Yes / This paper demonstrates a non-Fourier prediction methodology of triple-layer human skin tissue for determining skin burn injury with non-ideal properties of tissue, metabolism and blood perfusion. The dual-phase lag (DPL) bioheat model is employed and solved using joint integral transform (JIT) through Laplace and Fourier transforms methods. Parametric studies on the effects of skin tissue properties, initial temperature, blood perfusion rate and heat transfer parameters for the thermal response and exposure time of the layers of the skin tissue are carried out. The study demonstrates that the initial tissue temperature, the thermal conductivity of the epidermis and dermis, relaxation time, thermalisation time and convective heat transfer coefficient are critical parameters to examine skin burn injury threshold. The study also shows that thermal conductivity and the blood perfusion rate exhibits negligible effects on the burn injury threshold. The objective of the present study is to support the accurate quantification and assessment of skin burn injury for reliable experimentation, design and optimisation of thermal therapy delivery.

Burn injuries are a common presentation to the accident and emergency department in the UK and account for a significant cost to the NHS. The accurate assessment of these injuries by determining area and depth can ensure the patient receives the most appropriate treatment. If these assessments are incorrect, it can result in inadequate treatment or unnecessary transfer to specialists' centres causing distress to the patient and a significant cost to the NHS. The accuracy of the initial assessment can vary depending on the experience of the assessor. This study explores if machine learning methods can aid in a more accurate diagnosis of these burn injuries which may in future help to develop models that can be used in clinical practise to aid clinicians. The initial stage will assess how accurately specialists can assess burn injuries compared to a true calculated body surface area. The second stage will assess if a new model can be created to determine the difference between images of normal skin and a burn injury. This will be through a deep learning approach. The third stage will assess if a model can be created to determine the difference between full thickness burns, partial thickness burns and normal skin. Finally, we will determine if a code can be created to extract the burn from an image of burn and normal skin. Initial results have shown that specialist burn surgeons have a tendency to overestimate burns. We have also been able to develop a model that is able to accurately place a burn into the correct category 97% of the time when compared to images of normal skin. / Plastic Surgery and Burns Research Unit (PSBRU)

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: Pressure garment therapy (PGT) forms a significant part of burn rehabilitation. It is most commonly used to treat hypertrophic scars but the benefits of this intervention remain questionable. Adherence with this intervention also presents several challenges for the patient and clinician. Aim of the study: The aim of this study was to explore the experiences of adult burn survivors who participated in PGT during 2006 - 2010 at Tygerberg Academic Hospital (TAH). Methods: A phenomenological study design using qualitative research methods was implemented. Semi-structured interviews were conducted with eight burn survivors. The participants were chosen using purposive sampling methods. Thematic analysis was conducted using pre-determined themes from the literature as a starting point. Data was coded and categorised according to themes that emerged during data analysis. Results: The findings of the study revealed that several factors impacted on the participant’s experiences of pressure garment therapy. Factors related to the consequences of the burn injury included the participant’s loss of function, loss of participation, loss of self-confidence, financial dependence, emotional impact and impact on relationships. Factors related to pressure garment usage included physical effects, socio-emotional effects and the wearing schedule (which included maintenance and effort, adherence and time). Factors that contributed to adherence included support, inner strengths, knowledge, seeing a difference, seeing others, enablers to accessing the service and satisfaction with the service. Factors that contributed to non-adherence included lack of support, emotional turmoil and barriers to accessing the service. Participants made recommendations to improve the overall burn service at TAH. Conclusion: The findings of the study show that participants experienced PGT as a beneficial intervention. There were several complex factors that impacted the participants’ experiences of PGT. The most significant benefit as described by the participants was the improvements noted in scar appearance, whilst the main barrier was that the garments were cosmetically displeasing due to their colour.Recommendations: To adopt a person-centred approach to burn management, recommendations made include improvements needed within the occupational therapy service such as changing the colour of the garment material, the standardisation of the PGT treatment protocols and improving staff attitudes. Other recommendations include establishing a network for counselling services as well as an information pack for patients admitted to the burns unit. / AFRIKAANSE OPSOMMING: Drukklereterapie vorm ʼn belangrike deel van die rehabilitasie van brandwonde. Dit is die mees algemene behandeling vir hipertrofiese littekens, maar daar bestaan steeds twyfel aangaande die voordele van hierdie intervensie. Daar bestaan heelwat uitdagings, vir beide die terapeut en die pasiënt, om die behandelingsriglyne na te volg. Doel van die studie: Die doel van hierdie studie was om die ervarings van volwasse brandwond oorlewendes wat vanaf 2006 tot 2010 drukklereterapie by Tygerberg Akademiese Hospitaal ontvang het, te ondersoek. Metode: ʼn Fenomenologiese studie ontwerp is geimplïmenteer deur middel van kwalitatiewe navorsingsmetodes. Semi-gestruktureerde onderhoude is met agt brandwond oorlewendes gevoer. Die deelnemers is gekies deur doelgerigte steekproefneming metodes. Tematiese analise is uitgevoer met behulp van voorafbepaalde temas wat as beginpunt uit die literatuur geneem is. Data is gekodeer en gekategoriseer volgens temas wat na vore gekom het tydens data analise. Resultate: Die bevindings van die studie het aangedui dat verskeie faktore die deelnemers se ervarings van drukklereterapie beïnvloed het. Faktore wat met die gevolge van die brand beserings verband hou het die volgende ingesluit: verlies aan funksie, verlies aan deelname, verlies aan selfvertroue, finansiële afhanklikheid, emosionele impak en die impak op verhoudings. Die volgende faktore het verband gehou met die gebruik van drukklere: fisiese faktore, sosio-emosionele faktore en die dra skedule (dit sluit in onderhoud van die drukklere, moeite, volg van die dra skedule en tyd). Faktore wat bygedra het tot die navolging van die skedule het die volgende ingesluit: ondersteuning, innerlike krag, kennis, die sien van ʼn verskil, sien van ander, toegang tot die diens en tevredenheid met die diens. Die volgende faktore het bygedra tot nie-navolging: gebrek aan ondersteunning, emosionele verwarring en hindernisse tot toegang tot die diens. Deelnemers het aanbevelings gemaak om die brandwonde diens te verbeter. Slot: Die bevindings van die studie dui daarop dat die deelnemers drukklereterapie as ʼn voordelige intervensie ervaar het. Daar was verskeie komplekse faktore wat ʼn impak op drukklereterapie gehad het. Die grootste voordeel, soos beskryf deur deelnemers, was die verbetering in litteken voorkoms; terwyl die hoof hindernis was dat die drukklere kosmeties onaanvaarbaar was as gevolg van die kleur. Aanbevelings: Die volgende aanbevelings is gemaak om ʼn persoon-gesentreerde benadering tot brandwond behandeling te verseker: verbeterings benodig binne die arbeidsterapie diens, soos die verandering van die kleur van drukkleremateriaal, die standaardisering van drukklereterapie protokolle en die verbetering van personeel houdings. Ander aanbevelings sluit in ʼn netwerk vir beradingsdienste, sowel as ʼn inligtingspakket vir pasiente wat tot die brandwondeenheid toegelaat word.

Burn injuries are a significant global health concern, causing high mortality and morbidity rates. Clinical assessment is the current standard for diagnosing burn injuries, but it suffers from interobserver variability and is not suitable for intermediate burn depths. To address these challenges, machine learning-based techniques were proposed to evaluate burn wounds in a thesis. The study utilized image-based networks to analyze two medical image databases of burn injuries from Caucasian and Black-African cohorts. The deep learning-based model, called BurnsNet, was developed and used for real-time processing, achieving high accuracy rates in discriminating between different burn depths and pressure ulcer wounds. The multiracial data representation approach was also used to address data representation bias in burn analysis, resulting in promising performance. The ML approach proved its objectivity and cost-effectiveness in assessing burn depths, providing an effective adjunct for clinical assessment. The study's findings suggest that the use of machine learning-based techniques can reduce the workflow burden for burn surgeons and significantly reduce errors in burn diagnosis. It also highlights the potential of automation to improve burn care and enhance patients' quality of life. / Petroleum Technology Development Fund (PTDF); Gombe State University study fellowship

Summaries in Afrikaans and English / A primary school child finds him or herself in the middle childhood years and it is considered to be a rich phase of life, since children have already reached important milestones. These children have the ability not only to act with empathy but also to maintain independent behaviour. As a result of the development in the cognitive and moral stage of development, these children can also distinguish between right and wrong and they show insight that social rules can be changed. As a result of this development, it is believed that this child will accept learners with different skills more confidently when the required awareness is provided. One group of learners with special skills, which I focused on during this research, are those who have been deformed by burn wounds. Statistics show that a growing number of children in South Africa are deformed by burn wounds. As a result of the changing policy on inclusive education, these children cannot be denied into the mainstream education system because of deformity or disability anymore. It is therefore believed that an increasing number of deformed or disabled children will be entering the mainstream education system. Information is gathered through various methods by using triangulation. The literature study, semi-structured interviews with children as well as teachers for experimental subjects, who completed an incomplete sentence test and open questions, added valuable information. Research indicated that children in this phase of life are indeed equipped with certain life skills, which place them in a privileged position to handle interaction with the deformed child, if they receive the required awareness. The information also indicated that the gestalt approach could be used as theoretical perspective for the compilation of the guideline. This approach recognises that play is the child's natural communication medium but also recognises that awareness is created through means of experimentation. To my knowledge, there is no program or guideline from the gestalt approach that enables education staff to address children's awareness in respect of their inherent skills in the middle childhood years. The researcher made a breakthrough in the integration of the gestalt approach with the education environment by constructing a practical guideline from the gestalt approach for education staff. Education staff should, however, receive training with regards to the gestalt approach in order to use this guideline effectively. / Laerskoolkind bevind hom- of haarself in die middelkinderjare en dit word as ryk lewensfase beskou, aangesien kinders reeds belangrike mylpale bereik het. Hierdie kinders beskik oor die vermoe om nie slegs empaties op te tree nie, maar om ook selfstandige gedrag te handhaaf. As gevolg van die ontwikkeling in die kognitiewe en morele ontwikkelingsterrein, kan hulle ook tussen reg en verkeerd onderskei en toon hulle insig dat sosiale reels verander kan word. As gevolg van hierdie ontwikkeling word daar verwag dat hierdie kind met die nodige bewusmaking, leerders wat oor verskillende bekwaamhede beskik, met meer selfvertroue sal kan aanvaar. Een groep leerders, waarop daar tydens hierdie navorsing gefokus sal word, wat oor spesiale bekwaamheid beskik, is diegene wat deur brandwonde geskend is. Statistieke toon dat toenemende aantal kinders jaarliks in Suid-Afrika, weens brandwonde geskend word. As gevolg van die veranderende beleid op insluitende onderwys, kan kinders weens geskend- of gestremdheid nie meer tot die hoofstroomonderwysstelsel geweier word nie. Die verwagting is dus dat toenemende aantal geskende of gestremde kinders die hoofstroomonderwysstelsel sal betree. Inligting is deur verskeie metodes ingesamel deur die benutting van triangulering. Die literatuurstudie, semi-gestruktureerde onderhoude met kinders asook onderwysers as proefpersone wat 'n onvoltooide sinnetoets en oop vrae voltooi het, het bruikbare inligting tot gevolg gehad. Daar is gevind dat kinders in hierdie lewensfase wei oor bepaalde lewensvaardighede beskik, wat hulle in 'n bevoorregte posisie plaas om, indien hulle die nodige bewusmaking ontvang, interaksie met die geskende kind sal kan behartig. Die inligting het verder ook daarop gedui dat die gestaltspelbenadering as teoretiese perspektief vir die samestelling van die riglyn benut kan word. Hierdie benadering erken dat spel die kind se natuurlike kommunikasiemedium is, maar ook dat bewuswording geskied deur middel van eksperimentasie. Sover bekend is daar geen program of riglyn vanuit die gestaltbenadering, wat opvoedkundige personeel in staat stel om kinders in die middelkinderjare se bewustheid ten opsigte van hulle inherente vaardighede aan te spreek nie. Die navorser het 'n deurbraak in die integrering van die gestaltbenadering met die opvoedkundige omgewing gemaak deurdat 'n praktiese riglyn vanuit die gestaltspelbenadering vir opvoedkundige personeel saamgestel is. Opvoedkundige personeel behoort egter opleiding met betrekking tot die gestaltspelbenadering te ontvang ten einde hierdie riglyn effektief te kan benut. / Social Work / M. Diac. (Play Therapy)

L’hypoalbuminémie est une trouvaille fréquente chez le patient brulé mais sa relation avec la morbidité et mortalité n’a pas été bien établie. Objectif : Déterminer si l’hypoalbuminémie dans les premières 24 heures suivant l’admission est associée avec la dysfonction d’organes (mesurée avec le score SOFA) chez les patients présentant des brûlures graves. Méthodologie : Nous avons révisé les dossiers médicaux des patients adultes avec de brûlures de 20% ou plus de surface corporelle admis pendant les premières 24 heures à l’unité de grands brulés du CHUM entre les années 2008 et 2009. Nous avons utilisé un modèle de régression linéaire multivariée pour déterminer si l’hypoalbuminémie était un prédicteur indépendant de la dysfonction d’organes. Résultats : 56 sujets ont été analysés. L’analyse de régression linéaire multiple a montré qu’en contrôlant pour l’âge, le sexe, la surface corporelle brûlée et les brûlures par inhalation, l’hypoalbuminémie pendant les premières 24 heures suivant l’admission est un prédicteur indépendant de la dysfonction d’organes. Une concentration d’albumine ≤30g/L est aussi associée à une augmentation de la dysfonction d’organes [score SOFA au jour 0 (p = 0.005), jour 1 (p = 0.005), moyenne de la première semaine (p = 0.004)], mais n’est pas associée avec la mortalité (p = 0.061). Conclusions : L’hypoalbuminémie est associée avec la dysfonction d’organes chez les patients brulés. À la différence de facteurs non modifiables comme l’âge, le sexe, la surface corporelle brûlée et la présence de brûlures par inhalation, la correction de l’hypoalbuminémie peut être un objectif intéressant pour un futur essai clinique. / Hypoalbuminemia is a common finding in burn patients, but its association with increased morbidity and mortality has not been well established. Objective: We have assessed if hypoalbuminemia in the first 24 hours of admission is associated with organ dysfunction in patients with severe burns. Methods: For a two year period (2008-2009), we reviewed the chart of burn adult patients with a total body surface area ≥ 20% admitted in our unit in the first 24 hours following the burn injury. A multiple linear regression analysis was conducted to assess hypoalbuminemia as an independent predictor of organ dysfunction. Results: 56 patients were analyzed. Multiple linear regression analysis showed that hypoalbuminemia in the first 24 hours of admission was an independent predictor of organ dysfunction. Serum albumin concentration ≤ 30 g/L was associated with a two-fold increased in organ dysfunction [SOFA scores at day 0 (p = 0.005), day 1 (p = 0.005) and first week mean values (p = 0.004), but not with mortality (p = 0.061). Conclusion: Hypoalbuminemia is associated with organ dysfunction in burn patients. Unlike unmodifiable predictors such as age, burn surface and inhalation burn, correction of hypoalbuminemia might represent a goal for a future trial in burn patients.

Introdução: O uso de matrizes dérmicas é uma opção no tratamento de vários tipos de sequelas de queimaduras. O objetivo deste estudo foi avaliar e comparar a contração tardia dos enxertos de pele de espessura parcial autólogos utilizados para o tratamento de sequelas de queimaduras associado com as matrizes dérmicas Integra®, Matriderm® e Pelnac®. Métodos: Este é um ensaio clínico prospectivo, randomizado e controlado, e foi aprovado pelo Comitê de Ética em Pesquisa da instituição. O estudo comparou a contração da área do enxerto de pele de espessura parcial autólogo associado ou não com a matriz dérmica após 1, 3, 6 e 12 meses da cirurgia para tratamento de sequelas de queimaduras em pacientes da Unidade de Queimados de um hospital universitário. Os critérios de inclusão foram pacientes acima de 18 anos de idade, com uma ou mais sequelas de queimadura causando prejuízo funcional, com seguimento pós-queimadura de no mínimo 1 ano, e com indicação de tratamento cirúrgico usando enxerto de pele de espessura parcial. Os critérios de exclusão foram a perda do seguimento clínico, perda da matriz dérmica e falha na integração de mais de 10% do enxerto de pele parcial. As sequelas dos pacientes foram submetidas a randomização permutada em bloco por sorteio (de acordo com as normas do CONSORT) para um de quatro grupos: Grupo Integra® (n=10), Grupo Pelnac® (n=10), Grupo Matriderm® (n=9), e Grupo Controle (n=10), cujo tratamento envolveu apenas o enxerto de pele sem uso de matriz dérmica. Utilizamos este tipo de randomização para garantir um número balanceado de participantes nos diferentes grupos. As cirurgias foram realizadas pelo mesmo cirurgião e consistiu na ressecção da sequela da queimadura, gerando um defeito de cobertura cutânea. As cirurgias foram em dois tempos para os grupos Integra® e Pelnac® (primeiro a ressecção da sequela e colocação da matriz dérmica, e 21 dias depois remoção da lâmina de silicone e aplicação do enxerto de pele de espessura parcial autólogo sobre a matriz), ou em tempo único para os grupos Matriderm® e Controle (ressecção da sequela, colocação da matriz e do enxerto de pele de espessura parcial, ou apenas do enxerto de pele de espessura parcial). A obtenção dos enxertos de pele foi realizada por meio de dermátomo elétrico com regulagem de 0,2mm de espessura em todos os grupos. No intraoperatório, o contorno do defeito tridimensional (que corresponde ao contorno da matriz ou do enxerto de pele) foi marcado com azul de metileno e transferido para um anteparo maleável estéril de superfície plana, sempre em posição de extensão máxima para membros e pescoço. A obtenção das medidas no pós-operatório foi realizada da mesma forma com 1, 3, 6 e 12 meses. Essas medidas foram posteriormente transferidas para uma folha de papel com escala de centímetros, e submetidas a fotografias com máquina fotográfica com plano focal paralelo ao da folha de papel e com distância fixa de 40 cm. O cálculo das dimensões foi realizado por meio do software de planimetria digital \"Image J\" e comparados entre os grupos. Dessa forma, foi possível calcular a porcentagem de contração do enxerto de pele de espessura parcial em relação ao defeito original. A análise estatística foi realizada pelo software SAS® 9.2 utilizando o modelo de regressão linear com efeitos mistos (efeitos aleatórios e fixos), e o nível designificância adotado foi 5%. Resultados: Foram operadas 39 sequelas de queimaduras em 30 pacientes, sendo 19 do sexo masculino e 21 do sexo feminino. Após 12 meses, os resultados mostraram que o Grupo Controle apresentou menores taxas de contração do enxerto comparado aos grupos das matrizes dérmicas Integra® (p<0,01), Matriderm® (p=0,01), e Pelnac® (p<0,01); o Grupo Pelnac® mostrou uma contração do enxerto de pele estatisticamente maior comparado ao Grupo Matriderm® (p<0,01) e ao Grupo Integra® (p=0,02); a contração do enxerto de pele do Grupo Integra® não apresentou diferença significativa comparado ao Grupo Matriderm® (p=0,16). A contração variou bastante entre as diversas áreas do corpo, e a região cervical apresentou uma elevada taxa de contração em todos os grupos, sendo estatisticamente maior comparado com as outras regiões do corpo (p<0,01). Conclusão: No tratamento de sequelas de queimaduras, a contração tardia dos enxertos de pele de espessura parcial foi maior quando associados com matrizes dérmicas, em comparação ao enxerto de pele sem uso de matriz. A contração dos enxertos teve grande variabilidade de acordo com o local da sequela, sendo que a região cervical apresentou os maiores índices de contração. / Purpose: The use of dermal matrices is an option in the treatment of burn sequelae. The objective of this study was to evaluate and compare the contraction of autologous split-thickness skin grafts used for the treatment of burn sequelae associated with dermal matrices. Methods: This is a prospective, randomized, controlled clinical trial, comparing the contraction of the autologous split-thickness skin graft associated or not with dermal matrix after 1, 3, 6 and 12 months postoperatively for the treatment of burn sequelae. Patients were selected from the Burns Unit of an university hospital, and our Institutional Review Board approved this study. Inclusion criteria were patients with one or more burn sequelae causing functional impairment, with post-burn follow-up of at least one year, and with an indication of surgical treatment using split-thickness skin graft. Exclusion criteria were the loss of follow-up, loss of the dermal matrix, and failure to integrate more than 10% of the split-thickness skin graft. Patients\' sequelae were randomly assigned to a randomized block design (according to the CONSORT standards) for one of four groups: Integra® Group (n = 10), Pelnac® Group (n = 10), Matriderm® Group (n = 9), and Control Group (n = 10), whose treatment involved only the skin graft without dermal matrix. Surgeries were performed by the same surgeon and consisted of resection of the burn sequelae, leading to a tegument defect. Surgeries were performed in two stages for the Integra® and Pelnac® groups (first resection of the sequela and placement of the dermal matrix, and 21 days later removal of the silicon sheet and application of the skin graft on the matrix), or in single stage for the Matriderm® and Control groups (resection of the sequelae, placement of the matrix and skin graft, or only the skin graft). The skin grafts were obtained using an electric dermatome with the regulation of 0.2 mm thickness in all groups. During the surgery, the contour of the three-dimensional defect (corresponding to the contour of the matrix or the skin graft) was marked with methylene blue and transferred to a sterile, flat surface, always in the position of maximum extension for limbs and neck. This procedure was also performed after 1, 3, 6 and 12 months postoperatively. Then, it was transferred to a sheet of paper with a centimeters scale and submitted to pictures using a camera with a fixed distance of 40 cm. The measures of the dimensions were carried out using the digital planimetry software \"Image J\" and compared among the four groups. Thus, we calculate the percentage of contraction of the split-thickness skin graft comparing it to the original defect. Statistical analysis was carried out using the linear regression model with mixed effects (random and fixed effects), and the significance level adopted was 5%. Results: Thirty-nine burn sequels were performed in 30 patients, 19 male and 21 female. Twelve months postoperatively, the results showed that the Control Group presented lower rates of skin graft contraction compared to the Integra® (p < 0.01), Matriderm® (p = 0.01) and Pelnac® (p < 0.01); the Pelnac Group showed a statistically larger contraction of the skin graft compared to the Matriderm® Group (p < 0.01) and the Integra® Group (p = 0.02); the contraction of the skin grafts from the Integra® Group did not present a significant difference compared to the Matriderm® Group (p = 0.16). The contraction varied widely among the treated areas, and the cervical region showed a high rate of contraction in allgroups, being statistically higher compared to the other body regions (p < 0.01). Conclusion: In the treatment of burn sequelae, the late contraction of split-thickness skin grafts was greater when associated with dermal matrices, in comparison to the skin graft without dermal matrix. The contraction of the skin grafts had great variability according to the location of the sequelae, and the cervical region had the highest rates of contraction.

As queimaduras causam alterações na estrutura anatômica da pele associadas a trauma. As queimaduras podem ser classificadas em lesões de primeiro, segundo e terceiro grau. As queimaduras de terceiro grau têm sido grande foco de pesquisas em busca de tratamentos mais conservadores e de maior rapidez no reparo para um resultado funcional e estético satisfatório. O tratamento convencional consiste no uso de medicamentos tópicos e no enxerto de pele natural ou sintética. Alternativamente, a terapia laser utiliza o processo de ablação para remoção do tecido queimado necrosado, devido ao não contato mecânico, à rapidez na aplicação e alcance a áreas de difícil acesso. Deste modo, a proposta deste estudo é avaliar a viabilidade de utilizar lasers de femtossegundos de altíssima intensidade como coadjuvante no tratamento de pacientes queimados. Para o estudo, foram utilizados 25 ratos da raça Wistar, divididos em grupos de 5 animais: grupos pele sadia, pele queimada, dois tipos de tratamento (desbridamento cirúrgico ou ablação a laser de femtossegundos) e em quatro tempos de acompanhamento do processo cicatricial. Três regiões do dorso dos animais foram expostas a fonte de vapor causando queimadura de terceiro grau. No terceiro dia após a queimadura, uma das regiões foi ablacionada com laser de altíssima intensidade de pulsos ultracurtos ( &lambda; = 785nm, 90 fs, 2 kHz e 10 &mu;J/pulso); outra recebeu o desbridamento cirúrgico; e a última foi considerada o controle de queimadura. As regiões foram analisados por tomografia por coerência óptica (OCT), histologia, reflectância total atenuada por espectroscopia no infravermelho usando transformada de Fourier (&mu;ATR-FTIR), microscopia de fluorescência por excitação de dois fótons (TPEFM) e a técnica de geração de segundo harmônico (SHG), nos dias 3, 5, 7 e 14 após os tratamentos. Os resultados mostraram que nas condições de irradiação utilizadas foi possível obter remoção de debris de queimadura de terceiro grau. As técnicas utilizadas para caracterização do tecido permitiram verificar que em todos os tratamentos houve a promoção da reparação tecidual. No décimo quarto dia, a curva de regeneração mostrou que o coeficiente de atenuação do tecido ablacionado a laser converge para os valores da pele sadia, porém as fibras de colágeno ainda não atingiram a mesma organização das fibras presentes na pele sadia. / Burns cause changes in the anatomical structure of the skin associated with trauma. The severity of the burn injury is divided into first, second and third-degree burns. The third-degree burns have been a major focus of research in search of more conservative treatments and faster results in repair for a functional and cosmetically acceptable. The conventional treatment is the use of topical natural or synthetic skin graft. An alternative therapy is the laser ablation process for burned tissue necrosis removal due to the no mechanical contact, fast application and access to difficult areas. The purpose of this study is to evaluate the feasibility of using high intensity femtosecond lasers as an adjunct treatment of burned patients. For this study, 65 Wistar rats were divided into groups of five animals: healthy skin, burned skin, two types of treatment (surgical debridement or femtosecond laser ablation) and four different times in the healing process monitoring. Three regions of the back of the animals were exposed to steam source causing third-degree burn. On the third day after the burn, one of the regions was ablated with high intensity ultrashort laser pulses (&lambda; = 785 nm, 90 fs, 2 kHz and 10 &mu;J/ pulse), the other received surgical debridement, and the last was considered the burn control. The regions were analyzed by optical coherence tomography (OCT), histology, attenuated total reflectance infrared spectroscopy using Fourier transform (&mu;-ATR-FTIR), two-photon excitation fluorescence microscopy (TPEFM) and second harmonic generation technique (SHG) on days 3, 5, 7 and 14 pos-treatments. The results showed that with the laser irradiation conditions used it was possible to remove debris from third degree burn. The techniques used to characterize the tissue allowed to verify that all treatments promoted wound healing. On the fourteenth day, the regeneration curve showed that the attenuation coefficient of laser ablated tissue converges to the values of healthy skin, but collagen fibers have not yet reached the same organization of those in the healthy skin

Introdução: A assistência hospitalar a pacientes portadores de queimaduras é altamente dispendiosa devido aos recursos humanos, materiais e estruturais necessários à sua viabilização. O conhecimento financeiro relativo a essa temática ainda é escasso, especialmente no que tange aos custos dos procedimentos executados por profissionais de enfermagem a pacientes, grandes queimados, em condições críticas. Objetivo: Identificar o custo direto médio (CDM) dos procedimentos realizados, com maior frequência, por profissionais de enfermagem, a pacientes grandes queimados internados em uma Unidade de Terapia Intensiva de Queimaduras (UTIQ). Método: Esta pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único, foi conduzida na UTIQ da Unidade de Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O CDM foi calculado multiplicando-se o tempo (cronometrado) despendido por profissionais de enfermagem na execução dos procedimentos, objeto de estudo, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais e soluções/medicamentos. Para a realização dos cálculos utilizou-se a moeda brasileira (R$). Resultados: A partir de 1354 observações, relativas a 12 procedimentos frequentemente realizados na UTIQ, obteve-se o CDM de R$ 1,88 (DP=1,04) para controle dos sinais vitais; R$ 28,78 (DP=69,74) para administração de medicamentos via intravenosa; R$ 16,97 (DP=7,92) para mensuração de diurese; R$ 2,68 (DP=1,20) para verificação de glicemia capilar; R$ 6,71(DP=2,20) para administração de medicamentos via sonda nasoenteral; R$ 50,07 (DP=11,89) para higiene íntima no leito; R$ 3,64 (DP=2,01) para auxílio alimentação; R$ 55,88 (DP=18,98) para banho no leito/arrumação da cama; R$ 287,11 (DP=372,87) para curativo; R$ 6,65 (DP=2,09) para higiene oral; R$ 3,13 (DP=1,08) para administração de medicamentos via oral e R$ 8,51 (DP=1,79) para administração de medicamentos via subcutânea. Conclusão: A apuração dos custos dos recursos consumidos nos procedimentos requeridos pelos pacientes, grandes queimados, em UTI, pode fundamentar as tomadas de decisão gerenciais subsidiando a sua eficiência alocativa, evitando a ocorrência de desperdícios e, quando possível, indicando estratégias de contenção/minimização de custos sem prejuízos à qualidade da assistência de enfermagem. / Introduction: Hospital care for critical burn patients is highly costly due to human, material and structural resources required for its viability. The financial knowledge concerning this subject is still scarce, especially in regard to the cost of procedures performed by nurses in critical burn patients. Objective: To identify the average direct cost (ADC) of the nursing procedures carried out with greater frequency for burn patients admitted into the burn intensive care unit (BICU). Methodology: This quantitative exploratory and descriptive single case study was conducted in BICU at the Burn Unit of the Hospital das Clinicas of the Faculty of Medicine, Universidade de Sao Paulo. The ADC was calculated by multiplying the time (chronometering) spent by nursing professionals in procedures, object of this study, by the unit cost of direct labor adding to the cost of materials and solutions/drugs. For the purposes of the calculation, the Brazilian currency (R$) was used. Results: Based on 1354 observations related to 12 procedures often performed in BICU, it was obtained the ADC of R$ 1.88 (SD=1.04) for \"control the vital signs\"; R$ 28.78 (SD=69.74) for \"administering medication intravenously\"; R$ 16.97 (SD=7.92) for \"measurement of diuresis\"; R$ 2.68 (SD=1.20) to \"check Capillary Blood Glucose\"; R$ 6.71 (SD=2.20) for \"drug administration via nasogastric tube\"; R$ 50.07 (SD=11.89) for \"patient intimate hygiene; R$ 3.64 (SD=2.01) for \"food aid\"; R$ 55.88 (SD=18.98) for \"bed bathing/make the bed\"; R$ 287.11 (SD=372.87) for \"dressing\"; R$ 6.65 (SD=2.09) for \"oral hygiene\"; R$ 3.13 (SD=1.08) for \"oral drug administration\" and R$ 8.51 (SD=1.79) for \"drug administration subcutaneously\". Conclusion: The calculation of the resource costs spent in the procedures required by critical burn patients, in ICU, justify the decision making of subsidizing its allocative efficiency, avoiding the occurrence of waste and, when possible, indicating control strategies/minimizing strategy costs without impairing the quality of nursing care

Introdução: O uso de matrizes dérmicas é uma opção no tratamento de vários tipos de sequelas de queimaduras. O objetivo deste estudo foi avaliar e comparar a contração tardia dos enxertos de pele de espessura parcial autólogos utilizados para o tratamento de sequelas de queimaduras associado com as matrizes dérmicas Integra®, Matriderm® e Pelnac®. Métodos: Este é um ensaio clínico prospectivo, randomizado e controlado, e foi aprovado pelo Comitê de Ética em Pesquisa da instituição. O estudo comparou a contração da área do enxerto de pele de espessura parcial autólogo associado ou não com a matriz dérmica após 1, 3, 6 e 12 meses da cirurgia para tratamento de sequelas de queimaduras em pacientes da Unidade de Queimados de um hospital universitário. Os critérios de inclusão foram pacientes acima de 18 anos de idade, com uma ou mais sequelas de queimadura causando prejuízo funcional, com seguimento pós-queimadura de no mínimo 1 ano, e com indicação de tratamento cirúrgico usando enxerto de pele de espessura parcial. Os critérios de exclusão foram a perda do seguimento clínico, perda da matriz dérmica e falha na integração de mais de 10% do enxerto de pele parcial. As sequelas dos pacientes foram submetidas a randomização permutada em bloco por sorteio (de acordo com as normas do CONSORT) para um de quatro grupos: Grupo Integra® (n=10), Grupo Pelnac® (n=10), Grupo Matriderm® (n=9), e Grupo Controle (n=10), cujo tratamento envolveu apenas o enxerto de pele sem uso de matriz dérmica. Utilizamos este tipo de randomização para garantir um número balanceado de participantes nos diferentes grupos. As cirurgias foram realizadas pelo mesmo cirurgião e consistiu na ressecção da sequela da queimadura, gerando um defeito de cobertura cutânea. As cirurgias foram em dois tempos para os grupos Integra® e Pelnac® (primeiro a ressecção da sequela e colocação da matriz dérmica, e 21 dias depois remoção da lâmina de silicone e aplicação do enxerto de pele de espessura parcial autólogo sobre a matriz), ou em tempo único para os grupos Matriderm® e Controle (ressecção da sequela, colocação da matriz e do enxerto de pele de espessura parcial, ou apenas do enxerto de pele de espessura parcial). A obtenção dos enxertos de pele foi realizada por meio de dermátomo elétrico com regulagem de 0,2mm de espessura em todos os grupos. No intraoperatório, o contorno do defeito tridimensional (que corresponde ao contorno da matriz ou do enxerto de pele) foi marcado com azul de metileno e transferido para um anteparo maleável estéril de superfície plana, sempre em posição de extensão máxima para membros e pescoço. A obtenção das medidas no pós-operatório foi realizada da mesma forma com 1, 3, 6 e 12 meses. Essas medidas foram posteriormente transferidas para uma folha de papel com escala de centímetros, e submetidas a fotografias com máquina fotográfica com plano focal paralelo ao da folha de papel e com distância fixa de 40 cm. O cálculo das dimensões foi realizado por meio do software de planimetria digital \"Image J\" e comparados entre os grupos. Dessa forma, foi possível calcular a porcentagem de contração do enxerto de pele de espessura parcial em relação ao defeito original. A análise estatística foi realizada pelo software SAS® 9.2 utilizando o modelo de regressão linear com efeitos mistos (efeitos aleatórios e fixos), e o nível designificância adotado foi 5%. Resultados: Foram operadas 39 sequelas de queimaduras em 30 pacientes, sendo 19 do sexo masculino e 21 do sexo feminino. Após 12 meses, os resultados mostraram que o Grupo Controle apresentou menores taxas de contração do enxerto comparado aos grupos das matrizes dérmicas Integra® (p<0,01), Matriderm® (p=0,01), e Pelnac® (p<0,01); o Grupo Pelnac® mostrou uma contração do enxerto de pele estatisticamente maior comparado ao Grupo Matriderm® (p<0,01) e ao Grupo Integra® (p=0,02); a contração do enxerto de pele do Grupo Integra® não apresentou diferença significativa comparado ao Grupo Matriderm® (p=0,16). A contração variou bastante entre as diversas áreas do corpo, e a região cervical apresentou uma elevada taxa de contração em todos os grupos, sendo estatisticamente maior comparado com as outras regiões do corpo (p<0,01). Conclusão: No tratamento de sequelas de queimaduras, a contração tardia dos enxertos de pele de espessura parcial foi maior quando associados com matrizes dérmicas, em comparação ao enxerto de pele sem uso de matriz. A contração dos enxertos teve grande variabilidade de acordo com o local da sequela, sendo que a região cervical apresentou os maiores índices de contração. / Purpose: The use of dermal matrices is an option in the treatment of burn sequelae. The objective of this study was to evaluate and compare the contraction of autologous split-thickness skin grafts used for the treatment of burn sequelae associated with dermal matrices. Methods: This is a prospective, randomized, controlled clinical trial, comparing the contraction of the autologous split-thickness skin graft associated or not with dermal matrix after 1, 3, 6 and 12 months postoperatively for the treatment of burn sequelae. Patients were selected from the Burns Unit of an university hospital, and our Institutional Review Board approved this study. Inclusion criteria were patients with one or more burn sequelae causing functional impairment, with post-burn follow-up of at least one year, and with an indication of surgical treatment using split-thickness skin graft. Exclusion criteria were the loss of follow-up, loss of the dermal matrix, and failure to integrate more than 10% of the split-thickness skin graft. Patients\' sequelae were randomly assigned to a randomized block design (according to the CONSORT standards) for one of four groups: Integra® Group (n = 10), Pelnac® Group (n = 10), Matriderm® Group (n = 9), and Control Group (n = 10), whose treatment involved only the skin graft without dermal matrix. Surgeries were performed by the same surgeon and consisted of resection of the burn sequelae, leading to a tegument defect. Surgeries were performed in two stages for the Integra® and Pelnac® groups (first resection of the sequela and placement of the dermal matrix, and 21 days later removal of the silicon sheet and application of the skin graft on the matrix), or in single stage for the Matriderm® and Control groups (resection of the sequelae, placement of the matrix and skin graft, or only the skin graft). The skin grafts were obtained using an electric dermatome with the regulation of 0.2 mm thickness in all groups. During the surgery, the contour of the three-dimensional defect (corresponding to the contour of the matrix or the skin graft) was marked with methylene blue and transferred to a sterile, flat surface, always in the position of maximum extension for limbs and neck. This procedure was also performed after 1, 3, 6 and 12 months postoperatively. Then, it was transferred to a sheet of paper with a centimeters scale and submitted to pictures using a camera with a fixed distance of 40 cm. The measures of the dimensions were carried out using the digital planimetry software \"Image J\" and compared among the four groups. Thus, we calculate the percentage of contraction of the split-thickness skin graft comparing it to the original defect. Statistical analysis was carried out using the linear regression model with mixed effects (random and fixed effects), and the significance level adopted was 5%. Results: Thirty-nine burn sequels were performed in 30 patients, 19 male and 21 female. Twelve months postoperatively, the results showed that the Control Group presented lower rates of skin graft contraction compared to the Integra® (p < 0.01), Matriderm® (p = 0.01) and Pelnac® (p < 0.01); the Pelnac Group showed a statistically larger contraction of the skin graft compared to the Matriderm® Group (p < 0.01) and the Integra® Group (p = 0.02); the contraction of the skin grafts from the Integra® Group did not present a significant difference compared to the Matriderm® Group (p = 0.16). The contraction varied widely among the treated areas, and the cervical region showed a high rate of contraction in allgroups, being statistically higher compared to the other body regions (p < 0.01). Conclusion: In the treatment of burn sequelae, the late contraction of split-thickness skin grafts was greater when associated with dermal matrices, in comparison to the skin graft without dermal matrix. The contraction of the skin grafts had great variability according to the location of the sequelae, and the cervical region had the highest rates of contraction.