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Acta Cirurgica Brasileira

versão On-line ISSN 1678-2674

Acta Cir. Bras. vol.26 no.5 São Paulo set./out. 2011

http://dx.doi.org/10.1590/S0102-86502011000500009 

9 - ORIGINAL ARTICLE
WOUND HEALING

 

Gel from unripe Musa sapientum peel to repair surgical wounds in rats1

 

Gel da casca de Musa sapientum verde no reparo de lesões operatórias em ratos

 

 

Dênia Amélia Novato Castelli Von AtzingenI; Alfredo GragnaniII; Daniela Francescato VeigaIII; Luis Eduardo Felipe AblaIII; Adriana Rodrigues dos Anjos MendonçaIV; Clayton Aparecido de PaulaV; Yara JulianoVI; José Carlos CorreaVII; Marcio Raimundo de FariaV; Lydia Masako FerreiraVIII

IFellow PhD degree, Postgraduate Program in Plastic Surgery, UNIFESP, Sao Paulo, Brazil. Main author. Conception, design, intellectual and scientific content of the study. Surgical procedures and data acquisition. Manuscript writing
IIPhD, Associate Professor, Department of Surgery, UNIFESP, Sao Paulo, Brazil. Responsible for conception and critical revision of the study
IIIPhD, Affiliate Professor, Department of Surgery, UNIFESP, Sao Paulo, Brazil. Critical revision
IVPhD, Full Professor, Department of Biology, UNIVÁS. Critical revision
VGraduate student, School of Medicine, UNIVÁS. Surgical procedures
VIPhD, Full Professor, Department of Bioestatistics, UNIVÁS and UNISA. Statistical analysis
VIIMD, DSc in Pathology, Pouso Alegre-MG, Brazil. Responsible for the pathological analysis
VIIIChairwoman, Head of the Department of Surgery, UNIFESP, Sao Paulo, Brazil. Critical revision

Correspondence

 

 


ABSTRACT

PURPOSE: To determine the optimum concentration of a gel obtained from unripe banana (Musa sapientum) peel for wound treatment in rats.
METHODS: A randomized triple blind study was conducted with 40 Wistar rats, which were divided into 4 groups: CG, control group; G2%, 2% gel concentration group; G4%, 4% gel concentration group; and G10%, 10 % gel concentration group. The banana peel gel was applied daily, for 7 days, to a 4-cm2 wound created on the back of each animal of all groups. After this period, the wounds were biopsied. Statistical analysis was carried out using the Kruskal-Wallis test complemented by the Student-Newman-Keuls test.
RESULTS: Macroscopic examination revealed that partial epithelialization occurred in all groups. Wound contraction was also observed in all groups and ranged from 1.38 to 1.57 mm in the study groups, and from 1.03 to 1.10 mm in the control group, with significant differences (p < 0.05) between the groups: CG and G10%, G2% and G4%, G2% and G10%. The interquartile deviation was smaller between the groups CG and G4%.
CONCLUSION: The 4% gel obtained from unripe banana peel (G4%) resulted in better epithelialization of wounds healed by secondary intention compared with other gel concentrations.

Keywords: Musa sapientum. Wound Healing. Rats.


RESUMO

OBJETIVO: Avaliar a concentração ideal do gel da casca de Musa sapientum verde no tratamento de feridas em ratos.
MÉTODOS: Estudo randomizado, triplo cego, com 40 ratos da linhagem Wistar divididos em quatro grupos: GC controle, G2% gel a 2%, G4% gel a 4%, G10% gel a 10%. Realizou-se aplicação diária do gel nas diferentes concentrações, durante sete dias, em uma ferida de 4 cm2 realizada no dorso de cada rato. Após este período, as lesões foram biopsiadas. Para analise dos dados utilizou-se o teste de Kruskal-Wallis complementado pelo teste de Student-Newman-Keuls.
RESULTADOS: Os achados macroscópicos demonstraram reepitelização parcial em todos os grupos. A contração da área da ferida variou entre 1,38 a 1,57 mm nos grupos de estudo, e entre 1,03 a 1,10 mm no grupo controle. Houve diferença significante (p < 0,05) entre os grupos: GC e G10%, G2% e G4%, G2% e G10%, sendo o desvio interquartílico menor entre os grupos GC e G4%.
CONCLUSÃO: O gel a 4% da casca de M. sapientum verde promoveu maior área de epitelização em feridas com cicatrização por segunda intenção, em relação ao gel nas outras concentrações testadas.

Descritores: Musa sapientum. Cicatrização. Ratos.


 

 

Introduction

Currently, it is estimated that about 3% of the Brazilian population have some type of wound. In absolute numbers, there are about four million persons with chronic wounds or complications of the healing process. This requires the search for new resources and technologies that can provide an effective wound treatment at low costs and more accessible to the Brazilian population1. The progress of accidental or surgical wounds depends on the tissue regeneration capacity; therefore, it is very important to understand and promote methods that help the healing process2,3.

At present, wound care is focused on the study of proteolytic enzymes (a class of drugs with bactericidal action) in the form of gels or creams. These drugs are indicated in all stages of wound healing by secondary intention. Enzymes can provide chemical debridement, increase the tensile strength of the scar, and stimulate epithelialization and formation of granulation tissue1. Papain is the most used substance in the treatment of wounds; it is a proteolytic enzyme composed of sulfhydryl proteases extracted from the Carica papaya plant that can be found either alone or combined with urea or chlorophyl1.

Unripe banana has been used as a new therapeutic alternative in the treatment of nipple fissures and peptic ulcers3. However, the use of unripe banana in wound healing by second intention is not well established4. Studies on this subject may corroborate or refute the effects of the treatment, and may also lead to different treatment approaches based on new findings4.

 

Methods

This study was approved by the Research Ethics Committee of the College of Health Sciences, Vale do Sapucai University (UNIVÁS), Pouso Alegre-MG, under the process 105/08. The animals were obtained from the Laboratory Animal Facility of UNIVÁS. The use of laboratory animals followed the principles of the Brazilian College on Animal Experimentation (COBEA) and the Council for International Organization of Medical Sciences (CIOMS) ethical code for animal experimentation. The research was performed at the Division of Plastic Surgery, Department of Surgery, Federal University of Sao Paulo (UNIFESP).

The gel used in the study was prepared from unripe banana peels. The fruit was washed in running water and placed on a clean cloth to dry at room temperature for 20 minutes. Next, the unripe banana was washed again with 500 ml of distilled water, dried with white paper towel, and allowed to dry for another 20 minutes at room temperature. After, the peel of the fruit was removed and the pulp was discarded. The peel was diced and ground in a porcelain mortar for 60 minutes until complete homogenization. The ground material was placed on a watch glass and weighed on an electronic analytical balance (Gehakpara, São Paulo, Brazil). The peel of one unripe banana yield about 50g of ground peel. The banana peel gel was prepared using natrosol gel (hydroxyethyl cellulose, Botanik Kosmetics) as a base gel. The gel and ground material were mixed in a mortar for 5 minutes to assure homogenization. The prepared formulation was placed in a previously sterilized, white 120g plastic container having a false bottom, stored at refrigeration temperature, and used within 30 days.

Forty Wistar rats were used in this study. The rats were housed individually in standard polypropylene cages. The light-dark cycle, humidity, and temperature were the same as the environment. Alls cages were at the same distance from the light source. The animals were fed standard rat chow and water ad libitum. Dipyrone (500 mg/ml) was added to the water and the analgesic solution was renewed every 6 hours during the experiment. The rats were distributed randomly into groups using the software Biostat 5.0. The allocation of the rats was kept in numbered, closed, opaque envelopes. The envelopes were later opened by the researcher responsible for the preparation of the gel containers.

The animals were divided into four experimental groups of 10 rats each: CG, control; G2%, 2% banana peel gel; G4%, 4% banana peel gel; and G10%, 10% banana peel gel. Before the surgical procedure, the animals were anesthetized with a mixture of ketamine hydrochloride (50 mg, Konig do Brasil Ltda) and 2% xylazine hydrochloride (20 mg, Konig do Brasil Ltda) at 2 mL/ kg body weight. The hair of the dorsal region of the animals was shaved in the cephalo-caudal direction, incision lines were marked on the skin with a thin felt tipped pen, and the skin was cleaned with 0.9% saline solution. A 2 x 2 cm surgical wound was created on the back of each animal in the interscapular region. The dorsal skin was resected together with the panniculus carnosus according to the incision lines previously marked; the incision was deepened until the dorsal muscular fascia, which was exposed. Hemostasis was achieved by digital pressure using sterile gauze.

The gel formulations were applied to the respective groups daily for seven days, including the day the surgery was performed. At the end of the 7-day period, the animals were euthanized by anesthesia overdose. Next, the tissue from the wound site was removed together with a 1-cm wide margin (Figure 1), fixed in 10% buffered formaldehyde solution, and sent to the pathology laboratory. The specimen was embedded in paraffin and stained with hematoxylin and eosin. Slides were prepared and photographed with a camera coupled to a light microscope; the images were digitized with Winfast software, and measurements were performed using Image Tool software. The advancement of the granulation tissue from the margin to the center of the wound was measured.

 

 

Statistical analysis was performed using the Kruskal-Wallis test followed by the Student-Newman-Keuls test4. The Kruskal-Wallis test was used to compare quantitative variables. The Statistical Package for the Social Sciences (SPSS) version 15.0 (SPSS Inc.) was used for the analysis. All statistical tests were performed at a significance level α of 0.05 (p<0.05).

 

Results

During the study, three rats in the CG group, two rats in the G4% group, and three rats in the G10% group died. The statistical comparison showed that there were significant differences in the total area of epithelialization between the groups G2% and G10% (p = 0.0329), CG and G4% (p = 0.0245), and G4% and G10% (p = 0.0153). The smallest interquartile deviation occurred between the CG and G4% groups.

The presence of hemorrhage, desquamation, and secretion was assessed by macroscopic examination. During the study period, hemorrhage was not observed; the animals had only a normal bleeding inherent to the procedure, which was controlled by application of digital pressure with gauze. Desquamation was observed to a greater extent on the third day of gel treatment in all groups. Surgical wounds in the CG group showed delayed reepithelialization and contraction compared to those in the G2%, G4% and G10% groups (Figure 2).

 

 

Discussion

Brazil has a large and unexplored pharmacopeia in the form of plants and herbs with medicinal properties. This privileged botanical diversity opens up possibilities for the development of new herbal drugs that could be part of a therapeutic arsenal5. Herbal therapy is widely used in several countries as an alternative to synthetic drugs due to a number of factors, such as local culture and lower costs (no royalties), because herbal products are typically not patentable. In many countries, herbal therapy is an important form of access to medication. In Africa, for example, it accounts for up to 80% of the medicine used by the population. However, the use of herbal medicine has its risks since there are many adverse reactions to the herbal compounds. There is a tendency for herbal products in their many different forms and applications to be labeled by the popular culture as natural and risk-free. The use of medicinal plants and herbal medicines to restore health is a common practice in many ethnical groups and a cumulative result of hundreds of years of empirical knowledge on the action of plants6.

The attention given to the use of medicinal plants by governments and health officials has increased significantly in the past years7. As a consequence, studies on the properties and uses of fruits and their pulps and peels have been carried out in India and China to determine their nutritional and medicinal value8,9. Studies on the properties of the banana, especially of its pulp, have shown that it is rich in flavonoids and leucocyanidin, which are compounds known to have anti-inflammatory and anti-neoplastic properties and liver-protective activity; in the peel it showed potent antihypertensive activity in renal hypertensive rats8,9. There are also studies in the literature reporting on the use of the peel and leaves of the banana plant to improve epithelialization and alleviate pain in the treatment of chronic wounds10.

Musa sapientum var. paradisiaca has been studied intensively for the past 30 years. A multicenter study showed that banana was useful in the treatment of ulcer dyspepsia; however, its medicinal use is still incipient10. Musa sapientum also promotes cellular alteration of the mucosa and increases the synthesis of DNA without carcinogenic or mutagenic effects11-14.

A study on the use of M. sapientum var. paradisiaca extracts was based on the premise that, since the plant has a healing action when used to treat gastric ulcers, it could also be used to treat skin wounds. The authors used techniques that allowed the assessment of the contraction of the scar surface area, epithelialization time, and presence of antioxidants. Rats were treated with aqueous and alcoholic extracts of M. sapientum var. paradisiaca for a period of 21 days. The results were satisfactory regarding the antioxidative properties of the extracts14. However, the use of the gel of unripe banana peel in wound healing by secondary intention is not well documented. The high economic and social costs for both the government and patients associated with the treatment of wounds are an important motivation for the search of new therapeutic alternatives. Therefore, if the effectiveness of unripe banana in the treatment of surgical wounds is confirmed, it will be an important step towards the development of a new alternative wound treatment. The identification of an extract prepared from either the peel or pulp of unripe bananas gives rise to new therapeutic possibilities.

 

Conclusion

The gel of unripe M. sapientum (banana) peel in the concentration of 4% improved the wound healing process in rats compared to the other gel concentrations as evidenced by the smaller residual wound area.

 

References

1. Mandelbaum HS, Di Santis EP, Mandelbaum MHS. Cicatrização: conceitos atuais e recursos auxiliares – parte I. An Bras Dermatol. 2003;78(4):393-408.

2. Sanches Neto R. Aspectos morfológicos e morfométricos da reparação tecidual de feridas cutâneas de ratos com e sem tratamento com solução de papaína 2%. Acta Cir Bras. 1993;8(1):18-23.         [ Links ]

3. Novak FR, Almeida JAG, Silva RS. Casca de banana: uma possível fonte de infecção no tratamento de fissuras mamilares. J Pediatr. 2003;79(3):221-6.         [ Links ]

4. Turolla MS, Nascimento ES. Informações toxicológicas de alguns fitoterápicos utilizados no Brasil. Rev Bras Cien Farm. 2006;42(2):289-306.         [ Links ]

5. Alves NDC, Santos TC, Rodrigues CR, Castro HC, Lira LM, Dornelas CB, Cabral LM. Avaliação da adequação técnica de indústrias de medicamentos fitoterápicos e oficiais do Estado do Rio de Janeiro. Cien Saude Coletiva. 2008;13(suppl.):745-53.         [ Links ]

6. Alexandre RF, Bagatini F, Simões CMO. Interações entre fármacos e medicamentos fitoterápicos à base de ginkgo ou ginseng. Rev Bras Farmacogn. 2008;18(1):117-26.         [ Links ]

7. Silveira PF, Bandeira MAN, Arrais PSD. Farmacovigilância e reações adversas às plantas medicinais e fitoterápicas: uma realidade. Rev Bras Farmacogn. 2008;18(4):918-26.         [ Links ]

8. Gupta N, Gupta SK, Shukla VK, Singh SP. An Indian community based epidemiological study of wound. J Wound Care. 2004;13(8):323-5.         [ Links ]

9. Liu J, Ren H, Xu J, Bai R, Yan Q, Huang W, Wu X, Fu J, Wang Q, Wu Q, Fu R. Total synthesis and antihypertensive activity of (+/-)7,8-dihydroxy-3-methyl-isochromanone-4. Bioorg Med Chem Lett. 2009;19(6):1822-4.         [ Links ]

10. Gore MA, Akolekar D. Banana leaf dressing for skin graft donor areas. Burns. 2003;29(5):483-6.         [ Links ]

11. Agarwal PK, Singh A, Goel S, Khanna HD, Goel RK. Evaluation of wound healing activity of extracts of plantain banana (Musa sapientum var. Paradisiaca) in rats. Indian J Exp Biol. 2009;47(1):32-40.         [ Links ]

12. Mohan Kumar M, Joshi MC, Prabha T, Dorababu M, Goel RK. Effect of plantain banana on gastric ulceration in NIDDM rats: role of gastric mucosal glycoproteins, cell proliferation, antioxidants and free radicals. Indian J Exp Biol. 2006;44(4):292-9.         [ Links ]

13. Goel RK, Saraim K, Rao CV. Role of gastric antioxidant and anti-Helicobactor pylori activities in antiulcerogenic activity of plantain banana (Musa sapientum var. paradisiaca). Indian J Exp Biol. 2001;39(7):719-22.         [ Links ]

14. Goel RK, Saraim K. Anti-ulcer drugs from indigenous sources with emphasis on Musa sapientum, tamrabhasma, Asparagys racemous and Zingiber officinale. Indian J Pharmacol. 2002;34(2):100-10.         [ Links ]

 

 

Correspondence:
Alfredo Gragnani
Disciplina Cirurgia Plástica - UNIFESP
Rua Napoleão de Barros, 715/4º andar
04024-002 São Paulo – SP Brasil
Tel/Fax: (55 11) 5576-4118 / 5571-6579
alfredogf@ig.com.br

Received: January 18, 2011
Review: March 22, 2011
Accepted: April 25, 2011
Conflict of interest: none
Financial source: none

 

 

1 Research performed at the Division of Plastic Surgery, Department of Surgery, Federal University of Sao Paulo (UNIFESP), Brazil. Part of the dissertation of the first author. Tutor: Alfredo Gragnani, Postgraduate Program in Plastic Surgery, UNIFESP.

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