Avaliação de cicatrizes de cirurgias estéticas de mama e abdome após aplicação de plasma rico em plaquetas autólogo: estudo prospectivo e randomizado

• Ano de defesa: 2016
• Autor(a) principal: Jovino Gentilini Junior
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Cirurgia Plástica; Plasma Rico em Plaquetas; Cicatrização; Plaquetas; Fator de Crescimento derivado das plaquetas; Sangue; Abdominoplastia; Mamoplastia; Plasma rico em plaquetas; Cirurgia plástica; Medicina; Fator de crescimento derivado de plaquetas
• Link de acesso: http://hdl.handle.net/1843/BUBD-AMQNEW

The healing of tissues is mediated by a large and varied sequence of events, intra and extracellular, in which platelets play an important role. Platelet Rich Plasma (PRP) is defined as a volume fraction of autologous blood plasma with concentration above 1000,000 platelets / microl. The PRP has been used in various fields of medi-cal and dental activity, with beneficial effects already described in dental implants, boné grafts and skin ulcerations.Platelets are essential in healing of tissues, with Growth Factors (CF) released by them playing an important role in this process. The PRP and growth factors have been widely described in the literature for aesthetic and restorative purposes, but there are few studies with level of evidence, to justify their benefits. Similarly, in plastic surgery, although widely used, research is also insufficient, considering the adopted model here. We've selected 48 patients who underwent abdominoplasty and mammoplasty, aged between 22 and 68 years (average 35 years), for an experimental, randomized, prospective and paired work, in which each patient served as his own control. During the procedure, the PRP was applied intradermally, on the edges of a segment previously marked scar, for, comparison with the opposite scar segment without the application of PRP. It was assigned a score to the best scar with values ranging from zero to three corresponding respectively to: indifferent, mildly, moderately and markedly better.The scars were evaluated by two plastic surgeons (named here as Evaluator 1 and Evaluator 2), using photographs taken four days, one month, three months and 12 months post-operatively.There was agreement among raters in around 70% as the best scar being the one with PRP application in the fourth day after the operation with this same trend repeated at three months. Both assessments were statistically very close to agreement beyond chance, with moderate Kappa index (statistically significant above 0,40). There was no agreement between the two raters in the one month postoperative evaluation. However, the two evaluators again present agreement at 12 months, with poor kappa index (below 0,20), not going beyond chance. As for the scores, there was the continuing trend of the first four days, with assessments moderately and markedly better for scars with PRP for both evaluators, but not statistically significant, with p equal to 0,82 for evaluator 1 and p equal to 0,070 for evaluator 2. One month after surgery, the evaluator 1 considered 6 scars(37,6%) moderately better and 7 scars markedly better (43,7) with a total of 16 PRP scars.The evaluator 2 saw no scar markedly better without PRP. Both assessments were considered without significance due to the small number of cases evaluated. At three months, it was maintained this trend and the scars treated with PRP were considered better. At 12 months, the evaluator 1 ranked around 40% of scars with PRP as markedly better and 17,7% of the scars without PRP as markedly better.Therefore, intradermal use of PRP was presented as promising, beneficially contributing in an evident way in the evolution of the healing process, with best results at 4 days and 90 days after surgery. There was no side effect observed in any of the scarring phases studied.