Functional independence in teenage patients with burns.

The purpose of this study was to assess the functional independence of teenagers undergoing a process of rehabilitation. A cross-sectional study was carried out on a sample of 63 teenagers, aged 12 to 20, who had suffered burns and were going through a process of rehabilitation, with the application of the Functional Independence Measurement (FIM). The data was analysed using descriptive statistics and also a test for comparison of means (Student's t-test), as well as Cronbach's reliability test. There was proof of a high degree of independence in FIM. Analysis of the location of the burn and also the performance of work and/or study activities showed these not to interfere with functional independence. The results indicate the reliability of the instruments applied, making it possible to conduct an assessment of the functional independence of the teenagers during the rehabilitation process.

Evaluation of Radiosterilized Glyercerolated Amniotic Membranes as a Substrate for Cultured Human Epithelial Cells.

Human amniotic membrane (HAM) is a biomaterial with biological properties beneficial to tissue repair, serving as a substrate for cell cultivation. Irradiation is used for tissue sterilization, but can damage the HAM structure. The objective of this paper was to construct a skin substitute, composed of human keratinocytes cultured on glycerolated HAMs, and to evaluate the influence radiation on subsequent cell culture growth. Four batches of HAMs were glycerolated, and half of them were radio-sterilzed with 25 kGy. Non-irradiated glycerolated HAM (ni-HAM) and irradiated glycerolated HAM (i-HAM) samples were then de-epithelized and analyzed using optical microscopy (Picrossirius staining), immunofluorescence and electron microscopy. Subsequently, keratinocytes were cultured on ni- and i-HAMs, and either immersed or positioned at the air-liquid interface. The basement membranes of the ni-HAM group remained intact following de-epithelialization, whereas the i-HAM group displayed no evidence or remnant presence of these membranes. Concerning the keratinocyte cultures, the ni-HAM substrate promoted the growth of multi-layered and differentiated epithelia. Keratinocytes cultured on i-HAM formed epithelium composed of three layers of stratification and discrete cell differentiation. The glycerolated HAM was compatible with cultured epithelia, demonstrating its potential as a skin substitute. Irradiation at 25 kGy caused structural damage to the amnion.

Is allograft skin, the gold-standard for burn skin substitute? A systematic literature review and meta-analysis.

BACKGROUND: Allograft skin (AS) transplantation has been considered to be the gold standard for replacing tissue damage, following burns. However, increasingly new biosynthetic skin substitutes are being developed as alternatives. The objective of this systematic review is to compare AS with other skin substitutes, which have been used in the treatment of burns. METHODS: Randomized clinical trial (RCT) and nonrandomized clinical trial (NRCT) studies comparing AS to any other skin substitute in the treatment of burns were extracted from PubMed/Medline, Scopus, EMBASE, and Web of Science. For the risk of bias analysis, the Cochrane bias risk handbook was used for RCT studies and ROBINS-1 was used for NRCT studies. Outcomes such as healing, self-grafting, scar appearance, and mortality were evaluated. RESULTS: Twelve RCT and six NRCT were selected, with most of the methodologies presenting a high risk of bias. Based on the outcomes of the studies, it was not possible to detect any advantages for using AS, as opposed to other skin substitutes. In the meta-analysis, only two outcomes could be evaluated: healing and graft take percentage; however, no significant differences were observed between the groups. CONCLUSION: Because of the poor quality of the primary studies, it was not possible to identify differences in the results that compared the use of AS with other substitutes in the treatment of patients with burns. These results support the fact that surgeons primarily base the choice of skin substitute on clinical experience and cost, at least when treating burns.

Evaluation of the body image of patients with facial palsy before and after the application of botulinum toxin.

BACKGROUND: The face is responsible for nonverbal communication. Facial nerve paralysis, which is the weakness or paralysis of the nerve responsible for the innervation of the muscles that perform these movements, is a condition that can raise serious physical, psychological, social, professional, aesthetic, and functional disorders. The physical aspect has a disastrous effect on the patient's self-image and emotional state. This study aimed to evaluate the self-image of patients with facial paralysis through the Body Image Quality Life Index (BIQLI), pre- and postclinical treatment with botulinum toxin. METHOD: A prospective, exploratory, comparative cohort was carried out, with quantitative analysis of the variables with 40 patients with facial paralysis treated by the Ambulatory of Plastic Surgery of Hospital das Clínicas, Faculty of Medicine, University of São Paulo. The Sociodemographic and clinical instrument and the BIQLI were applied. Descriptive statistics and statistical inference were used to perform the analyses. RESULTS: It was found that the majority of the paralysis occurred in female individuals (55%), with an average age of 47,875 (DP), single and married (38.88%), and with secondary education completed (16.66%). CONCLUSION: The body image evaluation of patients with facial paralysis submitted to the botulinum toxin treatment showed an ability to identify the positive impact of therapy in the period between 15 and 180 days by the BIQLI.

Massive localized lymphedema (MLL) in bariatric candidates.

BACKGROUND: Mild lymphedema of lower limbs and eventually abdomen is not exceedingly rare in morbid obesity. However, few large symptomatic masses have been reported. In a consecutive series of patients, all requiring resection of the lesion before bariatric treatment, clinical features and surgical findings are described, aiming to clarify the nature of this intricate problem. METHODS: Subjects (n=4, 50% females, age 34.0+/-13.7 years (19-53), BMI 56.4+/-10.5 kg/m(2) (44.1-73.1) displayed lesions on the anteromedial aspect of the thigh (n=3) and hypogastrium (n=1). All reported episodes of intertrigo of local skin-folds in the preceding years, managed by local care and antibiotics. The mass was described as a serious nuisance, impairing walking, dressing and personal hygiene. RESULTS: The mass was surgically removed without requirement for blood transfusion except in the case of one huge mass. Complications were relatively minor and consisted of partial skin dehiscence and lymph leakage for 2-3 weeks. Histologically, a complex pattern was observed including skin hypertrophy, edema, fibrosis, foci of microabscesses and dilated blood vessels, along with the pathognomonic lymphangiectasia. On follow-up to 6 months, improvement or restoration of the ability to walk occurred, with no additional skin infection and no recurrence. CONCLUSIONS: 1) Surgical treatment was effective. 2) Functional rehabilitation was achieved. 3) No recurrence was observed within the follow-up period.

Construção de substituto da pele composto por matriz de colágeno porcino povoada por fibroblastos dérmicos e queratinócitos humanos: avaliação histológica / Construction of a skin substitute composed of porcine collagen matrix populated with human dermal fibroblasts and keratinocytes: histological evaluation", "_e": "n

INTRODUÇÃO: O uso de enxertos autólogos é limitado pela extensão da área doadora e pelo estado clínico dos pacientes, no caso de lesões extensas. Alotransplantes coletados de cadáveres ou voluntários são rejeitados após uma ou duas semanas, servindo apenas como cobertura temporária para essas lesões. O tratamento de grandes lesões cutâneas com tegumento autólogo reconstruído constitui alternativa atraente, já que, a partir de um pequeno fragmento de pele do paciente, pode-se obter culturas de células que se multiplicam rapidamente e podem ser criopreservadas, permitindo, assim, sua utilização em novos tratamentos por tempo indeterminado. Este estudo pretendeu avaliar o comportamento histológico de queratinócitos e fibroblastos humanos cultivados sobre uma matriz de colágeno porcino derivada da submucosa intestinal. MÉTODO: Células da epiderme e derme humana foram cultivadas separadamente e semeadas sobre matriz de colágeno porcino, onde permaneceram em ambiente controlado por 21 dias, antes de serem submetidas a análise histológica. RESULTADOS: Observou-se que os fibroblastos invadem e colonizam a matriz de colágeno, enquanto os queratinócitos se organizam de forma laminar e estratificada sobre a superfície em que foram semeados. CONCLUSÕES: A utilização da matriz de colágeno porcino como carreador de células da pele humana é possível e a organização dessas células se assemelha à arquitetura da pele humana.

BACKGROUND: In the case of extensive lesions, the use of autologous grafts is limited by the extent of the donor area and the clinical condition of patients. Allografts collected from cadavers or volunteers are usually rejected after 1 to 2 weeks, thus serving only as temporary cover for these lesions. Treating major cutaneous lesions with reconstructed autologous skin is an attractive alternative, because it is possible to obtain cultures of cells that multiply rapidly and can be cryopreserved from a small fragment of the patient's skin, thereby facilitating its indefinite use in new treatments. This study evaluated the histological behavior of cultured human keratinocytes and fibroblasts on a collagen matrix derived from porcine small intestinal submucosa. METHODS: Cells from human epidermis and dermis were grown separately and seeded on porcine collagen matrix, which was maintained in a controlled environment for 21 days before being subjected to histological analysis. RESULTS: Fibroblasts invaded and colonized the collagen matrix, whereas keratinocytes were organized in laminated and stratified layers on the surface on which they were seeded. CONCLUSIONS: The use of porcine collagen matrix as a support for human skin cells is feasible, and the organization of these cells resembles the architecture of human skin.