Effects of therapeutic ultrasound and paraffin with or without vacuum massage on biomechanical properties of grafted skin after burn: a randomized controlled trial

Gonçalves, Adriana da Costa; Guirro, Rinaldo Roberto de Jesus; Rossi, Lidia Aparecida; Farina Junior, Jayme Adriano; Carvalho, Camila Silva de; Ferro, Ana Paula; Guirro, Elaine Caldeira de Oliveira

doi:10.1590/1806-9282.20220994

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Brasil

Revista da Associação Médica Brasileira

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Brasil

Español English

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Original Article • Rev. Assoc. Med. Bras. 68 (12) • 2022 • https://doi.org/10.1590/1806-9282.20220994 copy

Effects of therapeutic ultrasound and paraffin with or without vacuum massage on biomechanical properties of grafted skin after burn: a randomized controlled trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to compare the effects of therapeutic ultrasound and paraffin with or without vacuum massage on the biomechanical properties of grafted skin after a burn.

METHODS:

A total of 44 patients with deep second- and third-degree burns, with a mean age of 35.89 (±11.53) years, who visited the Hospital Burn Unity, were included in the study. The therapeutic interventions were randomly defined by drawing lots, with a crossover design (crossover), and a minimum interval of 7 days (washout) between interventions. Skin biomechanical parameters such as distensibility (R0) and viscoelasticity (R6) were noninvasively evaluated by Cutometer before and after 0, 10, 20, and 30 min of intervention with therapeutic ultrasound and paraffin alone, as well as associated with negative pressure therapy of the skin (vacuum therapy). In this study, all groups showed increased distensibility (R0) in the period immediately after the application of the resources and a progressive reduction in the effects in the consecutive tests. Participants with skin grafts showed a decrease in viscoelasticity (R6) in all groups, except therapeutic paraffin and therapeutic ultrasound and vacuum massage.

CONCLUSION:

The biomechanical properties of grafted skin after a burn are altered after therapeutic intervention with ultrasound alone or associated with vacuum massage, such as intervention with paraffin associated with vacuum massage, for both parameters evaluated, skin distensibility (R0) and skin viscoelasticity (R6). However, the same did not occur for the intervention with isolated paraffin. There was no significant difference between the interventions therapeutic ultrasound and therapeutic paraffin.

Keywords
Skin transplantation; Burns; Physical therapy modalities; Ultrasonic therapy

Area	Group	Pre	P0	P10	P20	P30
Normal skin	TU (n=39)	0.32 (0.27–0.38)	0.36ª (0.31–0.45)	0.35 (0.29–0.40)	0.33 (0.30–0.40)	0.31^b (0.29–0.38)
	TP (n=38)	0.30 (0.25–0.36)	0.31 (0.27–0.37)	0.34 (0.26–0.39)	0.34 (0.28–0.38)	0.32 (0.26–0.38)
	TUV (n=32)	0.35 (0.27–0.42)	0.36 (0.30–0.44)	0.33 (0.30–0.41)	0.34 (0.28–0.40)	0.31^b (0.26–0.40)
	TPV (n=32)	0.33 (0.25–0.38)	0.35^a (0.27–0.40)	0.32^b (0.27–0.37)	0.30^b (0.26–0.36)	0.32 (0.26–0.37)
Skin graft area	TU (n=39)	0.13 (0.10–0.16)	0.14 (0.10–0.19)	0.13 (0.10–0.18)	0.12 (0.09–0.17)	0.13 (0.09–0.16)
	TP (n=38)	0.11 (0.09–0.16)	0.13 (0.10–0.16)	0.12 (0.10–0.16)	0.11 (0.10–0.14)	0.12 (0.10–0.16)
	TUV (n=32)	0.13 (0.10–0.16)	0.14 (0.09–0.18)	0.11 (0.08–0.16)	0.12 (0.09–0.16)	0.11^b (0.08–0.15)
	TPV (n=32)	0.11 (0.09–0.16)	0.13 (0.10–0.17)	0.10 (0.08–0.15)	0.10 (0.08–0.15)	0.11 (0.09–0.16)

Area	Group	Pre	0	10	20	30
Normal skin	TU (n=39)	0.45 (0.40–0.50)	0.36^a (0.31–0.42)	0.42 (0.37–0.48)	0.44^b (0.38–0.50)	0.45^b (0.36–0.50)
	TP (n=38)	0.47 (0.43–0.50)	0.42^a (0.37–0.47)	0.43 (0.40–0.50)	0.44 (0.39–0.49)	0.46 (0.38–0.53)
	TUV (n=32)	0.43 (0.38–0.48)	0.39 (0.32–0.45)	0.43^b (0.40–0.51)	0.48^b (0.41–0.53)	0.50^b (0.39–0.55)
	TPV (n=32)	0.45 (0.39–0.49)	0.44 (0.36–0.47)	0.46^b (0.42–0.53)	0.47ª^,b (0.43–0.52)	0.47 (0.39–0.54)
Skin graft area	TU (n=39)	0.59 (0.53–0.71)	0.53ª (0.45–0.64)	0.59 (0.48–0.69)	0.57 (0.51–0.67)	0.63 (0.48–0.72)
	TP (n=38)	0.57 (0.50–0.71)	0.55 (0.50–0.64)	0.55 (0.51–0.63)	0.56 (0.52–0.67)	0.55 (0.49–0.66)
	TUV (n=32)	0.60 (0.50–0.73)	0.50 (0.43–0.59)	0.57 (0.50–0.71)	0.59 (0.49–0.65)	0.67^b (0.53–0.82)
	TPV (n=32)	0.58 (0.55–0.66)	0.52^a (0.42–0.59)	0.60^b (0.51–0.70)	0.60 (0.52–0.71)	0.58 (0.49–0.63)

Area	Time (min)	TU	TP	TUV	TPV
Normal skin	Pre	0.32 (0.27–0.38)	0.30 (0.25–0.36)	0.35 (0.27–0.42)	0.33 (0.25–0.38)
	0	0.36 (0.31–0.45)	0.31 (0.27–0.37)	0.36 (0.30–0.44)	0.35 (0.27–0.40)
	10	0.35 (0.29–0.40)	0.34 (0.26–0.39)	0.33 (0.30–0.41)	0.32 (0.27–0.37)
	20	0.33 (0.30–0.40)	0.34 (0.28–0.38)	0.34 (0.28–0.40)	0.30 (0.26–0.36)
	30	0.31 (0.29–0.38)	0.32 (0.26–0.38)	0.31 (0.26–0.40)	0.32 (0.26–0.37)
Skin graft area	Pre	0.13 (0.10–0.16)	0.11 (0.09–0.16)	0.13 (0.10–0.16)	0.11 (0.09–0.16)
	0	0.14 (0.10–0.19)	0.13 (0.10–0.16)	0.14 (0.09–0.18)	0.13 (0.10–0.17)
	10	0.13 (0.10–0.18)	0.12 (0.10–0.16)	0.11 (0.08–0.16)	0.10 (0.08–0.15)
	20	0.12 (0.09–0.17)	0.11 (0.10–0.14)	0.12 (0.09–0.16)	0.10 (0.08–0.15)
	30	0.13 (0.09–0.16)	0.12 (0.10–0.16)	0.11 (0.08–0.15)	0.11 (0.09–0.16)

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[1] *Corresponding author: ecguirro@fmrp.usp.br