Introdução: Atualmente a elevada prevalência de feridas crónicas apresenta-se como um desafio para a prática de enfermagem. Neste sentido, o mel farmacêutico devido às suas diversas propriedades e efeitos terapêuticos nomeadamente antibacterianos, anti-inflamatórios, de desbridamento e de redução do odor da ferida, poderá apresentar-se como uma alternativa viável e versátil no tratamento deste tipo de feridas. É fundamental avaliar as características da ferida e preparar o seu leito, tornando propicia a cicatrização, podendo para isso recorrer-se ao acrónimo TIME. Objetivos: Os objetivos deste trabalho foram: analisar se o mel farmacêutico possui evidência científica suficiente para ser usado no tratamento de feridas crónicas; conhecer os efeitos da aplicação do mel em feridas crónicas; avaliar a eficácia do mel como desbridante autolítico nas feridas crónicas; e promover uma melhor prática de enfermagem baseada na evidência científica disponível. Metodologia: Foi efetuada uma pesquisa em bases de dados científicas online, nomeadamente B-on e EBSCO, com as palavras-chave: "Wound" OR "Wound Healing", AND "Honey" OR "Medical-grade Honey", AND "Nurse" OR "Nursing". Da pesquisa resultaram vários artigos, foram selecionados os que serviam de base orientadora para a análise crítica da temática em estudo, depois de aplicados os seguintes critérios de inclusão: serem elaborados por enfermeiros, ou por uma equipa multidisciplinar que inclua um enfermeiro como autor e terem data de publicação posterior a 2011. Resultados: De um modo geral, o mel quando aplicado em feridas crónicas (úlceras dos membros inferiores, úlceras diabéticas, úlceras de pressão, queimaduras e feridas de utentes com patologia oncológica) originou uma diminuição do odor, da dor, do exsudado, do tamanho da ferida, da contaminação bacteriológica (combatendo inclusive bactérias multirresistentes aos antibióticos) e dos sinais inflamatórios. Quando comparado com outros produtos, promoveu a cicatrização das feridas de um modo mais rápido e favorável. Constatou-se que o mel estimula a formação de tecido de granulação e de epitelização. Neste sentido, o mel mostrou ser capaz de combater os obstáculos que mais se opõem ao processo de cicatrização das feridas crónicas, tais como: tecido desvitalizado ou necrótico, infeção, inflamação, desequilíbrio de humidade no leito da ferida e o ph. Verificou-se que este produto poderá prevenir infeções ou tratá-las em simultâneo com antibióticos, potenciando o seu efeito e diminuindo a possibilidade de aparecimento de resistência à sua ação. Conclusões: Concluiu-se que o mel farmacêutico é adequado para tratar feridas crónicas. Possui inúmeras propriedades, apresentando-se como um produto versátil com efeitos benéficos, independentemente da fase de cicatrização em que a ferida se encontre. Contudo, para alcançar resultados positivos com o seu uso é necessário criar condições que favoreçam a cicatrização, ou seja, a preparação adequada do leito da ferida e eleição do produto à base de mel mais adequado para as características da ferida. Neste sentido, o acrónimo TIME apresenta-se como um instrumento viável que permite uma avaliação e intervenção eficaz no tratamento de feridas.

OBJECTIVES: To evaluate the efficacy of autologous platelet-rich plasma (PRP) gel in the treatment of refractory pressure injuries and its effect on wound healing time and quality of life of patients. METHODS: A random number table method was used to group 102 patients with refractory pressure injuries into either a control group (CG) (51 cases) receiving negative pressure wound therapy (NPWT) or a study group (SG) (51 cases) receiving NPWT+PRP gel. RESULTS: The total efficacy rate in the SG (92.16%) was higher than that in the CG (76.47%) (po0.05). The SG exhibited lower visual analog scale (VAS) scores and pressure ulcer scale for healing (PUSH) scores, smaller wound sizes and depths, and shorter wound healing times than the CG after 21 days of treatment (po0.05). After 6 months of treatment, the SG scored higher than the CG on the psychological, physiological, social functions, and daily activity domains on the World Health Organization Quality of Life (WHOQOL-BREF) scale (po0.05). The incidence of postoperative complications in the SG (13.73%) was not significantly different from that of the CG (7.84%) (p40.05). CONCLUSION: In the treatment of refractory pressure injuries, PRP gel can accelerate wound healing, reduce wound pain, shorten the treatment cycle, regulate tissue inhibitor matrix metalloproteinase-1 (TIMP-1) and matrix metalloproteinase-9 (MMP-9) levels and the expression of specific proteins in granulation tissue, reduce the levels of the inflammatory factors interleukin-1b (IL-1b), IL-8, and tumor necrosis factor-a (TNF-a), and improve the quality of life of patients without increasing complications.

OBJECTIVES: To analyze the histology and histomorphometry of healing associated with acellular dermal matrix in skin wounds in rabbits. METHODS: Twelve male rabbits were divided into two groups: the control group (CG) and the matrix group (MG). Three skin wounds with a total area of 20 20 mm were created on the dorsal region of each animal. Photographic records of the lesions taken over a 21-day period and use of the ImageJ program allowed calculation of the wound contraction rate. The lesions were biopsied on days 3, 14 and 21 for histomorphometric analysis to define the thicknesses of the dermis and epidermis (hematoxylin-eosin) and calculate the densities of type I and type III collagen (picrosirius). RESULTS: No significant difference in the healing rate was found between the groups (p40.05). The MG presented greater epidermal thickness on day 3 (po0.05) and on days 14 and 21 (po0.001). The MG presented greater dermal thickness throughout the study period (po0.05). The type I collagen density was higher in the MG throughout the study period (po0.05), and the type III collagen density was higher in the MG on days 3 and 14 (po0.05) and on day 21 (po0.001). CONCLUSION: The use of acellular dermal matrix increased the thickness of the dermal and epidermal layers and the amount of type I and III collagen during skin wound healing and did not alter the rate of wound contraction.

OBJECTIVES: Negative-pressure wound therapy has been widely adopted to reduce the complexity of treating a broad range of acute and chronic wounds. However, its cost is high. The objective of this study was to evaluate the following two different methods of negative-pressure wound therapy in terms of healing time: a low-cost method of negative-pressure wound therapy (a pressure stabilizer device connected to a hospital wall-vacuum system with a gauze-sealed dressing, USP) and the standard of care (vacuum-assisted closure, VAC). METHODS: This is a randomized, controlled, non-inferiority, unblinded trial. Patients admitted with complex injuries to a trauma center in a public referral hospital who were indicated for orthopedic surgery were randomized to a USP or VAC group. The primary outcome was the time required to achieve a “ready for surgery condition”, which was defined as a wound bed with healthy granulation tissue and without necrosis or purulent secretion. Wound bed area contraction, granulation tissue growth and the direct costs of the dressings were secondary outcomes. RESULTS: Variation in area and granulation tissue growth were essentially the same between the systems, and healing time was equal between the groups (p=0.379). In both systems, serial debridement increased wound area (p=0.934), and granulation tissue was also increased (p=0.408). The mean treatment cost was US$ 15.15 in the USP group and US$ 872.59 in the VAC group. CONCLUSIONS: For treating complex traumatic injuries, USP was non-inferior to and less expensive than VAC.

Patients who have suffered burns frequently experience psychological consequences, among which anxiety disorders are prominent. Benzodiazepines are commonly administered to treat these symptoms. The effects of benzodiazepines on healing may not be direct but rather are modulated by alterations of the sleep architecture. This hypothesis is supported by studies that demonstrate the effects of benzodiazepines on the immune system and the inflammatory profile under both normal sleep conditions and during sleep deprivation, particularly rapid eye movement sleep deprivation.

Objective: Oral ulcers are a lesion in the oral mucosa that impacts chewing or drinking. Epoxyeicosatrienoic Acids (EETs) have enhanced angiogenic, regenerative, anti-inflammatory, and analgesic effects. The present study aims to evaluate the effects of 1-Trifluoromethoxyphenyl-3-(1-Propionylpiperidin-4-yl) Urea (TPPU), a soluble epoxide hydrolase inhibitor for increasing EETs level, on the healing of oral ulcers. Methods: The chemically-induced oral ulcers were established in Sprague Dawley rats. The ulcer area was treated with TPPU to evaluate the healing time and pain threshold of ulcers. The expression of angiogenesis and cell proliferation-related protein in the ulcer area was detected using immunohistochemical staining. The effects of TPPU on migration and angiogenesis capability were measured with scratch assay and tube formation. Results: Compared with the control group, TPPU promoted wound healing of oral ulcers with a shorter healing time, and raised pain thresholds. Immunohistochemical staining showed that TPPU increased the expression of angiogenesis and cell proliferation-related protein with reduced inflammatory cell infiltration in the ulcer area. TPPU enhanced cell migration and tube-forming potential in vitro. Conclusions: The present results support the potential of TPPU with multiple biological effects for the treatment of oral ulcers by targeting soluble epoxide hydrolase.

Dakin's solution (DS) is a time-honoured antiseptic that still remains part of the wound care armamentarium. In spite of its cytotoxicity, some question its use in the current era. We report the case of a 52-year-old diabetic woman who was admitted for sepsis because of a severely infected diabetic foot. Urgent surgical drainage and debridement left a 9 × 9-cm deep, complex, infected wound with both bone and tendon involvement. Treatment with local negative pressure was unsuccessful. DS was regularly instilled through a tube left in the wound dressing. A marked improvement was observed with this strategy as the wound bed was much cleaner and fully granulated after 6 weeks. No adverse effects were noted. This case debunks the myth that topical antiseptics necessarily impair wound healing. DS can still be considered an option for difficult-to-treat, complex and heavily infected wounds.

Objetivo: Analizar la evidencia en la literatura sobre el uso de aceites esenciales para la cicatrización y/o prevención de infecciones en heridas quirúrgicas. Método: Revisión sistemática de acuerdo con el modelo JBI y el PRISMA. Se realizó una búsqueda en las bases de datos CINAHL, LILACS, CENTRAL, EMBASE, PUBMED, Scopus y Web of Science, en el periodo de noviembre/2020, con actualizaciones en diciembre/2021, utilizando descriptores y palabras clave. La calidad de la evidencia se evaluó por la herramienta JBI critical appraisal para ensayos controlados aleatorizados. Resultados: Se incluyeron cinco publicaciones. Tres estudios evaluaron la curación y la presencia de infección tras episiotomía mediante la escala REEDA (Redness-Edema-Ecchimosis-Discharge-Approximation); uno evaluó la curación después de cirugía periodontal utilizando el índice de placa y el índice gingival modificado; y los demás consideraron la presencia de infección posterior a la episiotomía. La mayoría de los estudios utilizaron aceite de lavanda, asociado a otros aceites o no (80%). Dos estudios demostraron mejorar la cicatrización. El resultado infección, aunque mencionado por el 60% de los estudios, no se evaluó como resultado primario. Conclusión: Se verificó la prometedora eficacia de los aceites esenciales, especialmente el de lavanda, en la cicatrización de heridas quirúrgicas, especialmente en episiotomías.

OBJETIVO Evaluar la efectividad del ácido hialurónico en la cicatrización de quemaduras de espesor parcial. MÉTODO Revisión sistemática de ensayos clínicos randomizados acerca de la utilización de ácido hialurónico en el tratamiento tópico de quemaduras de piel, basada en las recomendaciones del Cochrane Handbook for Systematic Reviews of Interventions. RESULTADOS Fueron recuperados de los ensayos clínicos randomizados que analizaron 143 pacientes portadores de quemaduras de espesor parcial y/o espesor parcial profundo, comparando la aplicación de Ácido Hialurónico al 0,2%, asociado con la Sulfadiazina de Plata al 1% 5g/cm2, versus Sulfadiazina de Plata al 1% 5g/cm2 aislada, para el resultado de una cicatrización completa. CONCLUSIÓN Esta revisión subraya la necesidad de nuevos ensayos clínicos randomizados bien planteados para el establecimiento de la relevancia terapéutica del ácido hialurónico en lo que se refiere a la cicatrización de quemaduras de espesor parcial o espesor parcial profundo.

Objetivo: Identificar los principales aspectos a valorar en personas adultas con heridas crónicas. Método: Revisión integrativa de la literatura científica publicada, entre 2010 y principios del año 2015, en las bases de datos PubMed y Web Of Science. Resultados: Existe un número muy limitado de estudios que se centraran exclusivamente en la valoración de las heridas. Sin embargo, se encontraron muchos aspectos a tener en cuenta en la valoración de personas con úlceras. Por lo que, estos aspectos fueron agrupados en: factores que afectaban significativamente a la cicatrización o desarrollo de nuevas heridas (como la edad, el estado nutricional, la capacidad funcional o la presencia de cormobilidades), factores psicosociales y aspectos relacionados con la lesión (localización, tamaño, profundidad, tipo de tejido, tiempo de evolución). Conclusión: En general, no se ha encontrado un aspecto único que se deba contemplar en la valoración de las heridas crónicas, sino una compleja interacción de factores que incluyen tanto aspectos fisiológicos, como sociales y psicológicos. De modo que, los profesionales deben ser conscientes de este enfoque multifactorial; para reconocer tempranamente el desarrollo y la evolución de la úlcera, e intervenir consecuentemente.