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      Atualização e sistematização de sequelas em queimaduras Translated title: Updating and systematization of sequelae in burns

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          Abstract

          Resumen Introdução e objectivo Definimos sequela de queimaduras como qualquer condição corporal anormal relacionada ou decorrente de uma queimadura, funcional as que levam a qualquer limitação da função e não-funcional quando ainda existe a sequela, porém não existe limitação da função, antigamente chamada de sequela estética. O presente estudo propõe uma sistematização de raciocínio no tratamento de sequelas de queimaduras de maneira para facilitar e estabelecer uma padronização do atendimento e da programação cirúrgica dos pacientes. Material e métodos Estudo realizado no ambulatório de sequelas de queimaduras do hospital das clínicas da Faculdade de Medicina da Universidade de São Paulo (Brasil). Foram tratados 640 pacientes e geraram esta sistematização do atendimento de pacientes com sequelas de queimaduras. Resultados Em razão da dificuldade no tratamento das sequelas de queimaduras desenvolvemos um algoritmo onde se tornasse fácil o ensino dos conceitos e do raciocínio lógico. A padronização dos procedimentos e das condutas tornou o atendimento de sequelas de queimaduras reprodutível, de fácil compreensão por parte dos cirurgiões plásticos e ainda melhoraram os resultados. Desta maneira, acreditamos que a formação acadêmica se torna mais fácil e efetiva. Conclusões O raciocínio médico padronizado é os algoritmos são uma arma poderosa e métodos auxiliares simples e eficazes na obtenção de resultados consistentes na prática diária da medicina.

          Translated abstract

          Abstract Background and objective We define burn sequelae as any abnormal body condition related to or resulting from a burn, functional when lead to any limitation of function and non-functional when the sequel still exists but there is no limitation of function, formerly called aesthetic sequelae. The present study proposes a systematization of reasoning in the treatment of burn sequelae in order to facilitate and establish a standardization of care and of the surgical schedule of patients. Methods We conduct a study in the burn sequelae outpatient clinic of the Hospital das Clinicas at the Faculty of Medicine of the University of São Paulo (Brazil), treating 640 patients and generating a systematization of care for patients with burn sequelae. Results Due to the difficulty in treating burn sequelae, we developed an algorithm where the teaching of concepts and logical reasoning became easy. The standardization of procedures made the treatment of burn sequelae reproducible, easy to understand by plastic surgeons and even improving the results. In this way, we believe that academic training becomes easier and more effective. Conclusions Standardized medical reasoning and algorithms are a powerful weapon and simple and effective auxiliary methods to obtain consistent results in the daily practice of medicine.

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          Most cited references14

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          Prevention and management of hypertrophic scars and keloids after burns in children.

          Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.
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            Comprehensive treatment of burns.

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              Current concepts in the development of cultured skin replacements.

              Current tissue-culture techniques permit the rapid expansion of keratinocyte populations, such that an area of cultured epithelium equivalent to that of the surface of an adult can be obtained from an initial small skin biopsy. Unfortunately, technical obstacles have delayed the widespread clinical use of multilayered sheets of epithelium. These factors include difficulties in preparing and transferring fragile cultured epithelial sheets, as well as frequent unsatisfactory "take" of cultured grafts on the wound bed. As greater understanding of the complex interactions of cells and matrix evolves, so have new techniques in the field of cultured keratinocytes for grafting. We have utilized an animal model that allows us to examine some of these new methods and the factors which influence graft take. It has become clear that adhesion properties of keratinocytes, early delivery of proliferative keratinocytes to the wound, the development of dermal replacements, and improved delivery systems for keratinocytes are important factors which must be considered for the optimal provision of skin replacements.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                2020
                : 46
                : suppl 1
                : 97-106
                Affiliations
                [2] orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina orgdiv2Divisão de Cirurgia Plástica e Queimaduras Hospital das Clínicas Brazil
                [1] orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina orgdiv2Divisão de Cirurgia Plástica e Queimaduras Hospital das Clínicas Brazil
                Article
                S0376-78922020000200016 S0376-7892(20)04600000016
                10.4321/s0376-78922020000200016
                4690ff61-9721-497c-9f45-6546186d1275

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 04 February 2020
                : 26 September 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 10
                Product

                SciELO Spain

                Categories
                Quemados

                Tratamento sequelas queimaduras,Sequelae burns,Queimaduras,Sequelas queimaduras,Burns,Sequelae burns treatment

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