RESUMO
Closed degloving injuries are uncommon, high-energy injuries that separate the bony structures from the soft tissue and frequently result in amputation. Because the epidermis is often intact, it is difficult to visualize the extent of the soft tissue damage. Although there is no gold standard of treatment for closed degloving injuries at present, previous cases have reported that neurovascular presentation is a key predictor of amputation Herein, we report a closed degloving injury involving the second through fifth phalanges of the left foot following a crushing injury with a forklift. Despite adequate capillary refill upon initial presentation, the patient ultimately underwent transmetatarsal amputation.
Assuntos
Lesões por Esmagamento , Lesões dos Tecidos Moles , Amputação Cirúrgica , Humanos , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/cirurgia , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/lesões , Dedos do Pé/cirurgiaRESUMO
To determine whether the effects of photobiomodulation (PBM) were associated with the use of Simvastatin in the functional recovery from sciatic nerve in mice submitted to crush injury. Fifty Swiss mice (approximately 3 months old; average weight 40 g) were randomly divided into six groups: naive, sham, control, PBM (660 nm, 10 J/cm2; 30 mW; 0.6 J per day for 28 days; 0.06 cm2; 16.8 J total and 20 s), Simvastatin (20 mg/kg), and PBM/Simv (association of the two protocols). The sciatic functional index (SFI), thermal heat hyperalgesia, mechanical hyperalgesia, and thermographic evaluation were used as analyses. The evaluations were performed preoperatively and 7, 14, 21, and 28 days after the initial injury analyzed by two-way analysis of variance (ANOVA) for mixed models followed by the Bonferroni post-test. All groups except sham and naive presented an SFI compatible with severe peripheral nerve injury on the 7th day of evaluation. The PBM group presented better results in the SFI analysis (p < 0.001) on the 21st postoperative day compared to the control group. This benefit was maintained when compared to the Simvastatin (p < 0.001) and PBM/Simv groups (p < 0.01). The results of the thermal and mechanical hyperalgesia and thermography analyses were not significant (p > 0.05). The obtained results showed that PBM alone was more effective compared to Simvastatin alone or PBM combined with Simvastatin for sciatic nerve injury in mice.
Assuntos
Traumatismos dos Nervos Periféricos , Neuropatia Ciática , Animais , Camundongos , Compressão Nervosa , Regeneração Nervosa , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Nervo Isquiático , Neuropatia Ciática/tratamento farmacológico , Sinvastatina/uso terapêuticoRESUMO
Trauma to the peripheral nervous system (PNS) results in loss of motor and sensory functions. After an injury, a complex series of events begins, allowing axonal regeneration and target reinnervation. However, this regenerative potential is limited by several factors such as age, distance from the lesion site to the target and severity of lesion. Many studies look for ways to overcome these limitations. Inosine, a purine nucleoside derived from adenosine, emerges as a potential treatment, due to its capacity to regulate axonal growth, neuroprotection and immunomodulation, contributing to motor recovery. However, no studies demonstrated their effects on PNS. C57/Black6 mice were submitted to sciatic nerve crush and received intraperitoneal injections of saline or inosine (70â¯mg/kg), one hour after injury and daily for one week. To evaluate axonal regeneration and functional recovery, electroneuromyography, Sciatic Function Index (SFI), rotarod and pinprick tests were performed. Our results showed that the inosine group presented a higher number of myelinated fibers and a large amount of fibers within the ideal G-ratio. In addition, the results of electroneuromyography showed greater amplitude of the compound muscle action potentials in the first and second weeks, suggesting anticipation of regeneration in the inosine group. We also observed in the inosine group, motor and sensory neurons survival, reduction in the number of macrophages and myelin ovoids in the sciatic nerves, and an early recovery of motor and sensory functions. Thus, we conclude that the use of inosine accelerates axonal regeneration promoting an early recovery of motor and sensory functions.
Assuntos
Inosina/farmacologia , Compressão Nervosa , Regeneração Nervosa/efeitos dos fármacos , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervo Isquiático/efeitos dos fármacos , Animais , Eletromiografia , Injeções Intraperitoneais , Inosina/administração & dosagem , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Camundongos , Regeneração Nervosa/fisiologia , Fármacos Neuroprotetores/farmacologia , Traumatismos dos Nervos Periféricos/patologia , Recuperação de Função Fisiológica/efeitos dos fármacos , Recuperação de Função Fisiológica/fisiologia , Teste de Desempenho do Rota-Rod , Nervo Isquiático/lesõesRESUMO
Considering the potential action of exercise on neuroplasticity and the need to adapt protocols to enhance functional recovery after nerve injury, this study evaluated the effects of two intensities of treadmill exercise on nervous and muscular tissues and functional recovery after nerve crush injury. Wistar rats were distributed into sedentary group (SED), and 10 m/min (EG10) and 17 m/min (EG17) exercise groups. The exercise started one week after the injury. Ten daily sessions were performed with a 2-day interval after the fifth day. The flexor digitorum muscle and two segments of the median nerve were analysed histomorphometrically by light microscopy and computer analysis. Function was evaluated by grasping test, in 3 moments. Approval number: 016/2013. In the proximal segments of the median nerve, the diameter of myelinated fibres and axon, the myelin sheath thickness and the ratio of axon diameter to fibre diameter (g ratio) were significantly larger (P<0.05) in the EG10. The number of myelinated fibres was lesser in the EG17 than the other groups (P<0.05). No difference in the number of myelinated fibres among groups was observed in the distal segments, but the SED presented significantly larger axon and fibre diameters than those that performed exercise. The EG10 presented greater area and diameter of muscle fibres (P<0.05) and functional improvement observed on the 21st day after injury (P<0.05) compared with the EG17 and SED. Continuous exercise at 10 m/min accentuates nerve regeneration, accelerating functional recovery and preventing muscle atrophy.
RESUMO
It has been hypothesized that anterior chamber-associated immune deviation (ACAID) to neural antigens induced prior to central nervous system injury can inhibit self-reactivity and lessen secondary degeneration. This work evaluated the effect of ACAID induced to three neural tissue-derived extracts (whole extract, cytosolic extract, CE; or organelle-membrane extract) prior to optic nerve injury on retinal ganglion cell (RGC) survival. The results show that only ACAID to the CE increased RGC survival at 7 and14 days post-injury (dpi). This effect was achieved by retinal polarization towards an anti-inflammatory profile, driven by regulatory T cells and M2-type macrophages at 7 dpi.
Assuntos
Câmara Anterior/imunologia , Autoantígenos/imunologia , Privilégio Imunológico/imunologia , Traumatismos do Nervo Óptico/imunologia , Retina/imunologia , Animais , Autoimunidade , Citosol/imunologia , Feminino , Hipersensibilidade Tardia/imunologia , Macrófagos/imunologia , Compressão Nervosa , Fatores de Crescimento Neural/biossíntese , Fatores de Crescimento Neural/genética , Ratos , Ratos Wistar , Células Ganglionares da Retina/imunologia , Linfócitos T Reguladores/imunologiaRESUMO
Crush injuries in peripheral nerves are frequent and induce long-term disability with motor and sensory deficits. Due to axonal and myelin sheath disruptions, strategies for optimized axonal regeneration are needed. Multipotent mesenchymal stromal cells (MSC) are promising because of their anti-inflammatory properties and secretion of neurotrophins. The present study investigated the effect of canine adipose tissue MSC (Ad-MSC) transplantation in an experimental sciatic nerve crush injury. Wistar rats were divided into three groups: sham ( n = 8); Crush+PBS ( n = 8); Crush+MSC ( n = 8). Measurements of sciatic nerve functional index (SFI), muscle mass, and electromyography (EMG) were performed. Canine Ad-MSC showed mesodermal characteristics (CD34-, CD45-, CD44+, CD90+ and CD105+) and multipotentiality due to chondrogenic, adipogenic, and osteogenic differentiation. SFI during weeks 3 and 4 was significantly higher in the Crush+MSC group ( p < 0.001). During week 4, the EMG latency in the Crush+MSC groups had better near normality ( p < 0.05). The EMG amplitude showed results close to normality during week 4 in the Crush+MSC group ( p < 0.04). There were no statistical differences in muscle weight between the groups ( p > 0.05), but there was a tendency toward weight gain in the Crush+MSC groups. Better motor functional recovery after crush and perineural canine Ad-MSC transplantation was observed during week 2. This was maintained till week 4. In conclusion, the canine Ad-MSC transplantation showed early pro-regenerative effects between 2-4 weeks in the rat model of sciatic nerve crush injury.
Assuntos
Tecido Adiposo/citologia , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/fisiologia , Regeneração Nervosa/fisiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Traumatismos dos Nervos Periféricos/terapia , Neuropatia Ciática/fisiopatologia , Neuropatia Ciática/terapia , Tecido Adiposo/metabolismo , Animais , Terapia Baseada em Transplante de Células e Tecidos/métodos , Cães , Eletromiografia , Bainha de Mielina/fisiologia , RatosRESUMO
To analyze the effect of photobiomodulation and dexamethasone on nerve regeneration after a sciatic nerve crushing model. Twenty-six Swiss mice were divided into the following groups: naive; sham; injured, low-level laser therapy (LLLT) (660 nm, 10 J/cm2, 0.6 J, 16.8 J total energy emitted during the 28 days of radiation, 20 s, for 28 days); dexamethasone (Dex) (local injection of 2 mg/kg for 10 consecutive days); and LLLT group associated with Dex (LLLT/Dex), with the same parameters of the other groups. For nerve injury, a portable adjustable pinch was used. The animals were evaluated using the Sciatic Functional Index (SFI) and Sciatic Static Index (SSI). The results obtained were evaluated with Image J™ and Kinovea™. Data and images were obtained at baseline and after 7, 14, 21, and 28 days after surgery. The evaluation of hyperalgesia, using Hargreaves, and behavior through the open field was also performed. In functional and static analysis, all groups presented significant differences when compared to the injured group. In the analysis of the SSI results, the group treated with both LLLT and dexamethasone was more effective in improving the values of this parameter, and in the SFI, the laser-treated group obtained better results. In the evaluation through the open field and the Hargreaves, there was no difference. The application of LLLT and dexamethasone was effective in nerve regeneration according to the results and was more effective when LLLT was associated with dexamethasone than in LLLT alone for the SSI.
Assuntos
Dexametasona/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Nervo Isquiático/lesões , Neuropatia Ciática/tratamento farmacológico , Neuropatia Ciática/radioterapia , Animais , Dexametasona/farmacologia , Modelos Animais de Doenças , Masculino , Camundongos , Regeneração Nervosa/fisiologia , Nervo Isquiático/efeitos dos fármacos , Nervo Isquiático/patologia , Nervo Isquiático/efeitos da radiação , Neuropatia Ciática/fisiopatologiaRESUMO
Preventing damage caused by nerve degeneration is a great challenge. There is a growing body of evidence implicating extracellular nucleotides and their P2 receptors in many pathophysiological mechanisms. In this work we aimed to investigate the effects of the administration of Brilliant Blue G (BBG) and Pyridoxalphosphate-6-azophenyl-2', 4'- disulphonic acid (PPADS), P2X7 and P2 non-selective receptor antagonists, respectively, on sciatic nerve regeneration. Four groups of mice that underwent nerve crush lesion were used: two control groups treated with vehicle (saline), a group treated with BBG and a group treated with PPADS during 28days. Gastrocnemius muscle weight was evaluated. For functional evaluation we used the Sciatic Functional Index (SFI) and the horizontal ladder walking test. Nerves, dorsal root ganglia and spinal cords were processed for light and electron microscopy. Antinoceptive effects of BBG and PPADS were evaluated through von Frey E, and the levels of IL-1ß and TNF-α were analyzed by ELISA. BBG promoted an increase in the number of myelinated fibers and on axon, fiber and myelin areas. BBG and PPADS led to an increase of TNF-α and IL-1ß in the nerve on day 1 and PPADS caused a decrease of IL-1ß on day 7. Mechanical allodynia was reversed on day 7 in the groups treated with BBG and PPADS. We concluded that BBG promoted a better morphological regeneration after ischiatic crush injury, but this was not followed by anticipation of functional improvement. In addition, both PPADS and BBG presented anti-inflammatory as well as antinociceptive effects.
Assuntos
Lesões por Esmagamento/tratamento farmacológico , Regeneração Nervosa/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Antagonistas do Receptor Purinérgico P2X/farmacologia , Analgésicos/farmacologia , Animais , Lesões por Esmagamento/metabolismo , Lesões por Esmagamento/patologia , Modelos Animais de Doenças , Feminino , Gânglios Espinais/efeitos dos fármacos , Gânglios Espinais/metabolismo , Gânglios Espinais/patologia , Hiperalgesia/tratamento farmacológico , Hiperalgesia/metabolismo , Hiperalgesia/patologia , Interleucina-1alfa/metabolismo , Camundongos Endogâmicos C57BL , Atividade Motora/efeitos dos fármacos , Atividade Motora/fisiologia , Regeneração Nervosa/fisiologia , Traumatismos dos Nervos Periféricos/metabolismo , Traumatismos dos Nervos Periféricos/patologia , Nervos Periféricos/efeitos dos fármacos , Nervos Periféricos/metabolismo , Nervos Periféricos/patologia , Fosfato de Piridoxal/análogos & derivados , Fosfato de Piridoxal/farmacologia , Distribuição Aleatória , Receptores Purinérgicos P2X7/metabolismo , Corantes de Rosanilina/farmacologia , Medula Espinal/efeitos dos fármacos , Medula Espinal/metabolismo , Medula Espinal/patologia , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Traumatic degloving injuries of the lower extremity are commonly diagnosed by soft tissue deficits and separation of soft tissue planes. The management of open degloving injuries is well documented with established treatment protocols. Because closed degloving injuries of the lower extremity are so rare, the protocol management is not well established. Unlike open degloving injuries, evidence of soft tissue injury and detachment of the tissue planes can be subtle. Owing to the rarity of these injuries, little has been described regarding the long-term outcomes. In the present report, 2 closed degloving cases are presented. The first case presented is of a 27-year-old railroad worker who sustained a severe closed degloving injury of his foot with digital soft tissue envelope transposition. The second case involved a 60-year-old automobile manufacturer, whose foot was crushed by a hydraulic fork lift, creating a degloving injury of the third, fourth, and fifth toes. The follow-up duration from the date of injury for patient 1 was 26 months and for patients 2 was 16 months. The purpose of presenting these cases is to report these rare injuries with the treatment, complications, and outcomes.
Assuntos
Amputação Cirúrgica/métodos , Lesões por Esmagamento/cirurgia , Avulsões Cutâneas/cirurgia , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Adulto , Lesões por Esmagamento/diagnóstico por imagem , Avulsões Cutâneas/diagnóstico por imagem , Seguimentos , Traumatismos do Pé/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Radiografia/métodos , Reoperação/métodos , Medição de Risco , Estudos de Amostragem , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/lesões , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
Objetivo: Verificar a influência da irradiação do laser de baixa intensidade na regeneração do nervo fibular comum de ratos após lesão por esmagamento. Métodos: Foram utilizados 25 ratos, divididos em três grupos: 1) nervo intacto, e não tratados; 2) nervo lesado, e não tratado; 3) nervo lesado, e laser irradiado sobre a região medular correspondente às raízes do nervo ciático e subsequentemente no trajeto do nervo lesado. A irradiação foi realizada por 14 dias consecutivos. Resultados: Foram avaliados por meio da análise funcional da marcha, através do índice funcional do peroneiro, e por análise morfométrica através do número total de fibras nervosas mielinizadas e sua densidade, número total de células de Schwann, número total de vasos sanguíneos e sua área, diâmetro mínimo da fibra e razão-G. Conclusão: De acordo com a análise estatística, não houve diferença significativa entre os grupos, e os autores concluem que a irradiação do laser de baixa intensidade possui pouca ou nenhuma influência na regeneração nervosa e recuperação funcional. Trabalho experimental.
Objective: To investigate the influence of low intensity laser irradiation on the regeneration of the fibular nerve of rats after crush injury. Methods: twenty-five rats were used, divided into three groups: 1) intact nerve, no treatment; 2) crushed nerve, no treatment; 3) crush injury, laser irradiation applied on the medullary region corresponding to the roots of the sciatic nerve and subsequently on the course of the damaged nerve. Laser irradiation was carried out for 14 consecutive days. Results: animals were evaluated by functional gait analysis with the peroneal functional index and by histomorphometric analysis using the total number of myelinated nerve fibers and their density, total number of schwann cells, total number of blood vessels and the occupied area, minimum diameter of the fiber diameter and G-quotient. Conclusion: according to the statistical analysis there was no significant difference among groups and the authors conclude that low intensity laser irradiation has little or no influence on nerve regeneration and functional recovery. Laboratory investigation.
Assuntos
Animais , Masculino , Ratos , Síndrome de Esmagamento , Marcha/fisiologia , Regeneração Nervosa , Nervo Fibular/lesões , Terapia com Luz de Baixa Intensidade/métodos , Interpretação Estatística de DadosRESUMO
OBJECTIVE: To investigate the influence of low intensity laser irradiation on the regeneration of the fibular nerve of rats after crush injury. METHODS: Twenty-five rats were used, divided into three groups: 1) intact nerve, no treatment; 2) crushed nerve, no treatment; 3) crush injury, laser irradiation applied on the medullary region corresponding to the roots of the sciatic nerve and subsequently on the course of the damaged nerve. Laser irradiation was carried out for 14 consecutive days. RESULTS: Animals were evaluated by functional gait analysis with the peroneal functional index and by histomorphometric analysis using the total number of myelinated nerve fibers and their density, total number of Schwann cells, total number of blood vessels and the occupied area, minimum diameter of the fiber diameter and G-quotient. CONCLUSION: According to the statistical analysis there was no significant difference among groups and the authors conclude that low intensity laser irradiation has little or no influence on nerve regeneration and functional recovery. Laboratory investigation .
RESUMO
OBJECTIVE: To analyze the efficiency of high voltage pulsed current (HVPC) with early application in three different sites, in the regeneration of the sciatic nerve in rats submitted to crush injury, the sciatic functional index (SFI) was used to assess the functional recovery. METHODS: After crushing of the nerve, 57 animals were submitted to cathodal HVPC at frequency of 50Hz and voltage of 100V, 20 minutes per day, 5 days per week. The rats were divided into five groups: control group; ganglion group; ganglion + muscle group; muscle group; and sham group. The SFI was determined weekly for seven weeks, from the preoperative period to the 6(th) postoperative week. RESULTS: Compared with the control group, the results showed a significantly better performance of group 2 for the first 3 weeks; group 3 showed significantly better performance in the third week; and group 4 showed a significantly negative performance during the 4(th) and 6(th) weeks. CONCLUSION: Early application of HVPC had a positive effect in the treatment of the spinal cord region and the sciatic nerve root ganglion with a dispersive electrode on the contralateral lumbar region or on the gastrocnemius. However, HVPC had a negative effect in the treatment with an active electrode on the gastrocnemius and a dispersive electrode on the contralateral thigh. Level of evidence II, Prospective comparative study.
RESUMO
OBJETIVO: Analisar a eficiência do tratamento com a estimulação elétrica de alta voltagem (EEAV) em três diferentes locais, aplicada precocemente na regeneração do nervo ciático submetido à lesão por esmagamento, e avaliada através do índice funcional do ciático (IFC), em ratos. MÉTODO: Após o esmagamento, 57 ratos foram submetidos à EEAV catódica nos parâmetros: frequência de 50Hz, 100V de tensão, 20 minutos diários, 5 dias por semana. Os ratos foram divididos aleatoriamente em: grupo controle; grupo gânglio; grupo gânglio + músculo; grupo músculo e; grupo simulado. O IFC foi avaliado semanalmente durante sete semanas, partindo do pré-operatório até a 6ª semana pós-operatória. RESULTADOS: Em comparação ao grupo controle, os resultados mostraram desempenho significativamente superior do grupo gânglio nas três primeiras semanas, e do grupo gânglio + músculo na 3ª semana, enquanto o grupo músculo teve desempenho significativamente negativo na 4ª e 6ª semanas. CONCLUSÃO: a EEAV aplicada precocemente, foi positiva no tratamento da região da medula e gânglio da raiz nervosa do ciático com o eletrodo dispersivo na região lombar contralateral ou no músculo gastrocnêmio. Porém, proporcionou efeitos negativos no tratamento com eletrodo ativo no músculo gastrocnêmio e dispersivo na coxa contralateral. Nível de evidência II, Estudo prospectivo comparativo.
OBJECTIVE: To analyze the efficiency of high voltage pulsed current (HVPC) with early application in three different sites, in the regeneration of the sciatic nerve in rats submitted to crush injury, the sciatic functional index (SFI) was used to assess the functional recovery. METHODS: After crushing of the nerve, 57 animals were submitted to cathodal HVPC at frequency of 50Hz and voltage of 100V, 20 minutes per day, 5 days per week. The rats were divided into five groups: control group; ganglion group; ganglion + muscle group; muscle group; and sham group. The SFI was determined weekly for seven weeks, from the preoperative period to the 6th postoperative week. RESULTS: Compared with the control group, the results showed a significantly better performance of group 2 for the first 3 weeks; group 3 showed significantly better performance in the third week; and group 4 showed a significantly negative performance during the 4th and 6th weeks. CONCLUSION: Early application of HVPC had a positive effect in the treatment of the spinal cord region and the sciatic nerve root ganglion with a dispersive electrode on the contralateral lumbar region or on the gastrocnemius. However, HVPC had a negative effect in the treatment with an active electrode on the gastrocnemius and a dispersive electrode on the contralateral thigh. Level of evidence II, Prospective comparative study.