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Introdução: Feridas complexas são lesões tegumentares graves, de difícil resolução com curativos convencionais. O objetivo deste estudo foi descrever uma técnica de cicatrização de feridas por terceira intenção, reprodutível e de baixo custo, aplicável a feridas complexas, utilizando uma prótese de policloreto de vinila (PVC) colocada temporariamente na área da lesão para promover proteção e estimular sua "granulação", seguida de enxerto autólogo de pele de espessura parcial. Método: De forma consecutiva, foram selecionados 20 pacientes com feridas complexas, decorrentes de causas externas, divididos em 2 grupos: A - pacientes que foram submetidos à técnica de cobertura com prótese de PVC, seguida de enxerto; e B - pacientes submetidos aos cuidados da equipe de curativo, com trocas diárias até granulação da ferida, padrão da nossa instituição. Os pacientes foram avaliados quanto ao tempo de internação; custos; em relação à dor local; à presença de complicações; ao tempo até a alta médica; e à satisfação do paciente. Resultados: O tempo de internamento e seus custos, assim como o tempo até a alta médica, foram menores no grupo A (p<0,05). Todavia, não houve diferença estatisticamente significativa em relação à dor local entre as técnicas A e B. Conclusão: A técnica utilizando prótese de PVC e enxerto possui boa eficácia para o tratamento de feridas complexas, sendo reprodutível e de baixo custo.
Introduction: Complex wounds are serious tegumentary injuries that are difficult to resolve with conventional dressings. This study aimed to describe a third-intention wound healing technique, reproducible and low cost, applicable to complex wounds, using polyvinyl chloride (PVC) prosthesis temporarily placed in the injured area to promote the protection and stimulate its "granulation," followed by autologous partial-thickness skin grafting. Method: Consecutively, 20 patients with complex wounds resulting from external causes were selected and divided into 2 groups: A - patients who underwent the coverage technique with PVC prosthesis, followed by grafting, and B - patients submitted to the care of the dressing team, with daily changes until wound granulation, standard in our institution. Patients were evaluated regarding length of stay; costs; local pain; complications; the time until medical discharge; and patient satisfaction. Results: The length of hospital stay, its costs, and the time until medical discharge were shorter in group A (p<0.05). However, there was no statistically significant difference in local pain between techniques A and B. Conclusion: The technique using PVC prosthesis and graft has good efficacy for treating complex wounds, being reproducible and inexpensive.
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Meta-analysis is an adequate statistical technique to combine results from different studies, and its use has been growing in the medical field. Thus, not only knowing how to interpret meta-analysis, but also knowing how to perform one, is fundamental today. Therefore, the objective of this article is to present the basic concepts and serve as a guide for conducting a meta-analysis using R and RStudio software. For this, the reader has access to the basic commands in the R and RStudio software, necessary for conducting a meta-analysis. The advantage of R is that it is a free software. For a better understanding of the commands, two examples were presented in a practical way, in addition to revising some basic concepts of this statistical technique. It is assumed that the data necessary for the meta-analysis has already been collected, that is, the description of methodologies for systematic review is not a discussed subject. Finally, it is worth remembering that there are many other techniques used in meta-analyses that were not addressed in this work. However, with the two examples used, the article already enables the reader to proceed with good and robust meta-analyses. Level of Evidence V, Expert Opinion.
Metanálise é uma técnica estatística adequada para combinar resultados provenientes de diferentes estudos, seu uso vem crescendo e ganhando cada vez mais importância no meio médico. Assim, não apenas saber interpretar metanálise, como também saber realizar uma, mesmo que simples, é fundamental na atualidade. Portanto, o objetivo principal deste artigo é apresentar os conceitos básicos que a norteiam e servir de guia para a condução de uma metanálise utilizando os softwares R e RStudio. Para isso, através do presente artigo o leitor tem acesso aos comandos básicos existentes nos softwares R e RStudio, necessários para a condução de uma metanálise. A grande vantagem do R é o fato de ser um software livre. Para um melhor entendimento dos comandos, dois exemplos foram apresentados de forma prática, além de revisados alguns conceitos básicos dessa técnica estatística. É suposto que os dados necessários para a metanálise já foram coletados, ou seja, descrição de metodologias para revisão sistemática não é assunto discutido. Por fim, vale relembrar que existem muitas outras técnicas utilizadas em metanálises que não foram abordadas neste trabalho. Todavia, com os dois exemplos utilizados, o artigo já habilita o leitor a proceder boas e robustas metanálises. Nível de Evidência V, Opinião do Especialista.
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OBJECTIVES: To compare the clinical outcomes of isolated anterior cruciate ligament (ACL) reconstruction with combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. METHODS: A search was conducted on the PubMed, Medline, Google Scholar, EMBASE, and Cochrane library databases, in line with the PRISMA protocol. The indexation terms used were "anterior cruciate ligament" OR "acl" AND "anterolateral ligament" AND "reconstruction." Articles that compared patients submitted to combined ACL and ALL reconstruction with those submitted to isolated reconstruction of the ACL, with levels of evidence I, II, and III, were included. Studies with follow-up of less than 2 years and articles that did not use "anatomical" techniques for ALL reconstruction, such as extraarticular tenodesis, were excluded. A meta-analysis with R software was conducted, with a random effects model, presented as risk ratio (RR) or mean difference (MD), with a 95% confidence level (CI) and statistically significant at p < 0.05. RESULTS: Ten articles were selected, with a total of 1495 patients, most of whom were men, of whom 674 submitted to ACL and ALL reconstruction and 821 to isolated ACL reconstruction. Combined ACL and ALL reconstruction exhibited a statistically significant advantage in residual pivot shift (RR 0.34, 95% CI 0.24-0.47, I2 = 0%, p < 0.01), rerupture rate (RR 0.34, 95% CI 0.19-0.62, I2 = 0%, p < 0.01), Lachman test (RR 0.59, 95% CI 0.40-0.86, I2 = 21%, p < 0.01), and postoperative Lysholm score (MD 2.28, CI 95% 0.75-3.81, I2 = 73%, p < 0.01). CONCLUSIONS: Combined ACL and ALL reconstruction obtained better postoperative clinical outcomes when compared with isolated ACL reconstruction, especially in reducing residual pivot shift and rerupture rate.
RESUMO
BACKGROUND: The number of studies and clinical interest in the anterolateral ligament of the knee (ALL) has grown in recent years. A meticulous and accurate ALL dissection is vital in anatomic and biomechanical studies, and a standardized technique is not yet established. As such, the aim of this study was to describe a step-by-step ALL dissection technique that could help authors consistently identify the ALL. METHODS: Twenty knees from frozen adult cadavers, with no preference for sex or age, were included in the study. All the cadavers were dissected using the same technique to determine the incidence of the ALL. RESULTS: A transverse incision is performed in the iliotibial band (ITB), around 10 cm proximal to the topography of the lateral epicondyle of the femur. Next, the ITB undergoes anterograde blunt dissection until its insertion at Gerdy's tubercle in the tibia. Maintaining biceps femoris insertion, a dissection is performed anteriorly to it, until the lateral collateral ligament (LCL) is found. Using the LCL, internal rotation and 30 to 60° flexion as references, the ALL can be located in the anterolateral topography of the knee, with its origin near the lateral epicondyle (proximal and posterior) and insertion between Gerdy's tubercle and the fibula (4.0 mm to 7.0 mm below the tibial plateau), expanding to the lateral meniscus (between the body and anterior horn), exhibiting a mean length of 4.0 ± 0.4 cm and mean width of 5.5 ± 0.8 mm. CONCLUSIONS: The present article describes an effective and reproducible ALL dissection technique that made it was possible to identify the ligament in 100% of the cases in the present study.