Silver was used for its antimicrobial effect by the ancient Greeks, long before the existence of microorganisms were first suspected. Nowadays a wide range of antimicrobial dressings containing silver, either incorporated within or applied on the dressings, are available for clinical use. This type of dressings is designed to provide the antimicrobial activity of silver in a more convenient application. The aim with this master thesis was to evaluate if silver release and antimicrobial effect of nine silver containing dressings are dependent on the test medium and if there is any relation between silver release and antimicrobial effect. Release of silver and antimicrobial effect was evaluated by using a 6-well co-culture system, with inoculated test medium in the wells and dressing pieces in the culture well inserts. Three different test media with increased complexity and nutrient value were inoculated with either Results show that release of silver depends on the test fluid used; for phosphate buffered saline (PBS), the silver concentration was as most 1.2 ppm, but for a complex media containing calf serum (SWF), it varied from 9 ppm to 134 ppm. The viable counts in PBS were reduced by at least 3 log units for all dressings and bacteria, whereas in SWF there were no reduction and instead growth was observed. In general, a high release resulted in less bacterial growth. Results also indicated that kinetics of silver release affect the antimicrobial effect. It is likely to assume that it is important for a dressing to release silver quickly. It has previously not been possible to correlate silver release of wound care dressings and antimicrobial effect, since the two factors have been measured in different test systems and in different media. Since both factors depend on test medium and method used, it is shown in the present study that it is important to use relevant test medium for in-vitro evaluation. When measuring silver release and antimicrobial effect in the same test system, a relation is found.

Made available in DSpace on 2014-06-11T19:32:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-29Bitstream added on 2014-06-13T20:04:11Z : No. of bitstreams: 1 araujo_i_dr_botfm.pdf: 815493 bytes, checksum: ff905d5c629291affa814184feaeb4d4 (MD5) / A UV traduz um dos estágios mais avançados da doença venosa crônica (DVC), e esta apresenta elevada morbidade pela sua cronificação e recidivas frequentes. Constitui importante problema de saúde pública por alterar a qualidade de vida do indivíduo e elevar o ônus público, já que os tratamentos são longos e dispendiosos. Apesar dos fatores de risco e a etiopatogenia desta doença serem conhecidos, grande parte da população usuária do sistema público de saúde não possui diagnóstico e tratamento precoces da DVC, resultando assim em evolução clínica tormentosa da doença. A dificuldade de avaliação com profissionais especializados predispõe a evolução da UV. Quando manejadas de formas inadequadas, as UVs tendem a tornar crônico o processo de cicatrização e ficam sujeitas a complicações como colonização crítica e infecção de partes moles. Esta revisão procura reunir informações atualizadas sobre a epidemiologia da DVC (enfocando principalmente dados do Brasil). Além disso, serão discutidos os fatores de risco, a etiopatogenia da UV e suas manifestações clínicas. Finalmente será feita uma atualização sobre os métodos auxiliares do processo de cicatrização da UV, expondo os avanços ao conhecimento relacionados a esta área, incluindo o preparo do leito da úlcera. O objetivo é propor mudanças que favoreçam a quebra do ciclo pernicioso da UV / The VU is one of the most advanced stage` s chronic venous disease (CVD), and it has a high morbidity, because your recidivates are chronics and happens frequently. It is an important public health problem, because it modifies the quality of an individual and put up the public costs, since the medical treatment are longs and expensive. In spite of the risk factors and the studies of this disease are knew, a very part of the population, that use the public health utilities, don`t have diagnosis and CVD`S precocious medical treatment, for this reason the disease evolution is very hard. There is the evolution of the VU, because it is very difficult to evaluate it with an expert professional. The VUs can become chronics in a healing process, when they are badly controlled; they can dominate it and contaminate the soft parts. The objective of this revision is to join current in formations about CVD`s epidemiology (mainly Brazilian documents). Besides, the risk factors, the VU`s path physiology and their clinic manifestations will be discussed Finally, will be done an update about the auxiliary methods of the VU`s healing process, showing the know advances in this area, and how to prepare an ulcer bed. The object is to suggest changes that finish the VU`s pernicious cycle

Made available in DSpace on 2015-01-26T13:21:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-08-28Bitstream added on 2015-01-26T13:30:37Z : No. of bitstreams: 1 000797433.pdf: 5903628 bytes, checksum: 6e0dcc47aa102e9bdce45d92e2e66c2f (MD5) / As Feridas Crônicas (FC) constituem um desafio constante para os laboratórios farmacêuticos. O Hemocentro de Botucatu desenvolve há 13 anos produtos formulados a partir do Plasma Fresco e do Concentrado de Plaquetas excedentes da prática clínica. Um destes produtos, bem estabelecidos e testados é o gel laminar de plaquetas (Biogel ou GP). Pesquisas na área de enfermagem identificaram oportunidades de melhorias para o Biogel sendo proposto nova formulação: membrana de quitosana enriquecida com hormônios plaquetários (Quitogel). Após estudos preliminares foi delineado o projeto de estudo de fase I, em pacientes portadores de FC utilizando o Quitogel comparando com o GP. Trata-se de um estudo prospectivo, do tipo ensaio clínico controlado, e teve como objetivo comparar o desempenho da membrana de quitosana dopada com hormônios plaquetários versus Gel de plaquetas estabelecendo o perfil de pacientes atendidos. Nos últimos 24 meses foram atendidos 135 novos casos de FC, sendo 45 do sexo masculino, com idade média de 49,57 anos e o tempo de ferida aberta foi de 87,57 meses. Do sexo feminino foram 90 casos, com média de idade de 52,91 anos e tempo médio de ferida aberta foi de 114,76 meses. Quanto ao tipo de úlcera, 81% foram venosas para mulheres contra 64% para homens. As lesões crônicas traumáticas (9%) foram mais prevalentes em homens, contra 2% em mulheres e as feridas diabéticas atingiram mais os homens (11%). Dos produtos comercializados mais usados pelos pacientes, destacam-se a colagenase (16%), sulfadiazina de prata (12%), fibrase® (10%), papaína (6%), Safgel®(5%), hidrogéis 5%. Foi identificado alto índice de automedicação, fato este, comprometedor do resultado do tratamento das FC, onde 33(44,55%), pacientes informavam ter um produto prescrito, mas usam voluntariamente outros 2 não prescritos. Destes 135 pacientes, participaram do estudo 27 deles, perfazendo um total de ... / Chronic wounds (CW are a constant challenge for pharmaceutical companies. The Blood Center of Botucatu develops products formulated 13 years ago from Fresh Plasma and platelets concentrate excess clinical practice. One of these products is well established and tested laminar platelet gel (Biogel/PG). Research in nursing identified opportunities for improvements to the Biogel/PG being proposed new wording: chitosan membrane enriched with platelet hormones (Quitogel). After preliminary studies have outlined the design of a phase I study in patients with CF using the Quitogel compared with Biogel/GP. This is a prospective, controlled clinical trial type, and aimed to compare the performance of the chitosan membrane doped with hormones versus Biogel/PG establishing the profile of patients seen. The past 24 months were served 135 new cases of CW, 45 male, mean age of 49.57 years and the time of open wound was 87.57 months. Females were 90 cases, with a mean age of 52.91 years and mean duration of open wound was 114.76 months. Regarding the type of ulcer, 81% were venous for women versus 64% for men. Chronic traumatic injuries (9%) were more prevalent in men, compared with 2% in women and diabetic wounds hit men (11%) more. Of marketed products most used by patients, include collagenase (16%), silver sulfadiazine (12%), fibrase ® (10%), papain (6%), Safgel ® (5%), 5% hydrogels. High rate of self-medication, a fact, compromising the outcome of the treatment of CW, where 33 (44.55%), was identified patients had reported having a prescribed product, but use the other 2 did not prescribed. Of these 135 patients, 27 of them participated in the study, a total of 31 lesions that were followed for 90 days. Comparison of the two products (Biogel/GP versus Quitogel), it was observed that in the preparation of doped chitosan membrane is easy storage (room temperature) and hydration with saline, gradually releases the hormones platelet does not favor ...

Wound healing, as a normal biological process in the human body, is achieved through four precise and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. However, many factors can interfere with one or more of these phases, thus causing improper or impaired wound healing. Maintaining a moist wound environment is crucial in facilitating the wound-healing process. The beneficial effects of a moist versus a dry wound environment include re-epithelization, tissue granulation, and repair. The use of hydrocolloid occlusive dressings in maintaining a moist wound environment has proven to be a useful adjunct in facilitating wound healing. Although hydrocolloid dressings have been widely used clinically in wound management, bacterial resistance, poor solubility and sustained drug release remain to be a problem for many of the drugs used in wound therapy. In chronic wound management, where patients normally undergo long treatments and frequent dressing changes, a system that delivers drugs into a wound site in a controlled fashion can improve patient compliance and therapeutic outcomes. Liposomes are small phospholipid vesicles that have been widely investigated as drug carriers for the delivery of therapeutic agents. They are spherical lipid vesicles consisting of phospholipid bilayers that improve the efficacy of the drugs by fusing with biological membranes, and eventually releasing their entrapped content into the cells or bacteria. The aim of this study therefore, is to develop a new bacitracin-based controlled release hydrocolloid dressing, with good absorptive properties for improving the efficacy of antibiotics in wound healing. HPLC (high-pressure liquid chromatography) assay of bacitracin was performed for quantification of the drug. Liposomes were prepared using thin film hydration and extrusion methods. Liposomes were also characterized based on their ideal particle size and encapsulation efficiency, and then incorporated into the different ratios of chitosan/gelatin hydrocolloid films. The films were prepared with increase in gelatin concentration and were evaluated for folding endurance, tensile strength, water absorption capacity, morphology, drug release kinetics, antimicrobial activity and stability. The morphology of these films was found to be very smooth and homogeneous proving a good compatibility between the two polymers. With increase in gelatin concentration, folding endurance, water absorption capacity, tensile strength, drug release kinetics and antimicrobial activity were increased. The antibacterial activity against various bacterial species was improved in the bacitracin loaded hydrocolloid films as compared to the blank films. Based on the findings above, it can be concluded that chitosan/gelatin films at 1:3 proportion is a successful wound dressing for wound management with improved wound healing properties than other formulations. This formulation is a potential candidate for the development of alternative pharmaceutical dosage forms, for the treatment of bacterial infected wounds, based on the activity of the eco-friendly chitosan matrix added to the bacitracin activity. In this work, chitosan also demonstrated a great potential as a dressing for advanced wound therapy and confirmed its good biocompatibility and potential to provide, in combination with liposomes, sustained drug release which is highly beneficial for wound treatment. The addition of gelatin improved the water affinity of the films and facilitated water mediated cross-linking process.

This diploma thesis is focused on the study of bioactive wound dressings. During the thesis, hydrogel, lyophilized and nanofiber wound dressings were prepared. Hydrogel and lyophilized wound dressings were prepared on basis of two polysaccharides – alginate and chitosan. Nanofiber wound dressings were prepared by spinning polyhydroxybutyrate. All prepared wound dressings were enriched with bioactive substances, which represented analgesics (ibuprofen), antibiotics (ampicillin) and enzymes (collagenase). Into hydrogel and lyophilized wound dressings were all the mentioned active substances incorporated, whereas nanofiber wound dressings were only with ibuprofen and ampicillin prepared. The theoretical part deals with the anatomy and function of human skin. There was explained the process of wound healing and also there were introduced available modern wound dressings. The next chapter of the theoretical part deals with materials for preparing wound dressings (alginate, chitosan, polyhydroxybutyrate) and with active substances, which were used during the experimental part of this thesis. In the theoretical part, the methods of preparation of nanofiber wound dressings and also the methods of cytotoxicity testing used in this work were presented. The first part of the experimental part of this thesis was focused on preparing already mentioned wound dressings. Then, their morphological changes over time and also the gradual release of incorporated active substances into the model environment were monitored. The gradual release of ampicillin was monitored not only spectrophotometrically, but also by ultra-high-performance chromatography. In wound dressings, in which collagenase was incorporated, was also the final proteolytic activity of this enzyme monitored. The effect of the active substances was observed on three selected microorganisms: Escherichia coli, Staphylococcus epidermidis and Candida glabrata. The cytotoxic effect of the active substances on the human keratinocyte cell line was monitored by MTT test and LDH test. A test for monitoring the rate of wound healing – a scratch test – was also performed.

Clinical management of complex wounds is essential to promote wound healing. Prolonged healing time may lead to longer and more costly hospitalizations and poorer patient outcomes. The removal of nonviable, necrotic tissue via debridement is vital to the healing process. One of the most common debridement techniques, in the United States, is the use of wet-to-dry dressings. There are no defined guidelines or protocols for the timing of dressing changes and subsceequent debridement. The purpose of this study was to perform a review of literature to determine the rationale for the use of wet-to-dry dressings, explore alternative time sequences of treatment, and to identify the risks and benefits for this methodology of debridement in an adult population with acute traumas. Inclusion criteria consisted of peer reviewed, English Language, research articles published within the last 5 years (2007-2012), adults with acute wounds treated by wet-to-dry dressing debridement. This review of literature was conducted using CINAHL and MEDLINE databases using the following search terms: Wound debridement, wet-to-dry dressing', timing, sequencing, schedul', standard', debridement, acute wound', and mechanical debridement. The review of literature yielded zero results meeting the search criteria therefore, a second review of literature was performed using the same search criteria but expanded to include articles published within the past 15 years (1997 -2012). The second review of literature also yielded zero results that met the search criteria. A lack of evidence supporting the use of wet-to-dry dressings for the purpose of debridement suggests that healthcare providers are following tradition rather than evidence based practices. Nurses and healthcare providers need education on best practices in wound care to advocate for their patients to ensure the best possible outcome. Further research on wound care modalities that are clinically efficient is needed.

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The diploma thesis is focused on the study of fibrous wound dressings prepared by electrospinning method from natural biopolymers. Three active ingredients were added to the dressings: ampicillin, ibuprofen and collagenase, which are responsible for relieving pain, reducing the risk of infection and selectively removing necrotic tissue in the wound. The theoretical part describes the therapeutic dressings currently available on the market and the most common methods of nanofiber production. The experimental part evaluates the optimization of the preparation of gelatin, alginate and chitosan fibrous wound dressings, which were subsequently enriched with active substances and their gradual release into the model environment was determined spectrophotometrically. Antimicrobial effects against E.coli and S. epidermidis strains andantifungal activity against C. glabrata yeast were monitored. Finally, two cytotoxicity tests on the human keratinocyte cell line HaCaT confirmed the safety of the prepared products, which can serve as bioactive skin dressings in the future.

O emprego do osso desmineralizado (OD), sobretudo de origem bovina, tem sido extensivamente avaliado em modelos experimentais; no entanto, há dúvidas se a quantidade de proteínas ósseas morfogenéticas (BMP) seria suficiente para induzir à reparação óssea. A associação com membranas, além de evitar o encapsulamento das partículas de OD, também poderia prevenir a dissolução precoce das poucas BMPs presentes no OD. O objetivo deste trabalho foi realizar uma avaliação histológica da reparação óssea induzida por OD em defeitos criados na mandíbula de ratos, e o efeito da utilização de membranas reabsorvíveis de colágeno impregnadas com sais de cálcio. O estudo envolveu 25 ratos Wistar, nos quais discos de OD foram utilizados no preenchimento de defeitos bicorticais na região de ângulo de mandíbula; no lado esquerdo, a face lingual e vestibular foi recoberta com membranas. Os animais foram divididos em grupos de cinco indivíduos cada e, então sacrificados depois de três, 10, 20, 30 e 60 dias pós-operatórios. A análise histológica revelou que nos primeiros 20 dias, houve intensa proliferação óssea nas duas extremidades, tanto na face vestibular quanto lingual, sendo provável também que a proliferação tenha ocorrido em toda margem do defeito circular. No entanto, aos 30 dias, houve uma inversão do quadro histopatológico: a resposta inflamatória até então moderada, cedeu lugar para um intenso infiltrado inflamatório envolvendo o OD, com ausência total da membrana, reduzindo a intensidade no grupo de 60 dias, que apresentou remanescentes de reação de corpo estranho em torno do OD, sem ocorrer preenchimento do defeito por osso neoformado. Pelos resultados observados, pode-se concluir que há presença de BMPs, responsável pela grande proliferação inicial, mas em quantidade insuficiente para conduzir à reparação total do defeito ósseo; a apresentação física em lâmina do OD, a partir do qual os discos foram preparados, parece ter dificultado a reabsorção da matriz óssea remanescente, provocando uma reação de corpo estranho. Por fim, a membrana de colágeno cálcica teve pouco efeito na proliferação óssea, gerando infiltrado inflamatório moderado ao seu redor. / The use of demineralized bone (DB), in special from bovine source, has been evaluated extensively in experimental models; however, doubts exist if there is sufficient quantity of bone morphogenetic proteins (BMP) to induce the bone repairing. The combination of membranes avoids the encapsulating of DB particles and also it could prevent the early dissolution of the few BMPs present in the DB. The aim of this study was to carry out a histological evaluation of the bone repairing induced by DB on defects created in the rat mandibles, and the effect of using resorbable collagen membranes impregnated with calcium salts. The study involves 25 Wistar rats, in which DB discs were employed to fill bicortical defects in the region of mandibular angle; at the left side, membranes recovered the lingual and buccal side. The animals were divided into groups of five individuals each one and then killed after three, 10, 20, 30 and 60 postoperative days. Within first 20 days, the histological analysis revealed intense bone proliferation in the two bone ends, buccal as much lingual, and it is also probable the proliferation has occurred all around of the circular margin defect. However, from 30 days, there was an inversion in the histological findings: the inflammatory reaction until then moderate became na intense inflammatory infiltrate that was involving the DB, with total absence of the membrane, and then reducing the intensity at 60-days group, which presented remnants of foreign body reaction enveloping the DB, without new bone filling of the defect. From these results, it can conclude by the presence of BMPs, responsible by the great initial bone proliferation; the physical form of DB in sheets, of which discs were prepared, seemed to have prevented resorption of the remnant bone matrix and raised foreign body reaction. Finally, the calcium-collagen membrane had little effect in the bone proliferation, raising moderate inflammatory infiltrate around it.

As úlceras Venosas (UV) produzem modificações radicais na vida dos indivíduos em decorrência de sua etiopatogenia. Estas são as formas mais comuns de úlceras de perna e causam um impacto significante na qualidade de vida dos pacientes, pois reduzem a produtividade no trabalho, além dos custos associados a tratamentos de longa duração, em virtude da cronicidade, tempo de cicatrização e freqüentes recidivas das lesões. Este trabalho teve como objetivos identificar as características sócio-demográficas da clientela, incluindo a caracterização da UV, calcular o custo total direto(CTD) dos materiais e de pessoal de enfermagem utilizados na realização do procedimento com bota de unna em pacientes portadores de UV, por um método baseado nas médias(CTDM) e um método baseado nas observações(CTDO) e correlacionar o CTDO, Circunferência do joelho e tornozelo, área e tempo de procedimento entre si e com as demais variáveis quantitativas do estudo. Como referencial teórico para aferição dos custos utilizou-se o sistema de custeio por absorção por procedimento ou produto. A pesquisa é do tipo exploratória, descritiva, comparativa, correlacional, com abordagem quantitativa. Foi realizada na unidade de ambulatório da clínica cirúrgica do Hospital Universitário da Universidade de São Paulo (HU-USP). A amostra foi constituída de 65 procedimentos com bota de unna realizados em nove pacientes portadores de UV. Para coleta de dados, foi utilizado um instrumento contendo dados demográficos e clínicos da clientela, caracterização da lesão e relativos ao tempo e consumo de material. Os resultados mostraram que os pacientes com UV 5 (55,55%) apresentavam idade igual e abaixo de 64 anos, com faixa etária predominante entre 49 a 56 anos (33,33%) e de 65 a 72 anos (33,33%). Foi verificado o predomínio do sexo feminino com 7 (77,78%) pacientes. Com relação à doença associada houve predomínio de HAS (33,33%) seguida de DM (22,22%), um mesmo paciente apresentou mais de uma patologia associada e que 5(55,55%) pacientes não apresentavam doenças associadas. O tempo de existência da úlcera mostrou um predomínio de menos de 2 anos (44,44%) e de mais de 5 anos (44,44%). As úlceras estavam localizadas preferencialmente na região maleolar 7 (77,77%) pacientes. Houve um predomínio de circunferência de joelho de 32 a 35,9 cm, circunferência de tornozelo entre 24,5 a 25,5 cm e de áreas de lesão de 2,0 e 61,0 cm2. O custo total direto médio (CTDM), relacionado ao procedimento com bota de unna foi de R$ 139,48 e a média do custo total direto observado(CTDO) foi R$ 96,47 (DP = 16,22) com variação de R$ 76,84 a 184,65. A média do custo da mão de obra do procedimento foi R$ 15,39 (DP = 3,28) com variação de R$ 8,00 a 22,50. Em relação às correlações foi evidenciado que custos elevados estão associados a procedimentos com maiores áreas de lesão, maiores Cj, com maior consumo de gaze n, rayon, zobec, fita adesiva, soro, faixa elástica, gaze, zobec e faixa crepe domiciliar, que maiores Ct tendem a estar associadas ao menor consumo de rayon e maior consumo de luva proc, que grandes áreas de lesão tendem a estar associadas a maior consumo de gaze e, rayon, zobec, luva proc e zobec domiciliar e tendem a estar associadas ao menor consumo de tempo e de faixa elástica, que maior tempo de procedimento a estar associado a maior consumo de gaze e soro e a menor consumo de luva de procedimentos. Acreditamos que os enfermeiros precisam ter conhecimento e meios para tomar decisões, baseados em evidências científicas, a respeito do tratamento mais apropriado para o paciente e que essa escolha deve estar baseada no custo-efetividade, lembrando que no cotidiano das atividades gerenciais, esses dados são imprescindíveis. Desta forma , podem respaldar seus argumentos em relação à necessidade de gastos frente aos diversos tipos de produtos, bem como suas decisões sobre alocação de recursos para as diferentes atividades junto à administração / The veined ulcers (UV) bring forth radical modifications in the life of the individuals resulting from their condition. The most common forms of ulcers are of the leg and it causes significant impact in the quality of life of the patients, reducing the work productivity, beside the costs associated with the long treatments, due to the chronic condition, time of healing and the frequent reappearance of the lesions. This work has the objective to identify the typical traits social-demographic of the clientele, including the characterization of the UV, calculate the total direct cost (CTD) of the materials and the nursing staff used to realize the procedure with the boot of unna in patients bearing the UV, by a method based in the medium (CTDM) and a method based in the observations (CTDO) establishing a relationship with the CTDO. Circumference of the knee and ankle, area and time of the procedure, alone and with the other variable quantity of study. As a theoretical reference to check the costs, we utilize the system of the cost by absorption of the procedure or product. The search is of the exploratory type, descriptive, establishing a relationship, comparative with a quantitative approach. It was realized in the ambulatory unit of the surgery clinic of the University Hospital of the University of Sao Paulo (HU-USP). The sample was formed of 65 procedures with the boot of unna, realized in nine patients affected with UV. To collect the data it was utilized an instrument containing demographic data and physicians of the clientele, characterized of the lesion and related to the time and use of the material. The results showed that the patients with UV 5 (55,55%) presented age equal and below of 64 years old, with etaria band predominantly between 49 and 56 years (33,33%) and between 65 and 72 years old (33,33%) It was verified the predominance of the feminine sex with 7 (77,78%) patients. In regards to the disease associated there was a predominance of HAS (33,33%) following of DM (22,22%), one patient presented more than one associated pathology and that 5 (55,55%) patients did not appear with associated deceases. The time that the ulcer demonstrated a predominance of less than 2 years (44,44%) and above 5 years old (44,44%) The ulcers were mainly localized in the malleolus region 7 (77,77%) patients. There was a predominance of the knee circumference of 32 to 35.9 cm, circumference of the ankle between 24, 5 to 25,5 cm and of the areas of lesion of 2,0 and 61,0 cm2. The total direct medium cost (CTDM), related to the procedure with the boot of unna was of R$ 139,48 and the medium total cost directly observed (CTDO) was of R$ 96,47 (DP = 16,22) with variation of R$ 76,84 to 184,65. The medium cost of the labor of the procedure was RS 15,39 (DP=3,28) with a variation of R$ 8,00 to 22,50. In regards to the correlations it was evident that the high costs were associated with procedures with major areas of lesion, major Cj, with more use of gauze, rayon, zobec, adhesive tape, serum, elastic band, gauze, zobec and crape band to domiciliate, and the major Ct have the tendency of being associated to the least usage of rayon and more use of glove proc, that large areas of lesion have the tendency to be associated to a bigger consume of gauze e, rayon, zobec, glove proc and zobec and have the tendency to be associates to the least consume of time and the elastic band, that large time of procedure to be associated with a major consume of gauze and serum and the lesser consume of glove of procedures. We believe that the nurses need to have knowledge and means to make decisions, based in scientific evidences, related to the best appropriated treatment to the patient and that this choice must be based in a cost effective, remembering of the daily general vital activities. Therefore, they can polish theirarguments in relation to the necessity of future expenses with the various types of products, as well as their decisions about allocating the source for the different activities along with the administration