Efeitos do laser na cicatrização de cesárea em pacientes com diabetes gestacional

• Autor(a) principal: Santos, Hugo Campos Oliveira
• Data de Publicação: 2013
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• dARK ID: ark:/38995/0013000003hfj
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tde/2994
• topic: Diabetes gestacional; Cesárea; Cicatrização; Laser; Gestational diabetes; Caesarean section; Wound healing; Laser; CIENCIAS BIOLOGICAS::BIOQUIMICA

Caesarean section is a surgical technique utilized to deliver the fetus from the uterus and an increase in this surgical procedure can be noted around the world. In Brazil, approximately 40% of total deliveries occur in this way, it is estimated that caesarean section corresponds to 80% of deliveries in private assistance between 2008 and 2012. Diabetes complicates gestation and pregnancy complicates diabetes, this combination increases the possibility of flawed scarring process, which may cause esthetic, psychological and clinical problems. The Low-Level Laser Therapy (LLLT) is an ally for the treatment of a number of wounds – accelerating cell metabolism and reducing inflammatory and infectious processes. The objective of this study was to evaluate the effects of AlGaInP LASER (660nm) treatment regarding wound healing quality and hypertrophic scar prevention in patients with gestational diabetes undergone caesarean section. The clinical study was performed at Hospital das Clínicas of the Federal University of Goiás, after Ethics Committee approval (CEP/HC.053/11). In the period between November (2011) and May (2013) 90 patients divided into 3 groups were assessed: Group A: LASER (3 Joules/cm2), Group B: LASER (6 Joules/cm2) and Group C (Control – no treatment). Caesarean incision was photographed in the periods: T1 (1day), T2 (2days), T3 (3days), T4 (15days) and T5 (30days). Photos were used in order to calculate mean area and standard deviation. The area of the photographs was analyzed and calculated in pixels with specific software (Software Image J – NIH/USA), measuring, thus, the wound contraction in percentage (%). The calculation was performed by the caesarean scar area reduction and the increase of incision contraction percentage (recovery) throughout the periods for each group. Contraction results (%) with regard to wound area were significant (p<0.05) for all groups studied, according to Kruskal Wallis’, Mann-Whitney’s and Wilcoxon’s tests. Groups treated with LASER (A and B) presented higher edge contraction, being 89% the scar reduction of Group A (p<0.001) and 81% of Group B (p<0.05), when compared to control group (73%). However, Group A demonstrated higher wounded area reduction when compared to group B, especially in the period between the 3rd and the 15th day from the postoperative (p<0.001). It was verified that the better performance of Low-power LASER (AlGaInP) occurred in the time reported in the literature as scarring process inflammatory stage (≤7days). Inflammatory process reduction may have contributed to reducing scarring time, increasing wound contraction percentage, benefitting, thus, the incision esthetic aspect throughout 30 days of treatment. During the study, occurrence of hypertrophic scars was not observed in any of the experimental groups in the period of 60days from the postoperative.