Wound healing is a complex process that started to be fully understood only in recent years. Recent research has been directed to act in the nutrition modulation of the healing process.
InTRODUÇÃOO processo cicatricial é comum a todas as feridas, independentemente do agente que a causou, é sistêmico e dinâmico e está diretamente relacionado às condições gerais do organismo . A cicatrização de feridas consiste em perfeita e coordenada cascata de eventos celulares, moleculares e bioquímicos que interagem para que ocorra a reconstituição tecidual. Os mecanismos da cicatrização em seqüência ordenada de eventos foram descritos por Carrel em 1910 13 , e divididos posteriormente em cinco elementos principais: inflamação, proliferação celular, formação do tecido de granulação, contração e remodelação da ferida 39 . Recentemente, Clark reclassificou esse processo em três fases divididas, didaticamente, em: fase inflamatória, fase de proliferação ou de granulação e fase de remodelação ou de maturação 15 . A lesão tecidual -estímulo inicial para o processo de cicatrização -coloca elementos sangüíneos em contato com o colágeno e outras substâncias da matriz extracelular, provocando degranulação de plaquetas e ativação das cascatas de coagulação e do complemento. Com isso, há liberação de vários mediadores vasoativos e quimiotáticos que conduzem o processo cicatricial mediante atração de células inflamatórias para a região da ferida 61 . ABCDDV/525Campos ACL, Borges-Branco A, Groth AK. Cicatrização de feridas. ABCD Arq Bras Cir Dig 2007;20(1):51-8. RESUMO -Introdução -A cicatrização de feridas consiste em perfeita e coordenada cascata de eventos que culminam com a reconstituição tecidual.O processo cicatricial é comum a todas as feridas, independe do agente que a causou. O processo de cicatrização é dividido didaticamente em três fases: inflamatória, proliferação ou granulação e remodelamento ou maturação. O colágeno é a proteína mais abundante no corpo humano e também é o principal componente da matriz extracelular dos tecidos. Estrutura-se numa rede densa e dinâmica resultante da sua constante deposição e reabsorção. O tecido cicatricial é resultado da interação entre sua síntese, fixação e degradação. Existem várias maneiras de avaliar a cicatrização das feridas. Os métodos mais utilizados atualmente são a tensiometria, a densitometria e morfometria do colágeno, a imunoistoquímica e, mais recentemente, a dosagem de fatores de crescimento. Métodos -Foram revisadas todas as dissertações de mestrado e teses de doutorado realizadas na linha de pesquisa "Cicatrização de órgãos e tecidos" do programa de Pós-Graduação em Clínica Cirúrgica da Universidade Federal do Paraná. Foi realizada, também, revisão atualizada da literatura internacional no Pubmed (www.pubmed.com) e nacional (www.bases.bireme.br). Conclusão -A cicatrização é um processo complexo, que começou a ser entendido em maior amplitude nos últimos anos. Recentes pesquisas têm sido direcionadas para atuar na modulação da cicatrização a nível molecular, na tentativa de evitar completamente cicatrizes patológicas. DESCRITORES -Cicatrização de feridas. MÉTODOSForam revisadas as dissertações de mestrado e teses de doutorado realizadas na linha de pesquisa...
Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites. Due to the enormous intraabdominal pressure secondary to the ascites, umbilical hernia in these patients has a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, such as wound infection, evisceration, ascites drainage, and peritonitis. Intermittent paracentesis, temporary peritoneal dialysis catheter or transjugular intrahepatic portosystemic shunt may be necessary to control ascites. Hernia repair is indicated in patients in whom medical treatment is effective in controlling ascites. Patients who have a good perspective to be transplanted within 3-6 mo, herniorrhaphy should be performed during transplantation. Hernia repair with mesh is associated with lower recurrence rate, but with higher surgical site infection when compared to hernia correction with conventional fascial suture. There is no consensus on the best abdominal wall layer in which the mesh should be placed: Onlay, sublay, or underlay. Many studies have demonstrated several advantages of the laparoscopic umbilical herniorrhaphy in cirrhotic patients compared with open surgical treatment.
Objective: to present recommendations based on the ACERTO Project (Acceleration of Total Post-Operative Recovery) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures. Methods: review of relevant literature from 2006 to 2016, based on a search conducted in the main databases, with the purpose of answering guiding questions previously formulated by specialists, within each theme of this guideline. We preferably used randomized controlled trials, systematic reviews and meta-analyzes but also selected some cohort studies. We contextualized each recommendation-guiding question to determine the quality of the evidence and the strength of this recommendation (GRADE). This material was sent to authors using an open online questionnaire. After receiving the answers, we formalized the consensus for each recommendation of this guideline. Results: the level of evidence and the degree of recommendation for each item is presented in text form, followed by a summary of the evidence found. Conclusion: this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons, the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery. The prescription of these recommendations can accelerate the postoperative recovery of patients submitted to elective general surgery, with decrease in morbidity, length of stay and rehospitalization, and consequently, of costs.
Fixation of the mesh for TEP repair is unnecessary. TEP repair with no mesh fixation is safe and is not associated with increased risk of mesh displacement.
Introduction: Studies suggest that weight loss induced by bariatric surgery and the remission of some comorbidities may be related to changes in the microbiota profile of individuals undergoing this procedure. In addition, there is evidence that manipulation of the intestinal microbiota may prove to be a therapeutic approach against obesity and metabolic diseases. Objective: To verify the changes that occur in the intestinal microbiota of patients undergoing bariatric surgery, and the impact of the usage of probiotics in this population. Methods: Articles published between 2007 and 2017 were searched in Medline, Lilacs and Pubmed with the headings: bariatric surgery, microbiota, microbiome and probiotics, in Portuguese, English and Spanish. Of the 166 articles found, only those studies in adults subjected to either Roux-en-Y gastric bypass or sleeve vertical gastrectomy published in original articles were enrolled. In the end, five studies on the change of intestinal microbiota composition, four on the indirect effects of those changes and three on the probiotics administration on this population were enrolled and characterized. Conclusion: Bariatric surgery provides changes in intestinal microbiota, with a relative increase of the Bacteroidetes and Proteobacteria phyla and reduction of Firmicutes. This is possibly due to changes in the gastro-intestinal flux, coupled with a reduction in acidity, in addition to changes in eating habits. The usage of probiotics seems to reduce the gastro-intestinal symptoms in the post-surgery, favor the increase of vitamin B12 synthesis, as well as potentiate weight loss.
The use of growth factors accelerates healing, stimulates greater angiogenic activity, and accelerates fibroplasia and collagen maturation.
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