Outcomes of Apert Syndrome Hand Reconstruction With Tilapia Skin: A Prospective Study.

BACKGROUND: Tilapia skin has already been used in various medical scenarios, but there are no studies showing the use of tilapia skin for hand reconstruction in Apert syndrome. The objective of this study is to determine whether the use of tilapia skin during graft bed preparation for children with Apert syndrome can shorten wound reepithelialization intervals, reduce the number of dressing changes, and decrease patient discomfort. METHODS: This is a prospective study on consecutive patients with Apert syndrome who underwent hand reconstruction at our Hospital. Patients were divided into 2 groups: (1) a control group consisting of patients who underwent conventional digit separation hand reconstruction surgery (2) an experimental group consisting of patients who underwent similar digit separation hand reconstruction surgery that commenced with the placement of a thin layer of tilapia skin at the raw commissures during a first operation, which was subsequently replaced by an autologous skin graft during a second operation staged 10 days postoperatively. Pain assessment was performed using the Visual Analog Scale. The number of dressing changes was also assessed. A T test compared the total number of dressings changes and pain data. RESULTS: Experimental group patients (n = 8) required an average of 9.4 days of daily dressing changes, and control group patients (n = 5) required an average of 20.8 days of daily dressing changes ( P < 0.05) and tended to experience significantly less pain when compared with patients in the control group ( P = 0.079). CONCLUSION: Tilapia skin can shorten wound reepithelialization intervals by reducing the total number of dressing changes.

Neovaginoplasty With Nile Tilapia Skin: Cytological and Microbiota Evaluation.

OBJECTIVES: To study the clinical, cytological, and vaginal microbiota findings in patients with Mayer-Rokitansky-Küster-Hauser syndrome who underwent neovaginoplasty using Nile tilapia fish skin. METHODS: This is a cross-sectional study with 7 cisgender women with Mayer-Rokitansky-Küster-Hauser syndrome who had previously undergone neovagina reconstruction using Nile tilapia fish skin at a university hospital. Local institutional review board approval and written permission from the patient were obtained. Between August 2019 and November 2021, within 12 to 24 months after surgery, vaginal specimens were obtained for conventional oncotic and hormonal cytology, and for Gram staining. The Nugent scores were calculated. Colposcopy was also performed. RESULTS: Squamous cells without atypia were found in all patients. Five patients had intermediate vaginal microbiota (Nugent score of 4), which was determined by the presence of few lactobacilli on Gram staining. In hormonal cytology, 4 patients presented with findings compatible with menacme. No colposcopic change was observed. When postsurgical dilation was performed correctly, a mean vaginal length of 8.3 cm was maintained after 1 year of follow-up. CONCLUSIONS: Squamous cells without atypia were present in neovaginas with Nile tilapia fish skin. Most vaginal contents revealed intermediate microbiota and hormonal results compatible with menacme. Studies with a greater number of patients are necessary for a more comprehensive understanding of the microbiome in neovaginas with this new technique, thereby providing support for the treatment and prevention of associated pathologies.

Linha do tempo da pele de tilápia (Oreochromis niloticus) na medicina regenerativa moderna: Da bancada ao paciente / Timeline of tilapia skin (Oreochromis niloticus) in modern regenerative medicine: From bench to patient

OBJETIVO: Descrever a trajetória de desenvolvimento dos curativos biológicos oriundos de pele de tilápia (Oreochromis niloticus) em glicerol e liofilizada para uso em cirurgias externas e, posteriormente, uma matriz proteica acelular (scaffold) para uso interno. RESULTADOS: A pele de tilapia no glicerol e liofilizada foi aplicada com sucesso em mais de 550 pacientes queimados. A pele de tilápia liofilizada obteve sucesso no tratamento de 53 mulheres em vaginoplastias, em 160 pacientes na redesignação sexual e na preparação do leito da ferida na autoenxertia em 15 portadores da Síndrome de Apert. O scaffold está sendo empregado na oftalmologia na medicina veterinária na reconstrução de córnea em 420 cães, nas duroplastias na neurocirurgia nos testes em animais, e em estudos para uso cirúrgico em 10 especialidades médicas. CONCLUSÕES: O curativo de pele de tilápia supera desafios do tratamento de queimados do Brasil. É barato, biossustentável, efetivo e reduz a dor do paciente, propiciando melhores resultados com potencial redução de custos, contribuindo para a qualidade de vida dos pacientes. O sucesso da pesquisa confirma a pele de tilápia como um novo biomaterial de grande potencial em medicina regenerativa.

OBJECTIVE: To describe the development trajectory of biological dressings made from tilapia (Oreochromis niloticus) skin in glycerol and freeze-dried for use in external surgeries and, subsequently, an acellular protein matrix (scaffold) for internal use. RESULTS: Tilapia skin in glycerol and freeze-dried was successfully applied to more than 550 burn patients. Freeze-dried tilapia skin was successful in the treatment of 53 women undergoing vaginoplasty, in 160 patients in sexual reassignment and in preparing the wound bed in self-grafting in 15 patients with Apert Syndrome. The scaffold is being used in ophthalmology, veterinary medicine in corneal reconstruction in 420 dogs, in duraplasty in neurosurgery in animal tests, and in studies for surgical use in 10 medical specialties. CONCLUSIONS: The tilapia skin dressing overcomes challenges in treating burns in Brazil. It is cheap, biosustainable, effective and reduces patient pain, providing better results with potential cost reduction, contributing to patients' quality of life. The success of the research confirms tilapia skin as a new biomaterial with great potential in regenerative medicine.

Desenvolvimento de uma matriz acelular de pele tilápia para tratamento de feridas: Um estudo experimental / Development of acellular tilapia skin matrix for wound treatment: An experimental study

OBJETIVO: Produzir um scaffold baseado em matriz extracelular (SMEC) biocompatível, atóxico e estéril, para tratamento de queimaduras e feridas. Explorou-se a utilização da pele de tilápia como alternativa, ressaltando suas propriedades semelhantes à pele humana e sua aplicação bem-sucedida em diferentes áreas médicas. MÉTODO: Descreve o processo de preparação dos SMEC de pele de tilápia, incluindo etapas de desengorduramento, descontaminação, descelularização e irradiação por raios gama a 25kGy para esterilização. São realizados testes laboratoriais para avaliar a toxicidade celular in vitro pelo método do MTT, análises histológicas com coloração de hematoxilina-eosina, análises microbiológicas e de quantificação de DNA. RESULTADOS: Destacam que os SMEC produzidos foram descelularizados de maneira eficaz, preservando a matriz extracelular e mostrando-se não citotóxicos. Além disso, a análise microbiológica evidenciou a esterilidade dos materiais após a irradiação, comprovando sua adequação para aplicação clínica. A quantificação de DNA revelou a efetividade da descelularização, reduzindo significativamente o conteúdo de DNA original do tecido. CONCLUSÕES: Foi possível o desenvolvimento de uma matriz oriunda da pele de tilápia, sendo ela não citotóxica, estéril, portadora de morfologia adequada para aplicação clínica e acelular. Assim, contribuindo para inovação da ciência brasileira.

OBJECTIVE: To produce a biocompatible, non-toxic, and sterile scaffold based on extracellular matrix (ECM) for the treatment of burns and wounds. The utilization of tilapia skin was explored as an alternative, highlighting its similar properties to human skin and its successful application in different medical areas. METHODS: The process of preparing tilapia skin-derived ECM scaffolds is described, including steps of degreasing, decontamination, decellularization, and gamma ray irradiation at 25kGy for sterilization. Laboratory tests were conducted to assess in vitro cellular toxicity using the MTT method, histological analyses with hematoxylin-eosin staining, microbiological analyses, and DNA quantification. RESULTS: It is emphasized that the produced ECM scaffolds were effectively decellularized, preserving the extracellular matrix and demonstrating non-cytotoxicity. Furthermore, microbiological analysis evidenced the sterility of the materials after irradiation, confirming their suitability for clinical application. DNA quantification revealed the effectiveness of decellularization, significantly reducing the original DNA content of the tissue. CONCLUSIONS: The development of a tilapia skin-derived matrix was achieved, which is non-cytotoxic, sterile, possesses suitable morphology for clinical application, and is acellular. Thus, contributing to the innovation of Brazilian science.

Nile Tilapia Fish Skin-Based Wound Dressing Improves Pain and Treatment-Related Costs of Superficial Partial-Thickness Burns: A Phase III Randomized Controlled Trial.

BACKGROUND: In a phase II study comparing Nile tilapia fish skin to silver sulfadiazine cream for outpatient management of superficial partial-thickness burns, the fish skin decreased reepithelialization time (average reduction, 1.43 days), dressing changes (average reduction, 3.72 dressings), and visual analogue scale pain scores. The present study aimed to further evaluate Nile tilapia fish skin efficacy for superficial partial-thickness burns. Unlike silver sulfadiazine cream, the fish skin has good adherence to the wound bed, which may prevent infections and decrease need for dressing changes. Thus, it could be a low-cost alternative to hasten healing and improve pain of burn patients. METHODS: A phase III randomized controlled trial was conducted from April of 2017 to October of 2018 in Fortaleza, Brazil, and included 115 outpatients aged 18 to 70 years with superficial partial-thickness burns affecting 15 percent or less of body surface area and no previous treatment. Fifty-seven patients were treated with the glycerolized fish skin and 58 with silver sulfadiazine cream 1%. Primary outcomes were reepithelialization time, number of dressings, treatment-related costs, and pain intensity, assessed by means of visual analogue scale, Electronic von Frey, Burns Specific Pain Anxiety Scale, and analgesic use. Patients were evaluated every 48 hours. RESULTS: Patients treated with fish skin required fewer days for reepithelialization (9.7 ± 0.6 days versus 10.2 ± 0.9 days; p = 0.001) and fewer dressings (1.6 ± 0.7 versus 4.9 ± 0.5; p < 0.001). They also had decreased analgesic needs and visual analogue scale, Burns Specific Pain Anxiety Scale, and Electronic von Frey measurements. Finally, fish skin use reduced the final average treatment-related cost per patient by 42.1 percent. CONCLUSION: By hastening reepithelialization, improving burn-related pain, and decreasing treatment-related costs, Nile tilapia fish skin could benefit the resource-poor public health systems of developing countries. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Tratamento de queimaduras de segundo grau profundo em abdômen, coxas e genitália: uso da pele de tilápia como um xenoenxerto / Treatment of deep second-degree burns on the abdomen, thighs, and genitalia: use of tilapia skin as a xenograft

A pele de tilápia possui microbiota não infecciosa e estrutura morfológica semelhante à pele humana. Estudos clínicos fase II, ainda não publicados, mostraram resultados promissores na sua utilização para tratamento de queimaduras. Nos protocolos destes estudos, pacientes com lesões em áreas de dobras de pele, como genitais e região inguinal, foram excluídos, pois achava-se que o biomaterial não aderiria apropriadamente, resultando em um grau de cicatrização inferior. Relato de caso de paciente do sexo feminino, 18 anos, sem comorbidades, com queimaduras de segundo grau profundo em abdômen, região inguinal, parte da genitália e metade superior de ambas as coxas, envolvendo 13,5% da área total da superfície corporal. A pele de tilápia foi aplicada nas lesões levando a uma reepitelização completa com 16 dias de tratamento. Não foram observados efeitos colaterais. A pele de tilápia traz, portanto, a promessa de um produto inovador, de fácil aplicação e alta disponibilidade, que pode se tornar a primeira pele animal nacionalmente estudada e registrada pela Agência Nacional de Vigilância Sanitária, para uso no tratamento de queimaduras. Este relato de caso contribui para reduzir as limitações em relação às áreas anatômicas apropriadas para a aplicação da pele de tilápia, uma vez que, mesmo com a necessidade de reposição de pele, foram obtidos bons resultados com aplicação na genitália e região inguinal.

Tilapia skin has a non-infectious microbiota and a morphological structure similar to human skin. Phase II clinical studies, not yet published, have shown promising results in their use for the treatment of burns. In the protocols of these studies, patients with lesions in areas of skin folds, such as genitals and inguinal regions, were excluded, as it was thought that the biomaterial would not adhere properly, resulting in a lower degree of healing. Case report of a female patient, 18 years old, without comorbidities, with deep second-degree burns in the abdomen, inguinal region, part of the genitalia and upper half of both thighs, involving 13.5% of the total body surface area. Tilapia skin was applied to the lesions leading to a complete re-epithelialization with 16 days of treatment. No side effects were observed. Tilapia skin, therefore, brings the promise of an innovative product, easy to apply, and highly available, which can become the first animal skin nationally studied and registered by the Agência Nacional de Vigilância Sanitária, for use in the treatment of burns. This case report contributes to reduce the limitations concerning the anatomical areas appropriate for the application of tilapia skin, since, even with the need for skin replacement, good results were obtained with application to the genitalia and inguinal region.

Male-to-Female Gender-Affirming Surgery Using Nile Tilapia Fish Skin as a Biocompatible Graft.

STUDY OBJECTIVE: Insufficient penile skin is common during vaginoplasty for male-to-female transition. This issue may be compensated by a scrotal skin flap, with the drawback of hair growth [1]. In recent studies, Nile tilapia skin was successfully used for the surgical management of Mayer-Rokitansky-Küster-Hauser syndrome [2,3] and vaginal stenosis [4,5]. This study aims to describe a novel technique for primary vaginoplasty in male-to-female gender-affirming surgery using Nile tilapia skin as a biocompatible graft to ensure adequate vaginal depth. DESIGN: Stepwise demonstration of the procedure with narrated video footage. SETTING: Transgender health clinic. INTERVENTIONS: A 29-year-old patient with gender dysphoria was referred to our office because of a desire for gender-affirming surgery. A physical examination revealed normal male genitalia with a 14-cm-long penis. Before surgery, approval from the institutional review board and written permission from the patient were obtained. After orchiectomy, penile disassembly, perineal dissection, and urethroplasty were performed, and a hollow Nile tilapia skin mold was prepared and sutured to the distal edge of the remaining penile skin. This structure was inverted, covering the newly created canal. The neocavity was then filled with a handmade inflatable vaginal mold, held in place by sutures in the labia majora. Finally, labiaplasty and clitoroplasty were conducted. After 7 days, the inflatable mold was removed, and the use of progressively larger dilators was initiated. After 3 weeks, a neovagina that was 16 cm long and able to accommodate the width of 2 fingers was detected. At that time, the Nile tilapia skin was completely reabsorbed into the neovaginal mucosa. There were no complications in the early postsurgical period. CONCLUSION: Nile tilapia skin, a safe, low-cost, and easy-to-use biocompatible material, may be an alternative option to scrotal skin grafts for neovaginal augmentation in primary vaginoplasty for male-to-female gender transition. However, further studies are needed to confirm this assertive.

Neovaginoplasty Using Nile Tilapia Fish Skin as a New Biologic Graft in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome.

Mayer-Rokitansky-Küster-Hauser syndrome is the second most common cause of primary amenorrhea, trailing only to gonadal dysgenesis. Neovaginoplasty is an appropriate treatment option for patients who have failed dilation therapy. Several biomaterials have been used in this procedure, including peritoneum, amnion, skin grafts, and myocutaneous flaps. Nile Tilapia Fish Skin has noninfectious microbiota, morphologic structure comparable to human skin, and high in vivo bioresorption. In addition, it showed good outcomes when used as a xenograft for burn treatment. Thus, we suggest it as a new biologic graft for vaginal agenesis management. In this descriptive study, neovaginoplasty using Nile Tilapia Fish Skin offered 3 patients an anatomic and functional neovagina via a simple method with potential long-term effectiveness. When postsurgical dilation was performed correctly, a vaginal length greater than 6 cm was maintained at 180 days follow-up. Histologic and immunohistochemical analyses revealed the presence of stratified squamous epithelium with high expression of cytokeratins and fibroblast growth factor, matching the characteristics of normal adult vaginal tissue. We believe that further studies will show Nile Tilapia Fish Skin to be a relevant option in the therapeutic arsenal of Mayer-Rokitansky-Küster-Hauser syndrome.

Uso da pele de tilápia do Nilo em medicina regenerativa: Status atual e perspectivas futuras / Nile tilapia fish skin use in regenerative medicine: Current status and future perspectives

OBJETIVO: O presente estudo tem como objetivo apresentar a trajetória do desenvolvimento da pele de tilápia como curativo biológico. MÉTODO: Descrição do processo de desenvolvimento da pele de tilápia como curativo biológico, desde a concepção da ideia para utilização no tratamento de queimaduras, até as perspectivas de sua utilização como scaffold em múltiplas especialidades médicas. RESULTADOS: Com o objetivo de oferecer uma alternativa segura, eficaz e de baixo custo para o tratamento de queimaduras, pesquisadores brasileiros desenvolveram um curativo biológico derivado da pele de tilápia. CONCLUSÃO: A pele de tilápia vem demonstrando um notável potencial como curativo biológico no tratamento de queimaduras e na medicina regenerativa.

OBJECTIVE: The present study aims to present the development trajectory of the tilapia skin as a biological dressing. METHODS: To describe the development process of tilapia skin as biological dressing, from the conception to the burn wounds treatment to the perspectives of its use as a scaffold in multiple medical specialties. RESULTS: In order to provide a safe, effective and low-cost alternative for the treatment of burn injuries, Brazilian researchers have recently developed a biological dressing derived from tilapia skin. CONCLUSION: The tilapia skin have been demonstrating the remarkable potential as a biological dressing in burn injuries treatment and in regenerative medicine.

Neovaginoplasty for radiation-induced vaginal stenosis using Nile Tilapia Fish Skin as a biological graft.

Tilapia skin showed good results when used as a biological graft for surgical management of Mayer-Rokitansky-Küster-Hauser syndrome. Thus, our researchers considered the use of this biomaterial for neovaginoplasty in radiation-induced vaginal stenosis. We report the case of a 41-year-old female patient with a total occlusion of the vaginal canal after radiotherapy for vaginal cancer. McIndoe neovaginoplasty using tilapia skin as a scaffold for proliferation of new vaginal epithelium was performed. Initially, laparoscopic dissection of the rectovaginal septum and vesicovaginal space spaces was conducted. In the vaginal surgical time, a transverse transmural incision was made in the scarred vaginal reminiscent followed by blunt dissection and insertion of an acrylic mold covered with tilapia skin. Good anatomical and functional outcomes were noted. Vaginal reconstruction with tilapia skin seems to be an excellent option for patients with radiation-induced vaginal stenosis due to its wide availability, easy application and high effectiveness.

Elaboração, desenvolvimento e instalação do primeiro banco de pele animal no Brasil para o tratamento de queimaduras e feridas / Elaboration, development, and installation of the first animal skin bank in Brazil for the treatment of burns and wounds

Introdução: A produção e a distribuição de pele humana pelos Bancos de Pele do Brasil é insuficiente para atender a demanda do país, suprindo menos de 1% da necessidade para tratar as vítimas de queimaduras. O objetivo do trabalho foi apresentar a elaboração e o desenvolvimento da implantação do primeiro Banco de Pele Animal do Brasil para tratamento da queimadura. Métodos: Trata-se de um estudo metodológico. O Banco de Pele Animal Aquático foi elaborado, desenvolvido e instalado a partir do desenvolvimento do processamento de pele da tilápia, da revisão sistemática de estudos referentes a banco de pele animal, de visitas à pscicultura em Jaguaribara-CE, da visita técnica aos bancos de pele humana no Brasil, de consulta técnica e de treinamento no Banco de Pele de Recife, da observação de todas as fases de processamento da pele de tilápia e da identificação da estrutura física da área onde ocorrem todos os processos. Resultados: Além da produção e da distribuição da pele da tilápia para os estudos em vítima de queimaduras, o banco está processando mais de 5000 peles de tilápia e encontra-se em fase de distribuição desta pele para estudos multicêntricos em outros estados e outras especialidades, que desenvolvem pesquisas nas áreas de ginecologia, ortopedia, endoscopia, estomaterapia, cirurgia vascular, odontologia e veterinária. Conclusão: este trabalho possibilitou a elaboração, o desenvolvimento e a implementação do primeiro Banco de Pele Animal do país e o primeiro Banco de Pele Aquática do mundo.

Introduction: The production and distribution of human skin by Brazilian skin banks is insufficient to meet the country's demand, supplying less than 1% of the need for treating burn victims. The objective of this work was to present the elaboration and development of the first animal skin bank of Brazil for the treatment of burns. Methods: This methodological study elaborated, developed, and installed The Aquatic Animal Skin Bank in terms of the development of tilapia skin processing after a systematic review of studies referring to animal skin banks based on visits to the pisciculture center in Jaguaribara-CE, technical visits to human skin banks in Brazil, technical consultation and training in the Recife Skin Bank, the observation of all phases of tilapia skin processing, and the identification of the physical structure of the area where the processes occur. Results: In addition to the production and distribution of tilapia skin for studies on burn victims, the bank is processing more than 5000 tilapia skin samples and is in the distribution phase of this skin for multicentric studies in other states and specialties including gynecology, orthopedics, endoscopy, stomatherapy, vascular surgery, dentistry, and veterinary medicine. Conclusion: This work enabled the elaboration, development, and implementation of Brazil's first animal skin bank and the world's first aquatic skin bank.

Tilapia fish skin as a new biologic graft for neovaginoplasty in Mayer-Rokitansky-Kuster-Hauser syndrome: a video case report.

OBJECTIVE: To describe a McIndoe procedure technique for surgical management of Mayer-Rokitansky-Kuster-Hauser syndrome with the use of Nile tilapia skin as a scaffold for the proliferation of new vaginal epithelium. DESIGN: Surgical video article. Local Institutional Review Board approval and written permission from the patient were obtained. There were no conflicts of interest. SETTING: University hospital. PATIENT(S): A 17-year-old woman who presented at our gynecology department with the complaint of primary amenorrhea. At physical examination, she had a phenotypically normal vulva with no vaginal canal. Magnetic resonance imaging of the abdomen and pelvis revealed normal ovaries and absence of uterus and vaginal canal. No other congenital malformations were found. Karyotype was 46,XX. INTERVENTION(S): The McIndoe procedure involved only a vaginal approach. Labia minora were separated, and a transverse midline incision of 3 cm was made. The vesicorectal space was progressively dissected. Blunt dissection was performed initially with digital separation of tissues. The neovagina was then inspected with the introduction of a vaginal speculum, allowing for review of hemostasis. Blunt dissection was continued with the aid of the speculum, to reach the appropriate vaginal dimensions. Subsequently, a vaginal acrylic mold covered with two pieces of processed and sterilized tilapia fish skin was inserted and accommodated into the newly created cavity. The external side of the tilapia skin, which maintained its grayish coloration after the removal of the scales, stayed in contact with the acrylic mold, while the white internal side of the tilapia skin, which was previously attached to the fish's muscle, stayed in contact with the walls of the neocavity. The mold was held in position by four multifilament polyglactin 1.0 sutures in the labia majora, thus preventing expulsion. MAIN OUTCOME MEASURE(S): Anatomic data, such as measurement of the final canal length, and histomorphologic analysis, 180 days after surgery. RESULT(S): The patient remained on bed rest for 9 days, after which the tilapia fish skin had been partially reabsorbed. After this time, the acrylic mold was removed. A larger plastic mold was then inserted and the patient was advised to wear it day and night for the first postoperative month. The vaginal mold had to be worn each night until normal sexual intercourse was possible. The final canal length 180 days after surgery was between 8 and 9 cm. For the histopathologic analysis, fragments of the lateral vaginal wall were removed 180 days after surgery and showed the presence of stratified squamous epithelium with five cell layers, ectasic blood vessels, and occasional desquamated epithelial cells. CONCLUSION(S): The procedure described offered this patient an anatomic and functional neovagina by means of a simple, safe, easy, effective, quick, and minimally invasive procedure. Limitations include the experimental nature of this study, based on a single case report with no long-term outcome results. The tilapia fish skin is a low-cost and widely available biomaterial.

Elaboração de um protocolo para implementação e funcionamento do primeiro banco de pele animal do Brasil: Relato de experiência / Preparation of a protocol for the implementation and functioning of the first animal skin bank of Brazil: Experience report / Elaboración de un protocolo para implementación y funcionamiento del primer banco de piel animal de Brasil: Relato de experiencia

Objetivo: Elaborar um protocolo para implementação e funcionamento do primeiro banco de pele animal do Brasil. Resultados: Para a construção do protocolo, até o presente momento, foram realizadas as seguintes etapas: visita técnica ao Banco de Pele Animal de Recife, onde foi traçado o levantamento das necessidades de insumos, controle de esterilização e organização do ambiente; identificação e descrição de todas as etapas do processamento da pele de tilápia; elaboração de planilhas de relação de materiais necessários para o processamento da pele de tilápia; e controle do gasto de material utilizado. Conclusão: Frente à incontestável importância e ineditismo da concepção do primeiro Banco de Pele Animal do Brasil e o primeiro para pele de animal aquática no mundo, o papel do enfermeiro é fundamental para a elaboração e implantação de um protocolo que, por meio de um gerenciamento adequado, assegure o estabelecimento de regras, uniformização dos procedimentos e rotinas de processo. Este trabalho permitirá a criação de manuais e controles que irão nortear os processos e garantir a qualidade de todas as etapas do processamento da pele da tilápia do primeiro Banco de Pele Animal do Brasil.

Objective: Elaboration of a protocol for the implementation and operation of the first animal skin bank in Brazil. Results: For development of the protocol, until now, the following steps were taken: technical visit to Recife Skin Bank and consulting the head nurse, where it was traced the supplies needs assessment, sterilization control and environmental organization; identification and description of all stages of tilapia skin processing; elaboration of spreadsheets regarding a list of materials necessary for the processing of tilapia skin and control of the expenditure of the material employed. Conclusion: Before of the undeniable importance and the conception originality of the first Animal Skin Bank of Brazil and the first for aquatic animal skin in the world, the role of a nurse becomes key piece to design and implement a protocol that, through adequate management, ensure the establishment of rules, standardization of procedures and process routines. This work will allow the creation of manuals and controls that will guide the processes and guarantee the quality of all stages of the skin processing of tilapia of the first Animal Skin Bank of Brazil.

Objetivo: Elaborar un protocolo para la implementación y el funcionamiento del primer banco de piel animal de Brasil. Resultados: Para el desarrollo del protocolo, hasta el presente momento, se realizaron las siguientes etapas: visita técnica al Banco de Piel de Recife y consultoría por la enfermera jefe, donde fue trazado el levantamiento de las necesidades de insumos, control de esterilización y organización del ambiente identificación y descripción de todas las etapas del procesamiento de la piel de tilapia; elaboración de planillas de relación de materiales necesarios para el procesamiento de la piel de tilapia y control del gasto de material utilizado. Conclusión: El papel del enfermero es fundamental, para la elaboración e implantación de un protocolo que, a través de una gestión adecuada, asegure el establecimiento de reglas, uniformidad de los procedimientos y rutinas de proceso. Este trabajo permitirá la creación de manuales y controles para orientar los procesos y garantizar la calidad de todas las etapas del procesamiento de la piel de la tilapia del Primer Banco de Piel Animal de Brasil.

Uso da pele de tilápia (Oreochromis niloticus), como curativo biológico oclusivo, no tratamento de queimaduras / The use of tilapia skin (Oreochromis niloticus), as an occlusive biological dressing, in the treatment of burn wounds

OBJETIVO: Avaliar a utilização da pele de tilápia do Nilo como curativo oclusivo temporário nas queimaduras de segundo grau superficial e profunda em ratos. MÉTODO: Estudo prospectivo, qualiquantitativo, no qual foram utilizados 40 ratos machos Wistar submetidos à cirurgia para produção de queimadura, divididos aleatoriamente em quatro grupos: C1, no qual as feridas foram lavadas com solução salina; C2, no qual o curativo aberto foi tratado com sulfadiazina de prata a 1%; T1, queimadura de 2º grau superficial, tratado com curativo oclusivo utilizando a pele de tilápia; e T2, queimadura de 2º grau profundo, igualmente tratado com pele de tilápia. Os animais foram tratados e acompanhados por 22 dias. No último dia, os animais foram anestesiados para realização de biópsia, coleta de sangue e foram eutanasiados. RESULTADOS: No dia 21, os grupos T1 e T2 demonstravam melhor delineamento dos bordos da ferida. O exame microscópico revelou que amostras dos grupos T1 e T2 eram representadas por tecido conjuntivo fibroso destituído de revestimento epitelial, exibindo infiltrado inflamatório histiolinfoplasmocitário, com graus variados de intensidade, e permeado por ocasionais granulócitos polimorfonucleares neutrófilos restritos à região superficial. Nos grupos C2, T1 e T2 observava-se que o tecido conjuntivo profundo apresentava-se livre de inflamação. Os exames de sangue não apresentaram alterações significativas (p<0,05). CONCLUSÃO: A pele da tilápia apresentou boa aderência no leito das feridas induzidas por queimaduras nos ratos, interferindo positivamente no processo cicatricial. Estes resultados possibilitam o prosseguimento das investigações para pesquisas em seres humanos, para confirmação de sua segurança e eficácia como curativo biológico.(AU)

OBJECTIVE: To evaluate the use of tilapia skin as a temporary occlusive dressing in superficial and deep second degree burns in rats. METHODS: A prospective, qualitative and quantitative study, in which 40 Wistar rats randomly divided into four groups and underwent surgery for burn production: C1, the wounds were washed with saline solution; C2, open dressing treated with silver sulfadiazine 1%; T1, superficial 2nd degree burn treated with an occlusive dressing of tilapia skin; and T2, deep 2nd degree burn also treated with tilapia skin. The animals were treated for 22 consecutive days. Blood was collected for hematological and biochemical tests on the last day and the animals were euthanized for histological analysis of the wound. RESULTS: On day 21, groups T1 and T2 showed improved delineation of the wound edges. Microscopic examination revealed that samples of groups T1 and T2 were represented by fibrous connective tissue devoid of epithelial lining, displaying lymphoplasmacytic inflammatory infiltrate, with varying degrees of intensity, and permeated by occasional polymorphonuclear granulocytes neutrophils restricted to the surface area. In groups C2, T1 and T2 the deep connective tissue had no inflammation. Blood tests presented no significant changes (p<0.05). CONCLUSION: The tilapia skin showed good grip on the wounds caused by burns in the tested rats, interfering positively on the healing process and not causing significant changes in hematological and biochemical parameters. These results allow the continuation of the investigations to clinical trials to confirm the safety and efficacy of its use as a biological dressing.(AU)

Objetivo: Evaluar el uso de la piel de tilapia del Nilo como un apósito oclusivo temporal en las quemaduras superficiales y profundas de segundo grado en ratones. Método: Un estudio prospectivo, cualitativo y cuantitativo, en donde fueron utilizados 40 ratones Wistar machos sometidos a cirugía para producción de quemadura, los cuales fueron divididos de manera aleatoria en cuatro grupos: C1, las heridas se lavaron con solución salina; C2, trató con sulfadiazina de plata al 1%; T1, quemadura de 2º grado superficial tratada con piel de tilapia; y T2, quemadura de 2o grado profunda tratada con piel de tilapia. Los animales fueron tratados y monitoreados durante 22 días. En el último día, fueron anestesiados para biopsia, extracción de sangre y sometidos a la eutanasia. Resultados: En el día 21, los grupos T1 y T2 mostraron una mejor delineación de los bordes de la herida. El examen microscópico reveló que los grupos T1 y T2 se representaban por tejido conectivo fibroso de revestimiento epitelial, enseñando infiltración inflamatoria histiolinfoplasmocitário, con diferentes grados de intensidad, y permeado con ocasionales granulocitos polimorfonucleares neutrófilos restringidas a la región superficial. En los grupos C2, T1 y T2 fue observado que el tejido conectivo profundo se presentaba libre inflamación. Conclusión: La piel de tilapia presentó una buena adhesión al lecho de las heridas inducidas por quemaduras en los ratones, interfiriendo positivamente en el proceso de cicatrización. Estos resultados permiten la continuación de las investigaciones para el estudio en humanos, para confirmar su seguridad y eficacia como un apósito biológico.(AU)

Tentativa de suicídio pós-queimadura: uma experiência humana inscrita na pele / Post-burn suicide attempt: a human experience inscribed in the skin / Intento de suicidio después de la quemadura: una experiencia humana inscrita en la piel

Fatores culturais desempenham papel fundamental no comportamento suicida, acarretando diferenças deste problema no mundo. Não há consenso literário de que pessoas que sofreram queimaduras apresentem inclinação maior para suicídio. Cada contexto identifica ideações suicidas e tentativas de suicídio no pós-trauma – fator novo que desafia o entendimento e o atendimento da equipe multidisciplinar nas organizações chamadas de Terceiro Setor. Objetivo: Desvelar aspectos relacionados à tentativa de suicídio pós-queimadura. Relato de caso: Descrição de caso de paciente vítima de choque elétrico. Os aspectos subjetivos vêm dos dados registrados a partir do acompanhamento multiprofissional no Instituto de Apoio ao Queimado (IAQ), no período maio de 2014 até outubro de 2015. Foram descritos os aspectos clínicos relacionados com desesperança, ideação suicida e tentativa de suicídio deste indivíduo. Conclusão: Queimadura é quase sempre acompanhada de perdas. As perdas variam com a situação particular do indivíduo e a extensão do ferimento da queimadura. A experiência humana de ser queimado é caracterizada por um processo ativo de construção de significado, que envolve indivíduos em diferentes formas socioculturais. A imagem da vida social deste homem pode parecer excessivamente séria e até mesmo opressiva. Essa clientela precisa da atenção da equipe no ambulatório multiprofissional chamado Terceiro Setor, pois a tentativa de suicídio pós-trauma pode ameaçar relações, projetos de vida e até mesmo a sobrevivência. O conhecimento antropológico aprofundado é parte de uma investigação moral cotidiana e pode influenciar decisões e ações do indivíduo em situação de vulnerabilidade...

Cultural factors play a pivotal role in suicidal behavior, resulting in vast differences in the characteristics of this problem worldwide. No consensus exists in the literature that people who have suffered burns are more inclined to commit suicide. In each context, however, suicidal ideation and suicide attempts are identified post-trauma – a new occurrence that challenges the multidisciplinary team’s understanding and clinical practice in tertiary care. Objective: To reveal human aspects related to suicide attempts after sustaining burns. Case report: A case description of electrical burn victim. The material (subjective aspects, family issues, gender differences) was derived from data complied during a multidisciplinary follow-up of patients, from May 2014 until October 2015, at the Institute of Burn Victims’ Support. We describe clinical features associated with hopelessness, suicidal ideation and attempted suicide of patients suffering electrical shock. Conclusion: Burns are often, if not always, accompanied by losses. The types of losses vary according to the individual’s particular situation and the extent of the burn injury. The human experience is characterized by an active process of meaning construction that involves individuals from differing social and cultural positions. The image of this man’s social life may appear excessively serious and even oppressive. These patients demand the attention of tertiary care health professionals given that post-trauma suicide attempts can threaten relationships, life plans and even survival. Profound anthropological knowledge should be part of an inquiry of everyday moral life, which may influence the decisions and actions of human beings in vulnerable situations...

Los factores culturales juegan un papel clave en el comportamiento suicida, resultando en diferencias de este problema en el mundo. No hay consenso en la literatura de que personas que sufrieron quemaduras sean más propensa al suicidio. En cada contexto, se identifican ideas suicidas e intentos de suicidios en el post-trauma. Nuevo factor que desafía la comprensión y el cuidado del equipo multidisciplinario del Tercer Sector. Objetivo: Desvelar los aspectos relacionados con el intento de suicidio después de la quemadura. Caso clínico: Reporte de caso de paciente víctima de choque eléctrico. Los aspectos subjetivos son provenientes de registros a partir del seguimiento multiprofesional en el Instituto de Apoyo al Quemado (IAQ), en el período de mayo de 2014 a octubre de 2015. Son descritas las características clínicas relacionadas con la desesperanza, ideación suicida y el intento de suicidio del caso. Conclusión:Quemadura es, a menudo, acompañada de pérdidas que varían de acuerdo a las circunstancias particulares de la persona y la extensión de la lesión por quemadura. La experiencia humana de ser quemado se caracteriza por un proceso activo de significado de decisiones, que envuelve personas que se colocan em diferentes formas socio-culturales. La imagen de la vida social puede parecer incluso opresiva. Estos clientes también necesitan ser atendidos por profesionales de salud del Tercer Sector, ya que el intento de suicidio post-trauma puede amenazar relaciones, proyectos de vida y hasta la sobrevivida. El conocimiento antropológico profundo es parte de una investigación moral cotidiana y puede influir en decisiones y acciones de la persona en situación de vulnerabilidad...

Padronização do tratamento cirúrgico do trauma elétrico na fase aguda / Standardization of surgical treatment of acute electrical trauma

INTRODUÇÃO: As queimaduras elétricas correspondem de 5 a 15% dos casos de acidentes com queimaduras. A maioria está associada a acidentes do trabalho, nos quais predominam as lesões com alta voltagem (acima de 1.000 Volts), em pacientes do sexo masculino. As taxas de mortalidade variam de 2 a 15%, nos mais diversos centros de queimados. O objetivo é revisar padronização das etapas cirúrgicas na fase aguda de desbridamento (primeiros 15 dias) pela comparação de dosagem de creatofosfoquinase, hidratação venosa e fotografias para a aplicação de uma rotina de etapas cirúrgicas. MÉTODOS: Trata-se de um estudo quantitativo, prospectivo, realizado em um hospital público da cidade de Fortaleza, CE, entre julho de 2013 a dezembro de 2015. A população foi composta por adultos jovens, entre 15 e 50 anos, de ambos os sexos, vítimas de queimaduras por choque elétrico, com lesão de terceiro grau, no mínimo muscular. RESULTADOS: Foram realizados 12 procedimentos cirúrgicos de amputações nos 15 pacientes do estudo (60%). Seis pacientes não sofreram amputação (40%). Um paciente sofreu três procedimentos de amputação no mesmo membro (pododáctilo, pé e coxa esquerdos) e outro, duas amputações em membros superiores distintos. CONCLUSÃO: O tratamento na fase aguda do choque elétrico deve incluir uma imediata e adequada reposição líquida venosa, associada com procedimentos cirúrgicos de desbridamentos e de amputações, o mais precoce possível, em etapas com intervalos de 48 a 72 horas.

INTRODUCTION: Electrical burns are responsible for 5% to 15% of cases of burn accidents. The majority is associated with workplace accidents, in which high-voltage injuries (>1,000 V) predominate in male patients. The mortality rates vary from 2% to 15% in different burn centers. The objective is to review the standardization of surgical steps in the acute phase of debridement (the first 15 days) by comparison of creatine phosphokinase levels, intravenous hydration, and photographs to implement routine surgical stages. METHODS: This was a quantitative, prospective study performed in a public hospital in the city of Fortaleza, Brazil, between July 2013 and December 2015. The population was composed of young adults between 15 and 50 years, of both sexes, who experienced electrical burns, with third-degree injuries and muscle involvement. RESULTS: Of the 15 patients in the study, 9 (60%) patients underwent 13 surgical amputation procedures and 6 (40%) patients did not undergo amputation. One patient underwent three amputation procedures in the same limb (toe, foot, and thigh) and another patient underwent two amputations in the upper limbs. CONCLUSION: Treatment in the acute phase of electrical shock must include immediate and adequate intravenous fluid replacement, along with surgical procedures of debridement and amputations, as early as possible, in steps with intervals of 48 to 72 hours.

Avaliação microscópica, estudo histoquímico e análise de propriedades tensiométricas da pele de tilápia do Nilo / Microscopic evaluation, histochemical study and analysis of tensiometric properties of the Nile Tilapia skin

OBJETIVO: Caracterizar a pele de tilápia do Nilo, uma possível fonte de biomaterial para enxertia, a partir de suas características físicas (resistência à tração), histomorfológicas e da tipificação da composição do colágeno. MÉTODOS: Amostras de pele de tilápia do Nilo foram utilizadas e, para os testes de tração (utilizando a máquina de ensaios universais Instron®), as peles foram submetidas à imersão em soluções de glicerol em crescente concentração. Parte das amostras foi fixada em formol neutro a 10%, processada e corada com o uso da hematoxilina e da eosina, para confecção de lâminas e posterior análise histológica e histoquímica. Todas as etapas foram reproduzidas também em pele humana, doada de cirurgias plásticas, para efeito comparativo. RESULTADOS: A morfologia da pele da tilápia mostrou-se semelhante à da pele humana, com derme profunda formada por espessas fibras colágenas organizadas, em disposição paralela/horizontal e transversal/vertical. A pele de tilápia também apresentou maior composição por colágeno tipo I em relação à pele humana (p=0,015). Nos testes de tração, a carga média suportada pela pele de tilápia foi de 43,9±26,2 N, enquanto a extensão à traçao teve valores médios de 4,4±1,045 cm CONCLUSAO: A pele de tilápia possui características microscópicas semelhantes à estrutura morfológica da pele humana e elevada resistência e extensão à tração em quebra, o que suporta sua possível aplicação como biomaterial. A derme desta pele é composta por feixes organizados de fibras de colágeno denso, predominantemente do tipo I, o que traz considerável importância para seu uso clínico.

OBJECTIVE: To characterize the Nile tilapia skin, a possible source of biomaterial for grafting, from their physical (tensile strength) and histomorphological characteristics, and from collagen classification. METHODS: Samples of Nile tilapia skin were used and, for microtensile tests (by Instron® universal testing machine), were subjected to immersion in glycerol solutions of increasing concentration. Part of the samples was fixed in neutral formalin 10%, processed and prepared using routine staining with hematoxylin and eosin into tissue slides, for further histological and histochemical analysis. All steps were also played in human skin, donated by plastic surgeries, for comparative effects. RESULTS: The morphology of Nile tilapia skin presented similarities with human skin, showing the deep dermis formed by thick organized collagen fibers, on parallel/horizontal and transversal/vertical arrangement. The tilapia skin also presented a larger composition of type I collagen, compared with human skin (p=0.015). On traction tests, the load average supported by tilapia skin was 43.9±26.2 N, while the traction extensile had mean values of 4.44±1.045cm. CONCLUSION: The tilapia skin has microscopic characteristics, similar to the morphological structure of human skin, and high resistance and tensile extension at break, which supports its possible application as biomaterial. The dermis of this skin is composed by organized bundles of dense collagen fibers, predominantly type I ones, which brings considerable importance for its clinical use.

Perfil epidemiológico de pacientes vítimas de choque elétrico em um hospital de referência em Fortaleza / Epidemiological profile of patients victims of electric shock in a referral hospital in Fortaleza

Objetivo: Este estudo tem como objetivo identificar o perfil epidemiológico dos pacientes vítimas de choque elétrico, atendidos em um Centro de Tratamento de Queimados do Estado do Ceará, no período de janeiro a dezembro de 2014. Método: Foi realizado um estudo retrospectivo, baseado nas internações dos pacientes vítimas de choque elétrico, no Centro de Tratamento de Queimados do Instituto Doutor José Frota (IJF), no período de janeiro de 2014 a dezembro do mesmo ano. Resultados: Dentre os 23 pacientes avaliados, observou-se maior incidência do sexo masculino (91%), a idade de 31 a 40 (39%) foi a mais acometida, o local de ocorrência do acidente, predominante, no sexo masculino, foi na construção civil. Quanto à superfície corpórea queimada (SQC), 44% dos pacientes apresentavam menos de 10%, 39% tinham entre 10 e 25% de SCQ e 17% possuíam SCQ maior que 25%. Os membros superiores foram os mais acometidos, com lesões em 83% dos pacientes. A maior parte dos internamentos durou menos de um mês. Conclusões: O trauma elétrico foi um pequeno número de casos do total das internações, mas foram graves, acometendo homens jovens em acidentes de trabalho, com morbidade elevada, sendo necessárias campanhas de prevenção de acidentes de trabalho.

Objective: This study aims to identify the epidemiological profile of patients victimized by electric shock assisted at a Burns Treatment Center in the state of Ceará, from January to December 2014. Methods: We conducted a retrospective study, based on admissions of victimized electric shock patients in the Burns Treatment Center of Dr. José Frota Institute (IJF), being diagnosed by electric shock, between the period January 2014 to December of the same year. Results: Among the 23 patients evaluated, there was a higher incidence among men (91%), age 31-40 (39%) was the most affected, the predominant site of occurrence in both genders was in the in civil construction field. As for the body burned surface area (BSA), 44% of patients had less than 10%, 39% had between 10 and 25% BSA and 17% had BSA larger than 25%. The upper limbs were the most affected, with lesions in 83% of patients. Most hospital admissions lasted less than a month. Conclusions: The electric trauma was a small number of cases out of the total admissions, but were serious, affecting young men in work accidents, with high morbidity, requiring prevention campaigns to avoid work site accidents.

Avaliação do conhecimento e promoção da conscientização acerca da prevenção de queimaduras na população de Fortaleza - CE / Assessment of knowledge and awareness promotion on the prevention of burns population of Fortaleza - CE

Objetivo: Analisar o grau de conhecimento da população de Fortaleza acercados riscos de queimaduras, caracterizando-os, a fim de promover uma conscientização sobre o assunto. Método: Estudo quantitativo, transversal, realizado no Instituto Dr. José Frota (IJF), durante o Dia Nacional de Prevenção de Queimaduras (6 de junho) no ano de 2014. A amostra foi formada por indivíduos presentes na recepção do hospital, os quais responderam a um questionário que abordava questões de prevenção e risco. A pesquisa foi aprovada pela Plataforma Brasil, no Comitê de Ética e Pesquisa do Centro Universitário Christus (Unichristus), e todos os participantes assinaram o Termo de Consentimento Livre e Esclarecido (TLCE). Resultados: A amostra foi composta por 80 participantes; 48(60%) deles são pessoas do sexo feminino. O grupo dos analfabetos foi composto por 6,3%; 32,6% possuíam ensino fundamental; 45,1%, o ensino médio e 16,3%, o ensino superior. Trinta por cento exerciam alguma profissão considerada de risco pelo presente estudo. Dos entrevistados, 57,5% já tinham sofrido alguma queimadura, sendo as queimaduras térmicas as mais prevalentes, com 80,7%, seguidas pelas químicas com 10,5%, elétricas com 7,8% e queimaduras por radiação com 1,8%. Aproximadamente metade (51,2%) afirmou tomar uma atitude considerada incorreta diante de uma queimadura. Entre os fatores de risco para as queimaduras analisadas, o único que mostrou mais risco que segurança, isto é, mais da metade dos entrevistados realizavam, foi o uso de extensões ou pinos T’s (81,3%), demonstrando ser uma prática comum. Conclusões: Apesar de muitos participantes terem-se mostrado informados, é notável a necessidade de haver mais campanhas informativas, a fim de diminuírem os fatores de risco e de se quebraremos costumes ineficazes em relação à conduta popular das queimaduras (pasta de dente, manteiga etc). Mais estudos com amostras maiores devem ser feitos, a fim de se ter resultados mais representativos e, ....

Purpose: To analyze the degree of knowledge of the population of Fortaleza on the risk of burns, characterizing them in order to promote awareness of the issue. Method: A quantitative, cross-sectional study conducted at the Institute Dr. José Frota (IJF) during the National Day to Prevent Burns (June 6) in the year 2014. The sample was comprised of individuals present at the reception of the hospital, which answered a questionnaire that addressed issues of prevention and risk. The study was approved by Brazil Platform in the University Center Christus (UniChristus) Research Ethics Committee and all participants signed a consent form (TLCE). Results: The sample consisted of 80 participants, 48 people (60%) were female. The group was composed of illiterate by 6.3%, 32.6% had primary education, 45.1% high school and 16.3% higher education. Thirty percent had some sort of risk profession considered by this study. Of the respondents, 57.5% of respondents had already suffered some burns, being most prevalent thermal burns, with 80.7%, followed by 10.5% with chemical, electrical with 7.8% and 1 with radiation burns 8%. Approximately half (51.2%) reported taking action deemed improper before a burn. Among the risk factors for burns analyzed, the one that showed the greatest security risk, ie more than half of respondents performed, was the use of extensions or pins T’s (81.3%), showing to be a common practice. Conclusions: Although many participants reported having been shown, it is remarkable the need for more information campaigns in order to reduce risk and to break inefficient habits with respect to conduct popular Burns (toothpaste, butter etc) factors. Further studies with larger samples should be made in order to have more representative results, and thus, more effective measures points found in deficit.