Este estudo teve como objetivo realizar uma revisão da literatura sobre os parâmetros de aplicação do ultrassom terapêutico no reparo tecidual do sistema musculoesquelético. Foi realizado um levantamento de dados sobre essa temática nas seguintes bases de dados: MEDLINE, LILACS e SciELO, em línguas portuguesa, inglesa e espanhola, sendo considerados apenas ensaios experimentais realizados em animais, publicados a partir de 2.000 e pesquisados até janeiro de 2.012. Foram encontrados 16 artigos sobre a utilização do ultrassom terapêutico no reparo tecidual, dos quais nove abordaram a lesão tendínea, quatro sobre reparo ósseo, dois verificaram o efeito na lesão muscular e um na lesão nervosa. Os achados desta revisão de literatura sobre as evidências científicas dos efeitos do ultrassom terapêutico no sistema musculoesquelético sugerem que não há padronização quanto à dosimetria adequada para o reparo tecidual deste, pois os artigos disponíveis são insuficientes para comprovar os seus reais efeitos e determinar os parâmetros indicados para este tipo de tratamento.

No abstract

Skin flaps are still a matter of concern among surgeons, as failures can occur leading to flap necrosis. However, low-level laser irradiation has been reported as an effective tool to improve the viability of ischemic flaps, yet its mechanisms of action remain unclear. We investigated the effect of low-level laser irradiation on the viability of random skin flaps in rats and determined COX-2 expression in the flap pedicle. The study animals comprised 24 EPM-1 Wistar rats which were randomly allocated into three equal groups. A cranially based dorsal random skin flap measuring 10 × 4 cm was created in all the animals. In one group, laser irradiation was simulated (sham group), and in the other two groups the animals were irradiated at 12 points with 0.29 J at 20 mW (energy density 10.36 J/cm(2), irradiance 0.71 W/cm(2)), or with 7.3 J at 100 mW (energy density 260.7 J/cm(2), irradiance 3.57 W/cm(2)). These procedures were applied to the cranial half of the flap immediately after surgery and were repeated on days 2 and 5 after surgery. The percentage necrotic area was determined on day 7 after surgery by the paper template method. The immunohistochemical expression of COX-2 in the samples was given scores from 0 to 3. The necrotic area was smaller in group irradiated at 7.3 J compared to sham-treated group and to the group irradiated at 0.29 J (P < 0.05); there was no difference between the sham-treated group and group irradiated at 0.29 J. COX-2 expression was lower in the group irradiated at 7.3 J than in the sham-treated group and the group irradiated at 0.29 J (P < 0.001). Low-level laser therapy was effective in decreasing random skin flap necrosis in rats using a laser energy of 7.30 J per point. Laser irradiation also decreased the expression of COX-2 in the flap pedicle.