RESUMO
The current evidence to support the use of massage for scar management is conflicting in the literature. The purpose of this study was to compare two scar massage protocols administered with pediatric burn survivors to determine if a more structured and standardized approach to scar massage could improve outcome. A retrospective review of the medical records of 100 children who received massage during the time period when two different protocols were implemented was conducted and data that was collected as part of the clinical exam regarding scar height, vascularity, pliability, itch and pain were extracted. Comparisons were made within subject for scar changes from baseline to follow up and between subjects receiving Protocol A and those receiving Protocol B for the same scar characteristics. Versions of the Vancouver Scar Scale were used to assess scars, while visual analogue scale, Itch Man Scale and Wong-Baker Faces Pain Scale were used to assess itch and pain. Results demonstrated improvements in itch and vascularity over time with both scar massage protocols. However, when comparing patients who received Protocol A to those who received Protocol B, there was no difference found in scar height, vascularity, pliability, itch or pain. Using commonly applied subjective scar assessment tools, we did not find clinically meaningful changes in scar characteristics with the implementation of a structured scar massage program compared to a general approach to massage. Further research is needed to better define the impact of massage on the recovery experience for burn survivors.
Assuntos
Queimaduras/terapia , Cicatriz/terapia , Massagem/normas , Sobreviventes/psicologia , Queimaduras/fisiopatologia , Criança , Pré-Escolar , Cicatriz/fisiopatologia , Protocolos Clínicos/normas , Feminino , Humanos , Masculino , Massagem/métodos , Massagem/estatística & dados numéricos , Medição da Dor/métodos , Pediatria/métodos , Pediatria/estatística & dados numéricos , Estudos Retrospectivos , Sobreviventes/estatística & dados numéricos , Escala Visual AnalógicaRESUMO
Even though the coronary reperfusion process is the most important tool to preserve cardiac function, after myocardial infarction, reperfusion of acutely ischemic myocardium can induce injury. We aimed to evaluate the functional and molecular aspects 4 weeks after myocardial ischemia-reperfusion (IR) in rats. Male Wistar rats (N = 47) were subjected to myocardial IR by short-term (30 min) ligation and subsequent reperfusion of the left descending coronary artery. Control rats (N = 7) underwent the same surgical maneuver without coronary ligation. After 4 weeks, rats had their cardiac function examined by ventricular pressure recording under basal condition or pharmacological stress. Myocardial fibrosis and molecular mediators of IR injury (reactive oxygen species, tumor necrosis factor-alpha and matrix-metalloproteinase-2) were assessed as well. Most of the rats subjected to IR did not show macroscopic signs of infarct, while only 17% of these animals showed large myocardial infarction scars. Of note, all animals submitted to IR presented the functional and molecular parameters altered when compared with the control subjects. Cardiac function was attenuated in all animals submitted to IR, regardless the presence or size of macroscopic cardiac scars. Interstitial fibrosis, matrix-metalloproteinase-2 activity and the expression of tumor necrosis factor-alpha were higher in the myocardium of all IR rats as compared to the control subjects (p<0.05). Myocardium superoxide anion and hydrogen peroxide were increased in rats without or with mild cardiac scars. These results show that IR leads to myocardial injury in rats. Besides, even the animals with an apparent healthy myocardium (without infarct scar) presented cardiac dysfunction and molecular changes that may contribute to the development of heart failure over time.
Assuntos
Cicatriz/patologia , Cicatriz/fisiopatologia , Traumatismo por Reperfusão Miocárdica/patologia , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Animais , Cicatriz/metabolismo , Colágeno/metabolismo , Modelos Animais de Doenças , Coração/fisiopatologia , Masculino , Metaloproteinase 2 da Matriz/metabolismo , Traumatismo por Reperfusão Miocárdica/metabolismo , Miocárdio/metabolismo , Miocárdio/patologia , Ratos , Ratos Wistar , Espécies Reativas de Oxigênio/metabolismo , Superóxidos/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Pressão VentricularRESUMO
BACKGROUND: Hypertrophic cardiomyopathy (HCM), a genetically transmitted disease, is the most common genetic cardiovascular disease. Current strategies to stratify risk are expensive and concentrated in wealthy centers. Twelve-lead electrocardiography (ECG) is inexpensive, universally available, and can be readily used for Selvester QRS scoring, which estimates scar size. This study aimed to establish the relation between ECG scar quantification and myocardial fibrosis (extent of myocardial delayed enhancement) in multidetector computed tomography (MDCT). HYPOTHESIS: There is a significant association between ECG scar quantification and the extent of myocardial delayed enhancement in MDCT. METHODS: Seventy-five patients with HCM underwent a routine clinical evaluation and echocardiography, 12-lead ECG, and MDCT study. Patients with and without an implantable cardioverter-defibrillator were included. RESULTS: The estimated Selvester QRS score of myocardial fibrosis was correlated significantly (R = 0.70; P < 0.01) with the quantified MDCT fibrosis. Compared with MDCT, the QRS score had 84.8% sensitivity and 88.8% specificity. Myocardial fibrosis was present in 88% of these patients with HCM (fibrotic mass, 9.87 ±10.8 g) comprising 5.66% ±6.16% of the total myocardial mass seen on the MDCT images. The Selvester QRS score reliably predicted the fibrotic mass in 76% of patients, which estimated 8.44% ±7.39% of the total myocardial mass. CONCLUSIONS: The Selvester QRS score provides reliable quantification of myocardial fibrosis and was well correlated with MDCT in patients with HCM.
Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cicatriz/diagnóstico por imagem , Eletrocardiografia , Tomografia Computadorizada Multidetectores , Miocárdio/patologia , Adulto , Cardiomiopatia Hipertrófica/patologia , Cardiomiopatia Hipertrófica/fisiopatologia , Cicatriz/patologia , Cicatriz/fisiopatologia , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de DoençaRESUMO
The excessive pathological scars are subdivided into hypertrophic, keloid and contracted. They have a complex pathophysiology, not entirely known that only exists in humans. Although the frequency of presentation is not high, excessive pathological scars can affect several areas of human functioning, in the first level of functions and body structures and in the second level of activities of daily life and participation. The evaluation of patients must be complete, including the scar, and any other affected body system, together with psychological, functional and socioeconomic factors. In the treatment of excessive scars there are multiple options that must be combined for a better result. The non-surgical treatments of the most used scars are the pressotherapy, silicone plates, intralesional injections and laser. There are other rehabilitation treatments that although without solid evidence could have a role in patients. The referral to the rehabilitation service is recommended for patients with excessive pathological scars located in areas of folds or special areas and / or, which are accompanied by pain, alterations in the function of the body segment or limitations in activities of daily life, for comprehensive assessment and multidisciplinary management. (AU)
Assuntos
Humanos , Masculino , Feminino , Cicatriz/classificação , Cicatriz/fisiopatologia , Cicatriz/terapia , Cicatriz/complicações , Cicatriz/diagnósticoRESUMO
The aim of this study was to determine how representative wear scars of simulator-tested polyethylene (PE) inserts compare with retrieved PE inserts from total knee replacement (TKR). By means of a nonparametric self-organizing feature map (SOFM), wear scar images of 21 postmortem- and 54 revision-retrieved components were compared with six simulator-tested components that were tested either in displacement or in load control according to ISO protocols. The SOFM network was then trained with the wear scar images of postmortem-retrieved components since those are considered well-functioning at the time of retrieval. Based on this training process, eleven clusters were established, suggesting considerable variability among wear scars despite an uncomplicated loading history inside their hosts. The remaining components (revision-retrieved and simulator-tested) were then assigned to these established clusters. Six out of five simulator components were clustered together, suggesting that the network was able to identify similarities in loading history. However, the simulator-tested components ended up in a cluster at the fringe of the map containing only 10.8% of retrieved components. This may suggest that current ISO testing protocols were not fully representative of this TKR population, and protocols that better resemble patients' gait after TKR containing activities other than walking may be warranted.
Assuntos
Artroplastia do Joelho/reabilitação , Cicatriz/fisiopatologia , Polietileno/uso terapêutico , Próteses e Implantes , Simulação por Computador , Marcha/fisiologia , Humanos , Redes Neurais de ComputaçãoRESUMO
INTRODUCTION: In the USA, 450,000 thermal burns receive medical treatment annually. Burn scars are commonly excised and covered with skin grafts. Long-term, these treatments commonly leave patients with discomfort, reduced total lung capacity and forced vital capacity, and restriction of thoracic expansion and shoulder joint mobility. In this article, we present our experience with using scar release and immediate flap reconstruction to treat thoracic restriction due to burn sequelae. METHODS: From 1998 to 2014, we enrolled 16 patients with anterior thoracic burn sequelae that had previously been treated conservatively or with skin grafts that eventually recidivated. Preoperatively, we measured thoracic circumference in expiration and inspiration, %FVC, %FEV1, and shoulder mobility. All patients underwent anterior thoracic scar release and immediate flap resurfacing. RESULTS: At 2 weeks to 3 months postoperatively (mean, 2.6 months), mean thoracic circumference upon inspiration increased from 83.6 cm±5.7 to 86.5 cm±5.8 (p<0.0000000001). Mean %FVC improved from 76.0%±2.64% to 88.2%±4.69% (p<0.0000001). Mean %FEV1 improved from 79.2%±3.85 to 87.8%±2.98 (p<0.000001). All 14 patients who had restricted shoulder mobility preoperatively no longer had restricted shoulder mobility postoperatively. The mean patient-reported satisfaction was 4.6/5 (range, 3-5). At a mean follow up of 2.5 years, none of the contractures recidivated. Complications included 2 cases of tissue necrosis of the distal end of the flap. In one case, the flap was restored; in the other case, the patient eventually had to receive a new flap. Additional complications included two local infections that were successfully treated with oral and local antibiotics and two hematomas that were drained and eventually healed without tissue loss. CONCLUSIONS: Scar releases and flaps provide a safe and effective method for the correction of restricted thoracic expansion, respiratory restriction, decreased range of shoulder motion, and discomfort from thoracic burn sequelae.
Assuntos
Queimaduras/cirurgia , Cicatriz/cirurgia , Contratura/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/cirurgia , Transplante de Pele , Retalhos Cirúrgicos , Traumatismos Torácicos/cirurgia , Adolescente , Adulto , Argentina , Criança , Cicatriz/fisiopatologia , Contratura/fisiopatologia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Ombro , Tórax/patologia , Capacidade Vital , Adulto JovemRESUMO
OBJECTIVES: The purpose of this study was to analyze the characteristics of oral-motor movements and facial mimic in patients with head and neck burns. METHODS: An observational descriptive cross-sectional study was conducted with patients who suffered burns to the head and neck and who were referred to the Division of Orofacial Myology of a public hospital for assessment and rehabilitation. Only patients presenting deep partial-thickness and full-thickness burns to areas of the face and neck were included in the study. Patients underwent clinical assessment that involved an oral-motor evaluation, mandibular range of movement assessment, and facial mimic assessment. Patients were divided into two groups: G1 - patients with deep partial-thickness burns; G2 - patients with full-thickness burns. RESULTS: Our final study sample comprised 40 patients: G1 with 19 individuals and G2 with 21 individuals. The overall scores obtained in the clinical assessment of oral-motor organs indicated that patients with both second- and third-degree burns presented deficits related to posture, position and mobility of the oral-motor organs. Considering facial mimic, groups significantly differed when performing voluntary facial movements. Patients also presented limited maximal incisor opening. Deficits were greater for individuals in G2 in all assessments. CONCLUSION: Patients with head and neck burns present significant deficits related to posture, position and mobility of the oral myofunctional structures, including facial movements.
Assuntos
Queimaduras/fisiopatologia , Traumatismos Faciais/fisiopatologia , Músculos Faciais/fisiopatologia , Movimento/fisiologia , Lesões do Pescoço/fisiopatologia , Adolescente , Adulto , Brasil , Criança , Cicatriz/fisiopatologia , Estudos Transversais , Feminino , Hospitais Públicos/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Mandíbula/fisiopatologia , Pessoa de Meia-Idade , Transtornos dos Movimentos/fisiopatologia , Postura/fisiologia , Amplitude de Movimento Articular/fisiologia , Adulto JovemRESUMO
PURPOSE: To assess the effect of prokinetic agents on abdominal wall wound healing in rats submitted to segmental colectomy and colonic anastomosis. METHODS: Sixty rats were randomly allocated into three groups according to the agents they would receive in the postoperative period: M (metoclopramide); B (bromopride); and C (control, saline 0.9%). Surgical procedures were performed identically in all animals, and consisted of a midline laparotomy followed by resection of a 1-cm segment of large bowel with end-to-end anastomosis. The abdominal wall was closed in two layers with running stitches. Abdominal wall samples were collected on the 3rd or 7th postoperative day for measurement of breaking (tensile) strength and histopathological assessment. RESULTS: There were no statistically significant differences in tensile strength of the abdominal wall scar between groups M, B, and C, nor between the three and seven days after surgery subgroups. On histopathological assessment, there were no statistically significant between-group differences in collagen deposition or number of fibroblasts at the wound site CONCLUSION: Use of the prokinetic drugs metoclopramide or bromopride had no effect on abdominal wall healing in rats submitted to segmental colectomy and colonic anastomosis.
Assuntos
Parede Abdominal , Colectomia , Colo/cirurgia , Fármacos Gastrointestinais/farmacologia , Cicatrização/efeitos dos fármacos , Parede Abdominal/cirurgia , Anastomose Cirúrgica , Animais , Cicatriz/fisiopatologia , Antagonistas de Dopamina/farmacologia , Fármacos Gastrointestinais/uso terapêutico , Masculino , Metoclopramida/análogos & derivados , Metoclopramida/farmacologia , Distribuição Aleatória , Ratos , Ratos Wistar , Resistência à Tração , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
PURPOSE: To assess the effect of prokinetic agents on abdominal wall wound healing in rats submitted to segmental colectomy and colonic anastomosis. METHODS: Sixty rats were randomly allocated into three groups according to the agents they would receive in the postoperative period: M (metoclopramide); B (bromopride); and C (control, saline 0.9%). Surgical procedures were performed identically in all animals, and consisted of a midline laparotomy followed by resection of a 1-cm segment of large bowel with end-to-end anastomosis. The abdominal wall was closed in two layers with running stitches. Abdominal wall samples were collected on the 3rd or 7th postoperative day for measurement of breaking (tensile) strength and histopathological assessment. RESULTS: There were no statistically significant differences in tensile strength of the abdominal wall scar between groups M, B, and C, nor between the three and seven days after surgery subgroups. On histopathological assessment, there were no statistically significant between-group differences in collagen deposition or number of fibroblasts at the wound site CONCLUSION: Use of the prokinetic drugs metoclopramide or bromopride had no effect on abdominal wall healing in rats submitted to segmental colectomy and colonic anastomosis.
OBJETIVO: Avaliar os efeitos do uso de drogas prócinéticas na cicatrização da parede abdominal de ratos submetidos à colectomia segmentar e anastomose no cólon esquerdo. MÉTODOS: Foram utilizados 60 ratos, alocados aleatoriamente em três grupos para receberem as seguintes medicações no período pós-operatório: M (metoclopramida); B (bromoprida) e C (solução salina a 0,9%). Os procedimentos cirúrgicos foram idênticos em todos os animais. Foi realizada laparotomia mediana, seguida de colectomia segmentar de 1-cm e anastomose colônica. O fechamento da parede abdominal foi feito em dois planos de sutura contínua. No 3° ou no 7° dia pós-operatório foram coletadas amostras da parede abdominal para medida da força de ruptura e avaliação histopatológica. RESULTADOS: Não houve diferença significativa entre os grupos no que diz respeito à força de ruptura da parede abdominal, nem entre os subgrupos no 3º e 7º dia após a cirurgia. À análise histopatológica não houve alterações na deposição de colágeno ou na quantidade de fibroblastos no sítio da cicatriz. CONCLUSÃO: O uso de drogas prócinéticas, metoclopramida ou de bromoprida, não interferiu na cicatrização da parede abdominal de ratos submetidos à colectomia segmentar e anastomose no cólon esquerdo.
Assuntos
Animais , Masculino , Ratos , Parede Abdominal , Colectomia , Colo/cirurgia , Fármacos Gastrointestinais/farmacologia , Cicatrização/efeitos dos fármacos , Anastomose Cirúrgica , Parede Abdominal/cirurgia , Cicatriz/fisiopatologia , Antagonistas de Dopamina/farmacologia , Fármacos Gastrointestinais/uso terapêutico , Metoclopramida/análogos & derivados , Metoclopramida/farmacologia , Distribuição Aleatória , Ratos Wistar , Resistência à Tração , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
BACKGROUND: Acne is an inflammatory disease of the pilosebaceous follicles. Oral isotretinoin is the treatment of choice for severe acne. Exaggerated cicatrization related to oral isotretinoin was reported in the 1980s and 1990s. Currently, dermabrasion for acne scar revision is only recommended 6 to 12 months after the completion of oral isotretinoin treatment. OBJECTIVE: To evaluate the evolution of healing from manual chemabrasion of depressed scars resulting from acne conducted within 1 to 3 months after oral isotretinoin treatment. METHODS AND MATERIALS: This was an interventional, prospective study involving 10 patients with depressed facial scars. A medium-depth chemical peel was applied to the entire face. Manual sandpaper dermabrasion was performed to areas of scarring until the appearance of bloody dew. A 6-month reepithelization follow-up was conducted. RESULTS: All of the patients presented with normal cicatrization, and neither hypertrophic scars nor keloids were observed. Depressed acne scar revision was satisfactory. CONCLUSION: Our observations may contribute to the discussion of the negative influence of oral isotretinoin on wound healing. Other studies are necessary to reevaluate the current recommendation of a 6- to 12-month waiting period after oral isotretinoin treatment before performing dermabrasion or fractional ablative laser for acne scar revision.