selección de pacientes con necesidad de tratamiento quirúrgico. Se utilizaron medidas de resúmenes para variables cualitativas como el porcentaje y para variables cuantitativas como la media y la desviación estándar. Se empleó el test estadístico prueba de Chi cuadrado con nivel de significación de &= 0.05 para la comparación de los grupos con diferentes modalidades de tratamiento. Resultados: el total de los pacientes tratados con Tisuacryl expresaron comodidad con el uso de este y no se produjo acúmulo de placa dentobacteriana. Solo el 30 % presentó enrojecimiento a los siete días, pero a los 15 se constató cicatrización total de la herida. Con Quirucem existieron todos los síntomas y signos estudiados y en todos los casos el enrojecimiento; más de la mitad presentó incomodidad en la evolución y el 40 % de los casos a los 15 días continuaban sin cicatrizar totalmente. Conclusiones: el Tisuacryl resultó más efectivo con respecto al Quirucem considerando el menor tiempo de cicatrización, mayor comodidad y estética en los pacientes.

ABSTRACT Introduction: Tisuacryl is a highly effective biomaterial as a periodontal dressing in papillectomies, gingivectomies and gingivoplasties. Objective: to determine the effectiveness of Tisuacryl with respect to surgical cement or Quirucem, used as a periodontal dressing in periodontal surgeries. Methods: observational analytical study of cases and controls in 60 patients with the diagnosis of chronic fibrous and fibro-edematous gingivitis from September 2016 to June 2017. Physical examination, periodontal history, periodontal treatment and selection of patients in need of surgical treatment were performed. Summary measures were used for qualitative variables, such as percentage and for quantitative variables such as mean and standard deviation. The chi-square statistical test with a significance level of &= 0.05 was used to compare the groups with different treatment modalities. Results: all patients treated with Tisuacryl expressed comfort with its use and no accumulation of dentobacterial plaque occurred. Only 30 % had redness at seven days, but at 15 days the wound was completely healed. With Quirucem all the symptoms and signs studied were present along with redness in all cases; more than the half of patients complained of discomfort during evolution and 40 % of the cases at 15 days remained totally unhealed. Conclusions: Tisuacryl was more effective than Quirucem considering the shorter time of cicatrization, greater comfort and better aesthetics results in patients.

Histological analysis of biocompatibility of different surgical adhesives in subcutaneous tissue.

The focus of this study was to test the hypothesis that there would be no difference between the biocompatibility of cyanoacrylate-based adhesives in rat subcutaneous tissues. In total, 60 male Wistar rats were used, and divided into four groups (n = 15): Group C (control, PVA-polyvinyl alcohol sponge), Group NO (N-butyl-2-octylcyanoacrylate), Group NH (n-hexyl-cyanoacrylate), and Group EC (Ethyl-cyanoacrylate). The animals were sacrificed after time intervals of 7, 15, and 30 days and tissues were analyzed under optical microscope as regards the events of inflammatory infiltrate, edema, necrosis, granulation tissue, giant cells, young fibroblasts, and collagen formation. The results were statistically analyzed by the Kruskal-Wallis and Dunn tests (p < .05). Significant inflammatory infiltrate was shown for all the adhesives in the time intervals of 7 (p = .004) and 15 days (p = .003). In the time interval of 30 days, moderate inflammatory infiltrate was observed in Groups NH and EC, with significant difference from Control (p = .001). The quantity of collagen fibers in all the experimental groups showed significant difference compared with Control in the time intervals of 7 (p = .002) and 15 days (p = .001), at 30 days only Group EC showed a smaller quantity of collagen fibers in comparison with Control (p = .001). The hypothesis was rejected. The adhesive N-butyl-2-octylcyanoacrylate had less influence on the inflammatory intensity of multinucleated giant cells. Ethyl-cyanoacrylate demonstrated the lowest level of biocompatibility among the adhesives, but its use in clinical practice may be promising for coaptation of smaller edges of superficial tissue. Surgical adhesives were shown to be feasible for clinical use in substitution of conventional suturing. Ethyl-cyanoacrylate should be used with caution due to its greater influence on tissues.

Incisões cirúrgicas mamárias tratadas com 2-octilcianoacrilato versus sutura intradérmica com fio de nylon: ensaio clínico randomizado / Surgical breast incisions treated with 2-octyl-cyanoacrylate versus intradermal nylon suture: a randomized clinical trial

RESUMO Objetivo: avaliar o perfil de segurança e os resultados estéticos do 2-octilcianoacrilato versus sutura intradérmica com fio de nylon em cirurgias mamárias. Métodos: ensaio clínico randomizado, aberto, que avaliou a ocorrência de complicações, como deiscência, hematoma, infecção e reações alérgicas após o uso do 2-octilcianoacrilato ou do fio de nylon. Também foi analisado o tamanho das incisões, o tempo de fechamento da pele e o tempo cirúrgico total. O resultado estético foi avaliado após 40 e 180 dias da cirurgia, por meio da largura média da ferida operatória e por avaliação subjetiva conceitual (ótimo, bom, razoável ou ruim). Resultados: foram incluídas 79 pacientes, sendo 37 no grupo 2-octilcianoacrilato e 42 no grupo de sutura com fio de nylon. O estudo foi interrompido antes do término do recrutamento dos pacientes pela ocorrência de maior número de deiscências no grupo do adesivo (OR: 11,42; IC95%: 1,36-96,02; p=0,007). Em relação às demais complicações analisadas, ao tempo cirúrgico e ao resultado estético no pós-operatório, não se observaram diferenças significativas entre os grupos. A média do tamanho da ferida operatória foi maior no grupo do adesivo em relação ao grupo da sutura, mas não houve correlação entre o tamanho da ferida e o maior número de deiscências. Conclusão: o 2-octilcianoacrilato apresentou maior risco de deiscência em relação à sutura intradérmica, com resultados estéticos equivalentes.

ABSTRACT Objective: to evaluate the safety profile and aesthetic results of 2-octyl-cyanoacrylate versus intradermal nylon suture in breast surgeries. Methods: an open-label, randomized, clinical trial evaluating the occurrence of complications, such as dehiscence, hematoma, infection, and allergic reactions after the use of 2-octyl-cyanoacrylate or nylon thread. The size of the incisions, skin closure time, and total surgical time were also analyzed. The aesthetic outcome was evaluated at 40 and 180 days after surgery, by means of the average width of the surgical wound and by subjective conceptual assessment (optimal, good, reasonable, or poor). Results: 79 patients were included: 37 in the 2-octyl-cyanoacrylate group and 42 in the nylon suture group. The study was stopped before the end of patient recruitment due to the occurrence of a greater number of dehiscences in the adhesive group (OR: 11.42; 95%CI: 1.36-96.02; p=0.007). Regarding the other analyzed complications, the surgical duration and postoperative aesthetic result, no significant differences were observed between the groups. The mean operative wound size was greater in the adhesive group than in the suture group, but there was no correlation between wound size and the largest number of dehiscences. Conclusion: while the cosmetic outcomes with the two techniques were similar, there was a greater risk of dehiscence with the use of 2-octyl-cyanoacrylate compared to intradermal suturing.

Evaluation of tensile strength of tissue adhesives made of fibrin and cyanoacrylate used as reinforcement of colon suture in "ex vivo" swine

ABSTRACT Aim: To evaluate rupture pressures of tissue adhesives of cyanoacrylate (Omnex®) and fibrin (Evicel®), used as reinforcement in colonic suture from "ex vivo" swine. Methods: Surgical procedures were performed in the Surgical Technique Laboratory. From a division in segments of 10 cm of descending colon and sigmoid colon from three "ex vivo" female swine, Landrace breed, which were resected in less than six hours after the slaughter time, 30 segments were selected, 10 of each animal. They were stored in saline solution 0.9% at 36 °C, being randomly allocated in three groups (Control, Evicel and Omnex), each one containing 10 segments. Results: The lower and higher pressure values found in the groups Control, Evicel and Omnex were 36 mmHg and 41 mmHg, 70 mmHg and 90 mmHg, 90 mmHg and 120 mmHg, respectively. Containing statistical significance (p-value <0.0001) concerning the 2 to 2 comparisons (Control, Evicel and Omnex) with 95% trusting rate based on the application of the Turkey Method. Conclusion: One concludes that the use of tissue adhesives in anastomoses colonic in an experimental animal model of "ex vivo" swine increased the anastomoses rupture pressures. Among the tested adhesives, cyanoacrylate presented higher rupture pressure in relation to fibrin adhesive.

RESUMO Objetivo: Avaliar as pressões de ruptura dos adesivos teciduais de Cianoacrilato (Omnex®) e de Fibrina (Evicel®), usados como reforço em suturas colônicas de suínos "ex-vivo". Métodos: Os procedimentos cirúrgicos realizados foram realizados no Laboratório de Técnica Cirúrgica. A partir da divisão em segmentos de 10 cm do colo descendente e colo sigmoide de três suínas fêmeas ex-vivo, da raça Landrace, ressecados em tempo inferior a seis horas em relação ao momento do abate, foram selecionados 30 segmentos, 10 de cada animal. Foram armazenados em soro fisiológico 0,9% a 36 °C, alocando-se aleatoriamente esses segmentos em três grupos (Controle, Evicel e Omnex) com 10 segmentos cada. Resultados: Os menores e maiores valores pressóricos encontrados nos grupos Controle, Evicel e Omnex foram 36 mmHg e 41 mmHg, 70 mmHg e 90 mmHg, 90 mmHg e 120 mmHg, respectivamente. Com significância estatística (Valor-p < 0,0001) para as comparações 2 a 2 (Sutura, Evicel e Omnex) com um intervalo de confiança de 95% construído a partir da aplicação do método de Turkey. Conclusão: A partir desse estudo conclui-se que o uso de adesivos teciduais em anastomoses colônicas, em modelo experimental animal de suíno ex-vivo, aumentou as pressões de ruptura das anastomoses. Dentre os adesivos testados, o adesivo de Cianoacrilato apresentou maiores pressões de ruptura em relação ao adesivo de Fibrina.

The effects of ethyl-2-cyanoacrylate and butyl-2-cyanoacrylate in the process of bone healing in rats. A controlled experimental study / Efeitos do etil-2-cianoacrilato e do butil-2-cianoacrilato no processo de consolidação óssea em ratos. Estudo experimental controlado

ABSTRACT Objective: Synthetic adhesives are used by various medical specialties, especially in surgery; however, studies reporting their use in orthopedic practice are scarce. The aim of this study was to compare the results in using ethyl-2-cyanoacrylate or butyl-2-cyanoacrylate in the treatment of fractures in rats. Methods: This was an experimental prospective controlled study in 90 rats, with humerus, femur, and tibia fractures, treated with ethyl-2-cyanoacrylate (SB group; n = 45) or butyl-2-cyanoacrylate (HA group; n = 45). Biomechanical and histomorphometric analyses were performed at three different moments (60, 120, and 180 days); besides a clinical study performed weekly by measurement of the animals body mass. Results: No differences were observed regarding body mass (p = 0.07). In both groups, there were no significant differences regarding maximum load (p = 0.6), yield point strength (p = 0.6), and stiffness coefficient (p = 0.4) of the femurs. The same was observed in tibias for maximum load (p = 0.4), yield point strength (p = 0.7), and stiffness coefficient (p = 0.6). The humerus from both groups had similar bone callus area (p = 0.66). In both groups, there were no statistical differences related to inflammatory cells (p = 0.4), osteoblasts (p = 0.2), and osteoclasts (p = 0.2). Conclusion: Ethyl-2-cyanoacrylate was more effective than butyl-2-cyanoacrylate in the treatment of fractures in rats.

RESUMO Objetivo: Os adesivos sintéticos são usados em várias especialidades médicas cirúrgicas, contudo, os estudos que relatam seu uso na prática ortopédica são escassos. O objetivo deste trabalho foi comparar os resultados do uso do etil-2-cianoacrilato e do butil-2-cianoacrilato no tratamento de fraturas em ratos. Métodos: Foi realizado um estudo experimental, prospectivo e controlado em 90 ratos com fraturas de úmero, fêmur e tíbia, tratados com etil-2-cianoacrilato (grupo SB; n = 45) ou butil-2-cianoacrilato (grupo HA; n = 45). Foram realizadas análises biomecânicas e histomorfométricas em três momentos (60, 120 e 180 dias), além do estudo clínico pela aferição semanal da massa corporal dos animais. Resultados: Não foram observadas diferenças relacionadas à massa corporal dos animais (p = 0,07). Os fêmures de ambos os grupos não apresentaram diferença com relação à carga máxima (p = 0,6), limite de elasticidade (p = 0,6) e coeficiente de rigidez (p = 0,4). Analisando-se as tíbias, o mesmo foi observado com relação à carga máxima (p = 0,4), ao limite de elasticidade (p = 0,7) e ao coeficiente de rigidez (p = 0,6). Os úmeros de ambos os grupos apresentaram a mesma área de calo ósseo formado (p = 0,66). Em ambos os grupos, não houve diferença estatística relacionada ao número de osteoblastos (p = 0,2), osteoclastos (p = 0,2) e células inflamatórias (p = 0,4). Conclusão: O etil-2-cianoacrilato foi mais eficaz do que o butil-2-cianoacrilato no tratamento de fraturas em ratos.

The effects of ethyl-2-cyanoacrylate and butyl-2-cyanoacrylate in the process of bone healing in rats. A controlled experimental study.

OBJECTIVE: Synthetic adhesives are used by various medical specialties, especially in surgery; however, studies reporting their use in orthopedic practice are scarce. The aim of this study was to compare the results in using ethyl-2-cyanoacrylate or butyl-2-cyanoacrylate in the treatment of fractures in rats. METHODS: This was an experimental prospective controlled study in 90 rats, with humerus, femur, and tibia fractures, treated with ethyl-2-cyanoacrylate (SB group; n = 45) or butyl-2-cyanoacrylate (HA group; n = 45). Biomechanical and histomorphometric analyses were performed at three different moments (60, 120, and 180 days); besides a clinical study performed weekly by measurement of the animals body mass. RESULTS: No differences were observed regarding body mass (p = 0.07). In both groups, there were no significant differences regarding maximum load (p = 0.6), yield point strength (p = 0.6), and stiffness coefficient (p = 0.4) of the femurs. The same was observed in tibias for maximum load (p = 0.4), yield point strength (p = 0.7), and stiffness coefficient (p = 0.6). The humerus from both groups had similar bone callus area (p = 0.66). In both groups, there were no statistical differences related to inflammatory cells (p = 0.4), osteoblasts (p = 0.2), and osteoclasts (p = 0.2). CONCLUSION: Ethyl-2-cyanoacrylate was more effective than butyl-2-cyanoacrylate in the treatment of fractures in rats.

OBJETIVO: Os adesivos sintéticos são usados em várias especialidades médicas cirúrgicas, contudo, os estudos que relatam seu uso na prática ortopédica são escassos. O objetivo deste trabalho foi comparar os resultados do uso do etil-2-cianoacrilato e do butil-2-cianoacrilato no tratamento de fraturas em ratos. MÉTODOS: Foi realizado um estudo experimental, prospectivo e controlado em 90 ratos com fraturas de úmero, fêmur e tíbia, tratados com etil-2-cianoacrilato (grupo SB; n = 45) ou butil-2-cianoacrilato (grupo HA; n = 45). Foram realizadas análises biomecânicas e histomorfométricas em três momentos (60, 120 e 180 dias), além do estudo clínico pela aferição semanal da massa corporal dos animais. RESULTADOS: Não foram observadas diferenças relacionadas à massa corporal dos animais (p = 0,07). Os fêmures de ambos os grupos não apresentaram diferença com relação à carga máxima (p = 0,6), limite de elasticidade (p = 0,6) e coeficiente de rigidez (p = 0,4). Analisando-se as tíbias, o mesmo foi observado com relação à carga máxima (p = 0,4), ao limite de elasticidade (p = 0,7) e ao coeficiente de rigidez (p = 0,6). Os úmeros de ambos os grupos apresentaram a mesma área de calo ósseo formado (p = 0,66). Em ambos os grupos, não houve diferença estatística relacionada ao número de osteoblastos (p = 0,2), osteoclastos (p = 0,2) e células inflamatórias (p = 0,4). CONCLUSÃO: O etil-2-cianoacrilato foi mais eficaz do que o butil-2-cianoacrilato no tratamento de fraturas em ratos.

Cola adesiva cirúrgica no reparo de lacerações perineais de primeiro grau no parto normal: estudo piloto aleatorizado controlado / Tissue adhesive for first-degree perineal tears repairing during normal delivery: a pilot randomized controlled trial

Introdução: O trauma perineal provocado pelo parto vaginal e seu reparo são importantes preocupações relacionadas ao períneo. A técnica ideal de reparo deve ser rápida, indolor, de fácil execução e que reduza a dor no puerpério. As evidências científicas apontam que a técnica e o material mais adequados para o reparo do trauma perineal são a sutura contínua e o fio poliglactina 910 de rápida absorção. Entretanto, em lacerações de primeiro e segundo graus, apesar de promover boa cicatrização, a sutura está relacionada à dor no períneo. A cola adesiva cirúrgica é um material utilizado em diversas cirurgias e especialidades médicas, com alto grau de resistência e facilidade no procedimento cirúrgico, o que parece se apresentar como uma alternativa eficaz no reparo perineal. Objetivo: Determinar a viabilidade de um ensaio clínico controlado e aleatorizado (ECA) sobre o uso da cola adesiva cirúrgica no reparo de lacerações perineais de primeiro grau durante o parto normal. Método: Estudo piloto paralelo, controlado e aleatorizado comparando a cola adesiva cirúrgica Epiglu® (etil-2-cianoacrilato) com o fio Vicryl Rapide® (poliglactina 910) no reparo perineal, realizado no Pronto Socorro e Maternidade Municipal Zoraide Eva das Dores, Itapecerica da Serra-SP. A amostra foi constituída por 20 mulheres com lacerações perineais de primeiro grau com necessidade de reparo durante o parto normal, distribuídas no grupo experimental (GE; n=10; submetidas ao reparo com Epiglu®) e grupo controle (GC; n=10; submetidas ao reparo com sutura com Vicryl Rapide®). O desfecho primário foi a ocorrência e intensidade da dor perineal após o parto e os desfechos secundários foram o processo de cicatrização, a satisfação da mulher com reparo perineal e o tempo dispendido pelo profissional para o reparo. Os desfechos foram avaliados pela Escala Visual Numérica de 11 pontos para intensidade da dor perineal; Escala REEDA, para cicatrização perineal; Escala Visual Analógica para satisfação da mulher; cronômetro digital para contagem do tempo de reparo dispendido em ambas as técnicas. Os dados foram coletados em quatro etapas: até 2 horas pós-parto, 12-24 horas, 36-48 horas e 10-20 dias pós-parto. Resultados: A média da intensidade da dor perineal foi significativamente menor entre as mulheres no GE, em todas as etapas do estudo (variação de 2,0-0,2 e 2,5-0,6 nos GE e GC, respectivamente). A cicatrização perineal apresentou escores significativamente melhores na escala REEDA entre as mulheres no GE, em todas as etapas (variação de 0,6-0,0 e 1,8-0,7, nos GE e GC, respectivamente). A satisfação das mulheres com reparo perineal foi significativamente superior no GE (100% estavam satisfeitas ou muito satisfeitas), em comparação com o GC (10% a 20% estavam insatisfeitas ou muito insatisfeitas). A média de tempo gasto para o reparo perineal foi 5 minutos no GE e 21 minutos no GC (p<0,001). Conclusão: O estudo mostrou que é viável adotar a técnica de reparo com Epiglu® utilizada no estudo piloto, bem como os mesmos desfechos e períodos de seguimento pós-parto. Além disso, os resultados foram importantes para comparar os métodos de reparo perineal e calcular o tamanho da amostra para o ECA. Protocolo: O estudo foi registrado no Portal de Registro Brasileiro de Ensaios Clínicos http://www.ensaiosclinicos.gov.br/rg/RBR-2h84gt/.

Introduction: One of the important concerns regarding the perineum is the trauma caused by the vaginal delivery and perinealrepair. The ideal perineal repair technique should be quick, painless, easy to perform in order to decrease pain in the puerperium. The scientific evidence indicates that the most suitable technique and material for the repair of perineal trauma are continuous suture and the polyglactin 910 rapid absorption thread. However, in the first and second degrees lacerations, despite promoting good healing, the suture is associated with perineum pain. The surgical adhesive is a tool used in several surgeries and medical specialties, had high resistance and is ease to manage during the surgical procedure, which seems to be an effective alternative for perineal repair. Objective: To determine the feasibility of a clinical randomized controlled trial (RCT) on the use of surgical adhesive in the repair of first-degree perineal trauma during vaginal delivery. Methods: Parallel, controlled and randomized pilot study comparing the outcomes of the use of surgical adhesive glue Epiglu (ethyl-2-cyanoacrylate) and Vicryl Rapide (polyglactin 910) thread in perineal repair. The research was performed at Pronto Socorro e Maternidade Zoraide Eva das Dores, Itapecerica da Serra-SP, Brazil. The sample comprised 20 women with first-degree perineal trauma that need repair during normal delivery, distributed in experimental group (EG, n=10, undergoing repair with Epiglu) and control group (CG;n=10, undergoing repair with Vicryl Rapide). The primary outcome was the occurrence and intensity of perineal pain after delivery and secondary outcomes were healing process, the womans satisfaction on perineal repair and the time spent by the professional to repair the trauma. The outcomes were evaluated by the 11-point Visual Numeric Scale for perineal pain intensity; REEDA Scale for perineal healing; Visual Analogue Scale for womens satisfaction; digital stopwatch for counting the repair time in both suture techniques. Data were collected in four stages: up to 2 hours after delivery, 12-24 hours, 36-48 hours and 10-20 days postpartum. Results: In all study stages, the average of the intensity of perineal pain among women in EG was significantly lower than CG (variation of 2.0-0.2 in EG and 2.5-0.6 in CG). In all stages, perineal healing showed significantly better REEDA scale scores among women in EG, (variation of 0.6-0.0 in EG and 1.8-0.7 in CG). The womens satisfaction with perineal repair was significantly higher in EG (100% were satisfied or very satisfied), compared with CG (10% to 20% were unsatisfied or very unsatisfied). The average time for perineal repair was 5 minutes in EG and 21 minutes in CG (p<0.001). Conclusion: The results of the study were important to compare perineal repair methods and calculate the sample size for the future RCT. In addition, we showed that is possible to adopt the perineal repair technique with Epiglu developed in the pilot study, as well as the same outcomes and postpartum follow-up periods. Protocol: The study was registered in the Brazilian Clinical Trials Registry http://www.ensaiosclinicos.gov.br/rg/RBR-2h84gt/.

Comparison of arterial repair through the suture, suture with fibrin or cyanoacrylate adhesive in ex-vivo porcine aortic segment

Abstract Introduction: Tissue adhesives can be used as adjacent to sutures to drop or avoid bleeding in cardiovascular operations. Objective: To verify the efficiency of fibrin and cyanoacrylate adhesive to seal arterial sutures and if the adhesives penetrate through suture line to the inner of arteries. Methods: 20 abdominal aorta segments of pigs were divided into two groups according to the adhesive which would be used as adjacent to the suture. In every arterial segment an arteriotomy was done, followed by a conventional artery closure. Afterwards a colloidal fluid was injected inside the arterial segment with a simultaneous intravascular pressure monitoring up to a fluid leakage through the suture. This procedure was repeated after application of one of the adhesives on the suture in order to check if the bursting pressure increases. The inner aorta segments also were analyzed in order to check if there was intraluminal adhesive penetration. Results: In Suture 1 group, the mean arterial pressure sustained by the arterial suture reached 86±5.35 mmHg and after the fibrin adhesive application reached 104±11.96 (P<0.002). In the Suture 2 group, the mean arterial pressure sustained by the suture reached 83±2.67 mmHg and after the cyanoacrylate adhesive application reached 152±14.58 mmHg (P<0.002). Intraluminal adhesive penetration has not been noticed. Conclusion: There was a significant rise in the bursting pressure when tissue adhesives were used as adjacent to arterial suture, and this rise was higher if the cyanoacrylate adhesive was used. In addition, the adhesives do not penetrate through the suture line into the arteries.

Local and systemic effects of fibrin and cyanoacrylate adhesives on lung lesions in rabbits

OBJECTIVES: Tissue adhesives can be used to prevent pulmonary air leaks, which frequently occur after lung interventions. The objective of this study is to evaluate local and systemic effects of fibrin and cyanoacrylate tissue adhesives on lung lesions in rabbits. METHODS: Eighteen rabbits were submitted to videothoracoscopy + lung incision alone (control) or videothoracoscopy + lung incision + local application of fibrin or cyanoacrylate adhesive. Blood samples were collected and assessed for leukocyte, neutrophil and lymphocyte counts and interleukin-8 levels preoperatively and at 48 hours and 28 days post-operatively. After 28 days, the animals were euthanized for gross examination of the lung surface, and lung fragments were excised for histopathological analysis. RESULTS: Fibrin and cyanoacrylate produced similar adhesion scores of the lung to the parietal pleura. Microscopic analysis revealed uniform low-cellular tissue infiltration in the fibrin group and an intense tissue reaction characterized by dense inflammatory infiltration of granulocytes, giant cells and necrosis in the cyanoacrylate group. No changes were detected in the leukocyte, neutrophil or lymphocyte count at any time-point, while the interleukin-8 levels were increased in the fibrin and cyanoacrylate groups after 48 hours compared with the pre-operative control levels (p<0.01). CONCLUSION: Both adhesive agents promoted normal tissue healing, with a more pronounced local inflammatory reaction observed for cyanoacrylate. Among the serum markers of inflammation, only the interleukin-8 levels changed post-operatively, increasing after 48 hours and decreasing after 28 days to levels similar to those of the control group in both the fibrin and cyanoacrylate groups.

Modificação das propriedades superficiais dos polímeros sintéticos e orgânicos após imersão em biofilme de C. albicans / Modification of the surface properties of two synthetic organic polymers after immersion in C. albicans biofilm

A proposta deste trabalho foi avaliar as alterações da rugosidade e hidrofobicidade superficial de 4 adesivos sintéticos e 1 orgânico aplicados em resinas acrílicas termopolimerizáveis (RAT) antes e após 7, 14 e 30 dias de serem submetidos em biofilme de Cândida albicans. Foram confeccionados cento e oito espécimes de resina acrílica termopolimerizável (10x10x3mm) na qual foram aplicados 4 adesivos sintéticos a base de CAs: Etil cianoacrilato convencional (ECAc - Superbonder®), Etil cianoacrilato em gel (ECAg ­ Superbonder ® em gel), Butil cianoacrilato (BCA ­ Tekbond®), Octil cianoacrilato (OCA ­ Dermabond ®) e 1 adesivo orgânico a base de veneno de cobra (AT- C.E.V.A.P, Unesp). Após da polimerização dos produtos aplicados, foram aguardados 48 horas para a leitura da rugosidade no perfilômetro e da hidrofobicidade no goniômetro, concluído este procedimento todos os espécimes passaram por um processo de esterilização por óxido de etileno para logo serem divididos em 3 grupos: 7, 14 e 30 dias. Seguidamente os espécimes foram inoculados com Cândida albicans SC5314 (1.107 células/mL) para a formação de biofilme. Concluído os períodos de avaliação, foi selecionado 1 espécime de cada grupo para ser corado através dos fluorocromos SYTO-9 e iodeto de propídeo para análise em microscópio confocal e simultaneamente os demais espécimes passaram pela remoção mecânica do biofilme, para logo serem lavados e secados a temperatura ambiente sobre exposição de luz UV durante 6 horas. Em seguida os espécimes foram envalados e esterilizados por óxido de etileno para finalmente ser avaliados no perfilômetro e goniômetro. Para a avaliação das medidas iniciais dos materiais testados foi empregado o teste de anova 1 critério e para a análise após da imersão em biofilme de Cândida albicans foi utilizado o teste de anova 2 critérios. Para as diferenças encontradas entre os grupos, foi utilizado o teste de comparação múltipla (Teste de Tukey). Foi adotado um nível de significância de 5%. Os resultados demonstraram que todos os grupos CAs conseguiram diminuir significativamente a rugosidade superficial, além de manter propriedades hidrofóbicas na sua superfície: ECAc (2,02 µm - 86.93°), ECAg (2.57µm -109.06°), BCA (0.78µm ­ 95.57°), OCA (0.61µm -102.47°), porém o AT tornou a superfície da resina acrílica hidrofílica, além de não conseguir diminuir a rugosidade da RAT (3.63µm ­ 59.49°). Após imersão em biofilme microbiano, foi constatado que o biofilme de C. albicans conseguiu diminuir significativamente os valores da rugosidade em todos os períodos avaliados, exceto o grupo BCA. Com relação a hidrofobicidade foi observada uma redução significante dos valores hidrofóbicos em todos os grupos testados após imersão em biofilme de C.albicans, exceto no grupo AT nos 3 períodos avaliados. Estes resultados confirmaram que os grupos CAs melhoram as características físico-químicas das RATs, destacando-se dentre eles o grupo OCA com superfícies menos rugosas e propriedades hidrofóbicas na sua superfície. Por outro lado, cabe salientar o grupo BCA cuja rugosidade foi inalterada. Finalmente as imagens em microscópio confocal revelaram que os grupos etil cianoacrilatos apresentam uma maior efetividade em inibir a adesão microbiana.(AU)

The objective of this study was to analyze the effect of synthetic and organic adhesives on the surface roughness and surface hydrophobicity of heat-polymerized acrylic resin before and after 7, 14 and 30 days of being submitted to the biofilm of C. albicans. One hundred and eight specimens of heat-polymerized acrylic resin were fabricated (10x10x3mm) for them apply on its surface 4 adhesives based on cyanoacrylate (CA): ethyl cyanoacrylate conventional (ECAc ­ Superbonder ®), ethyl cyanoacrylate gel (ECAg ­ Superbonder ® gel), butyl cyanoacrylate (BCA ­ Tekbond ®), octil cyanoacrylate (OCA-Dermabond®) and one fibrin sealant derived from Snake-venom (AT ­ C.E.V.A.P, Unesp). After the polymerization of the applied products, 48 hours were expected for the roughness reading in the profilometer and the hydrophobicity in the goniometer. Following this procedure, all specimens underwent sterilization process by ethylene oxide to divide them into 3 groups: 7, 14 and 30 days. Afterward specimens were inoculated with C. albicans SC5314 (1.107 cells/mL) for biofilm formation. After evaluation periods, the remaining biofilme of one specimen from each group were stained with fluorochromes SYTO-9 and propidium iodide to be analyzed by confocal microscopy (MC) and simultaneously others specimens were mechanically biofilm removed, washed, and dried room temperature on UV light exposure for 6 hours. Then specimens were embossed and sterilized by ethylene oxide to finally be analyzed in profilometer and goniometer. The data were statistically analyzed using one-way anova for initial measurements and two-way anova test for analysis after immersion in Candida albicans biofilm. For differences found between groups, the multiple comparison test (tukey test) was used, considering a significance level of 5%. Results showed that all CAs were able to reduce surface roughness and maintain hydrophobic properties on the surface: ECAc (2,02 µm - 86.93°), ECAg (2.57µm -109.06°), BCA(0.78µm ­ 95.57°), OCA (0.61µm -102.47°), however the AT group changes the acrylic resin surface hydrophilic, as well as not being able to reduce the surface roughness of the RAT (3.63µm ­ 59.49°). Subsequent immersion in microbial biofilms, it was verified that Candida albicans biofilm was able to reduce roughness values in all groups, except the BCA group. Regarding hydrophobicity, a significant lowering of hydrophobic values was observed in all groups tested after immersion in C. albicans biofilms, except in AT in the 3 periods evaluated. These results corroborated that CAs groups improve the physico-chemical characteristics of RATs, among them the OCA group with hydrophobic properties and with lowest mean values of roughness in three evaluated periods. On the other hand, BCA group didn't change the roughness of the surface after immersion in biofilms. Finally, confocal microscope images revealed that ethyl cyanoacrylate groups have a greater effectiveness in inhibiting microbial adhesion.(AU)

Comparação de resultado estético em cicatrizes com uso de fios cirúrgicos e Prineo® / Comparison between surgical sutures and Prineo® in terms of esthetic result and scar formation

Introdução: Cicatrização de ferida é um processo bem organizado que tem como finalidade a reparação tecidual completa. Colas e adesivos tópicos oferecem uma alternativa não invasiva, de retirada fácil e espontânea; boa força tênsil; menor tempo de aplicação, sendo o Prineo® uma cola adesiva associada a uma malha de poliéster aplicados sobre a ferida. Método: Trata-se de um estudo transversal retrospectivo com análise de 101 procedimentos cirúrgicos no período de 2012 a 2014, nos quais a síntese da ferida operatória ocorreu com fios cirúrgicos de náilon ou Prineo®, sendo aplicada análise estatística. Resultados: Neste estudo, seis pacientes apresentaram dermatite de contato ao uso do Prineo® com significância estatística (p = 0,042). O uso desse sistema diminuiu a taxa de alargamento cicatricial (p < 0,05). O presente trabalho não apresentou diferença estatística (p = 0,068) na qualidade da cicatriz entre os pacientes que utilizaram Prineo® em relação ao grupo controle, demonstrando que em ambos os grupos o resultado cicatricial foi de excelente (87%) a bom (27%) na sua maioria. Conclusão: Conclui-se no estudo que os pacientes que utilizaram o sistema de octil-2-cianocrilato associado a malha, Prineo®, apresentaram menores índices de alargamento cicatricial, dependentes de uma espessura de derme satisfatória, e maiores taxas de dermatites por contato em relação àqueles em que a ferida foi encerrada com fios cirúrgicos. Os dois grupos demonstraram qualidades cicatriciais excelentes a bons, sem diferença estatística em tais resultados estéticos cicatriciais.

Introduction: Wound healing is a well-organized, directed process of tissue repair. The process can be expedited using topical glues and adhesives, which offer a non-invasive, easily removable alternative to suturing. Furthermore, such products have good tensile strength and involve lower application time. In particular, the Prineo® adhesive is applied to a polyester mesh that covers the wound. Method: We carried out a retrospective, cross-sectional study, with subsequent statistical analysis , involving 101 surgical procedures in which wound closure was performed using either nylon sutures or Prineo®. All the procedures were performed between 2012 and 2014. Results: Six patients had contact dermatitis after Prineo® was used, with statistical significance (p = 0.042). Furthermore, Prineo® decreased the rate of scar enlargement (p < 0.05) . There was no statistical difference between the Prineo® and suture groups in terms of scar quality (p = 0.068); in both groups, the scar result was mostly excellent (87 %) to good (27%). Conclusion: Patients whose wounds were closed using Prineo® a system involving octyl-2-cyanoacrylate and an associated polyester mesh displayed lower rates of scar enlargement, which depended on whether the thickness of the dermis was satisfactory. However, the same patients had higher rates of contact dermatitis than those whose wounds were closed using surgical sutures. Both groups showed excellent to good scar quality, with no significant difference in terms of esthetic scar results.

Uso de adhesivos tisulares para el cierre de heridas en la práctica médica / Use of tissue adhesives for the wound closure in medical practice

Introducción: los adhesivos tisulares generan una película impermeable que una vez aplicados sobre la herida quirúrgica mantienen los bordes juntos hasta que se produce la cicatrización, lo que ayuda a disminuir el riesgo de infección de las heridas tratadas. Su empleo en la medicina permite simplificar procedimientos quirúrgicos complejos y brinda mayor comodidad al paciente. Objetivo: identificar los ámbitos de la práctica médica donde el cierre quirúrgico de heridas con el uso de adhesivos tisulares ofrece mejores resultados. Métodos: estudio descriptivo con un diseño de análisis de decisión, se confeccionó un árbol de decisión que comparó dos posibles alternativas: uso de adhesivos tisulares en adultos y en pediatría. La información se obtuvo de la literatura mediante la revisión de bases de datos médicas en el periodo de enero/2002 a diciembre/2012. Se identificaron 25 estudios (15,4 por ciento) que fueron válidos para estimar las probabilidades de complicaciones y éxito en el cierre de heridas. Resultados: el uso de adhesivos titulares en adultos mostró los mejores resultados con una alta probabilidad de éxito (0,99) para el cierre de heridas en piel y mucosas y especialmente en la cirugía de cabeza y cuello. En pediatría la probabilidad de éxito fue de 0,96 y su mejor uso se decidió en la cirugía de tórax y abdomen. Conclusiones: el uso de adhesivos titulares en adultos y niños ofrece una alta perspectiva de éxito para el cierre de heridas en piel y mucosas, si bien su uso en adultos es su mejor opción(AU)

Introduction: tissue adhesives generate, based on its characteristics, a water-proof film that once spread over the surgical wound, can keep wound edges together until cicatrization, all of which helps to decrease the infection risk. The use of tissue adhesives in medicine allows making complex surgical procedures simpler in addition to making the patient feel more comfortable. Objective: to identify the areas of medical practice where the surgical wound closure with adhesives exhibits better results. Methods: descriptive study with analysis decision design; a decision tree was created to compare two possible alternatives: use of tissue adhesives in adults and in pediatrics. Information was taken from literature through revision of medical database in the period of January 2002 to December 2012. Twenty five studies (15.4 percent), which were valid for estimating the odds of complications and successes of each wound closure option. Results: the use of tissue adhesives in adults showed the best results with high probabilities of being successful (0.99) in closing skin and mucosa wounds, mainly in the head and the neck. The probabilities for success in pediatrics were 0.96 and it is better used in thorax and abdomen surgery. Conclusions: use of tissue adhesives in adults and children provide high success probabilities for the closure of wounds in the skin and in the mucosa, although their use in adult people is the best choice(AU)