Este estudo teve como objetivo realizar uma revisão da literatura sobre os parâmetros de aplicação do ultrassom terapêutico no reparo tecidual do sistema musculoesquelético. Foi realizado um levantamento de dados sobre essa temática nas seguintes bases de dados: MEDLINE, LILACS e SciELO, em línguas portuguesa, inglesa e espanhola, sendo considerados apenas ensaios experimentais realizados em animais, publicados a partir de 2.000 e pesquisados até janeiro de 2.012. Foram encontrados 16 artigos sobre a utilização do ultrassom terapêutico no reparo tecidual, dos quais nove abordaram a lesão tendínea, quatro sobre reparo ósseo, dois verificaram o efeito na lesão muscular e um na lesão nervosa. Os achados desta revisão de literatura sobre as evidências científicas dos efeitos do ultrassom terapêutico no sistema musculoesquelético sugerem que não há padronização quanto à dosimetria adequada para o reparo tecidual deste, pois os artigos disponíveis são insuficientes para comprovar os seus reais efeitos e determinar os parâmetros indicados para este tipo de tratamento.

No abstract

Skin flaps are still a matter of concern among surgeons, as failures can occur leading to flap necrosis. However, low-level laser irradiation has been reported as an effective tool to improve the viability of ischemic flaps, yet its mechanisms of action remain unclear. We investigated the effect of low-level laser irradiation on the viability of random skin flaps in rats and determined COX-2 expression in the flap pedicle. The study animals comprised 24 EPM-1 Wistar rats which were randomly allocated into three equal groups. A cranially based dorsal random skin flap measuring 10 × 4 cm was created in all the animals. In one group, laser irradiation was simulated (sham group), and in the other two groups the animals were irradiated at 12 points with 0.29 J at 20 mW (energy density 10.36 J/cm(2), irradiance 0.71 W/cm(2)), or with 7.3 J at 100 mW (energy density 260.7 J/cm(2), irradiance 3.57 W/cm(2)). These procedures were applied to the cranial half of the flap immediately after surgery and were repeated on days 2 and 5 after surgery. The percentage necrotic area was determined on day 7 after surgery by the paper template method. The immunohistochemical expression of COX-2 in the samples was given scores from 0 to 3. The necrotic area was smaller in group irradiated at 7.3 J compared to sham-treated group and to the group irradiated at 0.29 J (P < 0.05); there was no difference between the sham-treated group and group irradiated at 0.29 J. COX-2 expression was lower in the group irradiated at 7.3 J than in the sham-treated group and the group irradiated at 0.29 J (P < 0.001). Low-level laser therapy was effective in decreasing random skin flap necrosis in rats using a laser energy of 7.30 J per point. Laser irradiation also decreased the expression of COX-2 in the flap pedicle.

L ow-level laser therapy (LLLT) has been investigated as a noninvasive and sterile alternative for improvement of microcirculation and, consequently, increasing the viability of ischemic skin flaps (1-13). It is known as an athermal treatment modality due to the relatively low doses and low powers that are unable to promote any change in tissue temperature.Several studies have demonstrated the efficacy of LLLT in accelerating the healing process, the promotion of analgesia, and an increase in microcirculation and capillarity (5,6,11). Skin flaps may progress to necrosis due to intrinsic and extrinsic factors that compromise local microcirculation (14); LLLT has been used to increase skin flap viability.Several parameters must be considered when applying LLLT. These include wavelength, output power, emission mode, spot size and shape of the beam, irradiance, energy density, irradiation time, application technique, energy per point and total energy delivered to the tissue (9). Although all of these parameters appear to be important in modulating physiological and therapeutic responses, wavelength, energy and application time have been suggested by the World Association for Laser Therapy (WALT) as key factors (15). Both infrared (1,2,4,6,11) and red (5,8-10) lasers have been used to increase skin flap viability. Despite the positive results demonstrated with both types of lasers, some studies suggest that lasers with wavelengths in the red spectrum are more effective at increasing skin flap viability (16). The energy used in previous studies assessing the effects of red lasers in dorsal random skin flaps ranged from 0.06 J to 1.44 J per point (3,9,5,10,12). Energies <0.3 J were ineffective (3,9), whereas energies from 0.3 J to 1.44 J (5,10,12) increased skin flap survival. According to Arndt-Schulz' law, very low doses are ineffective, and intense stimuli may result in negative responses in tissue physiology. It appears that energies from 0.3 J to 1.44 J are in the therapeutic window for improving skin flap survival. Nevertheless, to the best of our knowledge, no studies have demonstrated an inhibitory effect on skin flap survival using higher energies of LLLT. Thus, the present study aimed to test an energy greater than those proven to be effective. Accordingly, the objective of the present study was to investigate the inhibitory effect of LLLT (λ=670 nm) on the viability of random skin flaps in rats when irradiated with 2.79 J of energy at each point. METHODS Study designThe present study was approved by the Ethics and Research Committee of Paulista University (São Paulo, Brazil) under protocol number CEP 008/11.The present analysis was an experimental, interventional, randomized study with a blinded assessor. All animals received humane care in strict compliance with the Ethical Guidelines for Animal Experiments, Council for International Organizations of Medical Sciences, Standards of Brazilian Science Society for Laboratory Animals, and current national legislation on Procedures for the Scientific Use of Anima...

O artigo analisa em amostra de universitários do curso de fisioterapia indicadores éticos ao uso de animais na pesquisa e no ensino e o nível de conhecimento e interesse dos alunos sobre o tema ética animal. Foi distribuído um questionário aos alunos do primeiro e segundo semestres do curso de fisioterapia, cujo preenchimento ocorreu em sala de aula, de forma voluntária. Os dados obtidos foram analisados e posteriormente colocados à discussão de forma descritiva. O questionário foi preenchido por 193 universitários; a maioria dos alunos pesquisados tinha conhecimento prévio sobre o tema ética animal, porém nunca participaram de aulas práticas com uso de animais e afirmam nunca ter pensado sobre a substituição dos animais por métodos alternativos. Os alunos se sensibilizaram quanto ao número de animais utilizados no ensino e nas pesquisas e demonstraram conhecimento a respeito do tema.

RESUMO Objetivo:Investigar o efeito da administração tópica do peptídeo relacionado ao gene da calcitonina (CGRP) por iontoforese na viabilidade de retalho cutâneo randômico em ratos. Métodos: Sessenta ratos Wistar EPM-1, adultos e machos foram submetidos a retalho cutâneo randômico. Os animais foram distribuídos aleatoriamente em quatro grupos. Nos animais do grupo 1 (controle, n=15) realizou-se simulação de estímulo elétrico, no grupo 2 (iontoforese placebo, n=15) os animais foram submetidos à corrente contínua, no grupo 3 (controle de absorção, n=15) os animais receberam simulação de estímulo elétrico com CGRP e, por fim os animais do grupo 4 (tratado, n=15) foram tratados com iontoforese de CGRP. Em todos os grupos estes procedimentos foram realizados imediatamente após a técnica operatória e nos dois dias subsequentes. A porcentagem da área de necrose foi avaliada no sétimo dia de pós-operatório. Resultados: A média das porcentagens das áreas de necrose foram: grupo 1-48%, grupo 2 -51%, grupo 3 -46% e, grupo 4 -28%. A análise estatística, através do teste de Kruskal-Wallis, evidenciou diferença significante (p<0,001). Conclusão: a administração tópica de CGRP por iontoforese é eficaz em aumentar a viabilidade de retalho cutâneo randômico em ratos. Descritores: Receptores Cgrp. Retalhos cirúrgicos. Iontoforese. Ratos. ABSTRACTPurpose: Assess the effect of the local administration of calcitonin gene-related peptide (CGRP) by iontophoresis on the viability of random skin flap in rats. Methods: Sixty Wistar-EPM 1 rats were submitted to dorsal skin flap of cranial base 10 x 4 cm with interposition of a plastic barrier between the skin flap and the donnor site. The animals were randomly distributed in four groups (n = 15 in each group) and were treated as follows: in group 1 (control), animals were submitted to a simulation of electrical current for 20 minutes; group 2, (iontophoresis placebo) animals were submitted to direct current of 4mA amplitude for 20 minutes; group 3 (absorption control) receive simulation of electrical current for 20 minutes with CGRP on one of the electrodes; group 4 (iontophoretically treated) treated by iontophoresis with CGRP. In all groups the procedures were performed immediately after the surgery and the two subsequent days. Results: The percentage of the necrosis area was calculated in all groups on the seventh postoperative day and results were as follows: group 1-48%; group 2 -51%; group 3 -46% and group 4 -28%. The statistical analysis presented significant difference when the comparison of group 4 to the other groups. Conclusion: The topical administration of the CGRP by iontophoresis is efficient to increase the viability of the random skin flap random in rats. Key words: Receptors, Calcitonin Gene-Related Peptide. Surgical Flaps. Iontophoresis. Rats. IntroduçãoA Cirurgia Plástica é uma especialidade que, com freqüência, utiliza-se em seu arsenal terapêutico dos retalhos cutâneos, principalmente nas cirurgias reconstrutoras. Porém, falhas na transferência do retalho podem oco...

Our aim was to assess the effects of magnesium sulphate given by iontophoresis on the viability of random skin flaps in rats. Endovenous magnesium sulphate is used to treat pre-eclampsia and diseases of blood vessels. Iontophoresis is an electrotherapeutic method which has shown satisfactory results in controlling ischaemia within the boundaries of the area in which it was given. Forty-five adult male Wistar rats, weighing 300 to 440 g were randomly divided into three groups of 15 animals each: random skin flap (control); random skin flap treated with magnesium sulphate without electrical stimulation; and random skin flap treated with magnesium sulphate with electrical stimulation of 4 mA for 20 minutes. The treatments were applied immediately after the operation and repeated on the following two days. The percentage of necrotic area was measured on the seventh postoperative day using a paper template. For each group, the mean percentage of flap necrosis was as follows: control, 46%; magnesium sulphate without electrical stimulation, 34%; and magnesium sulphate with electrical stimulation, 42%. There was no significant difference among the groups (p = 0.18). Magnesium sulphate given by iontophoresis does not increase the viability of random skin flaps in rats.

OBJETIVO: Investigar o efeito da administração do cloridrato de hidralazina, por iontoforese, na viabilidade de retalho cutâneo randômico em ratos. MÉTODOS: Sessenta ratos da linhagem Wistar foram distribuídos aleatoriamente em 4 grupos (n=15), estes animais foram submetidos a retalho cutâneo randômico dorsal, de base cranial, com dimensões de 10X4cm. Os animais do grupo 1 foram utilizados como controle, os do grupo 2 foram submetidos a eletroestimulação com corrente direta 4mA-20' imediatamente após a técnica operatória e nos dois dias subseqüentes. No grupo 3 simulação de estímulo elétrico com Cloridrato de Hidralazina. No grupo 4 iontoforese com Cloridrato de Hidralazina 4mA-20'. A análise dos resultados foi realizada no sétimo dia pós-operatório e interpretada com o Teste não paramétrico de Kruskal-Wallis. RESULTADOS: A media da área de necrose foi: grupo 1 = 45%; grupo 2 = 39%; grupo 3 = 46% e grupo 4 = 41%, sendo que a análise estatística não evidenciou diferença significante entre os grupos (p>0,05). CONCLUSÃO: o Cloridrato de Hidralazina, quando administrado por iontoforese, não é eficaz em aumentar a área de viabilidade de retalho cutâneo randômico em ratos.