Resumo Contexto A úlcera varicosa (UV) é o estágio mais avançado da doença venosa crônica (DVC) dos membros inferiores (MMII), frequentemente associada a episódios de hemorragia que podem provocar anemia crônica (AC) e retardar a sua cicatrização. Não há, na literatura, trabalhos que avaliem a prevalência da AC nos portadores de UV dos MMII, e poucos trabalhos analisam o uso da pentoxifilina no tratamento das UV dos MMII. Objetivos Avaliar a prevalência da AC nos pacientes portadores de UV de MMII e a resposta terapêutica ao sulfato ferroso (SF) e a associação da pentoxifilina com SF no tratamento adjuvante das UV dos MMII. Métodos Foram avaliados 67 pacientes portadores de UV de MMII atendidos no ambulatório de Cirurgia Vascular do Hospital das Clínicas, Recife, PE. Após as avaliações clínica e laboratorial iniciais, os pacientes diagnosticados com AC foram randomizados em dois grupos: o grupo controle, que recebeu SF (900 mg/dia via oral), e o grupo de estudo, tratado com SF (900 mg/dia via oral) e pentoxifilina (1.200 mg/dia). Todos foram reavaliados após 90 dias. Resultados Entre os pacientes avaliados, 27 (40%) apresentavam AC. Após o tratamento, foram observados aumento dos níveis de hemoglobina e de hematócrito e melhora das taxas da cinética do ferro, assim como a diminuição da profundidade e da área das UV em ambos os grupos, sem diferença estatística. Conclusões Foi encontrada alta prevalência de anemia na população estudada. A associação do SF com a pentoxifilina não se mostrou mais eficaz do que o emprego isolado do SF no tratamento adjuvante da UV dos MMII.

Abstract Background Venous ulcers (VU) are the most advanced stage of chronic venous disease (CVD) of the lower limbs. They are frequently associated with episodes of hemorrhage that can provoke chronic anemia (CA), delaying healing. There are no studies in the literature analyzing the prevalence of CA among patients with VU of the lower limbs and few studies have analyzed use of pentoxifylline to treat VU of the lower limbs. Objectives To evaluate the prevalence of CA in patients with lower limb VU and responses to treatment with ferrous sulfate (SF) compared with a combination of SF plus pentoxifylline as adjuvant treatment for VU of the lower limbs. Methods A total of 67 patients with lower limb VU were recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital das Clínicas, Recife, PE, Brazil. After initial clinical and laboratory assessments, patients diagnosed with CA were randomized into one of two groups: a control group, given SF (900 mg/day oral route), or a study group, treated with SF (900 mg/day oral route) and pentoxifylline (1,200 mg/day). All were reassessed after 90 days. Results Twenty-seven patients (40%) had CA. After treatment, increases were observed in hemoglobin and hematocrit levels, iron kinetics had improved, and both depth and area of VU had reduced in both groups, without statistically significant differences. Conclusions A high prevalence of anemia was detected in the study population. The combination of SF and pentoxifylline was not more effective than SF alone for adjuvant treatment of VU of the lower limbs.

SUMMARY: Peripheral nerve regeneration is a serious clinical problem. The goal of this work was to evaluate comparatively a biopolymer tube of sugarcane with an expanded polyethylene tube as a tube guide in peripheral nerve regeneration. Fourteen male albino Wistar rats were used, separated into three different groups: control (CG), lesion + polyethylene tube (PG) and lesion + sugarcane biopolymer (SBG). At 60 days old, animals from the PG and SBG underwent surgery for tubulization of the sciatic nerve, and 60 days after the injury they were sacrificed for collection of the nerve. In the analysis of the number of nerve fibers, a smaller number was seen in the PG and SBG groups compared to the CG, no difference was seen between the PG and SBG groups (p<0.05). With regard to the number of blood vessels, the SBG group had a larger number than the CG and PG groups (p<0.05). The SBG also presented increase on axonal diameter and G -ratio compared to PG (p<0.05). Taken together these data revealed that biopolymer tube favors a suitable environment for peripheral nerve regeneration.

RESUMEN: La regeneración nerviosa periférica es un problema clínico grave. El objetivo de este trabajo fue evaluar comparativamente un tubo de biopolímero de caña de azúcar con un tubo de polietileno expandido, como guía de tubo en la regeneración de nervios periféricos. Se utilizaron dieciocho ratas Wistar albinas macho, separadas en tres grupos: control (CG), lesión + tubo de polietileno (PG) y lesión + biopolímero de caña de azúcar (SBG). A los 60 días de edad, los animales del PG y SBG fueron sometidos a una cirugía para la tubulización del nervio ciático, y 60 días después de la lesión fueron sacrificados para la recolección del nervio. En el análisis del número de fibras nerviosas, se observó un número menor en los grupos PG y SBG en comparación con el CG; no se observaron diferencias entre los grupos PG y SBG (p <0,05). Con respecto al número de vasos sanguíneos, el grupo SBG tuvo un número mayor que los grupos CG y PG (p <0,05). El SBG también presentó un aumento en el diámetro axonal y la proporción G en comparación con PG (p <0,05). En conjunto, estos datos revelaron que el tubo de biopolímero favorece un entorno adecuado para la regeneración de nervios periféricos.

RESUMO Objetivo: avaliar o uso do curativo de filme e gel de biopolímero de celulose bacteriana no tratamento de pacientes com feridas isquêmicas submetidos à revascularização dos membros inferiores. Métodos: ensaio clínico randomizado realizado no ambulatório de Angiologia e Cirurgia Vascular do Hospital das Clínicas da Universidade Federal de Pernambuco, entre janeiro de 2017 e dezembro de 2018. Foram acompanhados 24 pacientes após revascularização de membros inferiores, divididos em dois grupos: Experimental, tratado com filme e gel de biopolímero de celulose bacteriana, e Controle, tratado com ácidos graxos essenciais. Os pacientes foram acompanhados em consultas semanais para troca dos curativos e o processo de cicatrização das feridas foi avaliado em um período de 90 dias. Resultados: a redução da área das feridas isquêmicas no período de 30 dias foi de 4,3cm2 (55%), em média, para o grupo experimental, e de 5,5cm2 (48,5%) para o grupo controle (p>0,05). A taxa de cicatrização completa, em 90 dias, foi de 34,8%, sendo 50% no grupo experimental e 18,2% no grupo controle (p=0,053). Conclusão: o filme de biopolímero de celulose bacteriana associada a gel pode ser utilizado como curativo no tratamento de feridas isquêmicas de pacientes submetidos à revascularização de membros inferiores

ABSTRACT Objective: to evaluate the use of a bacterial cellulose biopolymer film and gel dressing in the treatment of patients with ischemic wounds submitted to lower limb revascularization. Methods: we conducted a randomized clinical trial in the Angiology and Vascular Surgery outpatient clinic of the Clinics Hospital of the Federal University of Pernambuco, between January 2017 and December 2018. We followed 24 patients after lower limb revascularization, divided into two groups: Experimental, treated with bacterial cellulose biopolymer film and gel, and Control, treated with essential fatty acids. Patients attended weekly appointments to change dressings and had their wound healing processes evaluated over a period of 90 days. Results: the reduction of the ischemic wounds’ areas after 30 days was 4.3cm2 (55%) on average for the experimental group, and the 5.5cm2 (48.5%) for the control group (p>0.05). The complete healing rate at 90 days was 34.8%, 50% in the experimental group and 18.2% in the control group (p=0.053). Conclusion: the bacterial cellulose biopolymer film associated with gel can be used as a dressing in the treatment of ischemic wounds of patients undergoing revascularization of the lower limbs.

RESUMO Objetivo: avaliar, através de dopplerfluxometria, de venografia, de histologia e de evolução clínica, o uso de enxertos tubulares de biopolímero de cana-de-açúcar (BP) na reconstrução de veias femorais em cães. Métodos: oito cães adultos foram submetidos à reconstrução de veia femoral, à esquerda com enxerto tubular de BP e à direita com veia autóloga. No período pós-operatório, os animais foram submetidos à avaliação clínica e dopplerfluxometria das veias femorais. Após 360 dias, os cães foram reoperados e submetidos à flebografia das veias femorais com contraste iodado. Os segmentos das veias femorais contendo os enxertos foram retirados e enviados para avaliação histopatológica. Resultados: os cães não apresentaram hemorragia, hematoma, infecção da ferida operatória ou edema dos membros operados. Um animal apresentou dilatação venosa superficial na região inguinal esquerda. A flebografia realizada 360 dias após a primeira cirurgia demonstrou que três (37,5%) enxertos de BP e sete (87,5%) do grupo controle (C) estavam pérvios. Na avaliação histopatológica foi encontrada uma reação inflamatória com neutrófilos e linfócitos na superfície externa de ambos os grupos. Na camada íntima de revestimento dos enxertos e na camada externa nos dois grupos, foi encontrada fibrose. Conclusão: com base nos resultados obtidos com o modelo experimental utilizado, conclui-se que a BP apresenta potencial para ser utilizado como enxerto tubular para revascularização venosa, porém novas pesquisas precisam ser realizadas para confirmar a sua eficácia na revascularização de veias de médio e grande calibre, o que poderia permitir o seu uso na prática clínica.

ABSTRACT Objective: to evaluate, through Doppler flowmetry, venography, histology and clinical evolution, the use of sugarcane biopolymer (BP) tubular grafts in the reconstruction of femoral veins in dogs. Methods: we submitted eight adult dogs to femoral vein reconstruction, on the left with BP tubular graft and on the right with autologous vein. In the postoperative period, the animals underwent clinical evaluation and femoral vein Doppler flowmetry. After 360 days, we reoperated the dogs and submitted them to femoral vein phlebography with iodinated contrast. We removed the segments of the femoral veins containing the grafts and sent them for histopathological evaluation. Results: the dogs did not present hemorrhage, hematoma, surgical wound infection or operated limb edema. One animal had superficial venous dilatation in the left inguinal region. Phlebography performed 360 days after the first surgery showed that three (37.5%) BP grafts and seven (87.5%) grafts from the control group (C) were patent. In the histopathological evaluation, we found an inflammatory reaction, with neutrophils and lymphocytes on the external surface of both groups. In the intimal layer of the grafts and in the outer layer in the two groups, we observed fibrosis. Conclusion: based on the results obtained with the experimental model used, BP presents potential to be used as a tubular graft for venous revascularization. However, new research must be performed to confirm its efficacy in the revascularization of medium and large diameter veins, which could allow its use in clinical practice.

RESUMO OBJETIVO: Avaliar a concordância para o padrão de curva, lado e níveis das vértebras apical superior, ápex e apical inferior das curvas de pacientes e respectivos familiares com escoliose idiopática. MÉTODOS: A concordância, pela classificação de Lenke, para o padrão de curva, lado e níveis das vértebras apical superior, ápex e apical inferior foi avaliada em 243 pares de pacientes e respectivos familiares com escoliose idiopática. RESULTADOS: A concordância familiar para o padrão de curva e lado foi de 51,4% (125 pares). Entre esses pares, a concordância dos níveis das vértebras foi de 91,2% (114 pares). A taxa de concordância para o padrão de curva e lado entre pais/filhos foi de 51,6% e entre irmãos foi de 50,0% (p= 0,411). As taxas de concordância dos níveis das vértebras foram respectivamente de 86,8% e 95,1% (p-valor = 0,219). CONCLUSÃO: O formato das curvas na escoliose idiopática tem relação familiar e com o grau de parentesco, uma vez que se reportou alta concordância para o padrão de curva, lado e níveis das vértebras apicais e ápex entre pacientes e familiares com a deformidade. A concordância foi maior entre aqueles com grau de parentesco mais próximo. Nível de Evidência Ii, Estudo Prospectivo de Menor Qualidade.

ABSTRACT OBJECTIVE: To evaluate the concordance for the curve pattern, side and levels of the superior apical vertebrae, apex and inferior apical vertebrae of curves in patients and their relatives with idiopathic scoliosis. METHODS: Concordance according to the Lenke classification for curve pattern, side and levels of the superior apical vertebrae, apex and inferior apical vertebrae were evaluated comparative and prospectively in 243 pairs of patients and respective relatives with idiopathic scoliosis. RESULTS: The family concordance for the curve pattern and side was 51.4% (125 pairs). Among these pairs, the concordance of the levels of the vertebrae was 91.2% (114 pairs). The concordance rate for the curve pattern and side between parents/children was 51.6% and between siblings was 50.0% (p-value= 0.411). The concordance rates of the levels of vertebrae were 86.8% and 95.1%, respectively (p-value = 0.219). CONCLUSION: Curve shape in idiopathic scoliosis is related to family and degree of kinship, since the data showed a high concordance for the curve pattern, side and levels of the apical vertebrae and apex between patients and relatives with this deformity. The concordance was higher in those with a closer degree of kinship. Level of Evidence II, Lesser Quality Prospective Study.

RESUMO Objetivo: avaliar a eficácia de curativos com membrana de Celulose Bacteriana (CB) no tratamento de úlceras venosas de membros inferiores. Métodos: estudo prospectivo, randomizado e controlado de 25 pacientes com úlceras decorrentes de doença venosa crônica nos membros inferiores provenientes do Serviço de Angiologia e Cirurgia Vascular do Hospital de Clínicas da Universidade Federal de Pernambuco e da Policlínica do Salgado da Secretaria Municipal de Saúde, Caruaru, Pernambuco. Os pacientes foram distribuídos aleatoriamente em dois grupos: grupo controle, que recebeu curativos com óleo de triglicerídeos (11 pacientes) e grupo experimental, tratado com membrana de CB (14 pacientes). Os pacientes foram acompanhados por um período de 120 dias. Resultados: houve uma redução na área de ferida em ambos os grupos. Não houve infecção ou reações ao produto em nenhum dos grupos. Pacientes do grupo CB mostraram diminuição da dor e interrupção mais precoce do uso de analgésicos. Conclusão: a membrana de CB pode ser usada como curativo para o tratamento de úlceras varicosas dos membros inferiores.

ABSTRACT Objective: to evaluate the efficacy of Bacterial Cellulose (BC) membrane dressings in the treatment of lower limb venous ulcers. Methods: we carried out a prospective, randomized, controlled study of 25 patients with chronic venous ulcer disease in the lower limbs from the Angiology and Vascular Surgery Service of the Federal University of Pernambuco Hospital and from the Salgado Polyclinic of the County Health Department, Caruaru, Pernambuco. We randomly assigned patients to two groups: control group, receiving dressings with triglyceride oil (11 patients) and experimental group, treated with BC membrane (14 patients). We followed the patients for a period of 120 days. Results: There was a reduction in the wound area in both groups. There were no infections or reactions to the product in any of the groups. Patients in the BC group showed decreased pain and earlier discontinuation of analgesic use. Conclusion: BC membrane can be used as a dressing for the treatment of varicose ulcers of the lower limbs.

ABSTRACT Introduction: The periareolar dermal release maneuver in mammoplasty promotes better mobility of the nipple-areola complex. However, there are doubts on possible nerve damages in this kind of topography. This quantitative analysis compared the nerve branches density from the medial, lateral and caudal side-flow of the nipple-areola complex (NAC). Methods: This was a prospective study. The study included 26 women who have undergone a mammaplasty reduction using the Pitanguy’s classic technique. The dermis fragments collected from the medial, lateral and caudal sides were properly prepared and subjected to a histological study in order to determine the nerve branches density in each studied sides. Results: Of 26 studied patients, 42.3% had a higher nerve branches density in the lateral side; 38.5%, on the medial side and 19.2% on the caudal side. The statistical analysis used to evaluate whether there was a predominance of one side where the dermis has been sectioned showed that the proportion comparison test was not significant (p = 0.304). Conclusion: The comparative analysis has shown that there is no preponderance of nerve density in any periareolar dermis side.

RESUMO Introdução: A manobra de liberação dérmica periareolar na mamoplastia promove uma melhor mobilidade do complexo mamilo-aréola (NAC). No entanto, existem dúvidas sobre possíveis danos nos nervos neste tipo de topografia. Este estudo objetiva uma análise quantitativa comparando a densidade dos nervos do fluxo lateral medial, lateral e caudal do NAC. Métodos: Trata-se de um estudo prospectivo. O estudo incluiu 26 pacientes do sexo feminino que foram submetidas à mamoplastia redutora pela técnica clássica de Pitanguy. Os fragmentos da derme coletados dos lados medial, lateral e caudal foram devidamente preparados e submetidos a um estudo histológico para determinar a densidade dos nervos em cada um dos lados estudados. Resultados: Dos 26 pacientes estudados, 42,3% apresentaram maior densidade de nervos no lado lateral; 38,5%, do lado medial e 19,2% do lado caudal. A análise estatística utilizada para avaliar se houve predominância de um lado onde a derme foi seccionada demonstrou que o teste de comparação de proporções não foi significativo (p = 0,304). Conclusão: A análise comparativa mostrou que não há preponderância de densidade de nervos em qualquer lado da derme periareolar.

ABSTRACT Purpose: This study was to confirm the safety and efficacy of BC dressing when used in surgical male wound healing at the urogenital area. Methods: Open, non-controlled clinical study of phase II. A total of 141 patients, among those children, adolescents and adults with hypospadias (112), epispadias (04), phymosis (13) and Peyronie's disease (12) that had a BC dressing applied over the operated area after surgery. A written informed consent was obtained from all participants. Study exclusion criteria were patients with other alternative treatment indications due to the severity, extent of the injury or the underlying disease. The outcomes evaluated were efficacy, safe and complete healing. The costs were discussed. Results: In 68% patients, the BC dressing fell off spontaneously. The BC was removed without complications in 13% of patients at the outpatient clinic during the follow-up visit and 17% not reported the time of removal. In 3% of the cases, the dressing fell off early. Complete healing was observed between 8th and 10th days after surgery. The BC dressings have shown a good tolerance by all the patients and there were no reports of serious adverse events. Conclusion: The bacterial cellulose dressings have shown efficacy, safety and that can be considered as a satisfactory alternative for postoperative wound healing in urogenital area and with low cost.

ABSTRACT Objectives: To present a simplified calculation for the measurement of osteotomy wedges used for the correction of angular uniplanar deformities of long bones and to compare the simplified calculation proposed (circumferential calculation) with the classical trigonometric calculations, as well as with the exact calculation performed by computer software AutoCADtm. Methods: The software AutoCADtm was used to calculate the bone wedges, for mathematical comparison of the three main groups, each one of them containing 18 hypothetical bone deformities which angles ranging from 5 to 90 degrees, with 5 degrees intervals between them. Results: In the analysis of 18 deformities, the hypothetical angular bone, the average lengths of the corrective wedges obtained by the trigonometric, circumferential and the exact metods were, respectively, 32.21 ± 16.81 mm, 33.16 ± 18.63 mm and 35.22 ± 23.52 mm. There was no statistically significant difference between the three calculation methods (p>0.05). Conclusion: The circumferential calculation proposed in this study is useful for being accurate and simple, not requiring any trigonometric knowledge. Level of Evidence II, Experimental Study.

RESUMO Racional: A aplicação de produtos em anastomoses colônicas que possam prevenir o surgimento de deiscências são de grande interesse médico. O emprego do polissacarídeo de melaço de cana-de-açúcar (Saccharum officinarum), que possui adequada tolerabilidade e compatibilidade in vivo, ainda não foi testado para este fim. Objetivo: Analisar os parâmetros biomecânicos em suturas colônicas de ratos submetidos à colectomia esquerda após aplicação de fita ou gel do polissacarídeo do melaço da cana-de-açúcar no sítio cirúrgico. Métodos: Quarenta e cinco ratos (Rattus norvegicus albinus da linhagem Wistar) foram sorteados em três grupos de 15 submetidos a: irrigação das suturas entéricas com soro fisiológico a 0,9%; aplicação de fita de polissacarídeo do melaço da cana-de-açúcar; e aplicação do gel do mesmo melaço. Os ratos foram submetidos à colectomia esquerda com anastomose primária, e tratados segundo os respectivos grupos. Cinco ratos de cada grupo foram avaliados em diferentes tempos após o procedimento: 30º, 90º e 180º dias de pós-operatório. Foram avaliadas as variáveis de força máxima de ruptura, módulo de elasticidade e deformação específica da força máxima. Resultados: As variáveis biomecânicas entre os tempos de coleta da pesquisa e os grupos de tratamento foram analisados estatisticamente. As características biomecânicas de força máxima de ruptura e o módulo de elasticidade do corpo de prova permaneceram idênticas, independente do tratamento com soro, fita ou gel de polissacarídeo, e do tempo de tratamento. No entanto, foi evidenciada maior deformação específica da força máxima da parede intestinal, aos 180 dias nos ratos tratados com gel de polissacarídeo de cana-de-açúcar. (p=0,09). Conclusão: Em relação ao controle, foi detectada maior elasticidade da parede intestinal nos ratos tratados com gel de polissacarídeo de cana-de-açúcar, sem alteração de outras características biomecânicas, independente do tipo ou tempo de tratamento.

ABSTRACT Background: The use of measures in colonic anastomoses to prevent dehiscences is of great medical interest. Sugarcane molasses, which has adequate tolerability and compatibility in vivo, has not yet been tested for this purpose. Aim: To analyze the biomechanical parameters of colonic suture in rats undergoing colectomy, using sugarcane molasses polysaccharide as tape or gel. Methods: 45 Wistar rats (Rattus norvegicus albinus) were randomized into three groups of 15 animals: irrigation of enteric sutures with 0.9% saline solution; application of sugarcane molasses polysaccharide as tape; and sugarcane molasses polysaccharide as gel. The rats underwent colon ressection, with subsequent reanastomosis using polypropylene suture; they were treated according to their respective groups. Five rats from each group were evaluated at different times after the procedure: 30, 90 and 180 days postoperatively. The following variables were evaluated: maximum rupture force, modulus of elasticity and specific deformation of maximum force. Results: The biomechanical variables among the scheduled times and treatment groups were statistically calculated. The characteristics of maximum rupture force and modulus of elasticity of the specimens remained identical, regardless of treatment with saline, polysaccharide gel or tape, and treatment time. However, it was found that the specific deformation of maximum force of the intestinal wall was higher after 180 days in the group treated with sugarcane polysaccharide gel (p=0.09). Conclusion: Compared to control, it was detected greater elasticity of the intestinal wall in mice treated with sugarcane polysaccharide gel, without changing other biomechanical characteristics, regardless of type or time of treatment.

RESUMO INTRODUÇÃO: Tratamentos promissores para o fechamento da perfuração da membrana timpânica vêm sendo estudados. Terapias provenientes de engenharia de tecidos provavelmente eliminarão a necessidade de uma intervenção cirúrgica convencional. A celulose bacteriana apresenta-se como uma alternativa por ser segura, de baixa toxicidade, biocompatível. OBJETIVOS: Investigar o efeito da aplicação direta do enxerto da celulose bacteriana na cicatrização de perfurações da membrana timpânica, comparado ao procedimento convencional com fáscia autóloga. MÉTODO: Incluíram-se 40 pacientes com perfuração da membrana timpânica por otite média crônica simples. Randomizados de 1 a 40, onde os ímpares (20) foram tratados com enxerto de celulose bacteriana (CB), e os pares (20), com enxerto de fáscia temporal autóloga (fáscia). Estudo clínico controlado e randomizado. O tempo cirúrgico e de hospitalização foram o tempo de epitelização e custos hospitalares. RESULTADOS: O fechamento das perfurações foi semelhante nos dois grupos. O tempo médio da cirurgia no grupo fáscia foi de 76,50 minutos e de 14,06 minutos no grupo com celulose bacteriana (p = 0,0001). O custo hospitalar pela tabela do SUS foi de R$ 600,00 para o grupo CB e R$ 7.778,00 para o grupo fáscia (p = 0,0001). CONCLUSÃO: A celulose bacteriana promoveu o fechamento da perfuração do tímpano, mostrando-se inovador, seguro, eficaz, efetivo, minimamente invasivo e de baixo custo.

ABSTRACT INTRODUCTION: Promising treatments for tympanic membrane perforation closure have been studied. Therapies derived from tissue engineering probably eliminate the need for conventional surgery. Bacterial cellulose is presented as an alternative that is safe, biocompatible, and has low toxicity. OBJECTIVES: To investigate the effect on healing of direct application of a bacterial cellulose graft on the tympanic membrane compared to the conventional approach with autologous fascia. METHODS: Randomized controlled trial. Forty patients with tympanic membrane perforations secondary to chronic otitis media were included, and were randomly assigned to an experimental group (20), treated with a bacterial cellulose graft (BC) and control group (20), treated with autologous temporal fascia (fascia). We evaluated the surgical time, hospital stay, time of epithelialization and the rate of tympanic perforation closure. Hospital costs were compared. The statistical significance level accepted was established at p < 0.05. RESULTS: The closure of perforations was similar in both groups. The average operation time in the fascia group was 76.50 min versus 14.06 min bacterial cellulose in the group (p = 0.0001). The hospital cost by the Brazilian public health system was R$ 600.00 for the bacterial cellulose group, and R$ 7778.00 for the fascia group (p = 0.0001). CONCLUSION: Bacterial cellulose grafts promoted the closure of the tympanic membrane perforations, and were demonstrated to be innovative, effective, safe, minimally invasive, efficacious and to have a very low cost.

PURPOSE: To evaluate the effects of particulate (granule-shaped) SCB on bone repair relating it to its biocompatibility and bone neoformation. METHODS: Thirty Wistar rats were submitted to a one 7-mm-diameter defect and divided equally into three experimental groups, with two different postoperative times of evaluation, 90 and 120 days. Each calvaria defect was filled up with clot (control group), particulated autogenous bone or granulated SCB. Five animals of each group were assessed at 90 and 120 days after surgery. In these two periods, histological and histometric analysis were obtained. RESULTS: The clot group showed a bone resorption trend while the autogenous bone group a bone repair trend. However in the SCB group, the critical defect filled up only with fibrous connective tissue and presented none bone neoformation. CONCLUSION : The sugarcane biopolymer when used in critical size defects was a biocompatible material and proved to be a good material to fill bone cavities, keeping them as uniform areas filled with soft tissue and avoiding the tissue shrinkage.

PURPOSE: To assess the histological response of damaged osteochondral tissue in the femoral condyles of rabbits after repairing the wounds with sugar cane biopolymer gel - compared to the control group. METHODS: The study investigated 16 New Zealand rabbits, at 90, 120 and 180 days after surgery. In all the animals, a lesion of 3.2 mm in diameter and 4 mm deep was induced in each right and left femoral condyle. Each animal has provided both knees, divided into medial and lateral condyle, resulting in 64 samples. 32 knees were divided into two groups: Right knee, medial and lateral condyles, filled with biopolymer; Left knee, medial and lateral condyles, unfilled. The anatomical specimens were removed, and subjected to histological techniques and morphometric and statistical analysis. RESULTS: In all the periods of the group under study an inflammatory reaction mediated by giant cells and mononuclear cells was found, while in the control group there was early healing produced by fibroblasts and few mononuclear cells with statistical significance between groups. CONCLUSION: The biopolymer gel caused an inflammatory reaction mediated by giant cells and mononuclear cells while the control group there was cicatrization mediated by fibroblasts.

OBJECTIVE: To evaluate the function of the subscapularis muscle by means of isometric strength, clinical examination and analysis of fatty infiltration in patients with recurrent anterior dislocation of the shoulder undergoing Latarjet-Patte surgery. METHODS: 38 patients operated from March 2011 to March 2012, with minimum follow-up of two years were evaluated, being 26 males and 12 females, with a mean age of 28.7 years old. Isometric strength was measured using a portable dynamometer and measuring the distance from the back of the hand during the lift-off test. We used the Rowe and Walch-Duplay scores for clinical evaluation. The degree of fatty infiltration of the subscapularis belly was assessed by computed tomography. RESULTS: The mean scores in the Walch-Duplay and Rowe were 84.7 and 89.4, respectively. The mean distance to the back of the hand was 7.34 cm on the operated side and 8.72 cm on the opposite side (p <0.0001). The mean strength measured in the lift-off test was 0.38 kg lower than on the contralateral side (p = 0.001). There was no fatty infiltration of the subscapularis in 16 patients (42.1%). Sixteen patients (42.1%) were classified as Goutallier grade 1 and six (15.8%) as grade 2. We found that the measured isometric strength decreases with increasing the degree of fatty infiltration (p <0.0001). CONCLUSIONS: The decrease in subscapularis strength, albeit of low magnitude (0.38 kg), was directly related to the degree of fatty infiltration and worse clinical outcomes. Level of Evidence III, Therapeutic Study - Investigating the Results of Treatment.

PURPOSE: To evaluate the biocompatibility and local sensibility reaction to bacterial cellulose hydrogel (0.8%) implanted in subcutaneous tissue of rabbits.METHODS:Fifteen New Zeland rabbits were randomly allocated into three groups: T1, 7 days, T2, 21 days, and T3, 84 days. The new material was implanted in the subcutaneous tissue of the ear; on the scalp over the periosteum; and on the outer and inner surfaces of the thighs, in the aponeurosis of the muscle. At 7, 21 and 84 postoperative days, the material was collected for histological study. The clinical signs, inflammatory response, angiogenesis and fibrogenesis were variables used for analysis of the biocompatibility and biological reactivity to BCH. Analyses were performed with an AXIO(r) Imager. The statistical tests were performed using the GraphPad Prism 5.0 program(r)RESULTS:The intensity of the inflammatory infiltrate, considering the different cell types (PMN, LMN and GC), was statistically significant, with group T1 different from groups T2 and T3 (p = 0.0124 and p <0.0001, respectively) and T2 different from the T3 group (p = 0.0007). Fibrogenesis grade 1 was the most prevalent in groups T1 (55.4%) and T2 (44.6%). The formation of neovascularization in the group was identified in 84.4% of samples.CONCLUSION:Bacterial cellulose hydrogel (0.8%) is biocompatible, integrating with the subcutaneous tissue of rabbits and inducing tissue remodeling.