Is allograft skin, the gold-standard for burn skin substitute? A systematic literature review and meta-analysis.

BACKGROUND: Allograft skin (AS) transplantation has been considered to be the gold standard for replacing tissue damage, following burns. However, increasingly new biosynthetic skin substitutes are being developed as alternatives. The objective of this systematic review is to compare AS with other skin substitutes, which have been used in the treatment of burns. METHODS: Randomized clinical trial (RCT) and nonrandomized clinical trial (NRCT) studies comparing AS to any other skin substitute in the treatment of burns were extracted from PubMed/Medline, Scopus, EMBASE, and Web of Science. For the risk of bias analysis, the Cochrane bias risk handbook was used for RCT studies and ROBINS-1 was used for NRCT studies. Outcomes such as healing, self-grafting, scar appearance, and mortality were evaluated. RESULTS: Twelve RCT and six NRCT were selected, with most of the methodologies presenting a high risk of bias. Based on the outcomes of the studies, it was not possible to detect any advantages for using AS, as opposed to other skin substitutes. In the meta-analysis, only two outcomes could be evaluated: healing and graft take percentage; however, no significant differences were observed between the groups. CONCLUSION: Because of the poor quality of the primary studies, it was not possible to identify differences in the results that compared the use of AS with other substitutes in the treatment of patients with burns. These results support the fact that surgeons primarily base the choice of skin substitute on clinical experience and cost, at least when treating burns.

Evaluation of the body image of patients with facial palsy before and after the application of botulinum toxin.

BACKGROUND: The face is responsible for nonverbal communication. Facial nerve paralysis, which is the weakness or paralysis of the nerve responsible for the innervation of the muscles that perform these movements, is a condition that can raise serious physical, psychological, social, professional, aesthetic, and functional disorders. The physical aspect has a disastrous effect on the patient's self-image and emotional state. This study aimed to evaluate the self-image of patients with facial paralysis through the Body Image Quality Life Index (BIQLI), pre- and postclinical treatment with botulinum toxin. METHOD: A prospective, exploratory, comparative cohort was carried out, with quantitative analysis of the variables with 40 patients with facial paralysis treated by the Ambulatory of Plastic Surgery of Hospital das Clínicas, Faculty of Medicine, University of São Paulo. The Sociodemographic and clinical instrument and the BIQLI were applied. Descriptive statistics and statistical inference were used to perform the analyses. RESULTS: It was found that the majority of the paralysis occurred in female individuals (55%), with an average age of 47,875 (DP), single and married (38.88%), and with secondary education completed (16.66%). CONCLUSION: The body image evaluation of patients with facial paralysis submitted to the botulinum toxin treatment showed an ability to identify the positive impact of therapy in the period between 15 and 180 days by the BIQLI.

Functional independence in teenage patients with burns.

The purpose of this study was to assess the functional independence of teenagers undergoing a process of rehabilitation. A cross-sectional study was carried out on a sample of 63 teenagers, aged 12 to 20, who had suffered burns and were going through a process of rehabilitation, with the application of the Functional Independence Measurement (FIM). The data was analysed using descriptive statistics and also a test for comparison of means (Student's t-test), as well as Cronbach's reliability test. There was proof of a high degree of independence in FIM. Analysis of the location of the burn and also the performance of work and/or study activities showed these not to interfere with functional independence. The results indicate the reliability of the instruments applied, making it possible to conduct an assessment of the functional independence of the teenagers during the rehabilitation process.