RESUMO
Tissue injuries that affect the skin and/or adjacent tissues and are usually over a bony prominence are called pressure injuries. The prevalence of these dysfunctions remains high, and despite technological advances, there is no consensus on the most appropriate treatment. The objective of this review was to evaluate the efficacy of photobiomodulation (PBM), ultrasound, and high-frequency electrophysical agents in the healing of pressure injuries in adults and the elderly. The search was conducted in the PubMed, Embase, Cochrane Library, Web of Science, and PEDro databases; in clinical trial records, a list of references of the selected articles, as well as through manual search (Google), of the last 5 years in humans in English and Portuguese. Nine thousand and sixty-seven studies were identified, 13 pre-selected, and 6 were included in this systematic review. PBM showed similar efficacy to other technologies indicated in other studies in healing pressure injuries. PBM with red wavelength (660 nm) in stages 2 and 3 pressure injuries effectively promoted healing compared to standard care. It was observed that the use of PBM accelerates tissue repair in pressure injuries; therapeutic ultrasound showed similar efficacy to other electrophysical agents but was effective in reducing the area of pressure injuries when comparing pre- and post-intervention. No clinical studies using the high-frequency electrophysical agent have been described in the last 5 years.
Assuntos
Lesões por Esmagamento , Úlcera por Pressão , Cicatrização , Adulto , Idoso , HumanosRESUMO
Report the effects of photobiomodulation (PBM) and therapeutic ultrasound (TUS) on the viability of TRAM in mice. MATERIALS AND METHODS: Fifty-five mice Swiss were subjected to treatment for 5 days. Group 1, treatment was performed with the agents switched off. Groups 2 to 5 were treated with different wavelengths 660 and 830 nanometers (nm) and groups 6 to 11 with TUS of 1 and 3 MHz frequency. Macrometric analyses were performed using a specific camera and analyzed by the ImageJ® software. Thermographic analyses were performed with the Flir C2 and analyzed using the FLIR Tools software. RESULTS: Group 9 obtained 95% of viable area on the 3rd day and 85% on the 5th day, showing the effectiveness of the TUS in the flap viability. Regarding skin temperature, there was a difference only in the immediate postoperative period in group 1, which had a lower temperature than the other groups. CONCLUSIONS: TUS demonstrated greater efficiency in maintaining the viability of TRAM. PBM 830 nm also demonstrated good results in the viability of TRAM.
Assuntos
Mamoplastia , Retalho Miocutâneo , Terapia por Ultrassom , Animais , Sobrevivência de Enxerto , Camundongos , Modelos Teóricos , Reto do Abdome/diagnóstico por imagem , Reto do Abdome/cirurgiaRESUMO
This study aimed to investigate the effects of photobiomodulation at a wavelength of 660 and 830 nm at different numbers of application points in the healing of open wounds in mice. In total, 120 mice were divided into 10 groups. The animals were submitted to cutaneous lesion of the open wound type (1.5 × 1.5 cm). Photobiomodulation at a wavelength of 660 and 830 nm and total energy of 3.6 J were used, applied at 1, 4, 5, and 9 points, for 14 days. The animals were subjected to analysis of the lesion area, skin temperature, and histological analysis. Macroscopic analysis results showed a difference (p < 0.05) between the irradiated groups and the sham group at 14 days PO. There was no statistical difference in skin temperature. Histological analysis findings showed better results for the epidermis thickness. Regarding the number of blood vessels, a difference was found between the 1- and 5-point 830-nm photobiomodulation groups and between the 4-point 660-nm group and the naive group. A significant difference in the number of fibroblasts was observed between the 830- and 660-nm photobiomodulation groups and the naive and sham groups. When comparing photobiomodulation wavelength, the 830-nm groups were more effective, and we emphasize the groups irradiated at 5 points, which showed an improvement in macroscopic analysis and epidermis thickness, an increase in the number of vessels, and a lower number of fibroblasts on the 14th day after skin injury.
Assuntos
Terapia com Luz de Baixa Intensidade , Dermatopatias , Animais , Fibroblastos , Camundongos , Ratos , Ratos Wistar , Pele , CicatrizaçãoRESUMO
The characterization of the temperature of skin ulcers may provide preliminary diagnostic evidence. The aim of this study was to characterize cutaneous ulcers of different etiologies by infrared thermography. 122 cutaneous ulcers of 87 patients (age 60.1 ± 15.7 years) were evaluated, allocated into five groups: venous ulcers (VU) n = 26, arterial ulcers (AU) n = 20, mixed ulcers (MU) n = 25, pressure ulcers (PU) n = 29, and neuropathic ulcers (NU) n = 22. The cutaneous temperature was recorded by infrared thermography (FLIR-450™); we also evaluated the ulcer area, the ankle brachial index (ABI), the range of motion (ROM) of the ankle, and pain. For the different variables, the statistical analysis was performed using the Kruskal Wallis test, ANOVA, the chi-squared test, and the Spearman test (SPSS™ software version 20, p < 0.05). A significant difference was found between the temperatures of PU and NU. The ABI was significantly lower in the MU and AU groups, and pain was also higher in these groups. The ROM was decreased in all groups, and the MU and VU groups had the lowest ROM. There was no correlation between temperature and the clinical findings (ABI, ROM, and pain). There was a moderate correlation in the analysis between the temperature and the area of the ulcer in the PU group, as larger ulcers had lower temperatures. It is possible to characterize cutaneous ulcers by infrared thermography, and there are temperature differences among ulcers with different etiologies.
Assuntos
Úlcera Cutânea , Úlcera , Temperatura Corporal , Humanos , Pessoa de Meia-Idade , Temperatura Cutânea , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/etiologia , TermografiaRESUMO
BACKGROUND: Breast cancer survivors have side effects from surgical treatment and adjuvant that may acutely or chronically compromise the musculoskeletal system, resulting in loss of muscle strength. OBJECTIVE: Handgrip strength and electromyography of the upper limbs and its relationship with dominance in women submitted to surgery for breast cancer. METHODS: Were evaluated 28 women. The handgrip strength was measured through dynamometer associated with electromyographic, in the muscles: descending trapezius, biceps brachial, triceps brachial, extensor carpi ulnaris, radial extensor carpi and superficial flexor of wrist and fingers. RESULTS: Reduction in grip strength on the side affected by the surgery, that occurred when the surgery was performed on the non-dominant side. The electromyographic showed significant differences in affected side. This shows the need to consider the affected side by surgery and dominance. CONCLUSIONS: Decreased grip strength and lower electromyographic activity of upper limb affected by surgery for breast cancer, when the side affected was not the dominant this loss was greater.
Assuntos
Neoplasias da Mama/fisiopatologia , Força da Mão/fisiologia , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Eletromiografia/métodos , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The purpose of this study was to assess blood flow after manual lymphatic drainage (MLD) in women who had received surgery for breast cancer and had post-axillary lymphadenectomy lymphedema. METHODS: Sixteen volunteers (mean age 64 ± 11.44 years) were divided into 2 groups. Those in group 1 received MLD without upper limb elevation, and those in group 2 received MLD with elevation of 30° of the upper limb. Blood flow velocity of the brachial vein and artery were measured using Doppler ultrasound before, immediately after, and 30 minutes after MLD, with and without 30° of upper limb elevation as defined by a random crossover design and an interval (washout) of 7 days. Comparison of data before and after MLD was evaluated by the Friedman test. RESULTS: There was a significant increase of blood flow velocity in the brachial vein after the therapeutic procedure with upper limb elevation. However, after 30 minutes the data returned to the pretreatment value. CONCLUSION: This preliminary study indicated that MLD promoted increased brachial vein velocity flow in the short term.
Assuntos
Linfedema/terapia , Drenagem Linfática Manual/métodos , Mastectomia/efeitos adversos , Fluxo Sanguíneo Regional/fisiologia , Adulto , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Massagem/métodos , Mastectomia/métodos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler Dupla/métodos , Extremidade Superior/fisiopatologiaRESUMO
Evaluate reliability and accuracy of infrared thermography in the assessment of women wth breasts cancer. Thirty-five participants had unilateral breast cancer and 17 control subjects were assessed using infrared thermography. To evaluate reliability, two professionals, who were experienced, measured the temperature of the infrared images in two different moments, with a one-week interval. Biopsy was used as a gold standard exam with regard identify breast cancer. The analysis illustrated excellent reliability in terms of the affected, contralateral and control breasts with the intra-class correlation coefficient values ranging from 0.948 to 0.999. Standard measurement error ranged from 0.04 to 0.28 °C, and minimum detectable change deviated from 0.11 to 0.78 °C. Moreover, low to moderate accuracy were observed in terms of the establishment of the breast cancer diagnosis with values of the area under the receiver operating characteristic (ROC) curve ranging from 0.571 and 0.749. Breasts affected by cancer present higher skin temperature compared to contralateral and control. Furthermore, excellent reliability of the analysis of the infrared images and low-moderate accuracy in terms diagnosis were observed. Considering the results, infrared thermography can be applied as an instrument complement the assessment of breast cancer patients, but not for diagnostic purposes.
Assuntos
Neoplasias da Mama , Feminino , Humanos , Raios Infravermelhos , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Temperatura Cutânea , TermografiaRESUMO
The purpose of this study is to investigate the effect of pulsed electrical field (PEF) and photobiomodulation laser (PBM) on the viability of the TRAM flap in diabetic rats. Fifty Wistar rats were divided into five homogeneous groups: Group 1-control; Group 2-diabetics; Group 3-diabetics + PEF; Group 4-diabetic + laser 660 nm, 10 J/cm2, 0.27 J; Group 5-diabetic + laser 660 nm, 140 J/cm2, 3.9 J. The percentage of necrotic area was evaluated using software Image J®. The peripheral circulation of the flap was evaluated by infrared thermography FLIR T450sc (FLIR® Systems-Oregon USA). The thickness of the epidermis (haematoxylin-eosin), mast cell (toluidine blue), leukocytes, vascular endothelial growth factor, fibroblast and newly formed blood vessels were evaluated. For the statistical analysis, the Kruskal-Wallis test was applied followed by Dunn and ANOVA test followed by Tukey with critical level of 5% (p < 0.05). The PEF reduced the area of necrosis, decreased the leukocytes, increased the mast cells, increased the thickness of epidermis and increased newly formed blood vessels when it was compared to the untreated diabetic group of animals. Laser 660 nm, fluence 140 J/cm2 (3.9 J) showed better results than the 10 J/cm2 (0.27 J) related to reduction of the area of necrosis and the number of leukocytes, increased mast cells, increased thickness of the epidermis, increased vascular endothelial growth factor, increased fibroblast growth factor and increase of newly formed blood vessels in diabetic animals. The laser and pulsed electrical field increase the viability of the musculocutaneous flap in diabetic rats.
Assuntos
Diabetes Mellitus Experimental/patologia , Diabetes Mellitus Experimental/radioterapia , Eletricidade , Terapia com Luz de Baixa Intensidade , Retalho Miocutâneo/patologia , Animais , Sobrevivência Celular/efeitos da radiação , Fatores de Crescimento de Fibroblastos/metabolismo , Leucócitos/patologia , Leucócitos/efeitos da radiação , Masculino , Mastócitos/metabolismo , Mastócitos/patologia , Mastócitos/efeitos da radiação , Necrose , Ratos Wistar , Temperatura Cutânea/efeitos da radiação , Fator A de Crescimento do Endotélio Vascular/metabolismoRESUMO
The aim of this study was to investigate the effect of laser photobiomodulation (PBM) on the viability of the transverse rectus abdominis musculocutaneous (TRAM) flap in rats subjected to the action of nicotine. We evaluated 60 albino Wistar rats, divided into six groups of ten animals. Group 1 (saline) underwent the surgical technique to obtain a TRAM flap; group 2 (laser 830 nm) underwent the surgical technique and was irradiated with a laser 830 nm; group 3 (laser 660 nm) underwent the surgical technique and was irradiated with a laser 660 nm; group 4 was treated with nicotine subcutaneously (2 mg/kg/2×/day/4 weeks) and underwent surgery; group 5 (nicotine + laser 830 nm) was exposed to nicotine, underwent the surgical technique, and was irradiated with a laser 830 nm; group 6 (nicotine + laser 660 nm) was exposed to nicotine, underwent the surgical technique, and was irradiated with a laser 660 nm. The application of PBM occurred immediately after surgery and on the two following days. The percentage of necrosis was assessed using the AxioVision® software. The number of mast cells (toluidine blue staining) was evaluated, and immunohistochemistry was performed to detect vascular endothelial growth factor expression (anti-VEGF-A), fibroblasts (anti-basic FGF), and neoformed vessels (anti-CD34). PBM with a wavelength of 830 nm increased the viability of the TRAM flap, with a smaller area of necrosis, increased number of mast cells, and higher expression of VEGF and CD34. PBM increases the viability of musculocutaneous flaps treated with to nicotine.