Viviane Fernandes de Carvalho

Adaptação transcultural do pressure ulcer scale for healing (PUSH) para a língua portuguesa

O objetivo do estudo foi realizar a adaptacao transcultural do Pressure Ulcer Scale for Healing (PUSH) para a lingua portuguesa, atraves da traducao do instrumento para a lingua portuguesa, feita por especialistas bilingues e comite de especialistas, e teste das propriedades de medida: confiabilidade interobservadores e validade convergente. Para tais analises foram utilizados o indice Kappa e os Testes de Fisher e Spearman. Apos aprovacao pelo Comite de Etica da Escola de Enfermagem da Universidade de Sao Paulo, 34 ulceras de pressao foram examinadas. Os resultados obtidos para os indices Kappa (0,90 a 1,0) entre as observacoes dos enfermeiros e estomaterapeutas (padrao-ouro) para todas as subescalas e escore total da escala, bem como a existencia de correlacao positiva e estatisticamente significativa (p<0,001) entre as observacoes relativas a classificacao das ulceras em estagios e escore total da escala, atestaram ambas as propriedades de medida, confirmando a futura utilizacao do PUSH, versao adaptada, em nosso meio.

Limiar de sensibilidade cutânea dos pés em pacientes diabéticos através do pressure specified sensory device: uma avaliação da neuropatia

OBJECTIVES: Neuropathy is a severe progressive loss of protective sensation in the feet, increasing patient vulnerability to mechanical trauma and consequently more prone to development of chronic wounds, major distortion of the foot bone architecture and to eventual limb amputation. Prophylaxis should be enforced to avoid foot ulceration and for this purpose, evaluation of the degree of loss of sensation on the skin is essential. The PSSD (Pressure Specified Sensory DeviceTM) was developed to quantify the threshold of pressure applied to the skin that the patient might recognize as positive. Pressure of one or two points is tested both statically and with movement, thus assessing the function of fast and slow response nerve fibers. METHODS: 33 diabetic patients, type II, with no previous history of wounds on the lower extremity were studied. The tests used were, one point static, one point moving and two points, static and moving on the cutaneous territory of the fibular nerve and posterior tibial nerve (two territories - medial plantar and calcaneous nerves). RESULTS: Altered values were observed for the static and dynamic tests over the three nerve territories studied. Differences were statically significant (p < 0.05). This numeric quantification of the threshold of pressure supports the evaluation of the status of the fiber/receptor structures as well as the functional deficit subsequent to diabetic neuropathy.

Negative pressure therapy (vacuum) for wound bed preparation among diabetic patients: case series

CONTEXT Complications from diabetes mellitus affecting the lower limbs occur in 40 to 70% of such patients. Neuropathy is the main cause of ulceration and may be associated with vascular impairment. The wound evolves with necrosis and infection, and if not properly treated, amputation may be the end result. Surgical treatment is preferred in complex wounds without spontaneous healing. After debridement of the necrotic tissue, the wound bed needs to be prepared to receive a transplant of either a graft or a flap. Dressings can be used to prepare the wound bed, but this usually leads to longer duration of hospitalization. Negative pressure using a vacuum system has been proposed for speeding up the treatment. This paper had the objective of analyzing the effects of this therapy on wound bed preparation among diabetic patients. CASE SERIES Eighty-four diabetic patients with wounds in their lower limbs were studied. A commercially available vacuum system was used for all patients after adequate debridement of necrotic tissues. For 65 patients, skin grafts completed the treatment and for the other 19, skin flaps were used. Wound bed preparation was achieved over an average time of 7.51 days for 65 patients and 10 days for 12 patients, and in only one case was not achieved. CONCLUSIONS This experience suggests that negative pressure therapy may have an important role in wound bed preparation and as part of the treatment for wounds in the lower limbs of diabetic patients.

Clinical trial comparing 3 different wound dressings for the management of partial-thickness skin graft donor sites.

PURPOSE: A review of the literature reveals a lack of consensus regarding local management of skin graft donor sites. This study was undertaken to determine the effects of 3 different dressings on healing of donor sites and patient discomfort related to donor sites. DESIGN: This study is a comparison cohort study. SUBJECTS AND SETTING: We recruited 34 burn patients scheduled for partial-thickness skin grafts; their mean age was 36 ± 18 years (mean ± SD, range 20 to 54 years), and 63% were male. All subjects were managed at Burn Unity Care, located in Sao Paulo, Brazil. MATERIALS AND METHODS: Subjects were randomly allocated to 1 of 3 groups: (1) a study group (group A) whose donor sites were dressed with a bovine collagen calcium-alginate dressing covered with transparent polyurethane film; (2) a second intervention group (group B), whose donor sites were dressed only with transparent polyurethane film dressing; and (3) a control group whose donor sites were dressed with rayon soaked in 0.9% saline (group C). Two independent observers assessed donor site wounds for epithelialization, scabbing, quantity and characteristics of exudate, and complications. Pain was measured using the visual analog scale, the brief pain inventory, and Index of Pain Management. RESULTS: Subjects managed with the bovine collagen calcium-alginate dressing covered with transparent polyurethane film (group A) achieved the greatest epithelialization (6.3 vs 8.2 for thin film dressing only P < .02 and 6.3 vs 11.7 days for control group P < .01). Patients managed with the bovine collagen calcium-alginate dressing covered with transparent polyurethane film also reported less pain that subjects allocated to the control (group C) or thin film only group (group B), (P < .05). Ninety percent of subjects allocated to the calcium alginate covered with thin film dressing reported mild pain intensity on the Visual Analog Scale, 85% of did not report pain localized to the donor site on the brief pain inventory, and scores on the Index of Pain Management ranged from 23 to 11. CONCLUSION: Study findings suggest that use of a collagen calcium-alginate dressing with a transparent film covering reduces the time for complete epithelialization and may reduce pain related to skin graft donor sites.

Intralesional pentoxifylline as an adjuvant treatment for perioral post-burn hypertrophic scars

Pentoxifylline (PTF), a methylxanthine derivative, has therapeutic use as an antifibrotic agent. In vitro, PTF inhibits the production of collagen and reduces the proliferation of fibroblasts in hypertrophic scars. This study aimed to evaluate changes in the elasticity of hypertrophic scars in the peribuccal area in burned patients, who presented with mouth-opening limitation. Eighteen patients were divided into two groups. The case group (n=10) was treated with PTF 1 mg ml(-1), while in the control group (n=8) no treatment was performed. Measurements of mouth opening (lip-to-lip and tooth-to-tooth distances in mm) were taken, before and after five therapeutic sessions with pentoxifylline with weekly intervals. The variations of these measures (Delta%) were calculated and submitted to statistical analyses. There was a significant improvement in the opening of the mouth, in vermilion distance (V=3.20 mm) as much as the dental distance (DD=4.19 mm) in the treated group, than in the control group. It was noted that pentoxifylline increases the elasticity of hypertrophic scars in the perioral area.

Crosscultural adaptation of the pressure ulcer scale for healing to the portuguese language

O objetivo do estudo foi realizar a adaptacao transcultural do Pressure Ulcer Scale for Healing (PUSH) para a lingua portuguesa, atraves da traducao do instrumento para a lingua portuguesa, feita por especialistas bilingues e comite de especialistas, e teste das propriedades de medida: confiabilidade interobservadores e validade convergente. Para tais analises foram utilizados o indice Kappa e os Testes de Fisher e Spearman. Apos aprovacao pelo Comite de Etica da Escola de Enfermagem da Universidade de Sao Paulo, 34 ulceras de pressao foram examinadas. Os resultados obtidos para os indices Kappa (0,90 a 1,0) entre as observacoes dos enfermeiros e estomaterapeutas (padrao-ouro) para todas as subescalas e escore total da escala, bem como a existencia de correlacao positiva e estatisticamente significativa (p<0,001) entre as observacoes relativas a classificacao das ulceras em estagios e escore total da escala, atestaram ambas as propriedades de medida, confirmando a futura utilizacao do PUSH, versao adaptada, em nosso meio.

Estudo comparativo da sensibilidade nos pés de diabéticos com e sem úlceras utilizando o PSSD

INTRODUCTION: To determine and compare thresholds of cutaneous sensitivity of lower extremities in diabetic patients with an ulcer on only one lower extremity. METHODS AND MATERIALS: The study group included 20 patients with mean age of 61.6 and average time with diabetes of 12.4 years. All patients were previously tested using Semmes-Weinstein monofilament 5.07. Sensitivity was evaluated using the two point discrimination test and the PSSD™ (Pressure-Specified Sensory Device) in order to assess touch thresholds in a quantitative manner, in g/mm2. Three skin areas were tested: hallux pulp, dorsum of foot and medial heel, including four tests: 1 point static, 1 point moving, 2 points static and 2 points moving. RESULTS: Mean 2 point discrimination distance in mm was higher in feet with ulcers, but the difference between extremities was only statistically significant for the hallux. With the PSSD™, all patients had higher pressure thresholds in feet with ulcers when compared with feet without ulcers, in all tests, with statistical significance. CONCLUSION: The PSSD™ was able to differentiate levels of sensation between extremities with and without ulcers in diabetic patients, with statistical significance.

Comparative study of Silver Sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis

The aim of this systematic review with meta-analysis was to compare the effect of Silver Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns. The electronic search was carried out in the electronic databases of Pubmed, ScienceDirect, Lilacs and BVS. The articles included were randomized clinical trials about burn treatment with SSD, which evaluated the healing and infection of burn wounds in humans. The exclusion criteria included articles, editorials and letters published in the form of abstracts, unpublished reports and case series, cross-sectional, observational experimental studies, and the use of sulfadiazine for other types of wounds. The search identified 873 references, and 24 studies were included in accordance with the eligibility criteria. The results showed a statistically favorable difference related to the time of healing for silver dressings (p<0.0001; MD 3.83; 95% CI 2.03-5.62) and dressings without silver (p<0.007; MD 2.9; 95% CI 0.81-5.00) in comparison with SSD. The rate of infection showed no difference in the group treated with SSD compared with the group treated with dressings containing silver (p>0.05). The rate of infection was significantly higher in the SSD group compared with the group treated with dressings without silver (p<0.005; MD 25.29% and MD 12.97%). Considering the clinical trials conducted up to the present time, the authors concluded that new dressings with and without silver show better results than SSD for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention.

Establishment of a protocol for storage of refrigerated autologous skin

Introduction: Autologous skin grafts are used for treatment of burn patients. These grafts can be stored and preserved, as long as the storage process is performed with strict quality control to reduce the risk of infection. Methods: A retrospective cohort study was conducted in the Burn Unit of the Hospital das Clínicas de São Paulo from February 2015 to July 2016. During this period, a protocol was established to store refrigerated skin, with control of collection, preservation, and packaging, and recording of all processes. To ensure quality, graft biopsies were collected for preand poststorage microbiology testing and a cross-sectional study for contamination was performed. Results: Critical deficiencies included inadequate packaging, lack of processing records, lack of biopsies for microbiology testing, and failure to discard specimens. Most of the samples were contaminated before and after storage (84.2%). Only two samples were sterile before storage but became contaminated after storage, with growth of Gram-positive skin bacteria. Conclusion: A promising method for the storage of refrigerated skin was established, but requires minor adjustments in quality control. ■ ABSTRACT

Adaptación transcultural del pressure ulcer scale for healing para el idioma portugués

O objetivo do estudo foi realizar a adaptacao transcultural do Pressure Ulcer Scale for Healing (PUSH) para a lingua portuguesa, atraves da traducao do instrumento para a lingua portuguesa, feita por especialistas bilingues e comite de especialistas, e teste das propriedades de medida: confiabilidade interobservadores e validade convergente. Para tais analises foram utilizados o indice Kappa e os Testes de Fisher e Spearman. Apos aprovacao pelo Comite de Etica da Escola de Enfermagem da Universidade de Sao Paulo, 34 ulceras de pressao foram examinadas. Os resultados obtidos para os indices Kappa (0,90 a 1,0) entre as observacoes dos enfermeiros e estomaterapeutas (padrao-ouro) para todas as subescalas e escore total da escala, bem como a existencia de correlacao positiva e estatisticamente significativa (p<0,001) entre as observacoes relativas a classificacao das ulceras em estagios e escore total da escala, atestaram ambas as propriedades de medida, confirmando a futura utilizacao do PUSH, versao adaptada, em nosso meio.