Comparison Between Numeric Parameters From Acute and Chronic Venous Leg Ulcers: Identification of Potential Objective Nonhealing Parameters.

BACKGROUND: Some authors claim that the clinical methods often employed to assess chronic venous leg ulcers (CVLU) are based on subjective interpretation. The treatments based on a subjective characterization could become a trial-and-error therapy, resulting in longer evolutions and high recurrence rates. PURPOSE: The aim of this work was to compare numeric parameters from acute and chronic venous leg ulcers to identify potential objective nonhealing parameters. METHODS: The study was performed with hospital outpatients from 2016 to 2019. Cohorts were established according to the ulcer evolution time. Data collected related to ulcer characteristics included exudate pH, lactate and glucose concentrations, temperatures, microbiology findings, and imaging study results. RESULTS: Approximately 83% of the examined ulcers were chronic. Seventy-one percent of CVLUs and 59% of the acute ulcers had a pH ≥8. A high variability was found for the concentration of glucose and lactate in exudates of both acute and chronic ulcers. Variations of temperatures of normal skin (ΔT1) and periulcer zone (ΔT2) in reference to the wound bed temperature with values above 1 could indicate the presence of an inflammatory process and be used as a new potential marker of inflammation. All the acute ulcers and 88% of CVLUs showed <80% of granulation tissue in the imaging study. Finally, more than 105 organisms per gram of tissuewere found in 100% of the analyzed samples. CONCLUSIONS: Whereas there were not significant differences among the clinical measured parameters between acute and chronic ulcers, further research on the use of objective measurable parameters is needed to establish cutoff points to differentiate the "chronic state" of an ulcer as a "nonhealing state" regardless of the evolution time. Also, the use of these easily obtainable and low-cost nonhealing parameters would be a new approach to accurately monitor this pathology.

Hemorragia fatal de una ulcera venosa crónica: Reporte de un caso / Fatal bleeding from a chronic venous ulcer: case report

Resumen La enfermedad venosa crónica es un trastorno común que se manifiesta con una amplia gama de signos. En casos en los que la enfermedad adquiere gravedad se le denomina insuficiencia venosa crónica y esta puede llevar al desarrollo de una úlcera venosa. Un trauma directo o la erosión de una vena varicosa pueden llevar a una hemorragia que, aunado a enfermedades crónicas concomitantes, factores toxicológicos, sociales o primeros auxilios inadecuados pueden llevar a la muerte en pocos minutos y en un escenario del crimen que puede ser confuso a primera vista para el equipo forense. Se reporta un caso valorado en la Sección de Patología Forense del Departamento de Medicina Legal del Poder Judicial de Costa Rica en el que se realizó una autopsia completa. Dentro de los hallazgos más importantes a nivel macróscopico se evidenció una úlcera cónica de características venosas en la pierna derecha en la cual, mediante la disección por planos y la inyección de colorante en la vena safena magna, se observó la salida de este por una vena varicosa relacionada con la úlcera.

Abstract Chronic venous disease is a common disorder that shows a large spectrum of signs. In cases in which the disease acquires severity it is named chronic venous insufficiency, and it can cause the development of a venous ulcer. Direct trauma to or erosion of a varicose vein can lead to a hemorrhage that, in combination with coexistent conditions, toxicologic or social factors, or inadequate first aid can produce death in few minutes and a crime scene which might be confusing at first sight to the forensics team. We present a case handled by the Forensic Pathology Section of the Department of Legal Medicine of the Judicial Power of Costa Rica in which a complete autopsy was performed. Among the most relevant macroscopic findings was evidence of a chronic ulcer with venous characteristics on the right leg, in which dissection by planes and dye injection into the great saphenous vein showed leakage of this dye out of a varicose vein related to the ulcer.

Avaliação da pentoxifilina e do sulfato ferroso no tratamento da úlcera varicosa dos membros inferiores / Evaluation of pentoxifylline and ferrous sulfate for treatment of lower limb venous ulcers

Resumo Contexto A úlcera varicosa (UV) é o estágio mais avançado da doença venosa crônica (DVC) dos membros inferiores (MMII), frequentemente associada a episódios de hemorragia que podem provocar anemia crônica (AC) e retardar a sua cicatrização. Não há, na literatura, trabalhos que avaliem a prevalência da AC nos portadores de UV dos MMII, e poucos trabalhos analisam o uso da pentoxifilina no tratamento das UV dos MMII. Objetivos Avaliar a prevalência da AC nos pacientes portadores de UV de MMII e a resposta terapêutica ao sulfato ferroso (SF) e a associação da pentoxifilina com SF no tratamento adjuvante das UV dos MMII. Métodos Foram avaliados 67 pacientes portadores de UV de MMII atendidos no ambulatório de Cirurgia Vascular do Hospital das Clínicas, Recife, PE. Após as avaliações clínica e laboratorial iniciais, os pacientes diagnosticados com AC foram randomizados em dois grupos: o grupo controle, que recebeu SF (900 mg/dia via oral), e o grupo de estudo, tratado com SF (900 mg/dia via oral) e pentoxifilina (1.200 mg/dia). Todos foram reavaliados após 90 dias. Resultados Entre os pacientes avaliados, 27 (40%) apresentavam AC. Após o tratamento, foram observados aumento dos níveis de hemoglobina e de hematócrito e melhora das taxas da cinética do ferro, assim como a diminuição da profundidade e da área das UV em ambos os grupos, sem diferença estatística. Conclusões Foi encontrada alta prevalência de anemia na população estudada. A associação do SF com a pentoxifilina não se mostrou mais eficaz do que o emprego isolado do SF no tratamento adjuvante da UV dos MMII.

Abstract Background Venous ulcers (VU) are the most advanced stage of chronic venous disease (CVD) of the lower limbs. They are frequently associated with episodes of hemorrhage that can provoke chronic anemia (CA), delaying healing. There are no studies in the literature analyzing the prevalence of CA among patients with VU of the lower limbs and few studies have analyzed use of pentoxifylline to treat VU of the lower limbs. Objectives To evaluate the prevalence of CA in patients with lower limb VU and responses to treatment with ferrous sulfate (SF) compared with a combination of SF plus pentoxifylline as adjuvant treatment for VU of the lower limbs. Methods A total of 67 patients with lower limb VU were recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital das Clínicas, Recife, PE, Brazil. After initial clinical and laboratory assessments, patients diagnosed with CA were randomized into one of two groups: a control group, given SF (900 mg/day oral route), or a study group, treated with SF (900 mg/day oral route) and pentoxifylline (1,200 mg/day). All were reassessed after 90 days. Results Twenty-seven patients (40%) had CA. After treatment, increases were observed in hemoglobin and hematocrit levels, iron kinetics had improved, and both depth and area of VU had reduced in both groups, without statistically significant differences. Conclusions A high prevalence of anemia was detected in the study population. The combination of SF and pentoxifylline was not more effective than SF alone for adjuvant treatment of VU of the lower limbs.

Triagem da sarcopenia e fragilidade em pacientes com úlceras venosas crônicas: um estudo transversal / Screening for sarcopenia and frailty in patients with chronic ulcers: a cross-sectional study

Resumo Contexto Pacientes com úlceras venosas reportam múltiplas comorbidades e são mais propensos a ser fisicamente inativos. A sarcopenia e a fragilidade aumentam a vulnerabilidade de um indivíduo para maior dependência e/ou morte. Objetivos Verificar presença da sarcopenia e fragilidade em pacientes portadores de úlceras venosas crônicas. Métodos Estudo observacional e transversal, realizado com 9 pacientes com idade média de 67,4 ± 8,42 anos e portadores de úlcera venosa nos membros inferiores classificadas no Consenso Internacional de Doenças Venosas Crônicas (CEAP) em estágio 6. Para identificação e classificação da sarcopenia, foi avaliada a força (dinamometria manual), a velocidade da marcha (teste de caminhada de 10 metros) e a massa muscular (circunferência da panturrilha). Para triagem de fragilidade, foram utilizados os critérios de Fried: perda de peso não intencional, fadiga, redução da força e da velocidade da caminhada e baixa atividade física. Resultados O fenótipo de fragilidade foi mais frequente (n = 9; 100%) em relação à sarcopenia (n = 1; 11,1%). Entre os critérios de Fried, os mais frequentes foram a exaustão (n = 9; 100%), seguida pela baixa atividade física (n = 8; 88,8%) e fraqueza muscular (n = 5; 55%). Por fim, o critério menos frequente foi a diminuição da velocidade da marcha (n = 2; 22,2%). No diagnóstico de sarcopenia, foi observada redução da força associada à redução da massa muscular (n = 1; 11,1%). Conclusões Pacientes com úlceras venosas crônicas apresentam condição de fragilidade ou pré-fragilidade, enquanto a condição de sarcopenia foi pouco frequente.

Abstract Background Patients with venous ulcers report multiple comorbidities and are more likely to be physically inactive. Sarcopenia and frailty increase vulnerability to dependence and/or death. Objectives To investigate the occurrence of sarcopenia and frailty in patients with chronic venous ulcers. Methods Observational study with cross-sectional design. Nine patients (67.4 ± 8.42 years) with lower limb venous ulcers classified as CEAP 6 according to International Consensus on Chronic Venous Diseases criteria (open and active ulcer) were evaluated. Sarcopenia was assessed and classified by assessment of strength (manual dynamometry), gait speed (10-meter walk test), and muscle mass (calf circumference). Frailty screening was based on the Fried criteria, consisting of five components: unintentional weight loss; exhaustion; weakness; slow gait speed; and low physical activity. Results Frailty was more frequent (n=9; 100%) than sarcopenia (n=1; 11,1%). The most common Fried criterion was exhaustion (n=9; 100%), followed by low physical activity (n=8; 88,8%), muscle weakness (n=5; 55%), and unintentional weight loss. Finally, the least frequent criterion was slow walking speed (n=2; 22.2%). In the subject diagnosed with sarcopenia, both weakness and reduced muscle mass were observed (n=1; 11,1%). Conclusions Patients with chronic venous ulcers exhibit frailty or pre-frailty and the components that comprise the condition of frailty in this population are exhaustion, low physical activity, and muscle weakness. Sarcopenia was identified in a small proportion of the patients.

Homens com úlcera venosa de perna e as implicações para vida laboral / Men with leg venous ulcers and implications for working life / Hombres con úlcera venosa de pierna y las implicaciones para la vida laboral

Objetivo: analisar as repercussões das úlceras venosas de perna para a vida laboral de homens em idade produtiva. Método: estudo qualitativo e descritivo cujo objeto tratou de homens com úlceras venosas e as implicações para sua atuação no mundo do trabalho. Participaram do estudo 22 homens atendidos em dois ambulatórios, pertencentes ao complexo de saúde de uma universidade pública do Rio de Janeiro. O instrumento de coleta foi a entrevista semiestruturada e os dados coletados foram tratados por meio da análise temática de conteúdo. Resultados: evidenciou-se que há dificuldades para estes homens atuarem no mercado de trabalho. Além disso, apresentaram medo do desemprego e sentimento de incapacidade. Por outro lado, o acolhimento dos colegas de trabalho foi um aspecto positivo para minimizar tal sentimento. Conclusão: é importante a criação de políticas públicas que contribuam para melhor qualidade de vida para minimizar impactos nas dimensões biopsicossocial dessa população trabalhadora.

Objective: to analyze the repercussions of venous leg ulcers for the working life of men of productive age. Method: qualitative and descriptive research whose object dealt with men with venous ulcers and its implications for their work in the world of work. Twenty-two men attended at two outpatient clinics belonging to the health complex of a public university in Rio de Janeiro participated in the study. The collection instrument was the semistructured interview and data were treated through the thematic content analysis. Results: the study evidenced that there are difficulties for these men to act in the labor market, in addition, they present fear of unemployment and feeling of incapacity. On the other hand, the reception of co-workers was a positive aspect to minimize this feeling. Conclusion: it is important to create public policies that contribute to a better quality of life to minimize impacts on the biopsychosocial dimensions of this population of workers.

Objetivo: analizar las repercusiones de las úlceras venosas de las piernas para la vida laboral de los hombres en edad productiva. Método: investigación cualitativa y descriptiva cuyo objeto se ocupó de hombres con úlceras venosas y sus implicaciones para su trabajo en el mundo del trabajo. Veintidós hombres atendidos en dos clínicas ambulatorias pertenecientes al complejo de salud de una universidad pública en Río de Janeiro participaron en el estudio. El instrumento de recolección fue la entrevista semiestructurada y los datos se trataron a través del análisis de contenido temático. Resultados: el estudio evidenció que existen dificultades para que estos hombres actúen en el mercado laboral, además, presentan temor al desempleo y sensación de incapacidad. Por otro lado, la recepción de compañeros de trabajo fue un aspecto positivo para minimizar este sentimiento. Conclusión: es importante crear políticas públicas que contribuyan a una mejor calidad de vida para minimizar los impactos en las dimensiones biopsicosociales de esta población de trabajadores.

Application of Merleau-Pontyan perspective on the physical and psychological implications of venous ulcers.

OBJECTIVE: to verify the application of the Merleau-Pontyan perspective on the physical and psychological implications of chronic venous ulcers in the existence of people who experience the disease. METHOD: a qualitative study, of the descriptive phenomenological type, developed with 36 patients. The field of investigation was the Outpatient Clinic of Wound Repair of the Hospital Universitário Antônio Pedro. The collection occurred from June to December 2016, through a phenomenological interview. RESULTS: the experiences inherent in people who have venous ulcers pass through the world and "return" to the body itself, reflecting on the biopsychosocial aspects and the sensitivity left on the being. CONCLUSION: the biological characteristics of the subject affected by the venous ulcer have repercussions on their physical aspect, promoting influences along with the emotional and social changes originating from the clinical picture on the social aspects and consequently reverberating on the quality of life of this individual.

Application of Merleau-Pontyan perspective on the physical and psychological implications of venous ulcers / Aplicación de la perspectiva Merleau-Pontiana sobre las implicaciones físicas y psicológicas de las úlceras venosas / Aplicação da perspectiva Merleau-Pontiana sobre implicações físicas e psicológicas das úlceras venosas

ABSTRACT Objective: to verify the application of the Merleau-Pontyan perspective on the physical and psychological implications of chronic venous ulcers in the existence of people who experience the disease. Method: a qualitative study, of the descriptive phenomenological type, developed with 36 patients. The field of investigation was the Outpatient Clinic of Wound Repair of the Hospital Universitário Antônio Pedro. The collection occurred from June to December 2016, through a phenomenological interview. Results: the experiences inherent in people who have venous ulcers pass through the world and "return" to the body itself, reflecting on the biopsychosocial aspects and the sensitivity left on the being. Conclusion: the biological characteristics of the subject affected by the venous ulcer have repercussions on their physical aspect, promoting influences along with the emotional and social changes originating from the clinical picture on the social aspects and consequently reverberating on the quality of life of this individual.

RESUMEN Objetivo: verificar la aplicación de la perspectiva Merleau-Pontiana sobre las implicaciones físicas y psicológicas de las úlceras venosas crónicas en la existencia de las personas que experimentan la enfermedad. Método: estudio de abordaje cualitativo, del tipo fenomenológico descriptivo, desarrollado con 36 pacientes. El campo de investigación fue el Ambulatorio de Reparación de Heridas del Hospital Universitario Antônio Pedro. La recolección ocurrió de junio a diciembre de 2016, por medio de una entrevista fenomenológica. Resultados: las experiencias vivenciales inherentes a las personas que poseen las úlceras venosas atravesan por el mundo y "retornan" al cuerpo propio, reflexionando sobre los aspectos biopsicosociales y sobre la sensibilidad que reposa sobre el ser. Conclusión: la característica biológica del sujeto acometido por la úlcera venosa repercutirá sobre su aspecto físico, promoviendo influencias junto a las alteraciones emocionales y sociales oriundas del cuadro clínico sobre los aspectos sociales y consecuentemente reverberando sobre la calidad de vida de este individuo.

RESUMO Objetivo: verificar a aplicação da perspectiva Merleau-Pontiana sobre as implicações físicas e psicológicas das úlceras venosas crônicas na existência das pessoas que vivenciam a doença. Método: estudo de abordagem qualitativa, do tipo fenomenológico descritivo, desenvolvido com 36 pacientes. O campo de investigação foi o Ambulatório de Reparo de Feridas do Hospital Universitário Antônio Pedro. A coleta ocorreu de junho a dezembro de 2016, por meio de uma entrevista fenomenológica. Resultados: as experiências vivenciais inerentes às pessoas que possuem as úlceras venosas perpassam pelo mundo e "retornam" ao corpo próprio, refletindo sobre os aspectos biopsicossociais e sobre a sensibilidade que repousa sobre o ser. Conclusão: a característica biológica do sujeito acometido pela úlcera venosa repercutirá sobre seu aspecto físico, promovendo influências juntamente às alterações emocionais e sociais oriundas do quadro clínico sobre os aspectos sociais e consequentemente reverberando sobre a qualidade de vida deste indivíduo.

Impact of venous ulcers on patients' quality of life: an integrative review.

OBJECTIVE: To analyze knowledge gathered about the impact of venous ulcers on patients' quality of life. METHOD: Systematic bibliographic review study with an integrative approach. Databases of MEDLINE, LILACS, IBECS, CINAHL Complete, Web of Science, Scopus, and CUIDEN Plus were used for selection with the PICOT guiding criteria, through the DeCS and MeSH: adult, aged, varicose ulcer, and quality of life, in Portuguese, Spanish, and English. The inclusion criteria were: full original articles available in the databases selected with adherence to the theme in Portuguese, Spanish, and English, published from 2007 to 2016. RESULTS: The sample included 14 national and international articles with different methodological approaches and investigative contexts, published from 2012 to 2016. CONCLUSION: Chronic venous ulcers act on patients' bio-psycho-social-spiritual and socioeconomic spheres, having a negative impact on their quality of life.

Impact of venous ulcers on patients' quality of life: an integrative review / Impacto de las úlceras venosas en la calidad de vida de los pacientes: revisión integrativa / Impacto das úlceras venosas na qualidade de vida dos pacientes: revisão integrativa

ABSTRACT Objective: To analyze knowledge gathered about the impact of venous ulcers on patients' quality of life. Method: Systematic bibliographic review study with an integrative approach. Databases of MEDLINE, LILACS, IBECS, CINAHL Complete, Web of Science, Scopus, and CUIDEN Plus were used for selection with the PICOT guiding criteria, through the DeCS and MeSH: adult, aged, varicose ulcer, and quality of life, in Portuguese, Spanish, and English. The inclusion criteria were: full original articles available in the databases selected with adherence to the theme in Portuguese, Spanish, and English, published from 2007 to 2016. Results: The sample included 14 national and international articles with different methodological approaches and investigative contexts, published from 2012 to 2016. Conclusion: Chronic venous ulcers act on patients' bio-psycho-social-spiritual and socioeconomic spheres, having a negative impact on their quality of life.

RESUMEN Objetivo: Analizar las producciones de conocimiento sobre el impacto de las úlceras venosas en la calidad de vida de los pacientes. Método: Estudio de revisión bibliográfica sistemática, tipo integrativa. Para la selección, se utilizaron las bases de datos MEDLINE; LILACS; IBECS; CINAHL Complete; Web of Science; Scopus y CUIDEN Plus, con criterios orientadores PICOT; mediante DECs y MeSH: adulto, anciano, úlcera varicosa y calidad de vida, en portugués, español e inglés. Fueron criterios de inclusión: artículos originales integralmente disponibles en las citadas bases, referentes a la temática, en idiomas Portugués, Español e Inglés, publicados entre los años 2007 y 2016. Resultados: La muestra incluyó 14 artículos nacionales e internacionales con diversos abordajes metodológicos y contextos de investigación, en publicaciones realizadas desde 2012 hasta 2016. Conclusión: Las úlceras venosas crónicas actúan sobre las esferas biopsicoespiritual y socioeconómica de los pacientes, con repercusiones negativas en la calidad de vida.

RESUMO Objetivo: analisar as produções de conhecimento sobre o impacto das úlceras venosas na qualidade de vida dos pacientes. Método: estudo de revisão bibliográfica sistemática, do tipo integrativa. Utilizaram-se, para seleção, as bases de dados MEDLINE; LILACS; IBECS; CINAHL Complete; Web of Science; Scopus e CUIDEN Plus, pelos critérios orientadores PICOT; através do DECs e MeSH: adulto, idoso, úlcera varicosa e qualidade de vida, nos idiomas português, espanhol e inglês. Os critérios de inclusão foram: artigos originais disponibilizados na íntegra, nas bases de dados selecionadas, com aderência à temática nos idiomas Português, Espanhol e Inglês, publicados entre os anos de 2007 e 2016. Resultados: a amostra incluiu 14 artigos nacionais e internacionais com diversas abordagens metodológicas e contextos investigativos, publicados entre os anos de 2012 e 2016. Conclusão: as úlceras venosas crônicas atuam sobre as esferas biopsicoespiritual e socioeconômica dos pacientes, repercutindo negativamente sobre a qualidade de vida.

A Post-marketing Surveillance Study of Chronic Wounds Treated With a Native Collagen Calcium Alginate Dressing.

Chronic wounds (ie, wounds that fail to progress through a normal, orderly, timely sequence of repair) continue to pose significant clinical and economic burdens. A prospective, descriptive, 3-week post-marketing surveillance study was conducted across 3 wound care centers in the United States to evaluate the effectiveness of a collagen calcium alginate dressing on chronic wounds in conjunction with standard care (SC) practices (eg, offloading, debridement, compression) to support healing. Eligible participants had to be >18 years of age, have at least 1 chronic wound, and no known sensitivity to collagen. Demographic characteristics were recorded at the screening visit on case report forms. At each visit, wound-related pain was assessed using the Visual Analog Scale along with wound characteristics including size (using digital planimetry), wound exudate (minimal, moderate, heavy), and odor (none, mild). Participants were monitored for adverse events as well as infection based on signs and symptoms in and around the local wound bed, the deeper structures, and the surrounding skin. An intention-to-treat approach was used for all analyses. If an observation was missing, the last observation carried forward principle was used. For wounds that healed, pain and exudate were set to 0 (no pain/exudate) at visit 4. Descriptive, paired t tests and the Wilcoxon signed rank test were used to analyze the data. Of the 31 participants (15 men, 16 women, mean age 66.6 years), most (13, 42%) had a diabetic foot ulcer or venous leg ulcer (10, 32%); median duration of all wounds was 148 days. Thirty (30) patients completed the study. The mean number of comorbidities was 10.6 ± 6.3, and patients used a mean of 9.3 ± 5.64 prescription or over-the-counter medications. For all wounds combined, mean wound area was 4.8 ± 8.38 cm2 at baseline. At week 3, a decrease in wound area of 38.1% was noted (median: 45% ± 42.54; P = .006); 3 wounds healed completely. The change in wound exudate level from visit 1 to visit 4 was statistically significant (P = .006). No adverse events or infections occurred. In this population, the use of etiology-appropriate SC and a collagen calcium alginate dressing resulted in a decrease in wound area after 3 weeks of care. Longer-term studies to confirm these observations and controlled clinical studies to compare the effects of this dressing to other nongauze dressing treatments are needed.

Impact of non-adherent Ibuprofen foam dressing in the lives of patients with venous ulcers.

Objective: to evaluate pain in patients with lower limb venous ulcer who used non-adherent Ibuprofen foam dressing (IFD). Methods: we conducted a prospective study of patients with lower limb venous ulcers treated from April 2013 to August 2014. We used the Numerical Scale and McGill Pain Questionnaire, performing the assessments at the moment of inclusion of the patient in the study and every eight days thereafter, totaling five consultations. We divided the patients into two groups: 40 in the Study Group (SG), who were treated with IFD, and 40 in the Control Group (CG), treated with primary dressing, according to tissue type and exudate. Results: at the first consultation, patients from both groups reported intense pain. On the fifth day, SG patients reported no pain and the majority of CG reported moderate pain. Regarding the McGill Pain Questionnaire, most patients of both groups reported sensations related to sensory, affective, evaluative and miscellaneous descriptors at the beginning of data collection; after the second assessment, there was slight improvement among the patients in the SG. After the third consultation, they no longer reported the mentioned descriptors. CG patients displayed all the sensations of these descriptors until the fifth visit. Conclusion: non-adherent Ibuprofen foam dressing is effective in reducing the pain of patients with venous ulcers.

Objetivo: avaliar a dor em pacientes portadores de úlcera venosa de membros inferiores que utilizaram curativo de espuma não aderente com Ibuprofeno (CEI). Métodos: estudo prospectivo de pacientes portadores de úlceras venosas de membros inferiores tratados no período de abril de 2013 a agosto de 2014. Foram utilizados os questionários Escala Numérica e Questionário de Dor de McGille, as avaliações eram feitas no momento da inclusão do paciente no estudo e a cada oito dias, totalizando cinco consultas. Os pacientes foram divididos em dois grupos: 40 no Grupo Estudo (GE), que foram tratados com CEI, e 40 no Grupo Controle (GC), tratados com curativo primário, conforme o tipo de tecido e exsudato. Resultados: na primeira consulta os pacientes de ambos os grupos relataram dor intensa. No quinto dia os pacientes do GE relataram ausência de dor e a maioria do GC relatou dor moderada. Com relação ao Questionário de Dor de McGill, a maioria dos pacientes de ambos os grupos, no início da coleta de dados, relataram sensações relacionadas aos descritores sensorial, afetivo, avaliativo e miscelânea, sendo que entre os pacientes do GE houve discreta melhora após a segunda consulta. Após a terceira consulta já não referiram os descritores citados. Os pacientes do GC manifestaram todas as sensações desses descritores até quinta a consulta. Conclusão: o curativo de espuma não aderente com Ibuprofeno é eficaz na redução da dor de pacientes portadores de úlceras venosas.

Úlceras flebostáticas / Phlebostatic ulcers

Las úlceras flebostáticas son las más frecuentes en los miembros inferiores y constituyen una de las complicaciones más graves de la insuficiencia venosa crónica. Se caracterizan por ser invalidantes y tener alta repercusión socioeconómica. El objetivo de este trabajo es revisar los aspectos más relevantes de la epidemiología, la clínica y del tratamiento de las úlceras flebostáticas. Para la exploración bibliográfica se realizaron búsquedas de artículos en las bases de datos informatizadas on-line Medline, Cochrane Library, artículos publicados en páginas web, revistas líderes en la publicación de estudios sobre úlceras flebostáticas, el Consenso Latinoamericano sobre Úlceras Venosas, las Guías Prácticas de la Sociedad de Cirugía Vascular y el Fórum Americano de Flebología. Las úlceras flebostáticas son las más frecuentes de los miembros inferiores, más comunes en el sexo femenino y en mayores de 60 años. Repercuten en la calidad de vida del paciente y los gastos sanitarios. No existe tratamiento único para ellas, por lo que en un paciente se usan varios tratamientos o su combinación. Las evidencias científicas apuntan hacia las terapias compresivas como de primera línea. A pesar de los avances tecnológicos realizados en el tratamiento de estas úlceras, así como la gran variedad de los mismos, donde se complementan los más modernos con los ya existentes, las úlceras flebostáticas son de difícil curación y de alta recurrencia(AU)

The phlebostatic ulcers are the most common in the lower limbs and represent the most serious complications of the chronic venous insufficiency. These ulcers are disabling and have a significant social and economic impact. The objective of this paper was to review the most outstanding aspects of the epidemiology, the clinical manifestations and the treatment of the phlebostatic ulcers. The literature search was made in Medline, Cochrane Library, articles published in different web pages, leading journals in the publication of studies about phlebostatic ulcers, Latin American Consensus on Venous Ulcers, Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. The phlebostatic ulcers are the most frequent in the lower limbs, mainly in females and in patients older than 60 years. They have an impact on the quality of life of patients and on health expenditures. There is not a unique treatment for this type of ulcers, so several therapies or a combination of them is used. The scientific evidences point to the compressive therapies as the first-line method. Despite the technological advances in the treatment of these ulcers, and their great variety, in which the already existing ones and the latest ones complement each other, these ulcers are difficult to be cured and highly recurrent(AU)

Úlceras flebostáticas / Phlebostatic ulcers

Las úlceras flebostáticas son las más frecuentes en los miembros inferiores y constituyen una de las complicaciones más graves de la insuficiencia venosa crónica. Se caracterizan por ser invalidantes y tener alta repercusión socioeconómica. El objetivo de este trabajo es revisar los aspectos más relevantes de la epidemiología, la clínica y del tratamiento de las úlceras flebostáticas. Para la exploración bibliográfica se realizaron búsquedas de artículos en las bases de datos informatizadas on-line Medline, Cochrane Library, artículos publicados en páginas web, revistas líderes en la publicación de estudios sobre úlceras flebostáticas, el Consenso Latinoamericano sobre Úlceras Venosas, las Guías Prácticas de la Sociedad de Cirugía Vascular y el Fórum Americano de Flebología. Las úlceras flebostáticas son las más frecuentes de los miembros inferiores, más comunes en el sexo femenino y en mayores de 60 años. Repercuten en la calidad de vida del paciente y los gastos sanitarios. No existe tratamiento único para ellas, por lo que en un paciente se usan varios tratamientos o su combinación. Las evidencias científicas apuntan hacia las terapias compresivas como de primera línea. A pesar de los avances tecnológicos realizados en el tratamiento de estas úlceras, así como la gran variedad de los mismos, donde se complementan los más modernos con los ya existentes, las úlceras flebostáticas son de difícil curación y de alta recurrencia(AU)

The phlebostatic ulcers are the most common in the lower limbs and represent the most serious complications of the chronic venous insufficiency. These ulcers are disabling and have a significant social and economic impact. The objective of this paper was to review the most outstanding aspects of the epidemiology, the clinical manifestations and the treatment of the phlebostatic ulcers. The literature search was made in Medline, Cochrane Library, articles published in different web pages, leading journals in the publication of studies about phlebostatic ulcers, Latin American Consensus on Venous Ulcers, Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. The phlebostatic ulcers are the most frequent in the lower limbs, mainly in females and in patients older than 60 years. They have an impact on the quality of life of patients and on health expenditures. There is not a unique treatment for this type of ulcers, so several therapies or a combination of them is used. The scientific evidences point to the compressive therapies as the first-line method. Despite the technological advances in the treatment of these ulcers, and their great variety, in which the already existing ones and the latest ones complement each other, these ulcers are difficult to be cured and highly recurrent(AU)

Impact of home visits on the functional capacity of patients with venous ulcers.

OBJECTIVE: to compare the impact of home visits, before and after instructions, on the functional capacity of adult and elderly patients with venous ulcers, by means of the KATZ-EIAVD Scale. METHOD: experimental, clinical, randomized, non-blind and controlled study, developed with 32 patients (case and control groups). The research settings were the Wound Care Clinic of the University Hospital Antonio Pedro, and the homes of patients assisted in this clinic. Data collection took place from February to June 2014, by means of a health unit evaluation tool, the KATZ-EIAVD Scale, and a script of instructions to be given to the research subjects that had received a home visit. RESULTS: the studied population present excellent independence for activities of daily living, with no significant variation among them. CONCLUSION: the studied groups have functional capacity with similar progress.

Impact of home visits on the functional capacity of patients with venous ulcers / Repercusión de la visita domiciliaria en la capacidad funcional de pacientes con úlceras venosas / Repercussão da visita domiciliar na capacidade funcional de pacientes com úlceras venosas

ABSTRACT Objective: to compare the impact of home visits, before and after instructions, on the functional capacity of adult and elderly patients with venous ulcers, by means of the KATZ-EIAVD Scale. Method: experimental, clinical, randomized, non-blind and controlled study, developed with 32 patients (case and control groups). The research settings were the Wound Care Clinic of the University Hospital Antonio Pedro, and the homes of patients assisted in this clinic. Data collection took place from February to June 2014, by means of a health unit evaluation tool, the KATZ-EIAVD Scale, and a script of instructions to be given to the research subjects that had received a home visit. Results: the studied population present excellent independence for activities of daily living, with no significant variation among them. Conclusion: the studied groups have functional capacity with similar progress.

RESUMEN Objetivo: comparar la repercusión de la visita domiciliaria, antes y después de indicaciones, en la capacidad funcional de pacientes adultos y ancianos con úlceras venosas, mediante Escala de KATZ-EIAVD. Método: estudio clínico experimental, randomizado, no ciego, controlado, desarrollado con 32 pacientes (grupos caso y control). Los campos de investigación fueron el Ambulatorio de Curación de Heridas del Hospital Antônio Pedro y los domicilios de pacientes allí atendidos. Datos recolectados de febrero a junio de 2014, mediante instrumento de evaluación de la unidad de salud, de la Escala de KATZ-EIAVD y de la rutina de indicaciones a brindarse a los sujetos de la investigación que recibieron visita domiciliaria. Resultados: las poblaciones estudiadas presentan óptima independencia en sus actividades de la vida diaria, sin cambios significativos entre sí. Conclusión: los grupos estudiados presentan capacidades funcionales evolucionando de manera semejante.

RESUMO Objetivo: comparar a repercussão da visita domiciliar, antes e após orientações, na capacidade funcional de pacientes adultos e idosos com úlceras venosas, por meio da Escala de KATZ-EIAVD. Método: estudo clínico experimental, randomizado, não cego e controlado, desenvolvido com 32 pacientes (grupos caso e controle). Os campos de investigação foram o Ambulatório de Reparo de Feridas do Hospital Universitário Antônio Pedro e os domicílios de pacientes atendidos no referido ambulatório. A coleta ocorreu de fevereiro a junho de 2014, por meio de instrumento de avaliação da unidade de saúde, da Escala de KATZ-EIAVD e de roteiro de orientações a serem prestadas aos sujeitos da pesquisa que receberam visita domiciliar. Resultados: as populações estudadas apresentam ótima independência nas atividades de vida diária, sem variação significativa entre si. Conclusão: os grupos estudados apresentam a capacidade funcional evoluindo de modo semelhante.

Impact of non-adherent Ibuprofen foam dressing in the lives of patients with venous ulcers / Impacto do curativo de espuma não aderente com Ibuprofeno na vida dos pacientes com úlcera venosa

ABSTRACT Objective : to evaluate pain in patients with lower limb venous ulcer who used non-adherent Ibuprofen foam dressing (IFD). Methods : we conducted a prospective study of patients with lower limb venous ulcers treated from April 2013 to August 2014. We used the Numerical Scale and McGill Pain Questionnaire, performing the assessments at the moment of inclusion of the patient in the study and every eight days thereafter, totaling five consultations. We divided the patients into two groups: 40 in the Study Group (SG), who were treated with IFD, and 40 in the Control Group (CG), treated with primary dressing, according to tissue type and exudate. Results : at the first consultation, patients from both groups reported intense pain. On the fifth day, SG patients reported no pain and the majority of CG reported moderate pain. Regarding the McGill Pain Questionnaire, most patients of both groups reported sensations related to sensory, affective, evaluative and miscellaneous descriptors at the beginning of data collection; after the second assessment, there was slight improvement among the patients in the SG. After the third consultation, they no longer reported the mentioned descriptors. CG patients displayed all the sensations of these descriptors until the fifth visit. Conclusion : non-adherent Ibuprofen foam dressing is effective in reducing the pain of patients with venous ulcers.

RESUMO Objetivo: avaliar a dor em pacientes portadores de úlcera venosa de membros inferiores que utilizaram curativo de espuma não aderente com Ibuprofeno (CEI). Métodos: estudo prospectivo de pacientes portadores de úlceras venosas de membros inferiores tratados no período de abril de 2013 a agosto de 2014. Foram utilizados os questionários Escala Numérica e Questionário de Dor de McGille, as avaliações eram feitas no momento da inclusão do paciente no estudo e a cada oito dias, totalizando cinco consultas. Os pacientes foram divididos em dois grupos: 40 no Grupo Estudo (GE), que foram tratados com CEI, e 40 no Grupo Controle (GC), tratados com curativo primário, conforme o tipo de tecido e exsudato. Resultados: na primeira consulta os pacientes de ambos os grupos relataram dor intensa. No quinto dia os pacientes do GE relataram ausência de dor e a maioria do GC relatou dor moderada. Com relação ao Questionário de Dor de McGill, a maioria dos pacientes de ambos os grupos, no início da coleta de dados, relataram sensações relacionadas aos descritores sensorial, afetivo, avaliativo e miscelânea, sendo que entre os pacientes do GE houve discreta melhora após a segunda consulta. Após a terceira consulta já não referiram os descritores citados. Os pacientes do GC manifestaram todas as sensações desses descritores até quinta a consulta. Conclusão: o curativo de espuma não aderente com Ibuprofeno é eficaz na redução da dor de pacientes portadores de úlceras venosas.

[Comparative study of the efficacy of larva therapy for debridement and control of bacterial burden compared to surgical debridement and topical application of an antimicrobial]. / Estudio comparativo de la eficacia de la larvaterapia (LT) para desbridar y controlar la carga bacteriana en úlceras venosas comparado con desbridamiento quirúrgico y aplicación de un antimicrobiano tópico.

Maggot debridement therapy (MDT) is the use of medical grade maggots of the fly Lucilia sericata for wound debridement. Recent observations show that MDT decreases bacterial burden as well. Venous ulcers are the most commonly seen in wound clinics and require, besides adequate treatment of venous hypertension, proper wound bed preparation with debri dement of necrotic tissue and control of potential infections. To evaluate the efficacy of MDT in venous ulcers a randomized controlled trial was designed to compare MDT to surgical debridement and topical application of silver sulfadiazine (SSD) in 19 patients for 4 weeks. The study variables were area reduction, wound bed characteristics, pain, odor, anxiety and bacterial burden using quantitative tissue biopsies. MDT was effective as surgical debridement associated with topical SDD in the debridement of the wound and in reducing its size. A significant difference was observed in the reduction of bacterial burden in favor of the MDT group. Odor and anxiety increased in the MDT group without any difference in the pain intensity between groups. In conclusion, this study suggests that MDT is as effective as surgical debridement for the debridement of necrotic tissue and promote wound healing in venous ulcers and better at reducing bacterial burden.

Quality of life assessment of patients with and without venous ulcer.

OBJECTIVES: to compare the quality of life of patients with chronic venous disease with and without ulcer and to identify the most affected aspects. METHOD: cross-sectional study with a sample of 204 patients with chronic venous disease. The quality of life was assessed with the help of the SF-36 questionnaire. To compare the scores between the groups, the Mann-Whitney test was used, considering a statistically significant difference when p<0.05. RESULTS: the quality of life score of patients with ulcer was lower when compared to that of patients without ulcer, in all domains and dimensions of the SF-36, particularly in the domains physical aspect and functional capacity, with very low scores. CONCLUSION: all aspects of quality of life were more compromised in people with ulcers. These findings can contribute towards a better understanding of the effects of chronic venous disease on the quality of life and towards a better orientation of therapeutic interventions in this population.