La matriz extracelular en la curación de las heridas cutáneas. Aspectos físicos, químicos y biológicos / Extracellular matrix in healing of cutaneous wounds. Physical, chemical and biological aspects

Se revisan los nuevos conocimientos sobre la matriz extracelular (MEC), que han permitido descubrir su importante rol en la cicatrización de las heridas cutáneas. Se describen sus características morfofisiológicas y cómo interviene en la curación de las heridas cutáneas. Se presentan cuatro casos clínicos en los que se aplicó este enfoque terapéutico: los sustitutos de piel y la "cura húmeda"

We review the new knowledge about the extracellular ma-trix (ECM) that has allowed us to discover its important role in the healing of cutaneous wounds. The morpho-physiological characteristics of ECM and its role in the healing of cutaneous wounds are described. Four clinical cases are presented where this therapeutic approach was applied: the skin substitutes and the "moist wound healing".

Effects of comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome / 中华烧伤杂志

Objective: To investigate the characteristics and comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome. Methods: A retrospective observational study was conducted. From May 2012 to December 2021, the data of 19 patients with iatrogenic Cushing's syndrome discharged from the Department of Burns and Plastic Surgery of the First Affiliated Hospital of Guangxi Medical University were collected, including 8 males and 11 females, aged 28-71 (56±11) years, with 12 cases of infected acute wounds and 7 cases of infected chronic wounds. The lesions were located in the limbs, perianal, and sacrococcygeal regions, with original infection ranging from 9 cm×5 cm to 85 cm×45 cm. After admission, the patients were performed with multidisciplinary assisted diagnosis and treatment, and the wounds were treated with debridement and vacuum sealing drainage, according to the size, severity of infection, suture tension, and bone and tendon tissue exposure of wounds, direct suture or autologous skin and/or artificial dermis and/or autologous tissue flap transplantation was selected for wound repair. The levels of cortisol and adrenocorticotropic hormone (ACTH) of patients at 8:00, 16:00, and 24:00 within 24 h after admission were counted. After admission, the number of operations, wound repair methods, and wound and skin/flap donor site healing of patients were recorded. During follow-up, the wounds were observed for recurrent infection. Results: The cortisol levels of 16 patients at 8:00, 16:00, and 24:00 within 24 h after admission were (130±54), (80±16), and (109±39) nmol/L, respectively, and ACTH levels were (7.2±2.8), (4.1±1.8), and (6.0±3.0) pg/mL, respectively; and the other 3 patients had no such statistical results. After admission, the number of surgical operation for patients was 3.4±0.9. The following methods were used for wound repair, including direct suturing in 4 cases and autologous skin and/or artificial dermis grafting in 9 cases, of which 2 cases underwent stage Ⅱ autologous skin grafting after artificial dermis grafting in stage Ⅰ, and 6 cases had pedicled retrograde island flap+autologous skin grafting. The wound healing was observed, showing that all directly sutured wounds healed well; the wounds in 6 cases of autologous skin and/or artificial dermis grafting healed well, and the wounds in 3 cases also healed well after the secondary skin grafting; the flaps in 4 cases survived well with the wounds in 2 cases with distal perforators flap arteries circumfluence obstacle of posterior leg healed after stage Ⅱ debridement and autologous skin grafting. The healing status of skin/flap donor sites was followed showing that the donor sites of medium-thickness skin grafts in the thigh of 4 cases were well healed after transplanted with autologous split-thickness grafts from scalp; the donor sites of medium-thickness skin grafts in 3 cases did not undergo split-thickness skin grafting, of which 2 cases had poor healing but healed well after secondary skin grafting 2 weeks after surgery; the donor sites of split-thickness skin grafts in the head of 2 patients healed well; and all donor sites of flaps healed well after autologous skin grafting. During follow-up of more than half a year, 3 gout patients were hospitalized again for surgical treatment due to gout stone rupture, 4 patients were hospitalized again for surgical treatment due to infection, and no recurrent infection was found in the rest of patients. Conclusions: The infected wounds in patients with iatrogenic Cushing's syndrome have poor ability to regenerate and are prone to repeated infection. Local wound treatment together with multidisciplinary comprehensive treatment should be performed to control infection and close wounds in a timely manner, so as to maximize the benefits of patients.

Análise do uso de matriz de regeneração dérmica em crianças / Analysis of the use of dermal regeneration matrix in children

OBJETIVO: Analisar as utilizações e do desfecho imediato da MRD Integra® no fechamento cutâneo de lesões extensas em crianças atendidas no serviço de Cirurgia Pediátrica do Hospital Infantil Joana de Gusmão no período de janeiro de 2002 a dezembro de 2017. MÉTODO: Trata-se de um estudo retrospectivo, analítico e vertical que avaliou os arquivos de todas as crianças submetidas a aplicação de MRD no período de janeiro de 2002 a dezembro de 2017, totalizando 155 pacientes. RESULTADOS: Foram analisados 155 pacientes submetidos ao implante de MRD, totalizando 191 implantes. A maioria dos pacientes era do sexo masculino (58,06%) e pré-púberes (32,02%). Os diagnósticos mais prevalentes foram queimadura em fase aguda (35,97%), retração cicatricial (32,8%) e retração cicatricial e cicatriz hipertrófica (14,28%). A pega total do implante foi observada em 68,42% dos pacientes, numa média de 19,16 dias. O número de implantes submetidos ao tratamento conjunto com curativos de pressão negativa (CPN) foi de 86 (46,24%). A porcentagem média de pega parcial foi de 82,30%. Dos 191 implantes, 58 tiveram complicações (30,36%). CONCLUSÕES: As MRD são uma opção atual para cobertura cutânea em crianças, com utilizações diversas, taxa aceitável de complicações e bom resultado imediato.

OBJECTIVE: To analyze the uses and the immediate outcome of MRD Integra® in the cutaneous closure of extensive lesions in children seen at the Pediatric Surgery service of Hospital Infantil Joana de Gusmão from January 2002 to December 2017. METHODS: This is a retrospective, analytical and vertical study that evaluated the files of all children submitted to the application of MRD from January 2002 to December 2017, totaling 155 patients. RESULTS: 155 patients submitted to MRD implantation were analyzed, totaling 191 implants. Most patients were male (58.06%) and prepubertal (32.02%). The most prevalent diagnoses were acute burns (35.97%), scar retraction (32.8%) and scar retraction and hypertrophic scarring (14.28%). Total implant take-up was observed in 68.42% of patients, with an average of 19.16 days. The number of implants submitted to joint treatment with negative pressure dressings (CPN) was 86 (46.24%). The average percentage of partial catch was 82.30%. Of the 191 implants, 58 had complications (30.36%). CONCLUSIONS: MRDs are a current option for skin coverage in children, with different uses, an acceptable rate of complications and a good immediate result.

Dermal regeneration template: a new option for the repair of a large surgical defect after mohs surgery in epidermolysis bullosa

La epidermólisis ampollar es un raro trastorno hereditario caracterizado por fragilidad cutánea, formación de ampollas mucocutáneas recurrentes luego de un traumatismo mínimo y cicatrización deficiente de heridas. Además, algunas variantes se han asociado con la aparición de carcinomas espinocelulares. Presentamos el caso clínico de un paciente con epidermólisis ampollar, que presentó un extenso carcinoma espinocelular localizado en cara posterior de brazo. Este fue tratado con cirugía micrográfica de Mohs y el defecto quirúrgico resultante fue reparado aplicando una matriz de regeneración dérmica sobre la herida durante un mes. Posteriormente continuamos con curaciones y ungüento antibiótico sobre la herida dos veces al día, completando la cicatrización con un excelente resultado cosmético y funcional. Enfatizamos en el carácter novedoso de esta opción terapéutica y en su utilidad en pacientes con epidermólisis ampollar.

Epidermolysis bullosa is a rare hereditary disorder characterized by skin fragility, recurrent mucocutaneous blisters following minimal trauma, and compromised wound healing. Moreover, some variants have been associated with squamous cell carcinoma. Following, we present the clinical case of a patient with epidermolysis bullosa, who presented a large squamous cell carcinoma of the arm. It was resected using Mohs micrographic surgery, and the final defect was repaired by applying a dermal regeneration template over the wound for a month. After this period, we continued using cures and antibiotic ointment over the wound twice a day, and healing was completed with excellent cosmetic and functional results. We emphasize the novelty of this therapeutic option, and its usefulness in patients with epidermolysis bullosa.

National expert consensus on the application of natural dermal matrix in wound repair (2020 version) / 中华烧伤杂志

Natural dermal matrix has good biocompatibility and can serve as " biological template" in wound repair. According to the source of material, natural dermal matrix can be divided into acellular dermal matrix (ADM), denatured dermal matrix, and scar dermal matrix. ADM is a biological material prepared by removing cellular components from the skin and retaining extracellular matrix (ECM) of the dermis. ADM possesses abundant natural biological information, low immunogenicity, and excellent regenerative capacity, which has greatly promoted the development of wound healing specialty as dermal substitute. Denatured dermis matrix is a layer of dermal tissue made by superficial tangential excision or dermabrasion on deeply burned wounds. The retained denatured dermis can recover gradually after transplantation of autologous skin on its surface, with similar structure, morphology, and biomechanics to healthy dermis. Scar dermal matrix is a kind of dermal scaffold made of autologous split-thickness scar tissue, possessing the characteristics of high survival rate, good texture, and slight scar reaction. Scar dermal matrix can effectively reduce secondary damage to the donor site when repairing scar contracture deformity. Based on the research progress at home and abroad and the opinions of domestic experts, this paper summarizes the indications, application methods, contraindications, and considerations of different types of natural dermal matrix in application of wound repair.

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.

Uso de dermis artificial (Integra®) en reparación de lesiones traumáticas extensas de cuero cabelludo / Use of artificial dermis (INTEGRA®) in repair of extensive traumatic scalp injuries

Resumen Objetivo: Presentar 4 casos clínicos en los cuales el uso de dermis artificial Integra® resultó ser una solución segura y confiable para defectos de cuero cabelludo. Materiales y Método: Revisión de fichas clínicas de pacientes ingresados al Departamento de Cirugía Plástica y Quemados del Hospital del Trabajador de Santiago con diagnóstico de lesión traumática extensa de cuero cabelludo entre los años 2005-2013 que se resolvieron con uso de Integra®. Resultados: 4 pacientes de sexo femenino con lesión traumática que comprometían entre 70-98% de la superficie de cuero cabelludo, tiempo promedio entre aplicación de Integra® e injerto dermoepidérmico fue 18 días con 100% de cobertura; solo hubo complicaciones menores (ulceración crónica de vertex y dolor neuropático). El tiempo promedio de alta laboral fue 368 días, usando órtesis capilar. Discusión: La cobertura inmediata del tejido es fundamental para la reconstrucción exitosa del cuero cabelludo. Aparte del tejido autólogo, la dermis artificial constituye una alternativa para la reconstrucción rápida del cuero cabelludo con excelentes resultados. Conclusiones: Integra® es una solución segura y confiable para reconstruir defectos complejos del cuero cabelludo.

Aim: To present 4 clinical cases in which the use of artificial dermis (Integra®) turned out to be a safe and reliable solution for scalp defects. Materials and Method: review of clinical records of patients admitted to the Department of Plastic Surgery and Burns of the Hospital of the Worker of Santiago with a diagnosis of extensive traumatic injury of the scalp between the years 2005-2013 that were resolved with use of Integra®. Results: 4 female patients with traumatic injury that compromised between 70-95% of the surface of scalp, average time between application of integra and dermoepidermal graft was 18 days with 100% coverage; there were only minor complications (chronic vertex ulceration and neuropathic pain). The average time of high labor was 368 days, using capillary orthosis. Discussion: The immediate coverage of the tissue is essential for the successful reconstruction of the scalp. Apart from autologous tissue, the artificial dermis is an alternative for rapid reconstruction of the scalp with excellent results. Conclusions: Integra is a safe and reliable solution to reconstruct complex defects of the scalp.

Tratamento pediátrico de grande queimado agudo: Manejo clínico, cirúrgico e uso de matriz de regeneração dérmica / Pediatric treatment of large acute burn: Clinical, surgical management and use of dermal regeneration matrix / Tratamiento pediátrico de gran quemado agudo: Manejo clínico, quirúrgico y uso de matriz de regeneración dérmica

Objetivo: Analisar o tratamento de queimaduras em fase aguda, conduta clínica, cirúrgica e uso de matriz de regeneração dérmica (MRD) em criança internada na Unidade de Queimados do Hospital Regional da Asa Norte (UQ-HRAN), Brasília-DF. Relato do Caso: D.M.R., 2 anos e 7 meses, masculino, vítima de queimadura por chama direta, 60% de superfície corporal acometida, 50% sendo de espessura total. Atendido inicialmente segundo Protocolo de Rotinas da UQ-HRAN, entretanto, evoluiu com piora clínica, necessitando de Unidade de Terapia Intensiva pediátrica, por 58 dias. Neste período, foi submetido a 2 escarotomias, 3 desbridamentos e 10 hemotransfusões, apresentou infecções nas áreas queimadas e variados esquemas antibióticos. Tendo em vista a extensão de áreas acometidas, restrição de áreas doadoras viáveis e impossibilidade de outros curativos, optou-se pelo implante de MRD no 16° dia de internação e, após a integração, foram realizadas 6 enxertias cutâneas. Recebeu alta no 118° dia de internação. Conclusão: Houve necessidade de assistência clínica e cuidados intensivos, além de utilização de técnica cirúrgica com implante de MRD em grande queimado agudo. Sendo assim, a MRD teve como objetivo proporcionar leito receptor de qualidade, associado a maior integração para enxertia cutânea futura, pois a carência de áreas doadoras o colocaria em risco de vida maior. Esse conjunto de fatores contribuiu para o sucesso do tratamento e a boa recuperação da criança.

Objective: To analyze the treatment of burn in acute-phase using clinical, surgical management and use of dermal regeneration matrix (DRM) in a child hospitalized at the Burn Unit of Asa Norte Regional Hospital (BU-ANRH), Brasília-DF. Case Report: D.M.R., 2 years and 7 months old, male, victim of direct fire, 60% of body surface affected, 50% full-thickness. Initially treated according to the BU-ANRH Routine Protocol, however, evolved to clinical decline, requiring a pediatric Intensive Care Therapy for 58 days. During this period, he underwent two escharotomies, three debridements and 10 blood transfusions. He exhibited infection in burned areas and used multiple antibiotic schemes. Due to the extension of affected surface, restriction of viable donor zone and unusable of other bandages, DRM was implanted on the 16th day of hospitalization and integration, he has done six cutaneous grafting. He was discharged on the 118th day of hospitalization. Conclusion: Clinical and intensive care were needed, besides the use of surgical technique with DRM implantation in a large acute burn. Thus, DRM has had as a goal to provide quality receptor bed, associated with greater integration for future cutaneous grafting, since the lack of donor areas would put it at greater risk of life. This set of factors contributed to the success of the treatment and the good recovery of the child.

Objetivo: Analizar el tratamiento de quemaduras en fase aguda, conducta médica clínica, quirúrgica y uso de matriz de regeneración dérmica (MRD) en niño internado en la Unidad de Quemados del Hospital Regional de Asa Norte (UQ-HRAN), Brasília-DF. Reporte de Caso: D.M.R., 2 años y 7 meses, masculino, víctima de quemadura de llama directa, 60% de la superficie del cuerpo afectada, 50% del espesor total. Inicialmente tratado de acuerdo con el Protocolo de Rutina UQ-HRAN, sin embargo, evolucionó con un empeoramiento clínico, necesitando cuidados en la Unidad de Terapia Intensiva pediátrica durante 58 días. Durante este período, fue sometido a 2 escarotomías, 3 desbridamientos y 10 transfusiones de sangre. Presentó infecciones en zonas quemadas y variados esquemas antibióticos. Debido a la extensión de las áreas afectadas, la restricción de las áreas viables de los donantes y la imposibilidad de otros curativos, se optó por el implante de MRD en el 16° día de internación y después de la integración, se realizaron 6 injertos cutáneos. Recibió alta en el 118° día de internación. Conclusión: Hubo necesidad de asistencia clínica y cuidados intensivos, además de utilización de técnica quirúrgica con implante de MRD en gran quemado agudo. Por lo tanto, la MRD tuvo como objetivo proporcionar lecho receptor de calidad, asociado a la mayor integración para el injerto cutáneo futuro, pues la carencia de áreas donantes lo pondría en mayor riesgo de vida. Este conjunto de factores, contribuyó al éxito del tratamiento y la buena recuperación del niño.

Advance of new dressings for promoting skin wound healing / 生物医学工程学杂志

As a temporary skin substitute, the dressings can protect the wound, stop bleeding, prevent infection and contribute to wound healing. According to the characteristics of the materials, wound dressings can be classified into traditional wound dressings, interactive dressings, bioactive dressings, tissue engineering dressings and smart dressings, etc. Different dressings have different characteristics, and some products have been widely used in clinic. Recently nanomaterials and three-dimensional bio-printing technology have significantly improved the performance of wound dressings. Future dressings will be developed from single function to multi-function composite, and integrated into an intelligent one. This paper reviews the current research progress and future development prospects of wound dressings.

Experts consensus on clinical application of bilayer artificial dermis (2019 version) / 中华烧伤杂志

Artificial dermis is a kind of tissue engineering dermal substitute and is used to repair dermal defects caused by a variety of reasons. This article describes the characteristics and the mechanism of repair and reconstruction of bilayer artificial dermis. Based on domestic experience of clinical applications and relative literature of bilayer artificial dermis, more than 50 domestic experts in related field reached a consensus on indications, contraindications, operation procedures in clinical application, cautions, and treatment and prevention of complications of bilayer artificial dermis, providing reference for clinical application.

Research Progress of Skin-substitute and Its Effectiveness Evaluation / 中国医疗器械杂志

Skin-substitute has developed rapidly and it is essential to evaluate its effectiveness before clinical use.This paper reviews the development of skin-substitute,methods to evaluate the effectiveness of skin-substitute and relevant standards.This paper highlights the and means of preclinical effectiveness evaluation and provides theoretical basis for preclinical safety evaluation of skin-substitute.

Reconstrucción plantar con matriz de regeneración dérmica (Integra®) en paciente quemado eléctrico: presentación de un caso y revisión de la literatura / Plantar reconstruction with matrix of dermal regeneration (Integra®) in an electric burned patient: case report and literature review

Resumen Introducción: Las lesiones complejas de la cara plantar del pie son de difícil manejo desde el punto de vista reconstructivo. En la literatura el tratamiento de elección es la cobertura mediante colgajos libres. Nuestro objetivo es presentar el caso de un paciente con una lesión plantar compleja, exitosamente resuelta con el uso de matriz de regeneración dérmica (Integra®) e injerto dermoepidérmico. Caso clínico: Hombre de 35 años, que sufre quemadura eléctrica de alta tensión con lesión compleja plantar bilateral. Se manejó con escarectomías sucesivas hasta delimitar el daño tisular, y posterior cobertura con Integra® e injerto con resultado estético y funcional óptimo. Discusión: Aunque los colgajos libres son la elección en el tratamiento de esta zona anatómica, infrecuentemente son la única alternativa de reconstrucción en el paciente quemado. No hay mayor evidencia en la literatura en el uso de matrices dérmicas para la cobertura de este tipo de lesiones. Conclusión: Los autores consideran que el manejo de lesiones plantares complejas mediante el uso de matrices de regeneración dérmica es una alternativa válida a considerar en situaciones en que, por diversos motivos, no se puede ofrecer un colgajo libre.

Abstract Introduction: Complex wounds of the plantar aspect of the foot are difficult to manage in the reconstructive point of view. The standard of treatment is covering the defect with free flaps. Our goal is to present the case of a patient successfully treated with the use of matrix dermal regenaration Integra® and dermoepidermal graft for a complex plantar lesion. Clinical case: Thirty-five year old man, who suffers from high voltage electrical burn with bilateral plantar complex injury. It was handled with successive escharectomies to delimit tissue damage and subsequent coverage with Integra® and grafting with optimal aesthetic and functional results. Discussion: Although free flaps are the choice in the treatment of this anatomical area, they are infrequently the only reconstructive option in burned patients. There is no greater evidence in the literature on the use of dermal matrices to cover such injuries. Conclusion: The authors believe that the management of complex footpad lesions using dermal regeneration matrices are a valid alternative to consider in situations where for various reasons, free flaps can't be offered.

Oral mucosa: an alternative epidermic cell source to develop autologous dermal-epidermal substitutes from diabetic subjects

Abstract Oral mucosa has been highlighted as a suitable source of epidermal cells due to its intrinsic characteristics such as its higher proliferation rate and its obtainability. Diabetic ulcers have a worldwide prevalence that is variable (1%-11%), meanwhile treatment of this has been proven ineffective. Tissue-engineered skin plays an important role in wound care focusing on strategies such autologous dermal-epidermal substitutes. Objective The aim of this study was to obtain autologous dermal-epidermal skin substitutes from oral mucosa from diabetic subjects as a first step towards a possible clinical application for cases of diabetic foot. Material and Methods Oral mucosa was obtained from diabetic and healthy subjects (n=20 per group). Epidermal cells were isolated and cultured using autologous fibrin to develop dermal-epidermal in vitro substitutes by the air-liquid technique with autologous human serum as a supplement media. Substitutes were immunocharacterized with collagen IV and cytokeratin 5-14 as specific markers. A Student´s t- test was performed to assess the differences between both groups. Results It was possible to isolate epidermal cells from the oral mucosa of diabetic and healthy subjects and develop autologous dermal-epidermal skin substitutes using autologous serum as a supplement. Differences in the expression of specific markers were observed and the cytokeratin 5-14 expression was lower in the diabetic substitutes, and the collagen IV expression was higher in the diabetic substitutes when compared with the healthy group, showing a significant difference. Conclusion Cells from oral mucosa could be an alternative and less invasive source for skin substitutes and wound healing. A difference in collagen production of diabetic cells suggests diabetic substitutes could improve diabetic wound healing. More research is needed to determine the crosstalk between components of these skin substitutes and damaged tissues.

Manejo de heridas complejas con sustitutos dérmicos / Management of complex wounds with dermal substitutes

Introducción: El manejo de heridas complejas con compromiso de la dermis en pacientes pediátricos es un desafío para los cirujanos infantiles; el uso de sustitutos dérmicos en la actualidad se presenta como una posibilidad de obtener una cicatriz estética y funcionalmente adecuada. Casos clínicos: Presentamos 2 pacientes con heridas complejas causadas por traumatismo y quemadura, tratados con INTEGRA™ Bilayer Matrix Wound Dressing e injerto dermoepidérmico asociados a uso de terapia de vacío, ambos con excelentes resultados funcionales y estéticos a los 15 meses de seguimiento.

Introduction: The management of complex wounds with dermis compromised in pediatric patients is a challenge for pediatric surgeons; the use of dermal substitutes is currently presented as a possibility of obtaining an aesthetically and functionally suitable scar. Cases Report: Two clinical cases of complex wounds caused by trauma and burn treated with INTEGRA™ Bilayer Matrix Wound Dressing and epidermal graft associated with use of vacuum therapy, both with excellent functional and aesthetic results, at 15 month follow-up.

Clinical application of artificial dermis combined with basic fibroblast growth factor in the treatment of cicatrix and deep skin wounds / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the effects of artificial dermis combined with basic fibroblast growth factor (bFGF) on the treatment of cicatrix and deep skin wounds.</p><p><b>METHODS</b>The clinical data of 72 patients with wounds repaired with artificial dermis, hospitalized in our unit from October 2010 to April 2015, conforming to the study criteria, were retrospectively analyzed. The types of wounds were wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone, in a total number of 102. Wounds were divided into artificial dermis group (A, n=60) and artificial dermis+ bFGF group (B, n=42) according to whether or not artificial dermis combined with bFGF. In group A, after release and resection of cicatrices or thorough debridement of deep skin wounds, artificial dermis was directly grafted to wounds in the first stage operation. After complete vascularization of artificial dermis, wounds were repaired with autologous split-thickness skin grafts in the second stage operation. In group B, all the procedures were exactly the same as those in group A except that artificial dermis had been soaked in bFGF for 30 min before grafting. Operation area, complete vascularization time of artificial dermis, survival of skin grafts, and the follow-up condition of wounds in the two groups were recorded. Data were processed with t test and Fisher's exact test.</p><p><b>RESULTS</b>(1) Operation areas of wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone in the two groups were about the same (with t values from -1.853 to -0.200, P values above 0.05). Complete vascularization time of artificial dermis in wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone in group B were respectively (15.6 ± 2.9), (14.7 ± 2.7), and (20.3 ± 4.4) d, and they were shorter by an average time of 2.7, 4.0, 7.4 d, respectively, as compared with those in corresponding types of wounds in group A [respectively (18.3 ± 4.7), (18.7 ± 4.2), and (27.7 ± 8.8) d, with t values from -2.779 to -2.383, P values below 0.05]. (2) The ratio of skin grafts with excellent survival in the three types of wounds in group B were higher than those in corresponding types of wounds in group A, but there were no statistically significant differences (with P values above 0.05). (3) Patients were followed up for 1 to 48 months, and there were no obvious cicatrices in skin graft sites and the donor sites during the following time.</p><p><b>CONCLUSIONS</b>Artificial dermis combined with bFGF can effectively shorten the vascularization time of artificial dermis in wounds after resection of cicatrices and deep skin wounds.</p>

Rapid Expansion and Auto-Grafting Efficiency of Porcine Full Skin Expanded by a Skin Bioreactor Ex Vivo

Full skin auto-grafts are required for reconstruction of skin burns and trauma scars. However, currently available clinical approaches such as sheet skin graft, mesh skin grafts, artificial skin graft, and in vivo skin expansion have limitations due to their potential danger for secondary damage and scar formation at the donor site, and discomfort during skin expansion. We developed an advanced bioreactor system and evaluated its function in skin expansion using porcine full skin. The reactor was designed as a pneumatic cylinder type, was programmed to adjust the pressure and the operating time. The system was composed of culture chamber unit, environmental control unit, and monitoring unit. Skins were expanded at 200 kPa pneumatic force and the expanded skins were analyzed by immunohistochemistry and histology. Furthermore we carried out auto-grafting experiment of the expanded skins in vivo using Yucatan pigs and skins were harvested and histologically analyzed after 8 weeks. The results showed that the bioreactor expanded skins to 160% in 4 hours. Histological analysis of the expanded skins revealed that epidermal cells and dermal fibroblasts were viable and remained integrity. The results of auto-grafting experiment indicated that fibrosis and scars were not detected in the grafted skins. This study demonstrates that the newly developed skin bioreactor enabled to obtain large sized full skin rapidly and successful grating.

Prevalência de doenças crônicas não transmissíveis e associação com autoavaliação de saúde: Pesquisa Nacional de Saúde, 2013 / Prevalence of chronic non-communicable diseases and association with self-rated health: National Health Survey, 2013

Resumo: Objetivo: Analisar o perfil de dez doenças crônicas não transmissíveis investigadas na Pesquisa Nacional de Saúde realizada no Brasil em 2013 e sua associação com a autoavaliação da saúde. Métodos: Estudo transversal de base populacional e abrangência nacional com 60.202 indivíduos com 18 anos ou mais. Foi utilizado processo amostral por conglomerado com três estágios de seleção: setor censitário, domicílio e indivíduo. Calculou-se a prevalência das doenças crônicas e os intervalos de confiança de 95% por idade, sexo e escolaridade, a idade média do primeiro diagnóstico e a proporção de limitação das atividades habituais. Para testar a associação com a autoavaliação de saúde, utilizou-se o procedimento de regressão logística ajustada por sexo e idade. Resultados: As doenças mais prevalentes foram hipertensão arterial (21,4%), depressão (7,6%), artrite (6,4%) e diabetes mellitus (6,2%). Indivíduos com diagnóstico de acidente vascular cerebral (AVC) referiram maior limitação das atividades habituais (38,6%). Observou-se um gradiente na prevalência segundo idade e escolaridade, e todas as doenças foram mais frequentes entre as mulheres. Pior autoavaliação de saúde foi encontrada entre aqueles com diagnóstico de AVC (OR = 3,60; valor de p < 0,001) e nos que referiram duas doenças (OR = 5,53; valor de p < 0,001) ou três ou mais doenças (OR = 10,86; valor de p < 0,001). Conclusões: Por se tratar de doenças associadas a fatores de risco modificáveis, a prevenção com foco populacional é a melhor estratégia para redução da carga dessas doenças.

ABSTRACT: Objective: To analyze the profile of 10 chronic noncommunicable diseases investigated in the National Health Survey carried out in Brazil in 2013 and their association with the self-rated health. Methods: A cross-sectional, population-based nationwide study with 60,202 individuals aged 18 years old or more. Sampling process by conglomerate was carried out in three stages of selection: census tract, household, and individual. The prevalence of chronic diseases by age, gender and educational status and the confidence intervals of 95% , the mean age at the first diagnosis and the proportion of limitation of the usual activities were calculated. To test the association with self-rated health, the logistic regression procedure adjusted for gender and age was used. Results: The more prevalent diseases were hypertension (21.4%), depression (7.6%), arthritis (6.4%), and diabetes mellitus (6.2%). Individuals diagnosed with stroke reported greater limitations in the daily activities (38.6%). There was a gradient in the prevalence by age and educational level, and all the diseases were more frequent among women. A worse self-rated health was observed among those with a diagnosis of stroke (OR = 3.60; p < 0.001) and those who referred two diseases (OR = 5.53; p < 0.001) or three or more diseases (OR = 10.86; p < 0.001). Conclusions: Because these diseases are associated with modifiable risk factors, the prevention with population focus is the best strategy to reduce the burden of these diseases.

Curativos utilizados no tratamento de queimaduras: uma revisão integrativa / Curaciones utilizadas en el tratamiento de quemaduras: una revisión integradora / Dressing used in the treatment of burns: an integrative review

Descrever os curativos utilizados no tratamento de queimaduras evidenciados em artigos científicos publicados entre os anos de 2005 a 2015. Método: Revisão Integrativa da Literatura, cujos dados foram coletados nas bases de dados LILACS e MEDLINE, sendo selecionados e analisados na íntegra 11 artigos. Resultados: Vários curativos são utilizados no tratamento de queimaduras. Dentre eles, estão os curativos com prata, os hidrogéis, os substitutos de pele, espuma de silicone, curativo úmido e petrolato. Todos aceleram o processo cicatricial e são eficazes no tratamento de queimaduras, sendo que os mais utilizados são os curativos com prata. Conclusão: Existem várias alternativas relacionadas ao curativo para o tratamento da queimadura, cabendo ao profissional que a cuidará decidir qual será melhor para o tratamento, levando em consideração a realidade local e custo-benefício...

To describe the dressing used to treat burns, evident in scientific articles between 2005 and 2015. Methods: Integrative literature review, whose data were collected in the LILACS and MEDLINE databases, and were selected and analyzed 11 articles in its whole. Results: A number of dressing are used in the treatment of burns, including silver dressing, hydrogels, skin substitutes, silicone foam, moist dressing and petrolatum. All accelerate the healing process and are effective in the treatment of burns, where the most used are silver dressings. Conclusion: There are several alternatives related to dressing for the treatment of burns, accounting professional to decide what will be best for treatment, taking into account local conditions and cost-effective...

Describir las curaciones utilizadas para tratar las quemaduras, evidentes en artículos científicos entre los años 2005 a 2015. Métodos: Revisión integradora de la literatura, cuyos datos se recogieron en las bases de datos LILACS y MEDLINE, y se seleccionaron y analizaron 11 artículos en su totalidad. Resultados: Una serie de curaciones se utilizan en el tratamiento de quemaduras, incluyendo curaciones con plata, hidrogeles, los sustitutos de la piel, espuma de silicona, vendaje húmedo y vaselina. Todos aceleran el proceso de cicatrización y son eficaces en el tratamiento de quemaduras, donde los más utilizados son los vendajes con plata. Conclusión: Hay varias alternativas relacionadas al vendaje para el tratamiento de quemaduras, correspondiéndole al profesional decidir lo que será mejor para el tratamiento, teniendo en cuenta las condiciones locales y el costo-beneficio...

Sustitutos cutáneos bioingenierizados para el tratamiento de heridas cutáneas difíciles de curar / Cutaneous substitutes for cutaneous lesions which are unresponsive to conventional treatment

Existe un aumento significativo de heridas cutáneas que no curan con terapias convencionales, situación preocupante tanto para la salud pública como para la economía mundial. Como posible solución se encuentra la ingeniería tisular cuyo fin es, mediante la generación de sustitutos cutáneos, entregar elementos capaces de reemplazar in vivo tejidos dañados, estimulando además la capacidad regenerativa intrínseca del paciente. Algunos productos han sido aprobados por la FDA (food and drug administration), los que han demostrado el cierre completo de heridas cutáneas refractarias a tratamientos habituales. De esta manera, la ingeniería tisular se considera actualmente como una alternativa terapéutica eficaz tanto para la cura de heridas cutáneas agudas como para heridas cutáneas crónicas, obteniéndose un balance costo-beneficio favorable a largo plazo para el paciente.

In recent years there has been a significant increase in skin lesions which do not heal with conventional therapies. This is a worrisome situation for both public health and global economy. One possible solution is tissue engineering which goal, is to generate substitute tissues that could be used to replace damaged ones in vivo, stimulating the patient’s intrinsic healing capacity. Some products have already been approved by the FDA (the Food and Drug Administration), and have already demonstrated complete closure of cutaneous lesions which are unresponsive to conventional treatment. Tissue engineering is considered an effective alternative therapy for acute and chronic lesions, and offer a favorable cost-benefit relationship in the long term.