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BACKGROUND: Diabetic foot ulcers (DFUs) constitute a complication that occurs in 19% to 34% of patients with diabetes mellitus (DM). The aim of this study is to describe median days to healing, average velocity of wound closure, and percentage of wound surface closed at 3, 6, and 12 weeks through the use of homogenized and lyophilized amniotic membrane (hAMpe) dressings for the treatment of DFUs in ambulatory patients. METHODS: An observational, descriptive, longitudinal study was performed. Patients presenting with granulation-based DFU, after proper debridement, were included from August 19, 2021, until July 14, 2023. hAMpe dressings placed every 3 days were used for the treatment of these ulcers. RESULTS: Sixteen patients were included with a mean age of 52.38 (8.07) years. The analyzed lesions were postsurgical ulcers in 15 of the 16 included patients. Median ulcer size was 19.5 cm2 (6.12-36). The median ABI was 1.10 (1-1.14). The median days to healing was 96 (71-170). The median percentage closure of the wound at 3 weeks was 41% (28.9%-55.3%), at 6 weeks it was 68.2% (48.6%-74.2%), and at 12 weeks it was 100% (81%-100%). The average velocity closure was 1.04% per day (95% CI 0.71%-1.31%). It was higher during the closure of the first 50% of the ulcer, 2.12% per day (95% CI 0.16%-4.09%), and decreased from 50% to 25% of the ulcer size to 0.67% per day (95% CI 0.23%-1.10%) and from 25% to closure to 0.47% per day (95% CI 0.14%-0.80%), P < .001. CONCLUSION: These results are difficult to compare to other studies given the higher surface area of the ulcers included in our sample. The development of hAMpe dressings enables patients to apply them without requiring assistance from health care teams and was not associated with any recognized complications.

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The use of biological membranes in wound dressings has increasingly become a reality. Accordingly, an ideal means of preservation is sought that can provide tissue maintenance for long periods without interfering with its quality or clinical applicability. Therefore, the objective of the present study was to evaluate and histologically and microbiologically compare frog skins subjected to two different preservation methods. Sixteen frog skins were evaluated and, depending on the preservation method, subdivided into two groups with eight skins each, namely, the Freezing Group, in which the skins were frozen at -4º in a 20% glycerin solution; and the Glycerin Group, whose skins were kept in 98% glycerin at room temperature (average of 28 ºC and average humidity of 78%). The skins were analyzed fresh (T0) and at 30 (T1), 60 (T2), 90 (T3), and 120 (T4) days of preservation. Data were analyzed comparatively. There was no bacterial or fungal growth, and the skin structure and collagen arrangement remained intact at all time points in both treatments. In conclusion, both preservation methods are efficient and capable of maintaining the tissue morphological structure and preventing the growth and proliferation of contaminants for up to 120 days.

A utilização de membranas biológicas em curativos tem se tornado cada vez mais uma realidade. Concomitante, busca-se um meio de conservação ideal que possa proporcionar a manutenção do tecido por longos períodos de tempo sem interferir em sua qualidade e aplicabilidade clínica. Desta forma, o objetivo deste trabalho foi o de avaliar e comparar histologicamente e microbiologicamente peles de rã submetidas a dois diferentes métodos de conservação. Foram avaliadas 16 peles de rã-touro as quais foram, em função do método de conservação, subdivididas em dois grupos com 08 peles cada: O Grupo Congelamento (GC) no qual as peles foram submetidas ao congelamento a -4º, em solução de glicerina a 20%; e o grupo Glicerina (GG), no qual as peles foram conservadas em temperatura ambiente (média de 28ºC e umidade média de 78%) em glicerina a 98%. As peles foram analisadas a fresco (T0) e com 30 (T1), 60 (T2), 90 (T3) e 120 (T4) dias de conservação. Os dados foram analisados de forma comparativa. Em todos os tempos analisados e em ambos os tratamentos, não houve crescimento bacteriano ou fúngico e a estrutura da pele e o arranjo de colágeno mantiveram-se íntegros. Conclui-se que, ambos os métodos de conservação são eficientes e capazes de manter a estrutura morfológica tecidual, e impedem o crescimento e a proliferação de contaminantes por até 120 dias.

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Resumen Objetivo: Mostrar la utilidad del apósito liofilizado de piel de cerdo comparado con el manejo conservador con sulfadiazina de plata en el proceso de cicatrización de la úlcera de pie diabético. Materiales y Método: Estudio cuasiexperimental en pacientes con diagnóstico de pie diabético, se establecieron 2 grupos de estudio utilizando una relación 2:1, el grupo de exposición (10 pacientes) tratado con apósito liofilizado de piel de cerdo y el grupo de control (5 pacientes) manejado con sulfadiazina de plata. La utilidad se midió con la cicatrización en semanas de tratamiento. El análisis estadístico incluyó prueba de t, prueba de z, regresión logística simple y cálculo de la probabilidad del evento. Resultados: El tiempo de cicatrización fue más corto en el grupo manejado con apósito liofilizado de piel de cerdo (10,20 semanas) que en el grupo con manejo a base de sulfadiazina de plata (13,8 semanas). A las 9 semanas de iniciado el tratamiento, la mitad de las pacientes con apósito de piel de cerdo ya habían cicatrizado comparado con la cicatrización en el grupo manejado con sulfadiazina de plata (20%). La probabilidad de cicatrización a las 11 semanas en paciente manejados con sulfadiazina de plata es 20% y con apósito liofilizado de piel de cerdo 80%. Conclusión: El apósito liofilizado de piel de cerdo tuvo mejores resultados en el estudio, comparado con el manejo estándar con sulfadiazina de plata. Es necesario realizar un estudio aleatorizado para determinar la efectividad de este material como herramienta terapéutica.

Aim: To demonstrate the usefulness of lyophilized pig skin dressings versus usual management with silver sulfadiazine in wound healing treatment for diabetic foot ulcers. Materials and Method: In this quasi-experimental study, we included patients diagnosed with diabetic foot. We established two groups with a distribution (2:1), the exposure group treated with lyophilized pig skin dressings (10 patients) and the control group (5 patients), the standard of care with silver sulfadiazine. Usefulness was measured with wound healing in treatment weeks. Statistical analysis included t-test, z-test, simple logistic regression, and calculation of probability of an event. Results: Wound healing time was shorter in the group treated with lyophilized pig skin dressing (10.20 weeks) than in the group treated with silver sulfadiazine (13.8 weeks). At 9 weeks after treatment started, 50% of patients treated with lyophilized pig skin dressings had complete wound healing compared with the patients in the group managed with silver sulfadiazine. (20%). The probability of wound healing been completed at 11 weeks in a patient managed with silver sulfadiazine is 20%, compared to lyophilized pig skin dressings is 80%. Conclusion: Lyophilized pig skin dressings had better outcomes than silver sulfadiazine in wound healing treatment for diabetic foot ulcers inside the study. Is mandatory develop another study with a randomized design to determinate the effectiveness as a therapeutic alternative.

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ABSTRACT We propose a novel surgical technique in cases of aggressive recurrent pterygium non-subsidiary of treatment with conjunctival autografts or antimetabolites. Two presented cases were treated with surgical excision and a sutured plasma rich in growth factors membrane (mPRGF) followed by rich in growth factors (PRGF) eye drops treatment. After surgery, dexamethasone, tobramycin and PRGF eye drops were prescribed for 6 weeks. After a 12-month and 3-year post-surgical follow-up respectively, treated eyes with mPRGF did not present relapse, and visual acuity improved in both cases. No ocular complications, pain, eye discomfort nor other symptoms were observed. The combined use of PRGF eye drops and mPRGF seems an effective and safe therapy for recurrent pterygium.

RESUMO Nós propomos uma nova técnica cirúrgica em casos de pterígio agressivo recorrente não subsidiário de tratamento com autoenxertos conjuntivais ou antimetabólitos. Dois casos foram tratados com excisão cirúrgica e um plasma suturado rico em membrana de fatores de crescimento (mPRGF), seguido de tratamento com colírios ricos em fatores de crescimento (PRGF). Após a cirurgia, foram prescritos colírios de dexametasona, tobramicina e PRGF por 6 semanas. Após 12 meses e 3 anos de acompanhamento pós-cirúrgico respectivamente, os olhos tratados com mPRGF não apresentaram recidiva e a acuidade visual melhorou nos dois casos. Não foram observadas complicações oculares, dor, desconforto ocular ou outros sintomas. O uso combinado de colírios de PRGF e mPRGF parece uma terapia eficaz e segura para o pterígio recorrente.

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Na procura por material alternativo no tratamento de feridas cutâneas, buscou-se com este estudo avaliar o comportamento da túnica vaginal canina conservada em glicerina a 98% como curativo biológico no tratamento de feridas cutâneas provocadas experimentalmente em ratos. Foram utilizados 16 ratos Wistar, nos quais foram induzidas experimentalmente duas lesões cutâneas na região dorsal, sendo uma cranial e a outra caudal. Uma ferida serviu de controle, a qual não recebeu tratamento, a outra recebeu a túnica vaginal recobrindo toda extensão da lesão. A seleção de qual das feridas, cranial ou caudal, iria receber a membrana foi feita de forma aleatória. Os animais foram distribuídos em quatro grupos de igual número para análises clínicas, macroscópicas e histológicas decorridos três, sete, 14 e 21 dias de pós-operatório. Na avaliação clínica e macroscópica pode-se observar que o processo de reparação teve evolução semelhante tanto no grupo controle quanto no grupo membrana. Na análise histopatológica foi constatada grande quantidade de infiltrado inflamatório nos períodos iniciais, no entanto, decorridos 21 dias, a epiderme já se encontrava reparada, e em todos os momentos foi observada maior presença de tecido conjuntivo no grupo membrana, sugerindo maior precocidade na cicatrização. Deste modo, concluiu-se que a túnica vaginal canina pode ser utilizada como nova alternativa no tratamento de feridas cutâneas.

In the search for alternative material in the treatment of cutaneous wounds, this study aimed to evaluate the behavior of canine vaginal tunic conserved in glycerin 98% as a biological dressing in the treatment of cutaneous wounds provoked experimentally in rats. Sixteen animals were used in which two cutaneous lesions were caused in the dorsal region, one cranial and the other caudal. One wound served as a control which did not receive treatment, the other received the vaginal tunic covering all extension of the lesion. The selection of which of the wounds, cranial or caudal, would receive the membrane was made at random. The animals were divided into four groups of equal numbers for clinical, macroscopic, and histological analyzes after three, seven, 14 and 21 postoperative days. In the clinical and macroscopic evaluation, it can be observed that the healing process had similar evolution in both the control group and the membrane group. In the histopathological analysis, a large amount of inflammatory infiltrate was observed in the initial periods; however, after 21 days the epidermis was already healed, and at all times a greater presence of connective tissue was observed in the membrane group, suggesting a greater precocity in healing. Thus, it was concluded that the canine vaginal tunic can be used as a new alternative in the treatment of cutaneous wounds.

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Abstract Objective: To evaluate the clinical effectiveness of amniotic membrane transplantation for ocular surface reconstruction. Methods: Prospective study including 23 eyes of 21 patients who underwent amniotic membrane transplantation at Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) and at Cirurgia e Diagnose em Oftalmologia do Paraná (CDOP) clinic, located in Curitiba, PR, Brazil, from may 2015 to july 2019. The amniotic membrane was collected from elective and term cesarean delivery, and conserved in preservation medium and glycerol 1:1, stored at -80° Celsius. The membrane was fixed on the ocular surface with 10-0 nylon, 8-0 vicryl, biological glue or a combination of these materials. Results: The ocular surface reconstruction was successful in 22 eyes (95.6%). Failure was observed only in 1 case (bullous keratopathy) in which the condition was maintained postoperatively. Patients' age ranged from 11-82 years, with a mean age of 37.4 years. There was a higher incidence in males (66.6%). A difference was perceived in the distribution of the affected eye (which was greater in the right eye - 65.2%). As for the previous ophthalmic surgery history, 12 of the 23 eyes had a positive history (52.2%). It was observed that all patients who had preoperative visual acuity assessed showed improvement or maintenance of corrected visual acuity. In the postoperative period, complications associated with the underlying disease were observed, although not particularly related to the amniotic membrane transplantation. There were not any cases of postoperative infection. Conclusions: There was an improvement in the general state of the ocular surface in almost all of the cases in which the transplant was performed. Therefore, the amniotic membrane can be considered a good alternative for reconstructing the ocular surface, as a single or supporting treatment.

Resumo Objetivo: Avaliar a eficácia clínica do transplante de membrana amniótica na reconstrução da superfície ocular. Métodos: Estudo prospectivo incluiu 23 olhos de 21 pacientes que realizaram transplante de membrana amniótica no Hospital de Clínicas da Universidade Federal do Paraná (UFPR) e na clínica de Cirurgia e Diagnose em Oftalmologia do Paraná (CDOP), localizados em Curitiba, PR, Brasil, no período de maio de 2015 a julho de 2019. A membrana amniótica foi captada a partir de parto cesárea eletivo e a termo, conservada em meio de preservação e glicerol 1:1 e armazenada a -80° Celsius. A membrana foi fixada na superfície ocular com fio nylon 10-0 ou vicryl 8-0 e/ou cola biológica. Resultados: A idade dos pacientes variou de 11-82 anos, com média de 37,4 anos. Houve maior incidência no sexo masculino (66,6%). Ocorreu diferença na distribuição do olho acometido (maior no olho direito - 65,2%). Quanto à história de cirurgia oftalmológica prévia, 12 dos 23 olhos tinham história positiva (52,2%). Observamos que nos pacientes em que foi possível a avaliação da acuidade visual pré-operatória, todos apresentaram melhora ou manutenção da acuidade visual. No pós-operatório foi observado complicações associadas à doença de base e não propriamente ao transplante de membrana amniótica. Não foram registrados casos de infecção pós-operatória. Conclusão: Houve melhora do estado geral da superfície ocular em quase totalidade dos casos em que o transplante foi realizado. Portanto, a membrana amniótica pode ser considerada uma boa alternativa para reconstrução da superfície ocular, como tratamento único ou coadjuvante.

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Avulsion of the nail plate is the most accomplished surgical procedure among the nail apparatus surgeries. Since it is not possible to use the removed nail to cover the nail bed, some materials have been suggested, however, they are generally not available for use and often at a high cost. To evaluate the use of Bacterial Cellulose (BC) dressing as a biological nail (Bio-Nail) after partial or total avulsion of the nail plate. Twenty-six candidates for nail avulsion, were randomized into two groups: Control, using Vaseline with gauze (11 patients) and Experimental group, BC group, using the Bio-Nail (15 patients). The patients were followed up during the 180-day period. The distribution of the patients in the groups was homogeneous for both sociodemographic and clinical data. The occurrence of infection (1 case in the control group) was not statistically relevant. The BC group had lower pain intensity (p = 0.011) with earlier temporal resolution when compared to the control group (p = 0.003). The BC group presented earlier reepithelization (p = 0.022) and better quantitative (p = 0.021) and qualitative conditions (p = 0.011) for the exudate. Regarding satisfaction, all the patients were satisfied. Good preservation of the nail plate area was observed in the BC group at the end of the 180-day period (p = 0.024). Average time of BC dressing permanence was 16.4 ± 7.1 days. BC showed to be appropriate as a dressing after partial or total avulsion of the nail plate. BC is a Bio-Nail promising for nail bed healing.

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Despite a considerable decrease in its incidence worldwide, burns remain the fourth most common type of trauma. The majority of burns are small, with 75% of injuries treated on an outpatient basis. Tilapia skin, as a biological material, has been suggested as an option for the management of burn wounds. After good results were obtained with the use of a glycerolised version of tilapia skin in burned children and adults, it was hypothesised that similar outcomes could be achieved with the use of a lyophilised version of tilapia skin. We report the case of a 33-year-old female patient with scalds to the upper abdomen, and both breasts, arms and forearms. Involvement of 10% of total body surface area with superficial partial thickness burns was calculated. The good adherence of tilapia skin to the wound bed, a 10-day period for complete re-epithelialisation of the wounds and the absence of side effects suggested that the lyophilised version of tilapia skin is effective for burn treatment. Compared with glycerolisation, lyophilisation is thought to permit extended storage of sterile tissue and decreased costs related to distribution and transport, but further studies are needed to confirm this.

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Se describen los casos clínicos de dos pacientes ingresados en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora de Santiago de Cuba: un anciano que recibió una revascularización coronaria en el Servicio de Cirugía Cardiovascular y presentó infección del sitio quirúrgico, así como rechazo al material de sutura; y una adulta joven asistida en la Unidad de Cuidados Intensivos por una endocarditis bacteriana, a la que, después de dos meses de estadía hospitalaria, se le desarrolló una úlcera por presión de grado III en la región sacra, con 8 cm de diámetro y exposición ósea. En estos pacientes se habían aplicado todos los protocolos terapéuticos establecidos según el tipo de afección, pero al no sanar las lesiones, se decidió aplicar apósitos de membrana amniótica, con lo cual la evolución fue favorable y se logró la cicatrización de las heridas.

The case reports of two patients admitted to Saturnino Lora Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba are described: an old man that received a coronary revascularization in the Cardiovascular Surgery Service and presented infection of the surgical site, as well as suture material rejection; and a young adult woman assisted in the Intensive Cares Unit due to a bacterial endocarditis, who after two months of hospitalization developed a grade III pressure ulcer in the sacral region, with a diameter of 8 cm and bony exposure. In these patients all the established therapeutic protocols had been implemented according to the type of disorder, but if there is no healing of the lesions, it was decided to apply amniotic membrane dressings, with which there was a favorable clinical course and the scaring of the wounds was achieved.

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