Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 541
Filtrar
1.
J Dent ; 144: 104940, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38490324

RESUMO

OBJECTIVES: To assess the clinical performance of class II restorations performed by repeatedly preheated resin composite "RC" at 68 °C up to ten times. METHODS: 105 patients were selected and randomized into three groups, each comprising 35 patients. Each patient was provided with a single class II Bulk-fill resin composite "BF-RC" posterior restoration based on the number of preheating cycles; group I (H0): The BF-RC was packed non-heated, group II (H1): BF-RC preheated once, and group III(H10): BF-RC preheated ten cycles. These restorations were evaluated at 1, 3,6, and 12 months, using the modified United States Public Health Service "USPHS". Statistical analysis was performed using Kruskal-Wallis test, Mann Whitney U test, and Friedmann test, where p = 0.05. RESULTS: All the 105 restorations did not suffer from any clinical situation that recommended replacement regarding retention, fracture, secondary caries, or anatomical form. Although all performed restorations did have Alpha and Bravo scores with good clinical performance, the non-preheated RC restorations"" suffered from relatively inferior clinical performance through the follow-up period regarding marginal adaptation, marginal discoloration, and color matching when compared to preheated groups. One and ten times of preheating conducted better clinical performance. CONCLUSIONS: After 12-months follow-up, although no restoration needed replacement or repair in the 3 tested groups, restorations with single and ten times of preheating aided in better clinical performance of RC restorations compared to the non-preheated restorations. Preheating of RC for 10 times could be used safely with good clinical performance of restorations. CLINICAL SIGNIFICANCE: By continually preheating RC syringe up to ten times, the dentist will not only benefit from the enhanced clinical performance and easiness of application but also will use preheated RC syringes without hesitation, relying on the absence of drawbacks related to multiple preheating cycles.


Assuntos
Cor , Resinas Compostas , Adaptação Marginal Dentária , Materiais Dentários , Restauração Dentária Permanente , Temperatura Alta , Humanos , Resinas Compostas/química , Resinas Compostas/uso terapêutico , Restauração Dentária Permanente/métodos , Masculino , Feminino , Adulto , Materiais Dentários/química , Pessoa de Meia-Idade , Adulto Jovem , Cárie Dentária/terapia , Propriedades de Superfície , Poliuretanos/química , Poliuretanos/uso terapêutico , Resinas Acrílicas/química , Seguimentos
2.
Int Wound J ; 20(1): 18-27, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35510525

RESUMO

Trauma, burns, and diabetes result in nonhealing wounds that can cause bone or tendon exposure, a significant health threat. The use of an artificial regeneration template combined with skin grafting as an alternative method to highly invasive flap surgery has been shown to be an effective way to cover full-thickness skin defects with bone or tendon exposure for both functional and aesthetic recovery. However, artificial regeneration templates, such as Pelnac, are overwhelmingly expensive, limiting their clinical use. Here, we demonstrate for the first time that polyurethane film combined with absorbable gelatine sponge, affordable materials widely used for haemostasis, are effective for dermal reconstruction in wounds with bone or tendon exposure. The absorbable gelatine sponge combined with polyurethane film was applied to eight patients, all resulting in adequate granulation that fully covered the exposed bone or tendon. The outcome of absorbable gelatine sponge combined with polyurethane film application indicates that this approach is a potential novel and cost-effective dermal reconstruction strategy for the treatment of severe wounds with bone or tendon exposure.


Assuntos
Pele Artificial , Cicatrização , Humanos , Poliuretanos/uso terapêutico , Transplante de Pele/métodos , Retalhos Cirúrgicos , Tendões
3.
J Tissue Viability ; 31(3): 531-536, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35718595

RESUMO

AIM: To analyze differences in re-epithelization, exudate absorbency, ease and pain on dressing removal between ALLEVYN™ Non-Adhesive and Betaplast™ N. METHODOLOGY: Patients admitted to the general ward undergoing split skin grafting were recruited. Allevyn and Betaplast were applied on the donor site. Exudate absorption was assessed daily using an absorbency grading chart. Dressing change was done on post-operative day five. Ease of dressing removal and pain score using the Wong-Baker Pain Scale was assessed. The percentage of re-epithelization for each dressing was assessed. RESULTS: 30 patients were recruited. There was a statistically significant difference in exudate absorption on post-operative day 3 (z = -2.006, p = 0.045, T = 236) and post-operative day 4 (z = -2.026, p = 0.0143, T = 188), pain score (z = -2.861, p = 0.004, T = 180), ease of removal (z = -2.668, p = 0.008, T = 126) and re-epithelization (z = -2.566, p = 0.009, T = 336) between Betaplast and Allevyn. CONCLUSION: Betaplast may have faster re-epithelization, better exudate absorption, and is easier to remove while minimizing discomfort as compared to Allevyn.


Assuntos
Poliuretanos , Transplante de Pele , Bandagens , Humanos , Dor , Poliuretanos/uso terapêutico , Estudos Prospectivos , Cicatrização
4.
Rev. bras. ciênc. vet ; 29(2): 69-73, abr./jun. 2022. il.
Artigo em Português | LILACS, VETINDEX | ID: biblio-1399492

RESUMO

Objetivou-se relatar o emprego de uma tala externa confeccionada com material de poliuretano e cobertura interna de neopreme na reparação cirúrgica do pectus excavatum em um felino jovem. O felino apresentava deformidade anatômica congênita na região do externo e sinais clínicos respiratórios. Imagens avançadas de tomografia foram utilizadas para moldar a tala impressa com tecnologia tridimensional. Esta alternativa possibilitou melhor planejamento cirúrgico e, com isso, conforto para o paciente, além da qualidade própria do material de poliuretano que é levemente maleável, o que permitiu melhor moldagem e expansão torácica durante a respiração. A tala se provou resistente o suficiente para suportar a tração ocasionada pelos fios de sutura e possibilitou o reposicionamento adequado do osso esterno ao mesmo tempo que se mostrou confortável e acarretou mínimas lesões ao paciente.


The aim of this paper was to report the use of an external splint made of polyurethane material and internal neopreme covering in the surgical repair of a pectus excavatum in a young feline. The feline exhibited a congenital anatomical deformity in the external region and clinical respiratory signs. Advanced CT images were used to shape the 3D-printed splint. This alternative allowed better surgical planning and, therefore, comfort for the patient, this because to the quality of the polyurethane material, which is slightly malleable, and allowed for better molding and chest expansion during breathing. The splint proved to be strong enough to withstand the traction caused by the suture threads and allowed the proper repositioning of the sternum, at the same time it was comfortable and caused minimal injuries to the patient.


Assuntos
Animais , Gatos , Poliuretanos/uso terapêutico , Contenções/veterinária , Cirurgia Torácica/métodos , Anormalidades Congênitas/veterinária , Gatos/anormalidades , Tórax em Funil/veterinária , Impressão Tridimensional
5.
Int J Pharm ; 616: 121533, 2022 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-35121047

RESUMO

Unimolecular micelles have attracted intense interests as drug carriers for tumor chemotherapy owing to their superior stability in comparison with the self-assembled supramolecular ones. Among them, the dendritic polymers with the polar frameworks could favour the loading of chemotherapeutic drugs rather than the hyperbranched polymers via radical polymerization, by enhancing the interaction with drugs. While the tedious synthesis procedure for dendritic polymers could be simplified with the construction principle on urethane chemistry. Here, the PEGylated dendritic polyurethanes, Ph-DPUGly-PEG and Ph-DPUTEA-PEG, were designed with glycerol or triethanolamine as monomer, respectively. The effect of the molecular architecture of the Ph-DPU-PEGs unimolecular micelles on the controlled drug releasing performance was compared. It was found that the Ph-DPUTEA-PEG with tertiary amine as branching points could efficiently endow the pH-triggered drug release, due to its protonation.


Assuntos
Micelas , Neoplasias , Doxorrubicina/química , Portadores de Fármacos/química , Humanos , Concentração de Íons de Hidrogênio , Neoplasias/tratamento farmacológico , Polietilenoglicóis/química , Poliuretanos/uso terapêutico
6.
Arthroscopy ; 38(4): 1279-1287, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34571182

RESUMO

PURPOSE: To compare, at long-term follow-up, the clinical outcomes and failures of collagen and polyurethane meniscal scaffolds for the treatment of partial meniscal defects. METHODS: Patients affected by partial meniscal defect with intact anterior and posterior meniscal attachments and an intact rim at the circumference of the missing meniscus were included, treated with a collagen meniscal implant or with polyurethane scaffold, and clinically evaluated by analysis of the subjective International Knee Documentation Committee score, the visual analog scale score for the evaluation of knee function and symptoms, and the Tegner score to assess the activity level. RESULTS: After 3 patients dropped out, a total of 47 patients, comprising 31 men and 16 women, with a mean age of 43 ± 14.1 years and mean body mass index of 25 ± 1.4, were clinically evaluated up to a mean of 10 years' follow-up. The International Knee Documentation Committee score improved from 42.9 ± 15.9 to 67.4 ± 12.4 (P < .0005) in the polyurethane implant group and from 46.8 ± 16.7 to 62.1 ± 22.6 (P < .0005) in the collagen meniscal implant group. The visual analog scale score decreased significantly from baseline values of 5.4 ± 2.3 and 4.4 ± 1.7, to 3.4 ± 2.5 and 2.7 ± 2.4, respectively, at final follow-up in the polyurethane implant (P = .002) and collagen meniscal implant (P < .0005) groups. The Tegner score improved in both groups without reaching the preinjury activity level. No significant differences in the scores were found between the polyurethane and collagen scaffold groups. A total of 10 implants failed, 5 per group, for a cumulative failure rate of 21.3%, with no differences between the 2 scaffolds. CONCLUSIONS: The long-term comparison showed positive and similar results for both polyurethane- and collagen-based meniscal scaffolds, with an implant survival rate of about 80% at 10 years of follow-up and no differences in terms of pain, function, and activity level. LEVEL OF EVIDENCE: Level IV, case-control comparative study.


Assuntos
Menisco , Lesões do Menisco Tibial , Adulto , Colágeno/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Poliuretanos/uso terapêutico , Lesões do Menisco Tibial/cirurgia , Alicerces Teciduais , Resultado do Tratamento
7.
Burns ; 48(3): 529-538, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34407914

RESUMO

INTRODUCTION: For extensive burns, autologous donor skin may be insufficient for early debridement and grafting in a single stage. A novel, synthetic polyurethane dermal template (NovoSorb® Biodegradable Temporising Matrix, BTM) was developed to address this need. The aim of this study was to evaluate use of BTM for primary dermal repair after deep burn injury. METHODS: A multicentre, prospective, clinical study was conducted from September 2015 to May 2018. The primary endpoint was % split skin graft take over applied BTM at 7-10 days after grafting. Secondary endpoints included % BTM take, incidence of infection and adverse events, and scar quality to 12 months after BTM application. RESULTS: Thirty patients were treated with BTM and delayed split skin grafting. The % graft take had a mean of 81.9% and % BTM take had a mean of 88.6%, demonstrating effective integration of BTM. When managed appropriately, it was possible for BTM to integrate successfully despite findings suggestive of infection. Scar quality improved over time. DISCUSSION: These results provide additional clinical evidence on the safety and performance of BTM as an effective dermal substitute in the treatment of patients with deep burn injuries.


Assuntos
Queimaduras , Pele Artificial , Queimaduras/cirurgia , Cicatriz/etiologia , Humanos , Poliuretanos/uso terapêutico , Estudos Prospectivos , Transplante de Pele/métodos , Cicatrização
8.
J Mater Chem B ; 9(38): 7979-7990, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34612287

RESUMO

Nerve guide conduits (NGCs) can replace autogenous nerve grafting in the treatment of peripheral nerve system (PNS) injury. However, the modulus of polyurethane NGCs that affects the outcome of PNS repair has been rarely elucidated in vivo. In this study, we developed biodegradable waterborne polyurethane (BWPU) NGCs with an outer BWPU membrane and an inner three-dimensional scaffold structure. The mechanical properties of BWPU NGCs can be modified by adjusting the molar content of polyethylene glycol (PEG) in the soft segments within the BWPU. Two types of BWPU NGCs with different moduli were prepared, containing 17% and 25% PEG in BWPU (termed as BWPU 17 NGCs and BWPU 25 NGCs, respectively). In rat sciatic nerves with 10-mm transected injury, mechanically stronger BWPU 17 NGCs exhibited superior nerve repair, which was similar to that obtained by the current gold standard autograft implantation, whereas weaker BWPU 25 NGCs displayed an unsatisfactory effect. Histological results revealed that both BWPU NGCs had anti-inflammatory effects and altered the activation state of macrophages to M2 phenotypes to enhance PNS regeneration. The analysis of growth-associated protein 43 expression, which regulates axon growth, revealed that the mechanical properties of BWPU NGCs influence the outcome of PNS regeneration by affecting the formation and extension of axons. These findings suggest that the mechanical properties of NGCs could play a key role in regulating PNS repair and should be considered in future biomaterial NGC designs.


Assuntos
Axônios/fisiologia , Materiais Biocompatíveis/uso terapêutico , Regeneração Nervosa , Traumatismos dos Nervos Periféricos/terapia , Poliuretanos/química , Animais , Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Adesão Celular/efeitos dos fármacos , Feminino , Macrófagos/citologia , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Músculo Esquelético/patologia , Regeneração Nervosa/efeitos dos fármacos , Traumatismos dos Nervos Periféricos/patologia , Polietilenoglicóis/química , Poliuretanos/farmacologia , Poliuretanos/uso terapêutico , Ratos , Ratos Sprague-Dawley , Nervo Isquiático/fisiologia
9.
PLoS One ; 16(10): e0257985, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618848

RESUMO

OBJECTIVES: The aims of this study were to compare the initial implant stability obtained using four different osteotomy techniques in low-density synthetic bone, to evaluate the instrument design in comparison to the implant design, and to determinate a possible correlation between the insertion torque and initial stability quotient (ISQ). MATERIALS AND METHODS: Four groups were identified in accordance with the osteotomy technique used (n = 10 implants per group): group G1, osteotomy using the recommended drilling sequence; group G2, osteotomy using an undersized compactor drill; group G3, osteotomy using an undersized drill; and group G4, osteotomy using universal osseodensification drills. Two polyurethane blocks were used: block 1, with a medullary portion of 10 pounds per cubic foot (PCF 10) and with a 1 mm cortical portion of PCF 40, and block 2, with a medullary of PCF 15 and with a 2 mm cortical portion of PCF 40. Tapered implants of 4 mm in diameter and 11 mm in length were used. The insertion torque (IT) and ISQ were measured. The dimensions of the final instrument used in each group and the dimensions of the implant were used to calculate the total area of each part, and these data were compared. RESULTS: Differences between the four groups were found for IT and ISQ values depending on the technique used for the osteotomy in the two synthetic bone models (p < 0.0001). All groups showed lower values of initial stability in block 1 than in block 2. CONCLUSIONS: Undersized osteotomies with instruments designed according to the implant body significantly increased the initial stability values compared to beds prepared with universal drills and using the drilling sequence standardized by the manufacturer.


Assuntos
Osso e Ossos/cirurgia , Implantação Dentária Endóssea/instrumentação , Osteotomia/instrumentação , Próteses e Implantes , Densidade Óssea , Doenças Ósseas Metabólicas , Osso e Ossos/fisiopatologia , Brasil , Humanos , Projetos Piloto , Poliuretanos/química , Poliuretanos/uso terapêutico , Torque
10.
Br J Community Nurs ; 26(10): 498-509, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34632793

RESUMO

Clinicians are under increasing pressure to provide high-quality patient outcomes at a reduced cost. Increasingly, community staff must acquire knowledge on advanced wound care products to cope with the growing caseload demands. This article describes the use of PolyMem® dressings to reduce pain, inflammation, oedema and bruising and their ability to debride and absorb exudate while providing an optimum healing environment. The PolyMem range includes multifunctional dressings for various painful chronic wounds. This article also presents five case studies with particularly good patient outcomes where PolyMem dressings were the primary dressing. All five patients were holistically assessed to enable consistent evidence-based treatment decisions. In four cases, the new PolyMem Silicone Border dressing was used. The patients found the PolyMem Silicone Border dressing comfortable and gentle on removal even when the skin was extremely fragile. The right dressing used at the right time on the right patient can improve patient outcomes.


Assuntos
Bandagens , Glicerol/uso terapêutico , Dor/prevenção & controle , Poliuretanos/uso terapêutico , Úlcera por Pressão/enfermagem , Silicones , Higiene da Pele , Humanos , Satisfação do Paciente , Resultado do Tratamento , Cicatrização
11.
Nat Commun ; 12(1): 4395, 2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285224

RESUMO

The unique properties of self-healing materials hold great potential in the field of biomedical engineering. Although previous studies have focused on the design and synthesis of self-healing materials, their application in in vivo settings remains limited. Here, we design a series of biodegradable and biocompatible self-healing elastomers (SHEs) with tunable mechanical properties, and apply them to various disease models in vivo, in order to test their reparative potential in multiple tissues and at physiological conditions. We validate the effectiveness of SHEs as promising therapies for aortic aneurysm, nerve coaptation and bone immobilization in three animal models. The data presented here support the translation potential of SHEs in diverse settings, and pave the way for the development of self-healing materials in clinical contexts.


Assuntos
Implantes Absorvíveis , Materiais Biocompatíveis/uso terapêutico , Engenharia Biomédica , Poliuretanos/uso terapêutico , Animais , Aneurisma Aórtico/cirurgia , Materiais Biocompatíveis/química , Modelos Animais de Doenças , Elastômeros/química , Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Humanos , Masculino , Teste de Materiais , Camundongos , Transferência de Nervo/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Poliuretanos/química , Ratos , Suínos , Porco Miniatura
12.
Molecules ; 26(4)2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33670378

RESUMO

Biodegradable and antimicrobial waterborne polyurethane dispersions (PUDs) and their casted solid films have recently emerged as important alternatives to their solvent-based and non-biodegradable counterparts for various applications due to their versatility, health, and environmental friendliness. The nanoscale morphology of the PUDs, dispersion stability, and the thermomechanical properties of the solid films obtained from the solvent cast process are strongly dependent on several important parameters, such as the preparation method, polyols, diisocyanates, solid content, chain extension, and temperature. The biodegradability, biocompatibility, antimicrobial properties and biomedical applications can be tailored based on the nature of the polyols, polarity, as well as structure and concentration of the internal surfactants (anionic or cationic). This review article provides an important quantitative experimental basis and structure evolution for the development and synthesis of biodegradable waterborne PUDs and their solid films, with prescribed macromolecular properties and new functions, with the aim of understanding the relationships between polymer structure, properties, and performance. The review article will also summarize the important variables that control the thermomechanical properties and biodegradation kinetics, as well as antimicrobial and biocompatibility behaviors of aqueous PUDs and their films, for certain industrial and biomedical applications.


Assuntos
Anti-Infecciosos/química , Plásticos Biodegradáveis/química , Polímeros/química , Poliuretanos/química , Ânions/química , Ânions/uso terapêutico , Anti-Infecciosos/uso terapêutico , Plásticos Biodegradáveis/uso terapêutico , Humanos , Polímeros/uso terapêutico , Poliuretanos/uso terapêutico , Solventes/química , Tensoativos/química , Tensoativos/uso terapêutico , Água/química
13.
Int J Pharm ; 595: 120243, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33484923

RESUMO

Cardiovascular diseases constitute a number of conditions which are the leading cause of death globally. To combat these diseases and improve the quality and duration of life, several cardiac implants have been developed, including stents, vascular grafts and valvular prostheses. The implantation of these vascular prosthesis has associated risks such as infection or blood clot formation. In order to overcome these limitations medicated vascular prosthesis have been previously used. The present paper describes a 3D printing method to develop medicated vascular prosthesis using fused deposition modelling (FDM) technology. For this purpose, rifampicin (RIF) was selected as a model molecule as it can be used to prevent vascular graft prosthesis infection. Thermoplastic polyurethane (TPU) and RIF were combined using hot melt extrusion (HME) to obtain filaments containing RIF concentrations ranging between 0 and 1% (w/w). These materials are capable of providing RIF release for periods ranging between 30 and 80 days. Moreover, TPU-based materials containing RIF were capable of inhibiting the growth of Staphylococcus aureus. This behaviour was observed even for TPU-based materials containing RIF concentrations of 0.1% (w/w). TPU containing 1% (w/w) of RIF showed antimicrobial properties even after 30 days of RIF release. Alternatively, these methods were used to prepare dipyridamole containing TPU filaments. Finally, using a dual extrusion 3D printer vascular grafts containing both drugs were prepared.


Assuntos
Antibacterianos/farmacocinética , Sistemas de Liberação de Medicamentos/métodos , Poliuretanos/química , Rifampina/farmacocinética , Tecnologia Farmacêutica/métodos , Células Sanguíneas/efeitos dos fármacos , Prótese Vascular/efeitos adversos , Preparações de Ação Retardada/química , Dipiridamol/farmacocinética , Liberação Controlada de Fármacos , Desenho de Equipamento/métodos , Células Endoteliais da Veia Umbilical Humana , Humanos , Inibidores da Agregação Plaquetária/farmacocinética , Poliuretanos/uso terapêutico , Impressão Tridimensional , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/efeitos dos fármacos , Trombose/etiologia , Trombose/prevenção & controle
15.
Knee Surg Sports Traumatol Arthrosc ; 29(1): 109-116, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654130

RESUMO

PURPOSE: The purpose of this study was to assess the clinical outcomes of the implantation of an aliphatic polyurethane scaffold for the treatment of partial loss of meniscal tissue at a mean follow-up of 36 months. METHODS: A retrospective review on prospectively collected data was performed on patients who underwent implantation of an aliphatic polyurethane-based synthetic meniscal scaffold. Patients were evaluated for demographics data, lesion and implant characteristics (sizing, type and number of meniscal sutures), previous and combined surgeries and complications. Clinical parameters were rated using NRS, IKDC subjective, Lysholm, KOOS, and Tegner activity score, both preoperatively and at final follow-up. RESULTS: Sixty-seven patients were evaluated at a mean follow-up of 36 months (48 M and 19 F; mean age 40.8 ± 10.6 years; mean BMI 25.4 ± 4.3). The scaffold was implanted on the medial side in 54 cases, and on the lateral one in 13. Forty-seven patients had undergone previous surgical treatment at the same knee and 45 required combined surgical procedures. All evaluated scores improved significantly from the baseline. Among possible prognostic factors, a delayed scaffold implantation had lower post-operative clinical scores: IKDC subjective (P = 0.049), KOOS Sport (P = 0.044), KOOS total (p = 0.011), and Tegner (P = 0.03) scores at follow-up. CONCLUSIONS: The polyurethane meniscal scaffold implantation led to a significant clinical benefit in a large number of patients. A delayed intervention correlated with worse results. LEVEL OF EVIDENCE: IV.


Assuntos
Meniscos Tibiais/cirurgia , Poliuretanos/uso terapêutico , Implantação de Prótese/métodos , Alicerces Teciduais , Adulto , Feminino , Humanos , Articulação do Joelho/cirurgia , Escore de Lysholm para Joelho , Masculino , Meniscectomia/métodos , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Lesões do Menisco Tibial/cirurgia , Resultado do Tratamento
16.
Adv Wound Care (New Rochelle) ; 10(12): 699-710, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-32870776

RESUMO

Significance: Negative pressure wound therapy (NPWT) has become a valuable adjunct in the treatment of acute and chronic wounds in several surgical disciplines. Retained foams are among its side effects, and they pose a rare but devastating complication at the site of this therapy, which might be associated with wound-healing complications, infection persistence, repeated surgical revisions, and prolonged antibiotic courses. Recent Advances: In the past 15 years, an increasing number of studies have identified this potential problem. Although the exact incidence remains unknown, initial studies have indicated rates of up to 10% in large collectives being treated by NPWT. Critical Issues: The lack of radiopaque markers does not allow for the visual control of retained foams using plain radiographs. Further imaging methods (e.g., CT and MRI) also do not help in adequate differential diagnosis. The lack of routine documentation of the number, type, and localization of the inserted foam(s) and unplanned surgery with a different surgical team pose risk factors for foam retainment. Future Directions: Introducing new documentation records for wounds treated with NPWT is recommended. At foam removal, all dressing materials should be examined for integrity. The development of foams with radiopaque markers by the industry, such as those routinely used in surgical gauze swabs, might also be a useful step to minimize the risk of foam retainment within wounds.


Assuntos
Infecções Bacterianas/microbiologia , Tratamento de Ferimentos com Pressão Negativa , Poliuretanos/uso terapêutico , Cicatrização/fisiologia , Infecção dos Ferimentos/microbiologia , Ferimentos e Lesões/microbiologia , Ferimentos e Lesões/terapia , Infecções Bacterianas/patologia , Infecções Bacterianas/terapia , Bactérias Gram-Negativas , Infecções por Bactérias Gram-Negativas , Humanos , Tratamento de Ferimentos com Pressão Negativa/métodos , Infecção dos Ferimentos/patologia , Infecção dos Ferimentos/prevenção & controle , Ferimentos e Lesões/patologia
17.
J Burn Care Res ; 42(3): 577-585, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33022032

RESUMO

Since autologous split-thickness skin grafts are scarce and lab skin growth requires a significant amount of time, there are limited available treatment approaches for patients with full-thickness burns greater than 90% TBSA. Additionally, to achieve the primary goal of skin coverage and resuscitation, there must exist a balance between fluid loss and metabolic derangement. Allografts and xenografts have traditionally been used early in the process to achieve these goals. Currently, novel approaches to treatment consider the additional use of synthetic dermal substitutes and autologous skin cell suspension to improve outcomes. This case series describes the treatment course of patients with greater than 90% TBSA full-thickness burn injuries using a staged, multifaceted approach of using NovoSorb Biodegradable Temporizing Matrix™ as the primary dermal substitute in conjunction with a RECELL™ Autologous Cell Suspensions Device applied with autograft and allograft to achieve improved resuscitation, limiting fluid loss, and finally skin coverage. Allograft and NovoSorb Biodegradable Temporizing Matrix™ were used early to cover excised burns, resulting in improved metabolic control by limiting the systemic inflammatory response syndrome and fluid loss. Both patients survived using this approach.


Assuntos
Queimaduras/terapia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Poliésteres/uso terapêutico , Polietilenos/uso terapêutico , Poliuretanos/uso terapêutico , Transplante de Pele , Acidentes de Trânsito , Adolescente , Desbridamento , Humanos , Masculino , Transplante Autólogo , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/terapia , Adulto Jovem
18.
Adv Skin Wound Care ; 34(1): 23-30, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33323799

RESUMO

OBJECTIVE: To study the impact of a newly introduced dressing on efficiency and quality of care in routine clinical practice in a Spanish community setting. DESIGN AND SETTING: An ambispective multicenter observational study was conducted in 24 primary care centers and 6 nursing homes in 4 different Spanish regions. The study was carried out between November 2017 and March 2019. PATIENTS AND INTERVENTION: A total of 128 wounds in 94 patients (primary care, n = 79; nursing home, n = 15) were analyzed before and 4 weeks after switching to the study dressing. OUTCOME MEASURES: Frequency of dressing changes; secondary outcomes were change in the mean wound area and weekly cost and patient and provider satisfaction. MAIN RESULTS: The mean number of dressing changes was significantly reduced with the study dressing from 3.14 ± 1.77 changes per week to 1.66 ± 0.87 (P < .001), a 47.1% reduction in frequency. Wound area significantly reduced from 9.90 ± 19.62 cm to 7.10 ± 24.33 cm. In addition, a 58.7% reduction in weekly costs was achieved with the intervention. Patients and providers agreed that their satisfaction with wound care improved. CONCLUSIONS: The use of the study dressing in routine clinical practice could lead to a major improvement in both efficiency and quality of wound care. Its use could reduce wound care-related costs through improvements in healing and a reduced frequency of dressing changes. It also enhanced the wound care experience from the perspective of both patients and providers.


Assuntos
Curativos Hidrocoloides/normas , Custos de Cuidados de Saúde/normas , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Poliuretanos/normas , Cicatrização , Idoso , Curativos Hidrocoloides/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/organização & administração , Casas de Saúde/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/métodos , Poliuretanos/uso terapêutico , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos , Espanha
19.
J Wound Care ; 29(10): 586-596, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33052794

RESUMO

OBJECTIVE: Biodegradable polymers can replace damaged tissue components using tissue engineering techniques. The objective of this study is to determine an optimum environment for polymer scaffolds to improve the proliferation of fibroblast cells capable of wound repair. METHOD: In this study, the addition of polysaccharides, such as chitosan (CH) or hyaluronic acid (HA), to a polyurethane (PU) polymer was evaluated using different methods to determine if they affect scaffold morphology and cell activity of fibroblasts prepared from human foreskin tissues. Mechanical properties, such as tensile strength, contact angle and swelling test, were used to check the physical and mechanical properties of the scaffold. Fibroblast growth was also measured at 24, 48 and 72 hours. RESULTS: Scanning electron microscopy (SEM) determined that a 3:1 ratio of PU/CH scaffold, developed by electrospinning, allowed the formation of a uniform structure in scaffold fibres. Physical mechanical tests showed that PU electrospun scaffolds were not modified by the addition of CH. The mean stretch and mean water absorption increased significantly using the PU/CH scaffold, compared with the PU scaffold. However, the mean tensile strength and the mean contact angle, used to study space and porosity, did not differ between scaffolds. Fourier transform infrared spectroscopy confirmed the functional groups (-OH, -NH and -C=O) in the PU/CH scaffold, compared with PU or CH chemical structures alone. HA was then added to CH and PU/CH scaffolds to evaluate the growth of fibroblast cells. Results showed that cell viability and the number of cells, using MTT and trypan blue exclusion assay, respectively, increased significantly at 24, 48 and 72 hours of culture in PU/CH/HA scaffold compared to HA, CH/HA, and PU/HA. Moreover, PU/HA at 48 and 72 hours also increased cell viability and cell numbers compared to HA and CH/HA scaffolds. However, scaffolds at 72 hours had limited space for cell growth. Moreover, SEM data demonstrated that fibroblasts were able to proliferate, penetrate, migrate and survive on PU/HA and PU/CH/HA three-dimensional scaffolds, especially during the first 48 hours. Furthermore, 4',6-diamidino-2-phenylindole (DAPI) staining confirmed that fibroblasts could penetrate PU scaffolds and showed higher cell viability and lower cellular damage in PU/CH/HA, compared to CH/HA and PU/HA scaffolds. Finally, flow cytometry using CD90 and CD105 surface markers revealed that >90% of cells isolated from the human dermis were fibroblasts. CONCLUSION: In summary, PU/HA and PU/CH/HA scaffolds were found to be biocompatible and provided a suitable environment for the growth and proliferation of fibroblasts, which filled and covered all pores between the fibres. The new scaffold used in this study, made of synthetic and natural polymers, is a good candidate for applications in tissue engineering. It is therefore recommended to use PU in grafts or in wound dressing.


Assuntos
Proliferação de Células/efeitos dos fármacos , Quitosana/uso terapêutico , Fibroblastos , Ácido Hialurônico/uso terapêutico , Poliuretanos/uso terapêutico , Engenharia Tecidual/métodos , Alicerces Teciduais , Materiais Biocompatíveis , Humanos
20.
Adv Skin Wound Care ; 33(6): 319-323, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32427788

RESUMO

OBJECTIVE: To compare the effects of early hydrophilic polyurethane (EHP) foam dressing and highly hydrophilic polyurethane (HHP) foam dressing on wound healing in patients with diabetes. METHODS: Twenty patients with diabetes with skin graft donor sites on the lateral thigh were enrolled in this study. Each donor site was divided into two equal-sized areas for the application of HHP or EHP foam dressing. The study endpoint was the time required for healing, defined as complete epithelialization of the donor site without discharge. All possible adverse events were also documented. MAIN RESULTS: Donor site healing was faster in 15 patients on the HHP half and 1 patient on the EHP half. In four patients, healing rates were the same between the HHP and EHP areas. Donor sites treated with HHP and EHP foam dressings healed in 17.2 ± 4.4 and 19.6 ± 3.7 days (P = .007), respectively. During the study period, no adverse event associated with the dressings occurred in either group. CONCLUSIONS: The HHP foam dressing might provide faster healing than EHP foam dressing for skin graft donor sites in patients with diabetes.


Assuntos
Curativos Hidrocoloides/estatística & dados numéricos , Pé Diabético/terapia , Poliuretanos/uso terapêutico , Transplante de Pele/métodos , Cicatrização/fisiologia , Adulto , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...