Tracheo-carinal reconstructions using extrathoracic muscle flaps.

OBJECTIVES: Prospective evaluation of tracheo-carinal airway reconstructions using pedicled extrathoracic muscle flaps for closing airway defects after non-circumferential resections and after carinal resections as part of the reconstruction for alleviation of anastomotic tension. METHODS: From January 1996 to June 2006, 41 patients underwent tracheo-carinal airway reconstructions using 45 extrathoracic muscle flaps (latissimus dorsi, n=25; serratus anterior, n=18; pectoralis major, n=2) for closing airway defects resulting from (a) bronchopleural fistulas (BPF) with short desmoplastic bronchial stumps after right upper lobectomy (n=1) and right-sided (pleuro) pneumonectomy (n=13); (b) right (n=9) and left (n=3) associated with partial carinal resections for pre-treated centrally localised tumours; (c) partial non-circumferential tracheal resections for pre-treated tracheal tumours, tracheo-oesophageal fistulas (TEF) and chronic tracheal injury with tracheomalacia (n=11); (d) carinal resections with the integration of a muscle patch in specific parts of the anastomotic reconstruction for alleviation of anastomotic tension (n=4). The airway defects ranged from 2 x 1 cm to 8 x 4 cm and involved up to 50% of the airway circumference. The patients were followed by clinical examination, repeated bronchoscopy, pulmonary function testing and CT scans. The minimum follow-up time was 6 months. RESULTS: Ninety-day mortality was 7.3% (3/41 patients). Four patients (9.7%) sustained muscle flap necrosis requiring re-operation and flap replacement without subsequent mortality, airway dehiscence or stenosis. Airway dehiscence was observed in 1/41 patients (2.4%) and airway stenosis in 1/38 surviving patients (2.6%) responding well to topical mitomycin application. Follow-up on clinical grounds, by CT scans and repeated bronchoscopy, revealed airtight, stable and epithelialised airways and no recurrence of BPF or TEF in all surviving patients. CONCLUSIONS: Tracheo-carinal airway defects can be closed by use of pedicled extrathoracic muscle flaps after non-circumferential resections and after carinal resections with the muscle patch as part of the reconstruction for alleviation of anastomotic tension.

Comparative study of upper lip frenectomy with the CO2 laser versus the Er, Cr: YSGG laser

Objectives: To compare upper lip frenulum reinsertion, bleeding, surgical time and surgical wound healing in frenectomies performed with the CO2 laser versus the Er, Cr:YSGG laser. Study design: A prospective study was carried out on 50 randomized pediatric patients who underwent rhomboidal resection of the upper lip frenulum with either the CO2 laser or the Er,Cr:YSGG laser. Twenty-five patients were assigned to each laser system. All patients were examined at 7, 14, 21 days and 4 months after the operation in order to assess the surgical wound healing. Results: Insertion of the frenulum, which was preoperatively located between the upper central incisors, migrated to the mucogingival junction as a result of using both laser systems in all patients. Only two patients required a single dose of 650 mg of paracetamol, one of either study group. CO2 laser registered improved intraoperative bleeding control results and shorter surgical times. On the other hand, the Er,Cr:YSGG laser achieved faster healing. Conclusions: Upper lip laser frenectomy is a simple technique that results in minimum or no postoperative swelling or pain, and which involves upper lip frenulum reinsertion at the mucogingival junction. The CO2 laser offers a bloodless field and shorter surgical times compared with the Er,Cr:YSGG laser. On the other hand, the Er,Cr:YSGG laser achieved faster wound healing.

Effect of Antecolic versus Retrocolic Gastroenteric Reconstruction after Pancreaticoduodenectomy on Delayed Gastric Emptying: A Meta-Analysis of Six Randomized Controlled Trials.

BACKGROUND: One of the most frequent complications of pancreaticoduodenectomy (PD) is delayed gastric emptying (DGE). The study aim was to evaluate the impact of the type of gastro/duodenojejunal reconstruction (antecolic vs. retrocolic) after PD on DGE incidence. METHODS: A systematic review was made according to the PRISMA guidelines. Randomized controlled trials (RCTs) comparing antecolic vs. retrocolic reconstruction were included irrespective of the PD techniques. A meta-analysis was then performed. RESULTS: Six RCTs were included for a total of 588 patients. The overall quality was good. General risk of bias was low. DGE was not statistically significantly different between the antecolic and retrocolic group (OR 0.6, 95% CI 0.31-1.16, p = 0.13). The other main surgery-related complications (pancreatic fistula, hemorrhage, intra-abdominal abscess, bile leak and wound infection) were not dependent on the reconstruction route (OR 0.84, 95% CI 0.41-1.70, p = 0.63). No statistically significant difference in terms of length of hospital stay was found between the 2 groups. There was also no difference of DGE incidence if only pylorus-preserving PD was considered and between the DGE grades A, B or C. CONCLUSION: This meta-analysis shows that antecolic reconstruction after PD is not superior to retrocolic reconstruction in terms of DGE.

Closure of large wounds using rubber bands in rabbits

OBJECTIVE: to verify the effectiveness of the rubber elastic band in the treatment of large wounds of the body wall of rabbits by means of traction of its edges. METHODS: we studied 30 New Zealand rabbits, divided into three groups (n=10): Group 1- healing by secondary intention; Group 2- removal and eutopic repositioning of skin as full thickness skin graft; Group 3- Approximation of wound edges with elastic rubber band. In all animals, we removed a segment of the back skin and subcutaneous tissue down to the fascia, in accordance with an acrylic mold of 8cm long by 12cm wide. All animals were observed for 21 days. RESULTS: two animals of groups 1 and 2 had wound abscess. In Group 2, there was partial or total graft loss in 90% of animals. The complete closure of the wounds was observed in four animals of Group 1, six of Group 2 and eight of Group 3. There was no difference between the scar resistance values of groups 2 and 3, which were higher than those in Group 1. The scars of the three groups were characterized by the presence of mature connective tissue mixed with blood vessels and inflammatory infiltration, predominantly polymorphonuclear. CONCLUSION: the tensile strength of the wound edges with rubber elastic band is as efficient as the skin graft to treat rabbits' large body wounds.

Laparoscopic versus open splenectomy in dogs

In the last few years, the use of laparoscopy in veterinary medicine has expanded and consequently so was the need for studies that establish the advantages, disadvantages and possible complications of each procedure. The purpose of the current study was to describe a laparoscopic splenectomy technique and the alterations due to this access, and compare it to the open procedure in dogs. A total of 15 healthy female mongrel dogs were used, with mean weight of 17.4±2.5kg. The animals were distributed into three groups: Group IA of open splenectomy (laparotomy) using double ligation of the vessels of the splenic hilum with poliglicolic acid, Group IB of open splenectomy (laparotomy) with bipolar electrocoagulation of the splenic hilum, and Group II of laparoscopic access with bipolar electrocoagulation of the splenic hilum. Operative time, blood loss, size of incisions, complications during and after surgery were evaluated. Other parameters included pain scores, white blood cell (WBC) counts and postoperative serum concentrations of alanine aminotransferase (ALT), alkaline phosphatase (ALP), creatine kinase (CK), C-reactive protein (CRP), glucose and cortisol. No differences were found in the evaluation of parameters between both open splenectomy techniques employed. Laparoscopic access presented significant differences (p<0,05) when compared with open surgery: Longer operative time, smaller abdominal access, decrease in blood loss, lower concentrations of CRP, higher levels of CK and ALP, and lower scores in the pain scale. Laparoscopic surgery showed fewer complications of the surgical wound. No significant differences were observed between groups in the postoperative temperature, WBC, ALT, cortisol and glucose concentrations. In conclusion, the laparoscopic technique is useful for splenectomy in dogs, being advantageous in terms of blood loss, surgical stress and surgical wounds. However, it expends more operative time and causes transitory increase in hepatic and muscular enzymes.

Étude d’impact de l’alimentation entérale précoce sur la durée de séjour hospitalier pour la chirurgie colique

Introduction: La réinstitution de l’alimentation entérale en deçà de 24h après une chirurgie digestive semble a priori conférer une diminution du risque d’infections de plaie, de pneumonies et de la durée de séjour. Le but de cette étude est de vérifier l’effet de la reprise précoce de l’alimentation entérale sur la durée de séjour hospitalier suite à une chirurgie colique. Méthodes: Il s’agit d’une étude prospective randomisée dans laquelle 95 patients ont été divisés aléatoirement en deux groupes. Dans le groupe contrôle, la diète est réintroduite lorsque le patient passe des gaz ou des selles per rectum, et qu’en plus il n’est ni nauséeux ni ballonné. Les patients du groupe expérimental reçoivent pour leur part une diète liquide dans les 12 heures suivant la chirurgie, puis une diète normale aux repas subséquents. L’objectif primaire de cette étude est de déterminer si la réinstitution précoce de l'alimentation entérale post chirurgie colique diminue la durée de séjour hospitalier lorsque comparée au régime traditionnel de réintroduction de l’alimentation. Les objectifs secondaires sont de quantifier l’effet de la réintroduction précoce de la diète sur les morbidités periopératoires et sur la reprise du transit digestif. Résultats: La durée de séjour hospitalier a semblé être légèrement diminuée dans le groupe expérimental (8,78±3,85 versus 9,41±5,22), mais cette difference n’était pas statistiquement significative. Des nausées ou des vomissements furent rapportés chez 24 (51%) patients du bras experimental et chez 30 (62.5%) patients du groupe contrôle. Un tube nasogastrique a du être installé chez un seul patient du groupe experimental. La morbidité périopératoire fut faible dans les deux groupes. Conclusion: Il semble sécuritaire de nourrir précocément les patients suite à une chirurgie colique. Cependant cette étude n’a pu démontrer un impact significatif de la reintroduction précoce de l alimentation per os sur la durée de séjour hospitalier.

Tiempo de profilaxis antibiótica en apendicetomía y aparición de infección del sitio quirúrgico, Bogotá

Resumen objetivo: determinar la asociación entre el tiempo de administración de profilaxis antibiótica y la aparición de infección del sitio quirúrgico en pacientes sometidos a apendicetomía, en una institución de III nivel de complejidad de Bogotá. Materiales y métodos: estudio observacional analítico, tipo cohorte retrospectiva de pacientes sometidos a apendicetomía en una institución de tercer nivel, entre el 1 de mayo de 2007 y el 31 de diciembre de 2008. Resultados: La muestra estuvo conformada por 1245 pacientes; encontrando una incidencia de ISQ de 8.4%. Se aplicó profilaxis antibiótica al 94% de los pacientes. La profilaxis antibiótica administrada en menos de 30 minutos previo a la incisión tuvo diferencias estadísticamente significativas en el análisis divariado, encontrando un RR= 0.44 IC 0.20 – 0.96, p=0.0372); adicional se encontró que mayores puntajes en las escalas de NNIS y SENIC aumenta el riesgo de presentar ISQ. El análisis multivariado mostró que la asociación de variables como edad, duración mayor de 2 horas, ASA 2, herida contaminada y herida sucia, resultaron factores de riesgo, teniendo mayor peso y siendo estadísticamente significativos al momento de predecir ISQ. Por su parte, la antibioticoterapia profiláctica no mostró diferencias estadísticamente significativas Conclusiones: se estableció que existe una asociación directa entre la incidencia de ISQ y la totalidad de variables incluidas en el SENIC y NNIS, a mayores puntajes se presento mayor tasa de infección. Asimismo, se concluye que el tener un mayor número de patologías asociadas, clasificadas en el ASA, se relaciona con aumento en el desarrollo de ISQ. Finalmente, la presencia de factores no modificables tales como la edad, el género, se encuentran relacionadas de una u otra forma con mayor probabilidad de desarrollar ISQ. Cabe resaltar que entre mayor número de factores de riesgo se encuentren asociados en un paciente, condicionan de manera significativa la aparición de ISQ como complicación postquirúrgica destacándose la edad, cirugía >2 horas, ASA y tipo de la herida.

Tratamiento del deslizamiento epifisiario capital femoral con fijación in situ versus luxación quirúrgica

Introducción: El Deslizamiento Epifisiario Capital Femoral es la enfermedad de la cadera más común en adolescentes entre los 9 y 16 años. Es de causa idiopática, más frecuente en hombres, se clasifica en 4 estadios según criterios clínicos y radiológicos. Se buscó evaluar la evolución de los deslizamientos moderados y severos tratados con una de las dos técnicas propuestas. Metodología Se realizó un estudio descriptivo con pacientes que fueron llevados a fijación in situ o luxación controlada entre 2008 y 2011. Resultados: Se incluyeron 26 pacientes, los cuales el 65.4% se les realizó luxación quirúrgica controlada y el 34.6% fijación in situ. El 70,6% de pacientes tenían DECF inestable y 70,5% tenían desplazamiento severo. La evaluación de la escala WOMAC para dolor, rigidez y capacidad funcional encontró mejores beneficios para el grupo de fijación in situ, estadísticamente significativos (p<0,05), no solo en términos de dolor, rigidez y capacidad funcional sino menor frecuencia de complicaciones. Las complicaciones más frecuentes en el grupo de luxación quirúrgica controlada fueron un caso de infección, 7 casos (41,2%) de necrosis avascular de cabeza femoral, 5 casos (29,4%) de condrolisis y 2 casos (11,8%) de pseudoartrosis; En el grupo de fijación in situ, solo 1 (11,1%) presentó Infección del Sitio Operatorio y 1 (11,1%) Condrolisis. Resultados significativos solo para necrosis avascular. Discusión: Los pacientes con deslizamientos moderados y severos manejados con fijación in situ tuvieron una mejor resultado con menor proporción de complicaciones.

Factores de riesgo para el desarrollo de complicaciones: infecciones en varicosafenectomia

La enfermedad venosa periférica de miembros inferiores se considera una de las afecciones más prevalentes, con morbilidad considerable, deterioro de la calidad de vida, e importante demanda de recursos de salud, que en la mayoría de casos requiere manejo quirúrgico como parte del tratamiento. Este estudio busca analizar si la técnica quirúrgica es un factor de riesgo, que incrementa la aparición de infección de sitio quirúrgico en 257 pacientes a quienes se les realizó varicosafenectomia. Metodología: Se realizó un estudio de cohorte retrospectiva; se recolectaron los datos a partir de los registros clínicos y quirúrgicos de pacientes que cumplieron con los criterios de inclusión, registrando factores de riesgo, descripción quirúrgica, complicaciones, y evolución post operatoria hasta 8 semanas. El análisis estadístico se realizó mediante el cálculo de riesgo relativo y regresión logística binomial. Resultados: Se demostró asociación entre la presencia de infección de sitio quirúrgico y tipo de cirugía con un RR = 3,05 (P= 0,01), clasificación CEAP con 29% menos riesgo en varicosafenectomia total (P= 0,008). Conclusiones: Existen variables clínicas y quirúrgicas que influyen en la probabilidad de desarrollar infección del sitio quirúrgico.

Percepción de pacientes mayores de 65 años o cuidadores sobre el posoperatorio de fractura de cadera y su recuperación funcional

Introducción: La fractura de cadera se presenta predominantemente en población mayor; se espera que para el año 2050 se presenten alrededor de 6 millones de fracturas de cadera a nivel global. Parkkari et al (1). Dado que el sistema de salud colombiano dificulta el seguimiento adecuado de los pacientes y su manejo posoperatorio integral, desconocen las estadísticas reales de los desenlaces funcionales, mortalidad y complicaciones asociadas a la fractura de cadera. Método: Estudio observacional descriptivo de corte transversal. Mediante una encuesta telefónica cuyo objetivo fue determinar el manejo intra y extra hospitalario por los servicios de rehabilitación y ortopedia, describir la mortalidad y la recuperación funcional percibidos por los encuestados. Resultados: De 286 pacientes intervenidos, 116 aceptaron participar (24% hombres y 76% mujeres). Edades entre 65 y 99 años (media: 81.3 años). En el primer año después de la cirugía, el 29% de los pacientes presento al menos un reingreso hospitalario; la mortalidad en el grupo femenino fue de 23% frente a un 43% en el grupo masculino. El 98% de los pacientes deambulaba previo a la cirugía, frente a un 78% de los pacientes a un año del procedimiento, 83 pacientes refirieron complicaciones pos-operatorias. En el grupo entre 65 y 74 años la capacidad de deambular posterior al procedimiento fue de 84%, para las edades entre 75 a 84 años fue del 82% y en los mayores de 85 años del 75%. Conclusiones: La recuperación funcional de los pacientes intervenidos por fractura de cadera, difícilmente llegan a alcanzar el estado funcional previo a la fractura, lo cual se traduce en situaciones de dependencia, riesgo de caída y complicaciones médicas.

Desenlaces clínicos del cuidado perioperatorio de reemplazos articulares según grupos relacionados de diagnóstico en un hospital de cuarto nivel

Introducción Los Grupos Relacionados de Diagnóstico (GRD) se han usado para determinar la calidad de la atención en varios sistemas de salud. Esto ha llevado a que se obtengan resultados en el mejoramiento continuo de la atención y del cuidado. El objetivo de este estudio es determinar desenlaces clínicos de los pacientes a quienes se les había realizado reemplazo de articulares según la complejidad clínica definida mediante GRD. Métodos Se realizó un estudio longitudinal descriptivo en el cual se incluyeron todos los pacientes que tuvieron cirugía de reemplazo total de hombro, cadera y rodilla entre 2012 y 2014. Se realizó la estratificación de los pacientes de acuerdo a tres niveles de complejidad dados por el sistema de GRD y se determinaron las proporciones de pacientes para las variables de estancia hospitalaria, enfermedad trombo-embólica, cardiovascular e infección del sitio operatorio. Resultados Se realizaron en total 886 reemplazos articulares de los cuales 40 (4.5%) presentaron complicaciones. Los eventos más frecuentes fueron las complicaciones coronarias, con una presencia de 2.4%. El GRD1, sin complicaciones ni comorbilidades, fue el que presentó mayor número de eventos. La estancia hospitalaria fue de 3.8 a 9.3 días para todos los reemplazos. Conclusiones Contrario a lo planteado en la hipótesis de estudio, se encontró que el primer GRD presentó el mayor número de complicaciones, lo que puede estar relacionado con el tamaño del grupo. Es necesario realizar nuevas investigaciones que soporten el uso de los GRD como herramienta para evaluar desenlaces clínicos.

Simvastatin improves the healing of infected skin wounds of rats

This study explores the potential of the simvastatin to ameliorate inflammation and infection in open infected skin wounds of rats. Methods: Fourteen Wistar rats weighing 285±12g were used. The study was done in a group whose open infected skin wounds were treated with topical application of sinvastatina microemulsion (SIM, n=7) and a second group with wounds treated with saline 0.9 % (SAL, n=7). A bacteriological exam of the wounds fluid for gram positive and gram negative bacteria, the tecidual expression of TNFá and IL-1â by imunohistochemical technique, and histological analysis by HE stain were performed. Results: The expression of TNFa could be clearly demonstrated in lower degree in skin wounds treated with simvastatin (668.6 ± 74.7 ìm2) than in saline (2120.0 ± 327.1 ìm2). In comparison, wound tissue from SIM group displayed leukocyte infiltration significantly lower than that observed in SAL group (p<0.05). Culture results of the samples taken from wound fluid on fourth post treatment day revealed wound infection in only one rat of group simvastatin (SIM), where Proteus mirabilis, Escherchia coli and Enterobacter sp were isolated. In the rats whose wounds were treated with saline (SAL), polymicrobial infection with more than 100,000 CFU/g was detected in all the wounds. Conclusion: In addition to its antiinflammatory properties, the protective effects of simvastatin in infected open skin wounds is able to reduce infection and probably has antibacterial action. The potential to treat these wounds with statins to ameliorate inflammation and infection is promising

A formação de conceitos no ensino de graduação em enfermagem à luz da teoria da aprendizagem significativa

The Theory of Meaningful Learning (TML) described by David Paul Ausubel offers a proposal for the teaching strategies to provide a more active and effective student learning. The projection of the TML practice is demonstrated through the development of concept maps (CM) technique, created by Joseph Donald Novak, which presents as a strategy, method or schematic feature, which is an indicator to identify the cognitive organization of the knowledge acquired by students. The survey was conducted in the light of TML in relation to learning concepts involving students of undergraduate nursing in a public university in the state of Rio Grande do Norte. Thus, the study aimed to compare the concept learning of students of undergraduate nursing, when subjected to different forms of education, to point approaches that promote more effective and meaningful results. It was a quasi - experimental study with a qualitative analysis, conducted with students of the Undergraduate Nursing of the Universidade Federal do Rio Grande do Norte (UFRN), approved by the Research Ethics Committee/UFRN Certification of Presention for Ethics Appreciation (CPEA) in 11706412.3.0000.5537. The study took place at two different times and involved content on complications mediate postoperative surgical wound in the same discipline with students who attended the 5th semester of the degree course in Nursing. For the viability of data collection, in the second half of 2013, we used the technique of CM, to represent the concept of complications mediate postoperative surgical wound covered in the classroom. CM were built at a different time from that of the discipline, with the support of tutors and preceded by a brief description and explanation about the form of preparation and application. In this study were subjected, 31 students of undergraduate nursing, registered in the discipline of Integral Attention to health I. In the first stage, 18 students participated in the survey, they had the teaching intervention based on TML, and in the second stage, all students participated in the lesson provided curriculum with the responsible teacher of the subject, on the same issue occurred. At the end of each meeting, the students 11 developed concept maps with the aid of software Cmap Tools®. Data analysis happened upon the technique of content analysis, supported by a conceptual map "glass", previously developed by researchers and aid in the preparation of the categories in which the concepts found were classified. The study found that the teaching intervention based on TML with the help of CM, managed to develop in students a more expressive teaching learning process than just classroom curriculum with the traditional teaching method, and also that the association between the intervention motion teaching with the traditional method and the use of the technique of CM encourages the student the ability to articulate the various acquired knowledge as well as apply them in real situations

Efeitos do tratamento com Hidrogel na cicatrização de úlceras venosas de membros inferiores: revisão sistemática

Chronic venous disease (CVD) is evident among the chronic diseases and affects the elderly population and primarily is responsible for leg ulcers in this population. The use of dressings in the care of a venous ulcer is a fundamental part of the treatment for healing, however, evidence to assist in choosing the best dressing is scarce. The main objective of this study was to evaluate the effectiveness of treatment with hydrogel in the healing of venous ulcers using search methods, synthesis of information and statistical research through a systematic review and meta-analysis. Randomized controlled trials were selected in the following databases: CENTRAL; DARE; NHS EED; MEDLINE; EMBASE; CINAHL. Beyond these databases three websites were consulted to identify ongoing studies: ClinicalTrials.gov, OMS ICTRP e ISRCTN. The primary outcomes were analyzed: complete wound healing, incidence of wound infection and the secondary were: changes in ulcer size, time to ulcer healing, recurrence of ulcer, quality of life of participants, pain and costs of treatment. Four studies are currently included in the review with a total of 250 participants. The use of hydrogel appears to be superior to conventional dressing, gauze soaked in saline, for the healing of venous leg ulcers; 16/30 patients showed complete healing of ulcers (RR 5,33, 95%CI [1,73,16,42]). The alginate gel was shown to be more effective when compared to the hydrogel dressing in reduction of the wound area; 61,2% (± 26,2%) with alginate e 19,4% (± 24,3%) with hydrogel at the end of four weeks of treatment. Manuka honey has shown to be similar to the hydrogel dressings in percentage of area reduction. This review demonstrated that there is no evidence available about the effectiveness of the hydrogel compared to other types of dressings on the healing of venous leg ulcers of the lower limbs, thus demonstrating the need of future studies to assist health professionals in choosing the correct dressing.

Avaliação clínica do efeito da irradiação pós-opratória do laser de baixa intensidade na cicatrização de gengivoplastias em humanos

Many studies have been made to understand the process of tissular cicatrization, as well as the possible effects of laser therapy in the wound healing. However, the influence of low frequency laser irradiation in the repairing process is not completely understood. Our study has the purpose to assess clinically the effect of postoperative irradiation of the low frequency laser in humans, and the gingival repairing process postgingivoplasty performed with the extern bevel technique. Twenty-four patients with inflammatory gingival hyperplasia were enrolled in this study, which did not reduce with basic periodontal procedures, and patients with melanin pigmentation, with esthetic indications. After surgery the test group, randomly selected by a drawing, received laser application with energy density of 4 J/cm2, immediately after surgery and each 48 hours, during a week, with a total of 4 sections. The control group did not receive irradiation. The visual clinical analyses were performed by a single blind examiner, in the 2nd, 4th, 6th, 8th, 15th and 21st days post surgery. For statistic analyses of the data was used a Q-square test. Concerning the color, the results showed a better wound healing during days 6 to 8. when assessed the degree of progress of surgical wound, the results showed that the test group had a better cicatrization compared with the control group in the 2nd, 6th, 8th and 15th days post surgery, and at the 21st day both groups had the same results. Our results confirm that the laser had clinical influence in the repairing process after gingivoplasty surgery during days 2 to 15 post surgery