Estudo experimental clínico da funcionalização de fio de nylon com clorexidina como alternativa profilática tópica para complicações do sítio cirúrgico
Surgical suture is an essential choice to obtain better anatomical and aesthetic results and avoid complications in the patient’s recovery, such as dehiscence, wound infections that can lead to sepsis, evisceration and indiscriminate use of systemic antibiotics. The study aims to find a topical prop...
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| Tipo de recurso: | tesis de maestría |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | Brasil |
| Institución: | Pontifícia Universidade Católica de São Paulo (PUC-SP) |
| Repositorio: | Repositório Institucional da PUC_SP |
| Idioma: | portugués |
| OAI Identifier: | oai:repositorio.pucsp.br:handle/43684 |
| Acceso en línea: | https://repositorio.pucsp.br/jspui/handle/handle/43684 |
| Access Level: | acceso embargado |
| Palabra clave: | CNPQ::CIENCIAS DA SAUDE Clorexidina Nylon Sutura Infecção Cirurgia Funcionalização Chlorhexidine Suture Infection Surgery Functionalization |
| Sumario: | Surgical suture is an essential choice to obtain better anatomical and aesthetic results and avoid complications in the patient’s recovery, such as dehiscence, wound infections that can lead to sepsis, evisceration and indiscriminate use of systemic antibiotics. The study aims to find a topical prophylaxis, evaluating the effectiveness of suturing with a nylon thread (NL) functionalized with chlorhexidine (DC), in a surgical wound. Determining the therapeutic concentration, evaluating the bactericidal and bacteriostatic potential of the device through a prospective single-center randomized double-blind clinical trial, with and without the use of systemic antibiotic prophylaxis (ATB) with cefazolin (CF). First, a biomaterial was developed, a suture thread chemically functionalized with DC using oxygen plasma, characterized with microbiological studies of bactericidal/bacteriostatic, FTIR, DSC, TGA and mechanical testing. Subsequently evaluated the clinical efficacy of the thread in 60 patients underwent inguinal hernioplasty surgery, divided into groups, which received ATB of CF 2g intravenously (IV) and another that not, among these halves used dermorrhaphy with NL without CD and the other with dermorrhaphy with NL with CD. Followed up at 14 and 28 days after surgery, and evaluated with parameters of: infection, hyperemia, serous secretion, purulent exudate, dehiscence, scar hypertrophy, edema, fibrosis, need for ATB use and length of hospital stay. Physicochemical analyzes such as FTIR made it possible to verify the modification of the surface of the nylon thread and choose the sample after 40 min of plasma treatment. In the mechanical test, the increase in mechanical resistance in the treated group can contribute to an increase in strength and stiffness of the material demonstrating safety in its use and the SEM showed the mechanical and structural changes in the thread. Microbiological analysis demonstrated the effectiveness of the thread against S. Aureus, E. Coli and Pseudomonas bacteria, the clinical trial showed a lower rate of complications at the surgical site en the group that used the thread chlorhexidine, both with highly significant p (<0,0001) indicating that the presence of the thread may be strongly associated with the type of healing and the high value of the chi-square applied demonstrate that the study is robust and the results are consistent and reliable |
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