The use of occlusive dressings: influence on excisional wound healing in animal model.

PURPOSE: To analyze the influence of occlusive dressing on the healing of excisional skin wounds in mice. METHODS: Pre-clinical, comparative, and translational study. Mice were divided into three experimental groups: wounds occluded with hydrocolloid (HD) dressings, transparent polyurethane film (TF) dressings, and without occlusion (WO), monitored at three, six and 14 days, with eight animals each. Closure rate, infiltration of neutrophils and macrophages, measurement of tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) and, histologically, angiogenesis were evaluated. RESULTS: Wound closure was accelerated in the occlusive groups. There was a decrease in TNF-α levels in the HD group when compared to the WO and TF groups. Neutrophils accumulation decreased in the HD group. Increased dosages of macrophages were evidenced in the HD group, compared to the WO and TF groups. Levels of VEGF were increased in the TF and HD groups. CONCLUSIONS: It is suggested that the occlusion of wounds modulates the inflammatory response.

Fatores preditivos para a cicatrização de úlceras da perna em pessoas com doença falciforme: coorte retrospectivo / Factors predictive of leg ulcer healing in people with sickle cell disease: a retrospective cohort / Factores predictivos de la cicatrización de úlceras de la pierna en personas con anemia falciforme: cohorte retrospectivo

Objetivo: identificar a taxa de cicatrização e os fatores preditivos para cura das úlceras da perna em pessoas com doença falciforme. Método: coorte retrospectivo, realizado de junho a agosto de 2020, em um serviço especializado de tratamento de pessoas com feridas, contemplando um período de nove anos, com amostra de 52 úlceras que atenderam os critérios de elegibilidade. Protocolo de pesquisa aprovado pelo comitê de ética. Resultados: a taxa de cicatrização foi 76,9%. Os fatores que contribuíram para cura em um menor tempo foram a não recidiva (HR= 3,03; IC 95%: 1,07-8,60) e extensão abaixo da mediana 7,25 cm2 (HR= 2,25; IC 95%: 1,19-4,27). Fatores para a não cicatrização foram: coberturas de alginato de cálcio (HR=0,29; IC 95%: 0,13-0,62), carvão com prata (HR=0,06; IC 95%: 0,02-0,21) e outras (HR=0,35; IC 95%: 0,15-0,80). Conclusão: a taxa de cicatrização da úlcera foi elevada. Recidiva, área da úlcera e determinadas coberturas podem influenciar no processo de cura.

Objective: to identify the healing rate and predictive factors for healing of leg ulcers in people with sickle cell disease. Method: retrospective cohort, carried out from June to August 2020, in a specialized service for the treatment of people with wounds, covering a period of nine years, with a sample of 52 ulcers that met the eligibility criteria. Research protocol approved by the ethics committee. Results: healing rate was 76.9%. The factors that contributed to cure in a shorter time were non-recurrence (HR= 3.03; 95% CI: 1.07-8.60) and extension below the median 7.25 cm2 (HR= 2.25; CI 95%: 1.19-4.27). Factors for non-healing were: calcium alginate dressings (HR=0.29; 95% CI: 0.13-0.62), charcoal with silver (HR=0.06; 95% CI: 0.02- 0.21) and others (HR=0.35; 95% CI: 0.15-0.80). Conclusion: the ulcer healing rate was high. Recurrence, ulcer area and certain dressings can influence the healing process.

Objetivo: identificar la tasa de curación y los factores predictivos para la curación de las úlceras en las piernas en pacientes con enfermedad de células falciformes. Método: cohorte retrospectiva, realizada de junio a agosto de 2020, en un servicio especializado para el tratamiento de personas con heridas, cubriendo un período de nueve años, con una muestra de 52 úlceras que cumplieron con los criterios de elegibilidad. Protocolo de investigación aprobado por el comité de ética. Resultados: La tasa de cicatrización fue del 76,9%. Los factores que contribuyeron a la curación en menor tiempo fueron la no recurrencia (HR= 3,03; IC 95%: 1,07-8,60) y extensión por debajo de la mediana de 7,25 cm2 (HR= 2,25; IC 95%: 1,19-4,27). Los factores de no cicatrización fueron: apósitos de alginato de calcio (HR=0,29; IC 95%: 0,13-0,62), carbón con plata (HR=0,06; IC 95%: 0,02-0,21) y otros (HR=0,35; IC 95%: 0,15-0,80). Conclusión: la tasa de curación de la úlcera fue alta. La recurrencia, el área de la úlcera y ciertos revestimientos pueden influir en el proceso de curación.

Biofilm model on mice skin wounds.

PURPOSE: To evaluate a biofilm model of Pseudomonas aeruginosa in excisional cutaneous wound in mice. METHODS: Preclinical, translational study conducted with 64 C57BL/6 mice randomly assigned to control and intervention groups. Evaluation was on days D0, D3, D5, D7 and D10 of wound making. The profile of biofilm formation and induction was evaluated using wound closure kinetics, quantitative culture, and evaluation of wounds using transmission electron microscopy (TEM). Clinical evaluation was performed by liver tissue culture, weight variation, and quantification of leukocytes in peripheral blood. Analyses were performed with GraphPad Prism software. RESULTS: Bacterial load for induction of infection with P. aeruginosa and survival of animals was 104 UFC·mL-1. In D5 (p < 0.0001) and D7 (p < 0.01), animals in the intervention group showed a delay in the healing process and had their wounds covered by necrotic tissue until D10. Statistical differences were observed in wound cultures and weight at D5 and D7 (p < 0.01). Liver cultures and leukocyte quantification showed no statistical differences. No bacteria in planktonic or biofilm form were identified by TEM. CONCLUSIONS: The findings raise questions about the understanding of the ease of formation and high occurrence of biofilm in chronic wounds.

The use of occlusive dressings: influence on excisional wound healing in animal model

Purpose: To analyze the influence of occlusive dressing on the healing of excisional skin wounds in mice. Methods: Pre-clinical, comparative, and translational study. Mice were divided into three experimental groups: wounds occluded with hydrocolloid (HD) dressings, transparent polyurethane film (TF) dressings, and without occlusion (WO), monitored at three, six and 14 days, with eight animals each. Closure rate, infiltration of neutrophils and macrophages, measurement of tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) and, histologically, angiogenesis were evaluated. Results: Wound closure was accelerated in the occlusive groups. There was a decrease in TNF-α levels in the HD group when compared to the WO and TF groups. Neutrophils accumulation decreased in the HD group. Increased dosages of macrophages were evidenced in the HD group, compared to the WO and TF groups. Levels of VEGF were increased in the TF and HD groups. Conclusions: It is suggested that the occlusion of wounds modulates the inflammatory response.

Biofilm model on mice skin wounds

Purpose: To evaluate a biofilm model of Pseudomonas aeruginosa in excisional cutaneous wound in mice. Methods: Preclinical, translational study conducted with 64 C57BL/6 mice randomly assigned to control and intervention groups. Evaluation was on days D0, D3, D5, D7 and D10 of wound making. The profile of biofilm formation and induction was evaluated using wound closure kinetics, quantitative culture, and evaluation of wounds using transmission electron microscopy (TEM). Clinical evaluation was performed by liver tissue culture, weight variation, and quantification of leukocytes in peripheral blood. Analyses were performed with GraphPad Prism software. Results: Bacterial load for induction of infection with P. aeruginosa and survival of animals was 104 UFC·mL-1. In D5 (p < 0.0001) and D7 (p < 0.01), animals in the intervention group showed a delay in the healing process and had their wounds covered by necrotic tissue until D10. Statistical differences were observed in wound cultures and weight at D5 and D7 (p < 0.01). Liver cultures and leukocyte quantification showed no statistical differences. No bacteria in planktonic or biofilm form were identified by TEM. Conclusions: The findings raise questions about the understanding of the ease of formation and high occurrence of biofilm in chronic wounds.

Formação do biofilme em ferida cutânea e seu comportamento diante das intervenções: revisão integrativa / Biofilm formation in cutaneous wounds and its behavior in the face of interventions: an integrative review

RESUMO Objetivo identificar na literatura a formação do biofilme e o seu comportamento diante das intervenções em feridas cutâneas. Métodos revisão integrativa, realizada nas bases de dados Cumulative Index to Nursing and Allied Health Literature , Literatura Latino-Americana e do Caribe em Ciências da Saúde, EMBASE, Scopus, The Cochrane Library Collaboration , MEDLINE/PubMed e Science Direct, sem delimitação temporal. Foram selecionados 19 estudos. Avaliação das informações ocorreu de forma descritiva, confrontando com os achados pertinentes. Resultados os estudos da amostra foram publicados no idioma inglês e contemplaram três tipos de pesquisa de biofilme: dois clínicos, seis in vitro e 11 in vivo (animal). Incluíram-se três temas: criação de modelo biofilme (n=4), avaliação do biofilme (n=3), comportamento do biofilme diante de intervenções para o seu manejo (n=12). Conclusão efeitos prejudiciais do biofilme na cicatrização de feridas foram confirmados. Diversas intervenções foram capazes de reduzir e eliminar o biofilme nos modelos in vitro e in vivo . Contribuições para a prática constatou-se que avaliação clínica da lesão não permite identificar o biofilme, inclusive quando presente encontra-se abaixo da superfície da lesão. Este achado suscita reflexão por parte dos enfermeiros a respeito das intervenções adotadas para a remoção do biofilme.

ABSTRACT Objective to identify in the literature the biofilm formation and its behavior when faced with interventions in cutaneous wounds. Methods an integrative review, carried out in the Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, EMBASE, Scopus, The Cochrane Library Collaboration, MEDLINE/PubMed and Science Direct databases, without temporal delimitation. Nineteen studies were selected. The information was evaluated descriptively, comparing it with the pertinent findings. Results the sample studies were published in English and included three types of biofilm research: two clinical, six in vitro and 11 in vivo (animal). Three themes were included: biofilm model creation (n=4), biofilm assessment (n=3), biofilm behavior before interventions for its management (n=12). Conclusion the detrimental effects of biofilm on wound healing have been confirmed. Several interventions were able to reduce and eliminate biofilm in in vitro and in vivo models. Contributions to practice it was found that clinical evaluation of the lesion does not allow the identification of biofilm, even when present; it is below the surface of the lesion. This finding raises reflection on the part of nurses regarding the interventions adopted for the removal of biofilm.

Contribuições do enfermeiro na pesquisa básica: modelo de fixação de curativo em feridas cutâneas excisionais de camundongos / Contributions of nurses in basic research: dressing fixation model for excisional cutaneous wounds of mice / Contribuciones del enfermero en la investigación básica: modelo de fijación de apósito en heridas cutáneas excisionales de ratones

Objetivo:validar método de fixação de curativos em feridas cutâneas excisionais de camundongos. Método: estudo pré-clínico. Amostra composta por animais da linhagem C57BL/6, que tiveram duas feridas excisionais confeccionadas na região dorsal. Foram avaliados diferentes métodos e produtos, amplamente aceitos na prática clínica, para fixação de curativos no modelo animal. Os desfechos avaliados foram tempo de permanência do curativo e ocorrência de eventos adversos. Resultados: atadura de crepom, fita microporosa e bandagem autoaderente apresentaram menor tempo de permanência quando comparadas ao filme de poliuretano. Esse, por sua vez, variou o tempo quando comparadas diferentes marcas (E, F, G e H) e número de voltas ao redor do corpo do animal. Com 1 volta, o tempo variou de < 24 a 36 horas. Com 2 voltas, as marcas E e G permaneceram 48 e 96 horas, respectivamente, e F e H tempo < 24 horas. Filme da marca G, cortado no tamanho 3 cm x 15 cm, dando 2 voltas no corpo do camundongo, manteve o curativo por 96 horas. A pele permaneceu íntegra, sem evento adverso. Conclusão: foi criado modelo de fixação de curativos para feridas em camundongos com produto disponível no Brasil e compatível com a estrutura copórea do animal.

Objective:validate method of fixation of dressings on excisional cutaneous wounds of mice. Method: preclinical study. Sample made up of animals of the C57BL/6 strain, which had two excision wounds made in the dorsal region. Different methods and products, widely accepted in clinical practice, for fixing dressings in the animal model were evaluated. The evaluated outcomes were the length of stay of the dressing and the occurrence of adverse events. Results: crepe bandage, microporous tape and self-adhesive bandage had a shorter residence time when compared to polyurethane film. This, in turn, varied the time when comparing different marks (E, F, G and H) and number of turns around the animal's body. With 1 lap, the time varied from <24 to 36 hours. With 2 laps, the marks E and G remained 48 and 96 hours, respectively, and F and H time <24 hours. G-brand film, cut to size 3 cm x 15 cm, giving the mouse body 2 turns, kept the dressing for 96 hours. The skin remained intact, with no adverse event. Conclusion: a dressing fixation model for wounds in mice was created with a product available in Brazil and compatible with the animal's body structure

Objetivo:validar método de fijación de apósitos en heridas cutáneas excisionales de ratones. Método: estudio preclínico. Muestra compuesta por animales del linaje C57BL/6 que tuvieron dos heridas excisionales confeccionadas en la región dorsal. Se evaluaron distintos métodos y productos, ampliamente aceptados en la práctica clínica, para fijación de apósitos en el modelo animal. Los resultados evaluados fueron tiempo de permanencia del apósito y ocurrencia de eventos adversos. Resultados: La venda de crepé, la cinta microporosa y el vendaje autoadherente presentaron menor tiempo de permanencia cuando comparados con la película de poliuretano. Esta, a su vez, varió en el tiempo cuando comparadas distintas marcas (E, F, G y H) y número de vueltas alrededor del cuerpo del animal. Con una vuelta completa, el tiempo varió de menos de 24 a 36 horas. Con dos vueltas, las marcas E y G permanecieron 48 y 96 horas, respectivamente, y F y H, tiempo igual e inferior a 24 horas. La piel permaneció íntegra, sin evento adverso. Conclusión: se creó un modelo de fijación de apósitos en ratones con un producto disponible en Brasil y compatible con la estructura del cuerpo del animal

Incontinence-associated dermatitis: a cohort study in critically ill patients. / Dermatite associada à incontinência: estudo de coorte em pacientes críticos.

OBJECTIVES: Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence- associated dermatitis critically ill adult patients. METHOD: Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis. RESULTS: An overall incidence of 20.4% was obtained. Nineteen (19) risk factors significantly associated with the disorder were found. The variables identified in the risk prediction model were male, trauma, use of hypnotics/sedatives, lactulose, nutritional support, loose stools and complaints of burning. CONCLUSION: The results showed that dermatitis is a common clinical finding in critically ill adult patients and requires special attention from the nursing staff.

Dermatite associada à incontinência: estudo de coorte em pacientes críticos / Dermatitis asociada con incontinencia: estudio de cohorte en pacientes críticos / Incontinence-associated dermatitis: a cohort study in critically ill patients

RESUMO Objetivos Estimar incidência, determinar fatores de risco e propor modelo de predição de risco para desenvolvimento de dermatite associada a incontinência em pacientes adultos críticos. Método Trata-se de um estudo de coorte concorrente realizado com 157 pacientes críticos. A coleta de dados foi conduzida diariamente entre fevereiro e julho de 2015 em hospital público e de ensino de Belo Horizonte, MG. Os dados foram lançados em banco de dados, submetidos a análise descritiva de sobrevida e multivariada. Resultados Obteve-se uma incidência global de 20,4%. Foram encontrados 19 fatores de risco que apresentaram associação significativa com o problema. As variáveis encontradas no modelo de predição de risco foram: sexo masculino, trauma, uso de hipnótico/sedativos, lactulona, suporte nutricional, fezes pastosas e queixa de ardência (local). Conclusão Os resultados mostraram que a dermatite é um achado clínico comum em pacientes adultos críticos e merece atenção especial para maior qualidade da assistência de enfermagem.

RESUMEN Objetivos Estimar incidencia, determinar factores de riesgo y proponer modelo de predicción de riesgo para el desarrollo de la dermatitis asociada a la incontinencia en pacientes adultos críticos. Método Se trata de un estudio de cohorte concurrente de 157 pacientes críticamente enfermos. La recolección de datos se realizó diariamente entre febrero y julio de 2015, en un hospital público y de enseñanza de Belo Horizonte-MG. Los datos se introdujeron en la base de datos, sometidos a análisis descriptivo, de supervivencia y multivariada. Resultados Se obtuvo una incidencia global del 20,4%. Se encontraron 19 factores de riesgo asociados significativamente con el problema. Las variables identificadas en el modelo de predicción de riesgo fueron: sexo masculino, trauma, uso de hipnóticos/sedantes, lactulona, soporte nutricional, heces sueltas y queja de ardor (local). Conclusión Los resultados mostraron que la dermatitis es un hallazgo clínico frecuente en pacientes adultos críticos y merece una atención especial para una mayor calidad de los cuidados de enfermería.

ABSTRACT Objectives Estimate incidence, determine risk factors and propose a prediction model for the development of incontinence- associated dermatitis critically ill adult patients. Method Concurrent cohort study with 157 critically ill patients. Data collection was daily performed between February and July 2015, at a public teaching hospital of Belo Horizonte, Minas Gerais. Data was entered in a database and subjected to descriptive, survival and multivariate analysis. Results An overall incidence of 20.4% was obtained. Nineteen (19) risk factors significantly associated with the disorder were found. The variables identified in the risk prediction model were male, trauma, use of hypnotics/sedatives, lactulose, nutritional support, loose stools and complaints of burning. Conclusion The results showed that dermatitis is a common clinical finding in critically ill adult patients and requires special attention from the nursing staff.