Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.446
Filtrar
1.
J Surg Res ; 246: 284-291, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31622885

RESUMO

BACKGROUND: Platelet-rich plasma (PRP) improves the healing of refractory wounds, and its application is receiving more attention in the field of wound repair. However, when a patient's condition is very poor, it may be difficult to provide whole blood to harvest autologous PRP. METHODS: We evaluated the efficacy and safety of allogeneic PRP in the field of chronic refractory wound repair. Sixty patients (39 males and 21 females, 57 ± 10 y old) with chronic wounds were enrolled in this prospective, randomized, single-center study during January 2014 to January 2018. Their wounds were treated by standard care. The patients with chronic refractory wounds were divided into allogeneic PRP treatment and control groups on the basis of the presence or absence of allogeneic PRP in wounds after debridement, respectively. Allogeneic PRP was prepared by collecting whole blood from healthy individuals and two-step centrifugation. Clinical effects were evaluated by visually observing wound conditions and objectively assessing wound surfaces. RESULTS: After 30 d of treatment, the allogeneic PRP-treated group showed bright red granulation that bled easily with reduced inflammatory exudation. No rejection reactions were observed. The rate of chronic wound healing was much faster in the allogeneic PRP-treated group than that in the control group. CONCLUSIONS: The present study shows that combined treatment of chronic wounds by standard care and allogeneic PRP significantly shortens healing time, suggesting that allogeneic PRP is an effective, safe adjuvant treatment for chronic wounds.


Assuntos
Transfusão de Plaquetas/métodos , Plasma Rico em Plaquetas , Úlcera Cutânea/terapia , Pele/lesões , Cicatrização , Adulto , Idoso , Doença Crônica/terapia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Desbridamento , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos , Resultado do Tratamento
3.
Cir Cir ; 87(S1): 8-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501623

RESUMO

Background: Procedures to remove adiposities and skin, such as dermolipectomy, can develop wounds that are difficult to heal by conventional therapies. Mesenchymal stem cells are indicated as potential candidates for regenerative therapy in wounds, due to their multipotentiality, low immunogenicity, modulating capacity of inflammation and tissue modeling processes. Case report: Patient with dehiscent chronic ulcer secondary to dermolipectomy, who received cutaneous treatment with mesenchymal stem cells. The therapy induced scar formation and neovascularization, as well as the decrease of infiltrated leukocytes and proinflammatory cytokines. Mesenchymal cells are proposed as an interesting alternative for the treatment of postoperative lesions.


Assuntos
Contorno Corporal/efeitos adversos , Lipectomia/efeitos adversos , Transplante de Células-Tronco Mesenquimais , Medicina Regenerativa/métodos , Úlcera Cutânea/terapia , Deiscência da Ferida Operatória/terapia , Geleia de Wharton/citologia , Adipogenia , Adulto , Antígenos de Superfície/biossíntese , Antígenos de Superfície/genética , Separação Celular , Doença Crônica , Cicatriz/etiologia , Feminino , Expressão Gênica , Humanos , Inflamação , Células-Tronco Mesenquimais , Neovascularização Fisiológica , Osteogênese , Úlcera Cutânea/etiologia , Deiscência da Ferida Operatória/etiologia , Cicatrização
5.
Adv Skin Wound Care ; 32(9): 1-5, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31403477

RESUMO

OBJECTIVE: To test the hypothesis that platelet-rich plasma (PRP) improves wound healing in rabbits by analyzing morphologic alterations in lesions with the use of PRP alone or combined with rosuvastatin (RSV). METHODS: Eight adult male New Zealand rabbits were used in this study. Researchers created four wounds on the back of each rabbit with an 8-mm punch. The control wound was treated with a 0.9% sodium chloride solution. Experimental wounds were treated with PRP, RSV, or both PRP and RSV. Dressings were changed with a new application of PRP and RSV every 4 days for 16 days. Wounds were biopsied on days 0, 7, 10, 14, and 17 for histopathologic evaluation of the scar tissue. MAIN RESULTS: Histopathology revealed reepithelialization in 100% of wounds treated with PRP alone after 17 days of treatment, compared with 50% of wounds treated with RSV alone and 75% of the wounds treated with PRP and RSV. Further, combining RSV and PRP reduced blood loss. The use of PRP alone induced 100% neovascularization, compared with 50% and 62.5% in wounds treated with PRP and RSV and RSV alone, respectively. All experimental wounds had a higher percentage of collagen fibers on day 17 postlesion when compared with control wounds (78.27% ± 4.69%). There were no significant differences among treatments; however, wounds treated with RSV alone had the lowest amount of collagen fibers (85.98% ± 3.51%). Wounds treated with PRP alone or PRP and RSV had 90.07% ± 6.20% and 90.76% ± 3.51% collagen fibers, respectively. CONCLUSIONS: The results of this study indicate that PRP elicits higher healing activity in the first 7 days postlesion. Treatments with RSV alone or RSV and PRP did enhance other healing phases.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Plasma Rico em Plaquetas , Rosuvastatina Cálcica/uso terapêutico , Úlcera Cutânea/terapia , Ferimentos Penetrantes/terapia , Animais , Modelos Animais de Doenças , Masculino , Coelhos , Úlcera Cutânea/etiologia , Úlcera Cutânea/patologia , Fatores de Tempo , Cicatrização , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/patologia
7.
Int J Low Extrem Wounds ; 18(3): 247-261, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31257948

RESUMO

Skin as a mechanical barrier between the inner and outer environment of our body protects us against infection and electrolyte loss. This organ consists of 3 layers: the epidermis, dermis, and hypodermis. Any disruption in the integrity of skin leads to the formation of wounds, which are divided into 2 main categories: acute wounds and chronic wounds. Generally, acute wounds heal relatively faster. In contrast to acute wounds, closure of chronic wounds is delayed by 3 months after the initial insult. Treatment of chronic wounds has been one of the most challenging issues in the field of regenerative medicine, promoting scientists to develop various therapeutic strategies for a fast, qualified, and most cost-effective treatment modality. Here, we reviewed more recent approaches, including the development of stem cell therapy, tissue-engineered skin substitutes, and skin equivalents, for the healing of complex wounds.


Assuntos
Administração dos Cuidados ao Paciente , Úlcera Cutânea , Lesões dos Tecidos Moles , Cicatrização , Humanos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/tendências , Regeneração/efeitos dos fármacos , Regeneração/fisiologia , Úlcera Cutânea/fisiopatologia , Úlcera Cutânea/terapia , Lesões dos Tecidos Moles/fisiopatologia , Lesões dos Tecidos Moles/terapia , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologia
8.
J Wound Care ; 28(Sup5): S30-S40, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31067172

RESUMO

OBJECTIVE: The aim of this study was to assess wound healing outcomes following direct, low-frequency, high-intensity, ultrasonic debridement as a surgical adjunct for non-healing lower extremity wounds. METHODS: A retrospective review was conducted for patients undergoing lower extremity wound treatment with direct, low-frequency (22.5 kHz), high-intensity (~60 W/cm2) ultrasonic debridement between January 2010 and January 2016. Clinical outcomes were assessed up to 180-days post-ultrasonic debridement. Descriptive statistics, cost and univariate analysis were performed. RESULTS: Overall, 82 wounds in 51 patients were included. Mean age was 57.0 years (range: 32-69), and average body mass index (BMI) was 30.8 kg/m². Patient comorbidities consisted of smoking (47%; n=24), hypertension (75%; n=38), diabetes (45%; n=23), and peripheral vascular disease (51%, n=26). Average wound age at initial presentation was 1013 days (range: 2-5475 days) with an average wound size of 9.0cm x 7.4cm. At 180-days post-debridement, 60% (n=49) of wounds had completely healed. Readmission (47%; n=24) and reoperation (45%; n=23) rates were characterised by the reason for readmission and reoperation respectively. Readmission for wound healing (70%, n=39) was primarily for further debridements (41%; n=16). Wound infection (30%; n=7) was the most common readmission for wound complications (30%; n=17). Reoperations primarily consisted of treatments for further wound healing 96% (n=51). Cost analysis showed a lower total treatment cost for patients with improved healing ($78,698), compared with non-improved wounds ($137,707). CONCLUSION: In a complex, heterogeneous cohort of chronic extremity wounds, the use of direct, low-frequency, high-intensity, ultrasonic debridement is a safe and reliable adjunctive therapy for the management of these wounds.


Assuntos
Desbridamento/economia , Traumatismos da Perna/terapia , Úlcera Cutânea/terapia , Ultrassom/economia , Adulto , Idoso , Análise Custo-Benefício , Feminino , Humanos , Traumatismos da Perna/complicações , Masculino , Pessoa de Meia-Idade , Pennsylvania , Estudos Retrospectivos , Úlcera Cutânea/complicações , Resultado do Tratamento , Cicatrização
9.
Hautarzt ; 70(5): 346-353, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-30937479

RESUMO

BACKGROUND: Treatment of chronic ulcers is challenging. Advanced age, comorbidities, and a lack of medical knowledge of the caretaker's relatives are additional burdens. This study analyses if patient driven teledermatology could support them in the treatment of leg ulcers. Another purpose was the evaluation of savings in time and costs through telemedicine. PATIENTS AND METHODS: Over a period of approximately 6 months, 50% of the patients were treated in an ambulant setting, the other 50% used mainly teledermatology. The tele-group used an application to upload their pictures, clinical results, and history. After examination, the expert sent back a treatment plan and a date for the next teleconsultation. RESULTS: In all, 40 patients-20 in the tele-group and 20 in the control group-(18 women, 22 men; median age: 75 years [39-88 years]) were included in the study. A total of 4 patients managed the teleconsultation on their own, while 3 patients were supported by relatives and 11 by nurses. Overall, 196 outpatient treatments took place in the control group (1.6 visits/patient/month), compared to 97 outpatient treatments (0.6 visits/patient/month) and 182 teledermatology consults (1.3/patient/month) in the tele-group. Six patients were only treated in the teledermatology setting. CONCLUSIONS: Results from this study suggest that teledermatology is well qualified for the treatment of chronic ulcers; at the same time teledermatology is able to reduce the number of outpatient treatments, in some cases teleconsultation alone is possible. This decreases waiting time and travel costs for patients. Mobile teledermatology for treatment of ulcers was well-accepted among the patients.


Assuntos
Dermatologia , Consulta Remota , Dermatopatias , Úlcera Cutânea , Telemedicina , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/terapia
10.
J Am Acad Dermatol ; 81(3): 834-846, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31009668

RESUMO

The field of dermatology has seen numerous therapeutic innovations in the past decade with platelet-rich plasma (PRP), recently garnering significant interest in alopecia, acne scarring, and skin rejuvenation. In other conditions of dermatology, such as chronic wounds and vitiligo, PRP has been investigated but has received less attention. The objective of this literature review was to focus on conditions of medical dermatology and to consolidate the available evidence on PRP for the practicing dermatologist. This review evaluates the literature up to October 31, 2018, and a search was conducted in the PubMed database for "platelet-rich plasma," "platelet releasate," "platelet gel," "platelet-rich fibrin" or "PRP" and "dermatology," "skin," "cutaneous," "wound," or "ulcer." In total, 14 articles met the inclusion criteria for this review. In studies representing Levels of Evidence 1b-4 according to the Centre for Evidence-Based Medicine, Oxford, PRP significantly improved wound healing in chronic diabetic ulcers, venous ulcers, pressure ulcers, leprosy ulcers, acute traumatic wounds, and ulcers of multifactorial etiologies. Two studies also documented benefits of adjunctive PRP in stable vitiligo. In chronic wounds of multiple etiologies and vitiligo, PRP warrants further investigation because it represents a potential therapeutic adjunct or alternative with a favorable side effect profile.


Assuntos
Alopecia/terapia , Cicatriz/terapia , Dermatologia/métodos , Plasma Rico em Plaquetas , Úlcera Cutânea/terapia , Humanos , Rejuvenescimento , Cicatrização
11.
Dermatol Ther ; 32(3): e12887, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30942949

RESUMO

Platelet rich fibrin (PRF) gel is a new second generation platelet concentrate, which has been widely used in various dermatological conditions such as nonhealing diabetic foot ulcers, venous ulcers, and trophic ulcers in leprosy. In this case report, we present a patient with nonhealing ulcer secondary to ecthyma gangrenosum, who showed dramatic response with PRF gel. This case suggests a role of PRF gel in nonhealing ulcers of infectious etiology which has not been described in English language literature. Considering previous literature and our case, it may be concluded that PRF gel may be utilized as an effective alternative for nonhealing ulcers of nonneoplastic etiology.


Assuntos
Ectima/complicações , Fibrina Rica em Plaquetas , Úlcera Cutânea/terapia , Feminino , Géis , Humanos , Pessoa de Meia-Idade
12.
Ann Hematol ; 98(8): 1867-1875, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30993415

RESUMO

Refractory skin ulcers due to severe chronic graft-versus-host disease (cGVHD) remain to be associated with significant morbidity and mortality.We performed an allogeneic donor skin transplantation in seven adult patients after allogeneic hematopoietic stem cell transplantation for cGVHD-associated refractory skin ulcers. While four patients received a split skin graft (SSG), in one patient, a full thickness skin graft for two small refractory ulcers of the ankle was performed, and one patient received in vitro expanded donor keratinocyte grafts derived from hair roots of the original unrelated donor. In one additional patient, a large deep fascial defect of the lower leg was covered with an autologous greater omentum free graft before coverage with an allogeneic SSG. An additional patient was treated with an autologous scrotal skin graft for a refractory ulcer associated with deep sclerosis of cGVHD after unrelated donor transplantation.All skin grafts engrafted and resulted in permanent coverage of the grafted ulcers without any signs of immunological mediated damage. In the patient receiving in vitro expanded keratinocyte grafts, two localized ulcers were permanently covered by donor skin while this approach failed to cover extensive circular ulcers of the lower legs.Allogeneic donor skin grafts are a valuable treatment option in refractory ulcers due to cGVHD but are restricted mainly to related donors while keratinocyte grafts from unrelated donors remain experimental. In male patients lacking a related donor, autologous scrotal skin graft may be an alternative option.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Doença Enxerto-Hospedeiro/cirurgia , Transplante de Células-Tronco Hematopoéticas , Queratinócitos/transplante , Úlcera Cutânea/cirurgia , Condicionamento Pré-Transplante/métodos , Adulto , Doença Crônica , Ciclofosfamida/uso terapêutico , Feminino , Sobrevivência de Enxerto/fisiologia , Doença Enxerto-Hospedeiro/imunologia , Doença Enxerto-Hospedeiro/patologia , Doença Enxerto-Hospedeiro/terapia , Humanos , Imunossupressores/uso terapêutico , Queratinócitos/citologia , Queratinócitos/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Irmãos , Pele/imunologia , Pele/patologia , Úlcera Cutânea/imunologia , Úlcera Cutânea/patologia , Úlcera Cutânea/terapia , Transplante Autólogo , Transplante Homólogo , Doadores não Relacionados , Irradiação Corporal Total
13.
Int Wound J ; 16(3): 800-812, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30821117

RESUMO

Healing of non-traumatic skin ulcers is often suboptimal. Prognostic tools that identify people at high risk of delayed healing within the context of routine ulcer assessments may improve this, but robust evidence on which factors to include is lacking. Therefore, we scoped the literature to identify which potentially prognostic factors may warrant future systematic reviews and meta-analyses. We conducted electronic searches in MEDLINE and Embase to identify studies in English published between 1997 and 2017 that tested the association between healing of the three most common non-traumatic skin ulcers encountered by health care professionals (venous leg, diabetic foot, and pressure ulcers) and patient characteristics, ulcer characteristics, and results from clinical investigations. We included 42 studies that investigated factors which may be associated with the healing of venous leg ulcers (n = 17), diabetic foot ulcers (n = 15), and pressure ulcers (n = 10). Across ulcer types, ulcer characteristics were most commonly reported as potential prognostic factors for healing (n = 37), including the size of the ulcer area (n = 29) and ulcer duration at first assessment (n = 16). A total of 35 studies investigated the prognostic value of patient characteristics (n = 35), including age (n = 31), gender (n = 30), diabetes (n = 22), smoking status (n = 15), and history of deep vein thrombosis (DVT) (n = 13). Of these studies, 23 reported results from clinical investigations as potential prognostic factors, with the majority regarding vessel quality. Age, gender, diabetes, smoking status, history of DVT, ulcer area, and ulcer duration at time of first assessment warrant a systematic review and meta-analysis to quantify their prognostic value for delayed ulcer healing.


Assuntos
Pé Diabético/fisiopatologia , Pé Diabético/terapia , Lesão por Pressão/fisiopatologia , Lesão por Pressão/terapia , Úlcera Cutânea/fisiopatologia , Úlcera Cutânea/terapia , Cicatrização/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
14.
JAMA Dermatol ; 155(6): 694-699, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30892572

RESUMO

Importance: Despite the increasing incidence of chronic cutaneous ulcers (CCUs), limited information exists regarding their incremental economic burden. Objective: To provide nationally representative estimates regarding the incremental health care cost of CCUs, controlling for comorbidities and sociodemographic characteristics. Design, Setting, and Participants: This retrospective analysis used 9 years of longitudinal data from the Medical Expenditure Panel Survey (MEPS; January 1, 2007, through December 31, 2015). Patients with CCUs were identified using Agency for Healthcare Research and Quality-produced software that included several codes from the International Classification of Disease, 9th Revision Clinical Modification, for chronic ulcers of the skin. A cross-validated 2-part generalized linear model estimated the adjusted incremental expenditure for individuals with CCUs while controlling for comorbidities and sociodemographic covariates. Data were analyzed from July 1 through September 1, 2018. Main Outcomes and Measures: Incremental cost of CCUs, total cost of care, and expenditures associated with inpatient care, outpatient care, prescription medications, emergency department visits, and home health care. Results: A total of 288 698 patients (52.4% female; mean [SD] age, 38.2 [22.4] years) were included, of whom 1786 had CCUs and 286 912 did not. Patients with CCUs were more likely to be female (1078 [60.4%]), non-Hispanic (1388 [77.7%]), previously or currently married (1440 [80.6%]), and covered by Medicaid/Medicare (852 [47.7%]) and had a lower income (954 [53.4%]) when compared with patients without CCUs (P < .001 for all). The mean (SD) annual cost of care per patient with CCUs was greater than 4 times that of patients without CCUs ($17 958 [$1031.90] vs $4373.20 [$48.48]). After controlling for Charlson comorbidity index and sociodemographic factors measured in MEPS, the cost of care for patients with CCUs was 1.73 times as high as that of patients without CCUs (95% CI, 1.53-1.96; P < .001), and patients with CCUs were estimated to incur $7582.00 (95% CI, $6201.47-$8800.45) more in annual health care expenditures. When accounting for the prevalence of CCUs (0.6%), CCUs were associated with more than $16.7 billion per year in population-level US health care expenditures. Among patients with CCUs, mean annual expenditures rose from the 2010-2012 to 2013-2015 periods in association with prescription medications ($3117.26 to $6169.12), outpatient care ($3568.06 to $5920.75), and home health care ($1039.54 to $1670.56). Conclusions and Relevance: Results of this study suggest that chronic cutaneous ulcers are associated with substantial incremental increases in annual health care expenditure. Expenses for patients with CCUs are increasing, particularly with regard to outpatient cost of care and prescription medication expenditure. As health care costs rise, investigators must identify strategies to prevent and treat CCUs.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Úlcera Cutânea/economia , Adolescente , Adulto , Idoso , Assistência Ambulatorial/economia , Doença Crônica , Feminino , Hospitalização/economia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medicamentos sob Prescrição/economia , Prevalência , Estudos Retrospectivos , Úlcera Cutânea/epidemiologia , Úlcera Cutânea/terapia , Estados Unidos , Adulto Jovem
15.
Wounds ; 31(3): 81-84, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30830857

RESUMO

INTRODUCTION: Evidence of the role of hyaluronic acid (HA) in the tissue repair process is extensive. Hyaluronic acid produces a positive effect on skin ulcer healing, so many companies produce it in various topical applications. OBJECTIVE: This retrospective, observational study examined the use of different HA-based products in patients with chronic skin ulcers of various etiologies (vascular, scleroderma, postoperative) to assess the indication, effectiveness, and possible adverse reactions. MATERIALS AND METHODS: A retrospective case review was conducted on 79 patients presenting to the Department of Dermatology of the Spedali Civili (Brescia, Italy) with multiple chronic skin ulcers of the legs of various etiologies. The authors counted a total of 106 chronic wounds with granulating appearance but not responsive to common wound dressings; for this reason, these wounds were treated with a HA-based product. The efficacy of the treatment was evaluated by dividing the population into 2 groups: sclerodermic (41 ulcers) and nonsclerodermic (65 ulcers). RESULTS: Initial results confirmed HA-based products were effective for healing chronic skin wounds. However, when wounds are grouped by etiology, it was evident that patients with sclerodermic ulcers showed a rapid inflammatory response that led to a clinical deterioration and worsening of skin ulcers (92.7%). In contrast, patients with noninflammatory ulcers (vascular, postoperative) had the severe inflammatory event reduced to 1.5%, with a recovery of 98.5%. CONCLUSIONS: The negative effects of HA-based products on a patient with scleroderma could be explained by the fact that HA can produce a proinflammatory effect causing keratinocyte migration.


Assuntos
Ácido Hialurônico/efeitos adversos , Inflamação/induzido quimicamente , Escleroderma Sistêmico/patologia , Úlcera Cutânea/patologia , Cicatrização/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Movimento Celular/efeitos dos fármacos , Contraindicações de Medicamentos , Feminino , Humanos , Ácido Hialurônico/farmacologia , Queratinócitos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escleroderma Sistêmico/terapia , Úlcera Cutânea/terapia , Cicatrização/fisiologia
16.
J Cosmet Dermatol ; 18(2): 495-507, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30912259

RESUMO

BACKGROUND: The biological mechanisms underlying the use of platelet-rich plasma (PRP), as well as the efficacy and possible adverse effects of PRP, have not yet been fully elucidated. Prior studies have evaluated PRP for cutaneous ulceration. However, the benefits from PRP still remain controversial and few have assessed the effects of ulceration etiologies. The purpose of our study is to determine the efficacy and safety of PRP and which kind of ulcer is more suitable for PRP by analyzing the effects of PRP on ulcers with different causes. METHODS: A comprehensive search was performed to identify randomized controlled trials (RCTs) regarding the application of PRP from PubMed, EMBASE, Scopus, and the Cochrane Library. The data were analyzed using Review Manager 5.3. RESULTS: A total of nineteen RCTs (909 patients) were included. In contrast with conventional treatments, PRP achieved higher healing rate, higher percentage of area reduction, and smaller final area in vascular ulcers. However, the advantage disappeared in diabetic and pressure ulcers. Concerning adverse events, PRP showed lower incidence in the short term, but higher in the long term. No significant differences were found in ulcer closure velocity and healing time. CONCLUSION: Platelet-rich plasma effectiveness and safety in treating cutaneous ulceration depend on what is the ulceration etiology. For diabetic ulcers, PRP showed no satisfactory results suggesting that PRP may not be suitable for diabetic patients. However, PRP could be efficient and more beneficial for vascular ulcers and effects on pressure ulcers remain unclear. Thus, PRP option should be carefully considered for each patient in accordance with their ulceration etiologies.


Assuntos
Pé Diabético/terapia , Plasma Rico em Plaquetas , Úlcera Cutânea/terapia , Cicatrização , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Úlcera Cutânea/etiologia , Fatores de Tempo , Resultado do Tratamento
18.
J Wound Care ; 28(3): 148-153, 2019 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-30840547

RESUMO

OBJECTIVE: Ischaemia is one of the biggest problems in wound healing. It causes chronic wounds and also prevents normal wound healing because the tissue is oxygen deprived. Most oxygen-supplying therapies are only feasible in a clinical setting, but topical haemoglobin applications, such as Granulox, can be used in a non-clinical setting. For home application, the haemoglobin solution is sprayed topically onto the wound using a pressurised ready-to-use device with a bag-on-valve system. Although this system does not mix product and propellant, the risk of product inhalation by the patient, user or bystanders has to be minimised. This safety study aimed to determine particle size and product concentration in the surroundings after application to determine if there is a risk that product particles enter the respiratory tract. METHODS: Measurements were performed using a laser scattered light photometer and a Scanning Mobility Particle Sizer (SMPS)-Spectrometer at different distances from the measuring devices to determine the inhalation risk for a possible user, patient and bystander. At all measuring points the amount of particles, their size and the formation of dust were measured. RESULTS: No nanoparticles or dust were created during the application of the haemoglobin spray. The concentrations of the measured particles are below the allowed limits defined by Austrian law. CONCLUSION: There is no risk of inhaling nanoparticles or being exposed to harmful concentrations of larger particles of the tested product. All the product's ingredients can be degraded and excreted by the human body through natural pathways.


Assuntos
Hemoglobinas/administração & dosagem , Curativos Oclusivos , Úlcera Cutânea/terapia , Administração Cutânea , Poluentes Atmosféricos , Poeira , Desenho de Equipamento , Hemoglobinas/efeitos adversos , Humanos , Nanopartículas
19.
J Wound Care ; 28(3): 154-161, 2019 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-30840549

RESUMO

Despite the understanding that wounds are a common problem affecting the individual, the health service and society as a whole, there continues to be a lack of a systematic, structured, evidence-based approach to wound management. The TIME principle was first published in 2003, 1 and has since been integrated by many into clinical practice and research. However, this tool has been criticised for its tendency to focus mainly on the wound rather than on the wider issues that the patient is presenting with. At an expert meeting held in London in 2018, this conundrum was addressed and the TIME clinical decision support tool (CDST) was elaborated upon. This article introduces the TIME CDST, explains why it is required and describes how its use is likely to benefit patients, clinicians and health-service organisations. It also explores the framework in detail, and shows why this simple and accessible framework is robust enough to facilitate consistency in the delivery of wound care and better patient outcomes. Finally, it outlines the next steps for the rollout, use and evaluation of the impact of the TIME CDST.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Úlcera Cutânea/terapia , Consenso , Dermatologia , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA