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2.
Medicine (Baltimore) ; 98(45): e17926, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702675

RESUMO

BACKGROUND: This systematic review protocol aims to provide the methods used to evaluate the effectiveness of acupotomy therapy for treating soft tissue disorder comparing to local steroid injection. METHODS: Fifteen databases will be searched from inception to Dec 2019. We will include randomized controlled trials (RCTs) assessing acupotomy for soft tissue disorder. All RCTs on acupotomy or related interventions will be included. Study inclusion, data extraction and quality assessment will be performed independently by two reviewers. Assessment of risk of bias and data synthesis will be performed using RevMan 5.3 software. Cochrane criteria for risk-of-bias will be used to assess the methodological quality of the trials. RESULTS: This study will provide a high-quality synthesis of pain visual analog scale and functional disability or the quality of life, the success treatment rate, the recurrent rate, and the complications rate to assess the effectiveness and safety of acupotomy for soft tissue disorder patients compare to local steroid injection. CONCLUSION: This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with soft tissue disorder. PROSPERO REGISTRATION NUMBER: CRD42018109080.


Assuntos
Terapia por Acupuntura , Dor Musculoesquelética/terapia , Lesões dos Tecidos Moles/terapia , Humanos , Injeções , Esteroides/administração & dosagem , Revisão Sistemática como Assunto
3.
Zhonghua Shao Shang Za Zhi ; 35(9): 683-689, 2019 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594187

RESUMO

Objective: To explore the effects of autologous platelet-rich plasma (PRP) in the repair of soft tissue defects of rabbits with free flap. Methods: Thirty 6-month-old New Zealand white rabbits, male and female unlimited, were used to harvest blood from the heart. PRP was prepared by Aghaloo method, then free flap model with size of 5 cm×3 cm was reproduced on each ear of the rabbit. According to the random number table, one ear of each rabbit was recruited to PRP group, and the other ear was recruited to normal saline group. The base of flap on rabbit ear in PRP group was evenly spread with 1.0 mL autologous PRP, and equivalent volume of normal saline was applied to that in normal saline group. Then, the flap was replanted in situ. On post surgery day (PSD) 2, 3, 5, 7, and 14, 6 rabbits in each group were taken. The survival of flap was observed and recorded. The morphology of the basal tissue of flap was observed by hematoxylin-eosin staining. The expressions of CD31 and α smooth muscle actin (α-SMA) in the basal tissue of flap were detected by immunofluorescence method. Another 6-month-old male New Zealand white rabbit without making flap under the same experimental conditions was used for harvesting whole blood and preparing PRP. Then blood platelet count in whole blood and PRP was determined, and the content of vascular endothelial growth factor (VEGF) and transforming growth factor ß (TGF-ß) was detected by double-antibody sandwich enzyme-linked immunosorbent assay. Data were processed with analysis of variance of factorial design, paired sample t test, and Bonferroni correction. Results: (1) On PSD 2, the flaps of wounds of rabbits in PRP group were reddish and adhered well to the basal tissue; the flaps of wounds of rabbits in normal saline group were dark red and poorly attached to the basal tissue. On PSD 3, the flaps of wounds of rabbits in PRP group were ruddy and closely adhered to the basal tissue; the flaps of wounds of rabbits in normal saline group were scattered in the plaque-like dark red and generally attached to the base. On PSD 5, the flaps of wounds of rabbits in PRP group were reddish and closely adhered to the basal tissue, and the flaps were alive; while flaps of wounds of rabbits in normal saline group were rosy and closely adhered to the basal tissue. On PSD 7, the surface of flaps of wounds of rabbits in PRP group was covered with a medium amount of rabbit hair. The color of flap was similar to that of the surrounding skin. The flaps of wounds of rabbits in normal saline group were generally attached to the base, and the surface was only covered with a small amount of fluff. On PSD 14, the incisions were healed well in PRP group, while small wounds in normal saline group were not healed. (2) On PSD 2, inflammatory cell infiltration was observed in flaps of wounds of rabbits in both groups. On PSD 3, the flaps of wounds of rabbits in PRP group showed neovascularization, with less interstitial hemorrhage; while there were less neovascularization in the flaps of wounds of rabbits in normal saline group. On PSD 5, a medium number of inflammatory cell infiltration and a small amount of new microvessels were observed in flaps of wounds of rabbits in normal saline group. Many fibroblasts, a small amount of inflammatory cells, and scattered new microvessels were observed in flaps of wounds of rabbits in PRP group. On PSD 7, the number of new microvessels in normal saline group was significantly lower than that in PRP group. On PSD 14, the new microvessels in the flaps of wounds of rabbits in PRP group gradually matured, and a large number of fibroblasts distributed around them. Some of the newly formed microvessels in the flaps of wounds of rabbits in normal saline group were mature, and the healing was slower than that of PRP group. (3) On PSD 2, 3, 5, 7, and 14, the expressions of CD31 and α-SMA in the basal tissue of flaps of wounds of rabbits in PRP group were significantly higher than those in normal saline group (t=10.133, 5.444, 9.450, 6.986, 8.394, 14.896, 10.328, 9.295, 13.902, 10.814, P<0.01). (4) The platelet count in activated PRP of rabbits was (2 863±962)×10(9)/L, which was significantly higher than (393±49)×10(9)/L in whole blood (t=7.690, P<0.05). (5) The content of VEGF and TGF-ß in activated PRP of rabbits was (564.3±3.2) and (1 143±251) pg/mL, which was significantly higher than (99.7±0.4) and (274±95) pg/mL in whole blood, respectively (t=287.390, 9.648, P<0.05 or P<0.01). Conclusions: PRP of rabbits contains high concentrations of VEGF and TGF-ß. Therefore, PRP can effectively promote microvascular regeneration in free flap tissue and accelerate the survival of free flap.


Assuntos
Retalhos de Tecido Biológico/transplante , Plasma Rico em Plaquetas , Lesões dos Tecidos Moles/terapia , Cicatrização , Animais , Feminino , Masculino , Coelhos , Fator de Crescimento Transformador beta/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
4.
Folia Histochem Cytobiol ; 57(3): 127-138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489604

RESUMO

INTRODUCTION: Diabetes mellitus (DM) is a serious, chronic metabolic disorder commonly complicated by diabetic foot ulcers with delayed healing. Metformin was found to have a wound healing effect through several mechanisms. The current study investigated the effect of both bone marrow-derived mesenchymal stem cells (BM-MSCs) and metformin, considered alone or combined, on the healing of an experimentally induced cutaneous wound injury in streptozotocin-induced diabetic rats. MATERIAL AND METHODS: Forty adult male albino rats were used. Diabetes was induced by single intravenous (IV) injection of streptozotocin (STZ). Next, two circular full thickness skin wounds were created on the back of the animals, then randomly assigned into 4 groups, ten rats each. BM-MSCs were isolated from albino rats, 8 weeks of age and labeled by PKH26 before intradermal injection into rats of Group III and IV. Groups I (diabetic positive control), II (metformin-treated, 250 mg/kg/d), III (treated with 2×106 BM-MSCs), and IV (wounded rats treated both with metformin and BM-MSCs cells). Healing was assessed 3, 7, 14, and 21 days post wound induction through frequent measuring of wound diameters. Skin biopsies were obtained at the end of the experiment. RESULTS: Gross evaluation of the physical healing of the wounds was done. Skin biopsies from the wound areas were processed for hematoxylin and eosin (H&E), Masson's trichrome staining and immunohistochemical staining for CD31. The results showed better wound healing in the combined therapy group (IV) as compared to monotherapy groups. CONCLUSIONS: Although both metformin and BM-MSCs were effective in the healing of experimentally induced skin wounds in diabetic rats, the combination of both agents appears to be a better synergistic option for the treatment of diabetic wound injuries.


Assuntos
Transplante de Células-Tronco Mesenquimais , Metformina/uso terapêutico , Cicatrização/efeitos dos fármacos , Ferimentos Penetrantes/tratamento farmacológico , Ferimentos Penetrantes/terapia , Animais , Diabetes Mellitus Experimental/induzido quimicamente , Masculino , Células-Tronco Mesenquimais/citologia , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Ratos , Pele/lesões , Pele/patologia , Lesões dos Tecidos Moles/tratamento farmacológico , Lesões dos Tecidos Moles/terapia , Estreptozocina
5.
Plast Reconstr Surg ; 144(3): 759-767, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461042

RESUMO

BACKGROUND: Marko Godina, in his landmark paper in 1986, established the principle of early flap coverage for reconstruction of traumatic lower extremity injuries. The aim of this study was to determine how timing influences outcomes in lower extremity traumatic free flap reconstruction based on Godina's original findings. METHODS: A retrospective review identified 358 soft-tissue free flaps from 1979 to 2016 for below knee trauma performed within 1 year of injury. Patients were stratified based on timing of coverage: 3 days or less (early), 4 to 90 days (delayed), and more than 90 days (late). The delayed group was further divided into two groups: 4 to 9 days and 10 to 90 days. Flap outcomes were examined based on timing of reconstruction. RESULTS: Flaps performed within 3 days after injury compared with between 4 to 90 days had decreased risk of major complications (OR, 0.40, p = 0.04). A receiver operating curve demonstrated day 10 to be the optimal day for predicting flap success. Flaps performed less than or equal to 3 days versus 4 to 9 days had no differences in any flap outcomes. In contrast, flaps performed within 4 to 9 days of injury compared to within 10 to 90 days were associated with significantly lower total flap failure rates (relative risk, 0.29, p = 0.025) and major complications (relative risk, 0.37, p = 0.002). CONCLUSIONS: Early free flap reconstruction performed within 3 days of injury had superior outcomes compared with the delayed (4 to 90 day) group, consistent with Godina's original findings. However, as an update to his paradigm, this ideal early period of reconstruction can be safely extended to within 10 days of injury without an adverse effect on outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Microcirurgia/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/terapia , Tempo para o Tratamento , Adolescente , Adulto , Feminino , Retalhos de Tecido Biológico/transplante , História do Século XX , Humanos , Extremidade Inferior/lesões , Masculino , Microcirurgia/história , Microcirurgia/normas , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/história , Tratamento de Ferimentos com Pressão Negativa/normas , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Reconstrutivos/história , Procedimentos Cirúrgicos Reconstrutivos/normas , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Int J Clin Pract ; 73(11): e13402, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31408240

RESUMO

INTRODUCTION: Platelet-rich plasma (PRP) is a blood component therapy with a supraphysiological concentration of platelets derived from allogenic or, more commonly, autologous blood. PRP has been used in different non-transfusion indications because of its role in the promotion of tissue repair and healing, in fields such as Traumatology, Dermatology and Dentistry. OBJECTIVE: To provide a synthesis of the efficacy of PRP for different clinical situations. METHODS: Systematic searches were carried out in MEDLINE, Embase, Cochrane Library and LILACS in July 2018 to identify systematic reviews (SRs) of randomized clinical trials (RCTs) focusing on PRP for non-transfusion use. Two authors independently screened all retrieved references in two stages (titles and abstracts at a first stage and full texts at a second stage). The methodological quality of SRs that met the eligibility criteria was appraised by AMSTAR 2. Conclusions were based on the most recent SRs with highest quality. RESULTS: One thousand two hundred and forty references were retrieved. After checking the inclusion criteria, 29 SRs of RCTs related to three different fields (wound care, Orthopedics and Dentistry) were included. The results suggest the benefit of PRP for different clinical situations, such as diabetic wounds, acute lesions of musculoskeletal system, rotator cuff lesions, tendinopathies, knee and hip osteoarthritis, total knee arthroplasty, allogenic bone graft for dental implants and periodontal intrabony defects. CONCLUSION: There is low to moderate quality evidence supporting the efficacy of PRP for specific clinical situations. The low quality of the evidence limits the certainty of these findings. Well-planned and well-conducted RCTs are still needed to further assess the efficacy of PRP.


Assuntos
Plasma Rico em Plaquetas , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Osteoartrite do Joelho/terapia , Lesões dos Tecidos Moles/terapia , Cicatrização
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.
Int J Low Extrem Wounds ; 18(3): 317-322, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31258007

RESUMO

Although the importance of vacuum-assisted wound closure therapy has been well established as road to definitive treatment of trauma wound in the adult population, its use in pediatric patients is not well described in the literature. This study was conducted to evaluate the outcome of vacuum-assisted wound closure therapy in pediatric patients. Twenty-two patients were prospectively treated for soft tissue defect in lower limb using vacuum-assisted wound closure device, as these wounds were not amenable for primary closure. After wound evaluation, thorough wound debridement was done. Vacuum-assisted wound closure dressing was applied once hemostasis was achieved. Dressings were changed as per protocol. After the development of healthy granulation tissue, wound coverage was achieved with skin graft or flaps. Mean age of patients was 9.455 years, ranging from 4 to 14 years. Early, healthy granulation tissue had formed in all patients. The average number of vacuum-assisted closure (VAC) dressings required was 2.682. Average duration of VAC therapy was 8.045 days. The sizes of soft tissue defects reduced from an average 69.18 cm2 to 50.73 cm2 after VAC therapy with a mean decrease of 26.66%. There was no complication because of VAC therapy. Vacuum-assisted wound closure therapy accelerated the process of healthy granulation tissue formation, and thus shortened the healing time. VAC therapy lessens the morbidity and pain associated with large wounds in pediatric patients and brings cheer and smile in growing children.


Assuntos
Desbridamento/métodos , Traumatismos da Perna/terapia , Tratamento de Ferimentos com Pressão Negativa/métodos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/terapia , Cicatrização , Bandagens , Criança , Terapia Combinada/métodos , Feminino , Humanos , Índia , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/fisiopatologia , Masculino , Estudos Prospectivos , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/fisiopatologia , Resultado do Tratamento
9.
J Orthop Surg Res ; 14(1): 234, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337441

RESUMO

BACKGROUND: Acute injuries of the hamstring muscle complex (HMC) type 3b (interfascicle/bundle-tear) are frequently observed in various sports disciplines both in elite and recreational sport. The treatment of choice of acute HMC injuries type 3b is a progressive physiotherapeutic exercise programme. Besides this, there is currently only insufficient scientific evidence to support other treatment methods, including local infiltrations and injections of platelet-rich-plasma. Very recently, it was demonstrated that extracorporeal shock wave therapy (ESWT) may accelerate regeneration after acute skeletal muscle injury. The aim of the present study is to test the hypothesis that the combination of radial ESWT (rESWT) and a specific rehabilitation program (RP) is effective and safe in treatment of acute HMC injury type 3b in athletes, and is statistically significantly more effective than the combination of sham-rESWT and RP. METHODS: We will perform a double blind, randomized, sham-controlled clinical trial at the clinic KinEf Kinesiología Deportiva, Ciudad Autónoma de Buenos Aires, Argentina. Forty patients with acute HMC injury type 3b will be randomly allocated to receive either rESWT (nine rESWT sessions; three sessions per week; 2500 radial extracorporeal shock waves (rESWs) per session; energy density depending on what the patient tolerates) or sham-rESWT. In addition, all patients will receive a specific rehabilitation program that will last for 8 weeks. The primary outcome measure will be the individual time (days) necessary to return to play. Secondary outcomes will include the presence or absence of reinjury during a time period of 6 months after inclusion into the study. DISCUSSION: Because of the lack of adequate treatment options for acute HMC injury type 3b in athletes and particularly the high reinjury rate, we hypothesize that the results of this trial will be of importance and have impact on clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03473899 . Registered March 22, 2018.


Assuntos
Atletas , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/reabilitação , Tratamento por Ondas de Choque Extracorpóreas/métodos , Músculos Isquiotibiais/lesões , Adolescente , Adulto , Traumatismos em Atletas/terapia , Terapia Combinada/métodos , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Placebos , Estudos Prospectivos , Lesões dos Tecidos Moles/reabilitação , Lesões dos Tecidos Moles/terapia , Resultado do Tratamento , Adulto Jovem
10.
Zhonghua Shao Shang Za Zhi ; 35(6): 459-463, 2019 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-31280541

RESUMO

Objective: To investigate the significance of intestinal fatty acid binding protein (IFABP) in the evaluation of intestinal barrier dysfunction of mice at the early stage of severe burn injury. Methods: Thirty-six 8-week-old C57BL/6 male mice were collected and divided into normal control group (n=6) and scald group (n=30) according to random number table. Back of each mouse in scald group was placed into hot water of 90 ℃ for 10 s, causing full-thickness scald (hereinafter refer to as burn) of 30% total body surface area, while mice in normal control group were not inflicted with burns. Six mice in normal control group were taken, and 6 mice in scald group at 1, 2, 6, 12, and 24 h post injury were taken respectively. The portal vein blood of each mouse was extracted and the plasma was separated to measure intestinal permeability with fluorescin isothiocyanate-dextran fluorescence probe tracing method and plasma IFABP content by enzyme-linked immunosorbent assay. The distal ileum tissue of mice in normal control group and scald group at each time point post injury was collected to observe the morphology of the intestinal mucosa tissue by hematoxylin-eosin staining. Data were processed with one-way analysis of variance and Student-Newman-Keuls test, and pearson correlation test was used to analyze the correlation between intestinal permeability and plasma IFABP content of burned mice. Results: (1) At 1, 2, 6, 12, and 24 h post injury, the intestinal permeability of mice in scald group was 2.7±0.8, 5.4±2.5, 7.3±4.2, 12.4±6.1, 1.4±0.7, respectively, obviously higher than 1.0±0.4 of normal control group (P<0.05 or P<0.01). The intestinal permeability of mice in scald group showed an increasing trend post injury, reaching the peak at 12 h post injury, and rapidly falling back at 24 h post injury. (2) At 1, 2, 6, 12, and 24 h post injury, the plasma IFABP content of mice in scald group was (64±11), (59±12), (76±18), (111±22), and (66±10) ng/mL, obviously higher than (35±8) ng/mL in normal control group (P<0.05 or P<0.01). The plasma IFABP content of mice in scald group showed an increasing trend post injury, reaching the peak at 12 h post injury, and rapidly decreasing at 24 h post injury. (3) Uniform thickness of mucosa, intact epithelia, regularly arranged villi, and no inflammatory cell infiltration were observed in ileum of mice in normal control group. In ileum of mice in scald group, shortened villi of mucosa with different degrees, edema of lamina propria, and infiltration of neutrophils were observed at 1 and 2 h post injury; obviously damaged and partially exfoliated ileal mucosa, disorderly arranged and broken villi, degenerated and necrotic epithelial cells, dilated central lacteal, and infiltration of lymphocytes and neutrophils were observed at 6 and 12 h post injury; the damage of ileal mucosa was alleviated, and basically intact epithelia, dilated central lacteal, and infiltration of inflammatory cells were observed at 24 h post injury. (4) There was a significantly positive correlation between the intestinal permeability and the plasma IFABP content of burned mice (r=0.841, P<0.05). Conclusions: The plasma IFABP can be used as a good biological indicator for the evaluation of intestinal barrier dysfunction of mice at the early stage of severe burn injury.


Assuntos
Queimaduras/terapia , Proteínas de Ligação a Ácido Graxo/uso terapêutico , Mucosa Intestinal/fisiopatologia , Lesões dos Tecidos Moles/terapia , Animais , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley
11.
Bull Exp Biol Med ; 167(1): 159-163, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31183655

RESUMO

We used rat model of splinted defect of the skin and soft tissues to compare the efficiency f mesenchymal stromal cells applied in sheets or in suspension for the treatment of these injuries. Transplantation of mesenchymal stromal cells significantly accelerated wound healing in comparison with the control. In the group treated by application of mesenchymal stromal cell sheets, the defect was closed by day 28, in the group treated with cell suspension by day 35, and in the control group after 49 days. According to histological analysis of the tissue samples, the formation of the granulation tissue and fibrosis occurred earlier after application of mesenchymal stromal cells. Application of mesenchymal stromal cells in the form of cell sheets demonstrated high efficiency, which allowed us to consider this approach as a promising method of healing of skin and soft tissue injuries.


Assuntos
Células-Tronco Mesenquimais/citologia , Cicatrização/fisiologia , Tecido Adiposo , Animais , Células Cultivadas , Masculino , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/fisiologia , Ratos , Ratos Wistar , Lesões dos Tecidos Moles/terapia , Transplante de Células-Tronco
12.
PLoS One ; 14(5): e0214106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083652

RESUMO

OBJECTIVES: Soft tissue wounds with exposed bone often require extended healing times and can be associated with severe complications. We describe the ability of artificial dermis with autogenic adipose-derived stem cells (ADSCs) to promote the healing of wounds with exposed bone in a rat model. METHODS: Adipose tissues harvested from the bilateral inguinal regions of Wistar rats were used as ADSCs. Rats were randomly divided into control and ADSC groups to investigate the efficacy of ADSC transplantation for wound healing (n = 20 per group). Soft tissue defects were created on the heads of the rats and were covered with artificial dermis with or without the seeded ADSCs. Specimens from these rats were evaluated using digital image analysis, histology, immunohistochemistry, cell labeling, and real-time reverse-transcription polymerase chain reaction (real-time RT-PCR). RESULTS: The average global wound area was significantly smaller in the ADSC group than in the control group on days 3, 7, and 14 after surgery (p<0.05). After 14 days, the blood vessel density in the wound increased by 1.6-fold in the ADSC group compared with that in the control group (p<0.01). Real-time RT-PCR results showed higher Fgfb and Vegf expression levels at all time points, and higher Tgfb1 and Tgfb3 expression levels until 14 days after surgery in the ADSC group than in the control group (p<0.05). CONCLUSIONS: In wounds with exposed bone, autogenic ADSCs can promote vascularization and wound healing. Use of this cell source has multiple benefits, including convenient clinical application and lack of ethical concerns.


Assuntos
Tecido Adiposo/citologia , Transplante de Células-Tronco , Células-Tronco/citologia , Cicatrização , Animais , Biomarcadores , Diferenciação Celular , Proliferação de Células , Modelos Animais de Doenças , Feminino , Imuno-Histoquímica , Ratos , Reação em Cadeia da Polimerase em Tempo Real , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/terapia , Transplante de Células-Tronco/métodos , Células-Tronco/metabolismo , Transplante Autólogo
13.
Int J Low Extrem Wounds ; 18(3): 323-335, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31140339

RESUMO

Tissue regeneration has become a promising strategy for repairing damaged skin tissues. Among the hydrogels for tissue regeneration applications, topical hydrogels have demonstrated great potential for use as 3D-scaffolds in the burn wound healing process. Currently, no report has been published specifically on icariin-loaded polyvinyl alcohol (PVA)/agar hydrogel on full-thickness burn wounds. In the present study, burn tissue regeneration based on biomimetic hydrogel scaffolds was used for repairing damaged extracellular matrix. Furthermore, a skin burn model was developed in rats, and the icariin-loaded PVA/agar hydrogels were implanted into the damaged portions. The regeneration of the damaged tissues with the help of the icariin-loaded hydrogel group exhibited new translucent skin tissues and repaired extracellular matrix, indicating that the hydrogel can enhance the wound healing process. Moreover, characterization studies such as X-ray diffraction, Fourier-transformed infrared spectroscopy, and differential scanning calorimetry reported the extent of compatibility between icariin and its polymers. Results of the field emission scanning electron microscopy images revealed the extent of the spread of icariin within the polymer-based hydrogel. Furthermore, the wound healing potential, confirmed by histopathological and histochemical findings at the end of 21 days, revealed the visual evidence for the biomimetic property of icariin-loaded PVA/agar hydrogel scaffolds with the extracellular matrix for tissue regeneration.


Assuntos
Queimaduras , Flavonoides/farmacologia , Regeneração/efeitos dos fármacos , Lesões dos Tecidos Moles , Cicatrização , Animais , Queimaduras/patologia , Queimaduras/terapia , Varredura Diferencial de Calorimetria/métodos , Medicamentos de Ervas Chinesas , Excipientes/farmacologia , Microscopia Eletrônica de Transmissão e Varredura/métodos , Modelos Animais , Álcool de Polivinil/farmacologia , Ratos , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/patologia , Lesões dos Tecidos Moles/terapia , Tecidos Suporte , Resultado do Tratamento , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologia
14.
Injury ; 50(7): 1376-1381, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31128908

RESUMO

INTRODUCTION: Open lower limb fractures can be devastating with outcomes determined by tissue damage and adherence to strictly defined care pathways. Managing such injuries in paediatric and elderly populations presents logistical and technical challenges to achieve best outcomes. Orthoplastic principles were developed mainly in the young adult population whereas requirements for paediatric and elderly patients need further understanding. METHODS: A retrospective analysis was performed on two groups of patients at the extremes of age, with type IIIb (severe) open lower limb fractures, presenting to a Major Trauma Centre (MTC) with orthoplastic services over a six-year period - the first group being under 16 years; the second group being over 65. The timelines of combined surgery to both fix the fracture and flap the soft-tissue defect were strictly observed. Each group were followed-up for a minimum of nine months. Data were analysed according to patient demographics, mechanism of trauma, time to wound excision, time to definitive surgery, fixation technique, soft-tissue reconstruction type, deep infection rate, flap survival, bony union, secondary amputation and functional outcome (Enneking score). RESULTS: 33 paediatric patients and 99 elderly patients were identified. Paediatric: The median age was 12 years. All the children were ASA Grade I. Open tibial fractures were most common (76%) followed by ankle fracture dislocation (12%). The majority were high-energy injuries and were commonly managed with external fixators (or frames) and free flap coverage. Median hospital stay was 12 days, and time to union 114 days, with median Enneking scores of 85%. There was one flap failure and no deep infections. Elderly: The median age was 76 years. ASA grades varied and reflected multiple comorbidities. High-energy injuries required free flaps, while more common, low-energy fragility fractures were covered with loco-regional flaps. Internal fixation with intramedullary nails was most commonly used. Median hospital stay was 13 days, and time to union was 150 days, with median Enneking scores of 70%. There was one flap failure, one deep infection, and one delayed amputation. DISCUSSION: These results reflect both similarities and important differences in managing open fractures in the extremes of age. The specific challenges of each group of patients are discussed, including surgical aspects, but also the importance of orthoplastics infrastructure within the MTC and input from allied professionals to facilitate patient pathways.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Expostas/terapia , Extremidade Inferior/lesões , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/terapia , Infecção da Ferida Cirúrgica/terapia , Centros de Traumatologia , Adolescente , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Desbridamento , Feminino , Fraturas Expostas/fisiopatologia , Humanos , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Lesões dos Tecidos Moles/fisiopatologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
15.
Eur J Trauma Emerg Surg ; 45(3): 507-515, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30895338

RESUMO

BACKGROUND: Industrial high-pressure fluid injection injuries (IHPFII) are largely occupational in nature, where these injuries are most often sustained by male manual workers. Such traumatic injuries are largely sustained with water, grease, paint, gasoline or paint thinner. IHPFII are extremely serious injuries with life and limb-threatening potential carrying the risk of life-long disability. METHODS: We reviewed the Water Jetting Association© adverse incident database of advisory alerts detailing cases from around the world that have been brought to the association's attention and the English-language literature on high-pressure hydrostatic injuries from 1937 to 2018. RESULTS: Accidents involving high-pressure water jets in the industry are uncommon. The clinical impact in all of the cases reviewed and the effects of water jet impacts range from instant fatalities at scene to loss of limb function and amputation. The majority of observed fatalities are due to major hemorrhage (exsanguination) secondary to the direct dissection of great vessels or high-energy blunt soft tissue injury and traumatic brain injury. CONCLUSIONS: As with any other trauma, IHPWJI commonly result in amputation or death. Nonetheless, a lack of comprehension of the potential severity of injuries and range of infective complications appears to be largely due to the apparent benignity of the initial presentation of the wound. This in turn leads to delays (both avoidable and unavoidable) in the transfer to appropriate medical facilities and definitive care. There is an identifiable need for education (including for health care providers across multiple levels), training and the availability of personal trauma kits for the timely and effective management of IHPWJI from the initial jet impact on the scene, as well as a need for an established referral system.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Exsanguinação/terapia , Pressão Hidrostática/efeitos adversos , Traumatismos Ocupacionais/terapia , Lesões dos Tecidos Moles/terapia , Infecção dos Ferimentos/terapia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Amputação , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/mortalidade , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/terapia , Edema/etiologia , Exsanguinação/etiologia , Exsanguinação/mortalidade , Humanos , Traumatismos Ocupacionais/etiologia , Traumatismos Ocupacionais/mortalidade , Rabdomiólise/etiologia , Rabdomiólise/terapia , Lesões dos Tecidos Moles/etiologia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Infecção dos Ferimentos/etiologia
16.
Eur J Trauma Emerg Surg ; 45(2): 181-189, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30725152

RESUMO

The number of geriatric patients is increasing. These patients exhibit specific characteristics, which influence the type of fracture care. Many patients have comorbidities, which make them more vulnerable to surgical procedures. The soft tissue envelope around the fracture often is compromised due to pre-existing diseases such as diabetes, chronic venous insufficiency or peripheral vascular disease. Bone mineral density has decreased, which enhances the risk of implant loosening. The goals of treatment differ from those, which are valid for younger adults. Primary goal is preserving independency of the elderly patient in his activities of daily life. Advantages and drawbacks of surgical procedures have to be balanced with those of conservative treatment. Fractures of the lower extremities will more often need surgical treatment than fractures of the upper extremities. Patient´s autonomy is best obtained by creating high stability in the fracture plane, which enables motion and weight-bearing. Second priority is prevention of general and local post-operative complications by the use of less invasive surgical procedures. Restoring anatomy and optimal function are less important goals. The implants, which are used, are inserted through small incisions, placed deep under the skin and use long anatomic or osseous corridors. Intramedullary devices have important advantages. This paradigm shift takes the special challenges and requirements of geriatric patients into account.


Assuntos
Tratamento Conservador/estatística & dados numéricos , Fixação Intramedular de Fraturas/estatística & dados numéricos , Geriatria , Fraturas por Osteoporose/terapia , Complicações Pós-Operatórias/fisiopatologia , Lesões dos Tecidos Moles/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Consolidação da Fratura/fisiologia , Geriatria/tendências , Humanos , Fraturas por Osteoporose/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Lesões dos Tecidos Moles/fisiopatologia , Resultado do Tratamento
17.
Can J Rural Med ; 24(1): 7-12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30638191

RESUMO

Introduction: The Canadian island of Newfoundland has a long history of fishing; however, no study to date has developed a regional profile of fishhook injuries on its east coast. Methods: To this end, we conducted a retrospective review of fishhook injuries at all Newfoundland East coast emergency departments from 2013 to 2015. Patient presentations were reviewed for the date of arrival, sex of the patient, location of fishhook injury, tetanus immunisation status, anaesthetic utilisation, diagnostic imaging, antibiotic management and technique of removal. Results: Information was retrieved for 165 patients. Most injuries occurred to the hand (80.6%), and out of five documented techniques, "advance and cut" was the most common extraction method (55.5%). There was a high percentage of prophylactic oral antibiotics prescribed (57%) and X-ray imaging (20%) utilised. Consultation was required for 4.2% of the fishhook injuries including consultation to a local fire department service. Conclusions: On the east coast of Newfoundland, fishhook injuries are addressed inconsistently, with potentially suboptimal methods for removal, coupled with unnecessary imaging and antibiotics. We believe that there is a role for education and other initiatives to improve the care delivered.


Assuntos
Corpos Estranhos/terapia , Recreação , Lesões dos Tecidos Moles/terapia , Ferimentos Penetrantes/terapia , Medicina de Família e Comunidade/métodos , Feminino , Corpos Estranhos/complicações , Humanos , Masculino , Terra Nova e Labrador , Estudos Retrospectivos , Lesões dos Tecidos Moles/complicações , Ferimentos Penetrantes/complicações
18.
Tidsskr Nor Laegeforen ; 139(1)2019 01 15.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-30644680

RESUMO

Background: Knowledge about diagnostics and treatment of chronic Morel-Lavallée lesions is sparse. Material and method: The patient presented is a 65-year-old woman who develops a post-traumatic chronic Morel-Lavallée lesion. The paper describes the course of her treatment including dos and don'ts with reference to literature from a systematic PubMed search. Results and interpretation: The Morel-Lavallée lesion is often missed in the trauma setting during both primary, secondary and tertiary examination, resulting in a chronic lesion. Knowledge of the lesion minimises this risk. The gold standard for diagnosis is magnetic resonance imaging, but ultrasonography may also be used in the acute setting. The chronic lesion can be successfully treated with doxycycline-induced obliteration of the cavity followed by compression treatment for a short period.


Assuntos
Lesões do Quadril , Lesões dos Tecidos Moles , Acidentes por Quedas , Idoso , Feminino , Lesões do Quadril/diagnóstico por imagem , Lesões do Quadril/terapia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/terapia
19.
Chin J Integr Med ; 25(8): 613-616, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30659456

RESUMO

OBJECTIVE: To investigate the immediate analgesic effect of sinew acupuncture for patients with soft-tissue injuries (STIs). METHODS: Two hundreds eligible adult patients suffering from STIs were recruited and received sinew acupuncture with flexible treatment schedules. The number of treatment sessions was pragmatically decided by each patient on the basis of their pain relief. The outcome measurement was the change of pain rating in the Visual Analogue Scale (VAS) during the first 5 sessions. The adverse effect was also observed. RESULTS: Of the 200 patients recruited, 7 were excluded due to incomplete data. In total, 888 sinew acupuncture treatments were administered to patients at 14 injury sites (including head, neck, shoulder, arm, chest, elbow, wrist, hand, waist and hip, knee, thigh, calf, ankle, and foot) where pain was felt. Compared with the baseline, the VAS rating after the first and last treatments were both significantly reduced at all the injury sites (P<0.01). The VAS rating was also significantly reduced after each session of treatment in the first five sessions (P<0.01). No serious adverse effect was observed. CONCLUSION: Sinew acupuncture had not only an immediate analgesic effect for STIs, but also an accumulated analgesic effect during the first 5 treatment sessions.


Assuntos
Terapia por Acupuntura , Analgésicos/farmacologia , Lesões dos Tecidos Moles/terapia , Terapia por Acupuntura/efeitos adversos , Analgésicos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Escala Visual Analógica
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