Evaluation of conventional therapeutic methods versus maggot therapy in the evolution of healing of tegumental injuries in Wistar rats with and without diabetes mellitus.

Larval therapy consists on the application of sterilized carrion flies larvae, reared in laboratory, on acute, chronic, and/or infected wounds in order to promote healing. Conventional methods for treating injuries include mechanical debridement or silver-based dressings; however, they are not always effective for wound healing. Larval therapy is a feasible and safe treatment for therapeutic application and, in many cases, the only and the most recommended alternative for difficult healing injuries. Thus, this study aimed to evaluate the competence of Cochliomyia macellaria F. (Diptera: Calliphoridae) as a suitable species for therapeutic application and evaluate time and effectiveness of the types of treatments most commonly used to treat integumental injuries. C. macellaria eggs were obtained from colonies established in laboratory and sterilized prior to application. Twenty-five larvae were applied for each centimeter squared of lesion. Lesions were induced in 24 Wistar rats; type 1 diabetes mellitus was induced in 12 of them. Animals were divided in four groups with three individuals each, being denominated: larval therapy, larval therapy associated with foam dressing with silver release, mechanical debridement with foam dressing silver and control group, without treatment. All treatments were applied once and held for 24 h. Medical application of larvae was found to be safe, as only dead tissue was removed, and efficient to accelerate healing process when compared to other treatments.

El sistema cutáneo, nuevo capítulo en el baremo médico / The Skin, a new chapter in the Medical Scale

En el baremo médico contenido en el Real Decreto 8/2004 no se contemplan las alteraciones en el sistema cutáneo como responsables de menoscabo físico; se valora el menoscabo estético que produce en los lesionados. La inclusión de este capítulo en el nuevo baremo médico de autos viene determinada por la importancia de la piel, como sistema corporal, primordialmente por su función, reguladora de múltiples procesos en el individuo, y por su extensión. La valoración de las alteraciones del sistema cutáneo se realizará principalmente en quemaduras profundas y extensas, así como en lesiones que produzcan trastornos dermatológicos, teniendo en cuenta el porcentaje de superficie corporal afectada y el modo de reparación. La puntuación se puede complementar con las alteraciones funcionales en otros sistemas si las hubiera, así como con el perjuicio estético producido. El resto de las lesiones en la piel que no ocasionan menoscabo funcional, fundamentalmente cicatrices no patológicas, se valoran exclusivamente en el capítulo del perjuicio estético (AU)

The Medical Scale contained in the Real Decreto 8/2004 did not consider the skin alterations as the cause of the physical impairment, it only contemplated the aesthetic impairment which produce in the injuried person. Including this new chapter is determined by the importance of the skin as a essential body system due to its function as a regulatory system for a wide range of processes and its large area. The skin assesment will be mainly done in deep and extensive burns, as well as injuries which produce dermalotogic disorders, taking into acount the body surface percentage afected and the way it can be repared. The score can be supplemented with the functional disorders in other systems in case they exist, as well as the aesthetic damage suffered. The other skin injuries which do not cause functional impairment, essentialy no pathologic scars, will be assesed exclusively in the aesthetic damage chapter (AU)

Revisão do diagnóstico de enfermagem integridade tissular prejudicada: uma análise de conceito / Nursing diagnosis review of impaired tissue integrity: a concept analysis

Os diagnósticos de enfermagem, enquanto categoria nominal, expressam o raciocínio diagnóstico realizado pelo enfermeiro a partir do exame clínico e permitem a comunicação dos fenômenos pertinentes à assistência. Entretanto, observa-se que determinados diagnósticos de enfermagem da taxonomia da NANDA-I não representam completamente os fenômenos observados na prática assistencial doenfermeiro. Nesse contexto, verifica-se que a definição do diagnóstico integridade tissular prejudicada não contempla danos às estruturas teciduais localizadas abaixo do tecido subcutâneo limitando sua utilização para diagnosticar lesões físicas com comprometimento de músculos, tendões, ossos, ligamentos, articulações e/ou cápsulas. Além disso, as listas de características definidoras e de fatoresrelacionados do diagnóstico em questão não apresentam, respectivamente, outras lesões teciduais e outros fatores associados à ocorrência de lesões que são evidenciados na prática. No intuito de contribuir para aumentar a abrangência do diagnóstico em estudo, bem como para o aprimoramento da taxonomia da NANDA-I, realizou-se este estudo com o objetivo de revisar o diagnóstico de enfermagemintegridade tissular prejudicada apresentado pela taxonomia da NANDA – I (2009-2011). Trata-se de uma análise de conceito utilizando o modelo de Walker e Avant. Para determinar o uso do conceito integridade tissular prejudicada, bem como os atributos definidores e os antecedentes desse diagnóstico realizou-se uma revisão integrativa da literatura orientada pelas seguintes questões: quais característicasdefinidoras do diagnóstico de enfermagem integridade tissular prejudicada são descritas na literatura? quais fatores relacionados do diagnóstico de enfermagem integridade tissular prejudicada são descritos na literatura? Os estudos foram selecionados nas bases de dados PUBMED, LILACS, BDEnf, CINAHL, Banco de Teses da CAPES, TESESENF, Banco de Dados Bibliográficos da USP (DEDALUS)...

Nursing diagnosis, as a nominal category, express a diagnostic reasoning of a clinical examination performed by a nurse and allows a communication of pertinent phenomena to assistance. Nevertheless, it can be noticed that some NANDA-I Taxonomy nursing diagnosis do not represent completely the observed phenomena in the nurse’s care practice. In this context, it was observed that impaired tissue integrity do not consider damage to the tissue structure located under thesubcutaneous tissue limiting its use to diagnose physical lesions compromising muscles, tendon , bones, ligaments, joints and/or capsule. Besides that, the list of defining characteristics and factors related to the diagnosis mentioned do not show, respectively, other tissue lesions and other factors associated to the occurrence oflesions which are enhanced in practice. In order to contribute to increase this study diagnosis scope, as well as to enhance NANDA-I taxonomy, the aim of this study was to review the structural components of nursing diagnosis of impaired tissue integrity shown by NANDA – I taxonomy (2009-2011). This paper is about a concept analysis using Walker and Avant´s model. In order to determine the concept of impaired tissue integrity, as well as the defining attributes and this diagnosticpreceding it was performed an integrative literature review guided by the following questions: which defining characteristics of nursing diagnosis impaired tissue integrity are described in the literature? Which factors related to nursing diagnosis impaired tissue integrity are described in the literature? The studies were selected from the following databases PUBMED, LILACS, BDEnf, CINAHL, CAPES Digital Bank of Theses Summaries, TESESENF, USP bibliographic database (DEDALUS) andthrough Google Advanced Scholar search, considering the following criteria of inclusion: articles published in Portuguese, English and Spanish and dissertations or theses which described defining characteris...

Estudo clínico do retalho lateral do braço ampliado / A clinical study of the extended lateral arm flap

OBJETIVO: Avaliar prospectivamente os resultados obtidos no tratamento de pacientes portadores de lesões do revestimento cutâneo de dimensões menores ou iguais a 20cm de comprimento por 10cm de largura com a utilização do retalho microcirúrgico lateral do braço ampliado distalmente ao epicôndilo lateral do cotovelo. MÉTODOS: Foram operados 23 pacientes, 69,5 por cento do sexo masculino, 73,9 por cento de origem traumática e a região receptora foi o membro inferior em 65.2 por cento dos casos. A idade variou de 6 a 62 anos, com média de 32 anos. O seguimento mínimo foi de 5 meses. RESULTADOS: Obtivemos sucesso na realização em 100 por cento dos casos. As dimensões dos retalhos variaram de 9 a 20cm em comprimento, com média de 14cm e em largura, de 3 a 8 cm, com média de 5.5cm. A maior distância entre o epicôndilo lateral e a extremidade distal do retalho foi de 8 cm, variando de 2 cm até 8 cm, com média de 4.9cm. CONCLUSÃO: O retalho microcirúrgico lateral do braço ampliado distalmente ao epicôndilo lateral do cotovelo mostrou-se seguro para a cobertura cutânea de lesões de dimensões iguais ou menores a 20cm de comprimento por 10 cm de largura, com o prolongamento do retalho até 8cm distal ao epicôndilo lateral.

OBJECTIVE: To prospectively evaluate the results obtained in the treatment of patients with cutaneous lesions smaller or equal to 20cm long by 10cm wide with the use of lateral arm flap extended distally to the lateral epicondyle of the elbow. METHODS: 23 patients underwent surgery, 69.5 percent of them male, 73.9 percent of traumatic origin, and the receiving region was the lower limb in 65.2 percent of cases. The age ranged from 6 to 62 years, with an average of 32 years. Minimum follow-up care was 5 months. RESULTS: We succeeded in 100 percent of cases. The size of flaps ranged from 9 to 20 cm in length, with an average of 14cm, and width, from 3 to 8cm, with an average of 5.5cm. The greatest distance between the lateral epicondyle and the distal flap was 8cm, ranging from 2cm to 8cm, with an average of 4.9cm. CONCLUSION: The lateral arm flap, extended distally to the lateral epicondyle of the elbow, was safe to cover cutaneous lesions of size equal to or smaller than 20cm long by 10cm wide, with the extension of the flap up to 8cm distal to the lateral epicondyle.