Injerto de piel libre como tratamiento exitoso de una úlcera de Marjolin / Free skin graft as a successful treatment of a Marjolin ulcer

Introducción: la úlcera de Marjolin hace referencia a la aparición de un carcinoma de células escamosas ulcerado sobre un área previamente lesionada, crónicamente inflamada o con cicatrices. Se estima que solo el 1,7 % de las heridas crónicas se malignizan. Caso clínico: se trata de una mujer de 76 años que presentó una úlcera venosa crónica en la región maleolar de diez años de evolución que se había extendido. Se realizó una biopsia insicional y se obtuvo un carcinoma de células escamosas, por lo que se realizó la resección del tejido afectado, cubriendo el área con injerto autólogo de piel libre, fenestrado, de espesor parcial, y posteriormente se realizaron curas durante la hospitalización y el manejo ambulatorio, con lo que se obtuvieron resultados satisfactorios. Discusión: la resección-desbridamiento quirúrgico de la úlcera de Marjolin y el cierre con injerto libre de piel permitió la evolución satisfactoria y la cicatrización de las lesiones.(AU)

Introduction: Marjolin’s ulcer refers to the appearance of ulcerated squamous cell carcinoma on a previously injured,chronically inflamed or scarred area; it is estimated that only 1.7 % of chronic wounds become malignant.Case report: this is a 76-year-old woman who presented a chronic venous ulcer in the malleolar region of ten years ofevolution that had spread. An incisional biopsy was taken, resulting in squamous cell carcinoma, for which resectionof the affected tissue was performed: the area was covered with a free, fenestrated, partial-thickness autologous skingraft. Later, cures were carried out during hospitalization and ambulatory management, obtaining satisfactory results.Discussion: the surgical resection-debridement of the Marjolin ulcer and the closure with a free skin graft allowed thesatisfactory evolution and healing of the lesions.(AU)

Effects of plasma rich in growth factors on wound healing in patients with venous ulcers.

Introduction: Significant evidence suggests that plasma-rich in growth factors (PRGF) favor the repair of chronic wounds, enabling a rapid return to functionality. However, components of PRGF and their effects on persistent ulcers and epithelial tissues are not well characterized. The goals of this research were to analyze the biological properties of platelet-derived factors, to examine their effectiveness on healing of venous ulcers, and to establish a correlation with clinical and sociodemographic data. Methods: For the preparation of PRGF, the centrifugation technique was used, obtaining a 100 % autologous and biocompatible blood sample that was treated with sodium citrate and calcium chloride. The patients were attended weekly at the outpatient clinic for nursing consultation and wound dressing changes, with PRGF application every 15 days. The treatment protocols are described, and follow-up results are reported. Results: Initially, the patients' ulcers ranged in sizes from 4 to 84 cm2. After 12 weeks of treatment, there was a significant mean reduction of 46.2 % in ulcer area. At baseline, epithelial tissue was absent in all venous ulcers, but its presence grew significantly by the treatment period. However, the reduction of the area of the ulcers did not show significant correlation with the concentrations of the patient's growth factors. Conclusions: Using the established protocol for PRGF isolating, it was possible to obtain a product with the presence of the six growth factors related to tissue regeneration and observed a positive response on wound healing following treatment of venous ulcers, with capacity to accelerate re-epithelialization and restore the skin functional integrity.

Healing of Venous Leg Ulcers Influenced by Individual Aspects: Cluster Analysis in a Specialist Wound Management Clinic.

INTRODUCTION/OBJECTIVE: Venous Leg Ulcers (VLU) present a challenging healing process. Attaining healing is a primary treatment objective, commonly pursued in Primary Health Care (PHC) or Specialist Wound Management Clinics. Our objective was to examine the association and interplay between sociodemographic, health, clinical, and care factors with the outcomes of VLU treatment in patients undergoing care at a Specialist Wound Management Clinic. METHODS: Longitudinal, observational study took place in a center for the treatment of chronic injuries linked to PHC. The sociodemographic aspects, health status and habits, clinical and care aspects of patients with VLU were scrutinized over a 1-year period. RESULTS: The sample comprised 103 participants, with some still under treatment (Treatment Group-TG/ n = 60) and others having achieved VLU healing (Healing Group-HG/ n = 43). An association between sociodemographic, health, clinical, and care factors and the healing outcome (HG) was identified. A moderate correlation was observed between factors predisposing to healing in the sociodemographic group and health habits. Notably, among sociodemographic factors, the older age group and improvements in health, particularly the reduced use of alcohol/smoking, appeared to exert the most significant influence on healing. Additionally, specialized service monitoring and the application of compression therapy were contributory factors. CONCLUSIONS: These findings substantiate the hypothesis that sociodemographic, health, clinical, and care-related aspects are intertwined with VLU healing. Protective factors associated with healing interacted synergistically, fostering a positive outcome over one year of treatment.

Risk factors for venous ulceration in patients with varicose veins of lower extremities.

The aim of this case-control study was to explore the potential risk factors for venous ulceration in patients with varicose veins of lower extremities and to establish a simplified diagnostic score model. Seventy subjects with varicose veins of lower extremities and venous ulceration were compared with 1164 controls with varicose veins of lower extremities and no history of venous ulceration. Stepwise multivariate logistic regression analysis was used to identify the risk factors for venous ulceration. The steps in developing the diagnostic score model were based on the Framingham Heart study. The area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic ability of the diagnostic score model. Multivariate analysis showed that men, overweight, obesity, longer duration varicose veins, deep venous valve insufficiency, low lymphocyte counts, and high fibrinogen content were independently associated with an increased risk of venous ulceration. The AUC for the diagnostic score model was 0.75, which indicated good discriminatory ability. Special attention should be paid to the high-risk group of patients with lower extremity varicose veins. The diagnostic score model might be a useful screening tool for clinicians, policy makers, and patients.

Evaluation of factors affecting the healing process of venous ulcers: A 12-week longitudinal study.

The process of healing venous ulcers is complex and influenced by many factors. By identifying the risk factors that influence a slower healing process, it is possible to predict impending delays and plan an individualised care plan. We analysed our database of patients with venous ulcers and identified clinical and demographic factors that delay the healing process. The research analysed the medical records of 754 patients with VLUs at Chronic Wound Treatment Unit of the University Hospital treated between 2001 and 2019. In study, the majority (64.3%) were women, the mean age was 65.7 years. The median duration of Chronic Venous Insufficiency was 24 years, 52% patients had had the disease >20 years, and 296 (39.3%) had experienced ulceration >12 months. Most of the patients (85.8%) had comorbidities, 84% were obese. At 12-week follow-up, 432 of the 754 ulcers had healed. Identified independent predictors of slower ulcer healing rates: wound area greater than 8.25 cm2 , location of the ulceration other than the medial ankle area, underlying disease >20 years, the presence of multiple comorbidities, depth of the ulcer, the presence of an unpleasant smell and alert pathogens. The presence of redness resulted in faster healing of VLUc. Many factors influence the healing process of venous ulceration. The results of the study can help in planning patient care and implementing appropriate early strategies to promote healing.

Análisis costo-efectividad del tratamiento con terapia compresiva en la cicatrización de úlceras venosas / Cost-effectiveness analysis of the treatment with compressive therapy in the healing of venous ulcers / Análise de custo-efetividade do tratamento com terapia compressiva na cicatrização de úlceras venosas

Objetivo: analizar el costo-efectividad y calcular la relación costoefectividad incremental del tratamiento multicapa compresivo con respecto al inelástico (bota de Unna y estiramiento corto) según la literatura actual. Método: estudio cuantitativo de costo-efectividad a través de un modelo con ayuda del software TreeAge® para la elaboración del árbol de decisión. Los supuestos anunciados se obtuvieron mediante el uso de datos secundarios de la literatura para estimar el costo y la efectividad de los parámetros asumidos. Para ello, se realizó una revisión sistemática de la literatura con metaanálisis. Resultados: el árbol de decisión, después del Roll Back, mostró que la terapia multicapa prevaleció sobre las alternativas en el caso base, presentó un costo intermedio por aplicación, pero obtuvo la mayor efectividad. El gráfico del análisis de costo-efectividad también demostró que había un dominio extendido de la bota de Unna sobre el vendaje de estiramiento corto. El análisis de sensibilidad reveló que el vendaje multicapa sigue siendo la alternativa con mayor costoefectividad, dentro del umbral de disposición a pagar. Conclusión: la alternativa con mayor costo-efectividad fue el vendaje multicapa, considerado estándar de oro en la literatura. La segunda alternativa con mayor costo-efectividad fue la bota de Unna, la terapia más utilizada en Brasil.

Objective: to analyze the cost-effectiveness and calculate the incremental cost-effectiveness ratio of multilayer compressive treatment in relation to inelastic (Unna boot and short stretch) therapy according to the current literature. Method: quantitative study about cost-effectiveness through modeling with the aid of TreeAge® software for construction of the decision tree. The anticipated assumptions were obtained by using secondary literature data to estimate the cost and effectiveness of the assumed parameters. A systematic literature review with meta-analysis was performed for this end. Results: the decision tree after Roll Back showed that the multilayer therapy dominated the alternatives in the base case, representing an intermediate cost per application, although with the highest effectiveness. The cost-effectiveness analysis graph also showed extended dominance of the Unna boot in relation to the short stretch bandage. The sensitivity analysis showed that multilayer bandage remains a more cost-effective alternative, within the threshold of willingness to pay. Conclusion: the most cost-effective alternative was multilayer bandage, considered the gold standard in the literature. The second most cost-effective alternative was the Unna boot, the most used therapy in Brazil.

Objetivo: analisar a custo-efetividade e calcular a razão de custoefetividade incremental do tratamento compressivo multicamadas em relação ao inelástico (bota de Unna e curto estiramento) de acordo com a literatura atual. Método: estudo quantitativo sobre custo-efetividade por meio de modelagem com auxílio do software TreeAge® para a construção da árvore de decisão. Os pressupostos anunciados foram obtidos pelo uso de dados secundários de literatura para estimativa do custo e efetividade dos parâmetros assumidos. Para tal, foi realizada uma revisão sistemática de literatura com metanálise. Resultados: a árvore de decisão, após Roll Back mostrou que a terapia multicamadas dominou as alternativas no caso-base, representando custo intermediário por aplicação, porém, com a maior efetividade. O gráfico da análise de custo-efetividade também mostrou uma dominância estendida da bota de Unna em relação à bandagem de curto estiramento. A análise de sensibilidade mostrou que a bandagem multicamadas permanece como alternativa mais custo-efetiva, dentro do limiar de disposição para pagar. Conclusão: a alternativa com maior custo-efetividade foi a bandagem multicamadas, considerada padrão ouro na literatura. A segunda alternativa mais custo-efetiva foi a bota de Unna, terapia mais utilizada no Brasil.

Telenfermagem a Pacientes com Úlceras Venosas: Orientações Fornecidas e Desfecho do Monitoramento Remoto / Telenursing to Patients With Venous Ulcers: Guidelines Provided and Outcome of Remote Monitoring / Teleenfermería a Pacientes con Úlceras Venosas: Directrices Proporcionadas y Resultado de la Monitorización Remota

Objetivos:identificar as orientações fornecidas aos pacientes com úlceras venosas (UVs) submetidos à telenfermagem e descrever o desfecho ocorrido com os pacientes com UVs monitorados à distância. Método: estudo transversal e documental, realizado com 159 prontuários de pacientes com UV submetidos à telenfermagem numa clínica de estomaterapia no Rio de Janeiro. Os critérios de inclusão foram pacientes com diagnóstico de UV submetidos à telenfermagem, de abril de 2018 a fevereiro de 2020. A análise de dados ocorreu por meio de estatística descritiva (frequência absoluta e relativa para as variáveis categóricas), auxiliada por planilha do aplicativo Microsoft Excel. Resultados: identificou-se um equilíbrio entre os participantes em relação ao sexo; apresentaram idade média (desvio-padrão) de 68,07 (5,28); ensino fundamental completo ou médio incompleto; aposentados ou pensionistas. Verificou-se que 40,88% dos pacientes possuíam ao menos uma doença de base, predominando hipertensão arterial sistêmica e diabetes mellitus. As orientações mais prevalentes foram: repouso com os membros inferiores elevados, utilização da terapia compressiva com meia elástica ou atadura elástica e realização da troca de curativo secundário em sua residência. Conclusão: os achados evidenciam a necessidade de ampliar as ações de enfermagem desenvolvidas na Clínica, buscando proporcionar a saúde integral aos pacientes.

Objectives:To identify the guidelines provided to patients with venous ulcers submitted to telenursing and describe the outcome that occurred with patients with venous ulcers monitored remotely. Method: Cross-sectional and documentary study, carried out with 159 medical records of patients with venous ulcers submitted to telenursing at an enterostomal therapy clinic in Rio de Janeiro, Brazil. The inclusion criteria were patients with a diagnosis of venous ulcer submitted to Telenursing, from April 2018 to February 2020. Data analysis was performed using descriptive statistics (absolute and relative frequency for categorical variables), aided by the application spreadsheet Microsoft Excel. Results: A balance was identified between the participants in relation to gender; had a mean age (standard deviation) of 68.07 (5.28); completed elementary school or incomplete high school; retirees or pensioners. It was found that 40.88% of the patients had at least one underlying disease, predominantly systemic arterial hypertension and diabetes mellitus. The most prevalent guidelines were: resting with the lower limbs elevated, using compressive therapy with elastic stockings or elastic bandage, and changing the secondary dressing at home. Conclusion: The findings show the need to expand the nursing actions developed at the clinic, seeking to provide comprehensive health to patients.

Objetivos:identificar las orientaciones proporcionadas a los pacientes con úlceras venosas sometidos a Teleenfermería y describir el desenlace ocurrido con los pacientes con úlceras venosas monitorizados a distancia. Método: estudio transversal y documental, realizado con 159 prontuarios de pacientes con úlceras venosas sometidos a teleenfermería en una Clínica de Estomaterapia de Rio de Janeiro. Los criterios de inclusión fueron pacientes con diagnóstico de úlcera venosa sometidos a teleenfermería, de abril de 2018 a febrero de 2020. El análisis de datos se realizó mediante estadística descriptiva (frecuencia absoluta y relativa para variables categóricas), auxiliada por la hoja de cálculo de la aplicación Microsoft Excel. Resultados: se identificó un equilibrio entre los participantes en relación al género; tenía una edad media (DE) de 68,07 (5,28); primaria completa o secundaria incompleta; jubilados o pensionados. Se encontró que el 40,88% de los pacientes tenían al menos una enfermedad de base, predominantemente Hipertensión Arterial Sistémica y Diabetes Mellitus. Las pautas más prevalentes fueron: reposo con los miembros inferiores elevados, uso de terapia compresiva con medias elásticas o venda elástica y cambio del vendaje secundario en casa. Conclusión: los hallazgos muestran la necesidad de ampliar las acciones de enfermería desarrolladas en la Clínica, buscando brindar salud integral a los pacientes

Cuidados prestados ao portador de úlcera venosa que auxiliam a cicatrização da ferida / Care provided to patients with venous ulcers to help the wound heal

Objetivo: Identificar na literatura quais são as mais recentes práticas assistenciais prestadas ao paciente portador de úlcera visando a cicatrização da ferida. Método: trata-se de uma revisão integrativa da literatura realizada no período de novembro e dezembro de 2022 indexados nos portais LILACS e MEDLINE, os descritores usados na busca foram "Úlcera varicosa" OR "Insuficiência venosa'' AND "cicatrização" AND "Assistência ao paciente". Resultados: foram incluídos 8 artigos, como principais resultados observou-se que a enfermagem realiza várias intervenções para cicatrização das lesões sendo a mais utilizada é o tratamento com terapia compressiva, seguido do tratamento com hidrocoloide e tratamento com gel de plaquetas homólogo. No que tange a avaliação de lesões, prevalece o uso do instrumento PUSH. Considerações finais: faz-se necessário a avaliação adequada, orientação do paciente e cuidador, cuidado multidisciplinar e associação de novas tecnologias para o tratamento de úlceras venosas. A padronização da utilização de escalas como a PUSH na avaliação dos cuidados prestados é essencial para nortear o atendimento.(AU)

Objective: To identify in the literature which are the most recent care practices provided to patients with ulcers, aiming at wound healing. Method: this is an integrative literature review carried out in the period of November and December 2022 indexed in the LILACS and MEDLINE portals, the descriptors used in the search were "Varicose ulcer" OR "Venous insufficiency'' AND "healing" AND "Assistance to the patient". Results: 8 articles were included. With regard to the assessment of injuries, the use of the PUSH instrument prevails. Final considerations: proper assessment, patient and caregiver guidance, multidisciplinary care and association of new technologies for the treatment of venous ulcers are necessary. The standardization of the use of scales such as the PUSH in the assessment of the care provided is essential to guide care.(AU)

Objetivo: Identificar en la literatura cuáles son las prácticas más recientes de cuidados prestados a pacientes con úlceras visando la cicatrización de las heridas. Método: se trata de una revisión bibliográfica integradora realizada en el período de noviembre y diciembre de 2022 indexada en los portales LILACS y MEDLINE, los descriptores utilizados en la búsqueda fueron "Úlcera varicosa" O "Insuficiencia venosa" Y "cicatrización" Y "Cuidados del paciente". Resultados: Se incluyeron 8 artículos, como principales resultados se observó que enfermería realiza diversas intervenciones para la cicatrización de las lesiones, siendo la más utilizada el tratamiento con terapia compresiva, seguida del tratamiento con hidrocoloide y el tratamiento con gel de plaquetas homólogas. En cuanto a la valoración de las lesiones, prevalece el uso del instrumento PUSH. Consideraciones finales: son necesarias una evaluación adecuada, la orientación al paciente y al cuidador, la atención multidisciplinar y la asociación de nuevas tecnologías para el tratamiento de las úlceras venosas. La estandarización del uso de escalas como el PUSH en la evaluación de los cuidados prestados es esencial para orientar la asistencia.(AU)

Calidad de vida relacionada con la salud en personas con úlcera venosa / Health-related quality of life of people with venous ulcer / Qualidade de vida relacionada à saúde em pessoas com úlcera venosa

Introducción: la úlcera venosa es la heridade origen vascular que más se presentaen la población adulta; afecta la calidad de vida,por loque se requiereun abordajeinterdisciplinarioparala atenciónde las personas que la padecen. Objetivo:describir las variables clínicas y sociales que interfieren en la calidad de vida relacionada con la salud de un grupo deadultosconúlcera venosa.Métodos:estudio observacional de tipo cohorte; incluyó 80 personas evaluadas en tres clínicas de Medellín(Colombia), en quienes seaplicó elinstrumento de evaluaciónCharing Cross Venous Ulcer Questionnaire. Se describieron las variablessociodemográficas y la evolución de la calidad de vidahasta la cicatrización y se construyó un modelo de regresión logística para explicar las variables asociadas a tener lapeorcalidad de vida. Resultados:el 28,8%de los participantes obtuvieron 64 o más puntos, es decir, grado de afección alto durantela primera mediciónde la calidad de vida;en el 68,8%el puntaje fue63o menos, lo que significó afecciónmoderadaysolo el 2,4%tuvo baja afección.Laspeores puntuaciones se registraron enmujeres,participantes de mayor edad y quienes tenían mayor compromiso de la herida; la afección involucró las dimensiones Estado emocional, Estética, Función social y Actividades domésticas,aunque hubo evolución favorablede la calidad de vidamientrasiba cicatrizandola úlcera. Conclusiones:lacalidad de vida relacionada con la saludestá altamente afectada en las personasque tienen úlcera venosa, siendo más frecuente en quienes tienen dolor constante,heridas más grandes, de mayor tiempo de antigüedad y aquellos con mala percepción desusalud; por tanto,se requiere oportunamentela intervención profesional e interdisciplinaria en salud para el logro de la cicatrizacióny del bienestary para mejorar la calidad de vida.

ntroduction: Venous ulcers are the most common vascular injury in the adult population. They affect the quality of life, so people who suffer from venous ulcers require an interdisciplinary approach to their care. Objective: To describe clinical and social variables that affect the health-related quality of life of a group of adults with venous ulcers. Methods: Observational cohort study carried out with 80 people examined in three medical centers in Medellín (Colombia) and who were given the Charing Cross Venous Ulcer Questionnaire to answer. Sociodemographic variables and the quality-of-life evolution until scarring were described. A logistic regression model was built to explain the variables associated with having the poorest quality of life. Results:There were28.8% of the participants who scored 64 or more points on the first quality of life measurement, which indicates a highly affected quality of life; 68.8% scored 63 or less, indicating a moderately affected quality of life, while only 2.4% indicated a slightly affected quality of life. The worst scores were seen among women, older participants, and those with greater ulcer severity. The dimensions of emotional status, cosmesis, social interaction, and domestic activities were affected, although there was a favorable evolution of the quality of life while the ulcer was healing. Conclusions: Health-related quality of life is highly affected in people with venous ulcers and is more common in those with constant pain, larger and older sores, and those with poor health perceptions. Therefore, timely professional and interdisciplinary healthcare interventions are required to achieve wound healing and wellness and improve quality of life

Introdução:a úlcera venosa é a ferida de origem vascular que ocorre mais frequentemente na população adulta e afeta a qualidade de vida, por isso é necessária uma abordagem interdisciplinar para o cuidado das pessoas que a sofrem. Objetivo:descrever as variáveis clínicas e sociais que interferem na qualidade de vida relacionada à saúde de um grupo de adultos com úlcera venosa.Métodos:estudo de coorte observacional; incluíram-se 80 pessoas avaliadas em três clínicas em Medellín (Colômbia), nas quais foi aplicado o instrumento de avaliação Charing Cross Venous Ulcer Questionnaire. Descreveram-se as variáveis sociodemográficas e a evolução da qualidade de vida até a cicatrizaçãoe construiu-se um modelo de regressão logística para explicar as variáveis associadas à pior qualidade de vida.Resultados: 28,8% dos participantes obtiveram 64 ou mais pontos, ou seja, alto grau de condição na primeira mensuração da qualidade de vida; em 68,8% a pontuação foi de 63 ou menos, o que significa condição moderada e apenas 2,4% em condição baixa. As piores pontuações foram registradas em mulheres, participantes mais velhos e naqueles com maior complicação da ferida; a afecção,envolvia as dimensões Estado Emocional, Estética, Função Social e Atividades Domésticas, embora houvesse evolução favorável da qualidade de vida enquanto a úlcera cicatrizava. Conclusões:a qualidade de vida relacionada à saúde é altamente afetada em pessoas com úlcera venosa, sendo mais frequente naquelas com dor constante, feridasmaiores, mais antigas e com má percepção de saúde; portanto, é necessária intervenção oportuna profissional e interdisciplinar em saúde para alcançar a cicatrização e o bem-estar e melhorar a qualidade de vida

Frailty syndrome, feelings of impotence and functional capacity in elderly patients with venous ulcers / Síndrome de fragilidade, sentimento de impotência e capacidade funcional em idosos portadores de úlcera venosa

Introduction: Chronic venous ulcers have a negative impact on the physical, psychic, and social domains, affecting the quality of life of patients, especially the elderly. This study aimed to assess frailty, functional capacity, and feelings of helplessness in older people with venous ulcers. Method: 112 older people were divided into two groups according to the presence or absence of venous ulcers. All patients were interviewed using the Edmonton Frail Scale (EFS), Health Assessment Questionnaire-20 (HAQ20), and the Impotence Feelings Measurement Instrument (IMSI) from May 2017 to August 2018. Results: Regarding the EFS score, 76.8% of patients with venous ulcers were classified as vulnerable and frail, compared to 28.6% of patients in the group without ulcers. Scores on the HAQ-20 showed statistically significant differences between groups in all categories of the instrument, indicating that older people with venous ulcers had reduced general functional capacity compared to older people without ulcers. The mean IMSI score was 41.2 for the group with venous ulcers and 33.4 for the group without ulcers. Conclusion: Venous ulcers had a negative impact on functional capacity and increased frailty and feelings of powerlessness in the elderly.

Introdução: Úlceras venosas crônicas exercem impacto negativo nos domínios físico, psíquico e social, afetando a qualidade de vida de pacientes, especialmente os idosos. O objetivo deste estudo foi avaliar o nível de fragilidade, capacidade funcional e sentimento de impotência em idosos com úlcera venosa. Método: Um total de 112 idosos foram distribuídos em dois grupos de acordo com a presença ou ausência úlcera venosa. Todos os pacientes foram entrevistados utilizando-se os questionários Edmonton Frail Scale (EFS), Health Assessment Questionnaire-20 (HAQ-20) e o Instrumento de Medida de Sentimento de Impotência (IMSI) no período de maio de 2017 a agosto de 2018. Resultados: Em relação à pontuação na EFS, 76,8% dos pacientes com úlcera venosa foram classificados como vulneráveis e frágeis, em comparação a 28,6% dos pacientes do grupo sem úlcera. Pontuações no HAQ-20 mostraram diferenças estatisticamente significantes entre os grupos em todas as categorias do instrumento, indicando que idosos com úlcera venosa apresentavam redução da capacidade funcional geral em comparação aos idosos sem úlcera. A pontuação média para o IMSI foi de 41,2 para o grupo com úlcera venosa e 33,4 para o grupo sem úlcera. Conclusão: Úlceras venosas causaram impacto negativo na capacidade funcional e aumento de fragilidade e sentimento de impotência nos idosos.

Correlation between Generic and Disease-Specific Quality of Life Questionnaires in Patients with Venous Ulcerations: A Cross-Sectional Study Carried out in a Primary Health Care Setting in Brazil.

Venous Ulcers (VU) are a serious health problem that affect the Quality of Life (QoL). They are evaluated by many different scales in the literature. We aimed to analyze the correlation between the Medical Outcomes Short-Form Health QoL (SF-36) and Charing Cross Venous Ulcer Questionnaire (CCVUQ) scales. This is a cross-sectional study conducted in a Brazilian center specializing in chronic VU of the Primary Health Care (PHC) provided to patients with active VU. The general QoL instrument SF-36 and the CCVUQ, specific for people with VU, were used. Spearman's Rho Test determined the correlation between the variables analyzed. Our sample had a total of 150 patients. We found a direct correlation between the domestic activities division (CCVUQ) aspect and the SF-36 Physical role functioning (strong), and Physical functioning (moderate) domains. The Social interaction division (CCVUQ) aspect presented moderate correlation with the domains of the SF-36 Physical role functioning and Physical functioning. The Vitality domain (SF-36) showed moderate correlation with the aspects of CCVUQ Cosmesis division and Emotional status division. The greatest forces of direct correlation were observed between the physical, functional and vitality aspects of SF-36 with those represented by domestic activities and social interaction in the CCVUQ.

Medidas de autocuidado para prevenção da recidiva de úlceras venosas: protocolo de revisão de escopo / Self-care measures to prevent venous ulcer recurrence: a scoping review protocol

OBJETIVO: Mapear as medidas de autocuidado para prevenção de recidiva de úlceras venosas nos diversos cenários de atenção à saúde. MÉTODO: Protocolo de revisão de escopo, tendo como pergunta de pesquisa: quais as medidas de autocuidado para prevenção de recidiva de úlceras venosas nos diversos cenários de atenção à saúde? Serão utilizados como bases de dados: Banco de Dados em Enfermagem (BDENF), CINAHL, LILACS, MEDLINE (via PUBMED), SCIELO, SCOPUS, Cochrane Library, EMBASE e Web of Science, além da literatura cinzenta. O processo de busca, a avaliação, seleção e extração de dados serão realizados por pares cegados e, em caso de divergência, um terceiro revisor será consultado. Os resultados serão apresentados na íntegra, em formato de narrativa e diagramas de fluxo, de forma a se alinhar à questão de pesquisa proposta. Protocolo registrado na Open Science Framework (OSF): osf.io/y7ckp.

OBJECTIVE: To map self-care measures to prevent venous ulcer recurrence in different healthcare settings. METHOD: Scoping review protocol, with the following research question: What are the self-care measures to prevent the recurrence of venous ulcers in different healthcare settings? The following databases will be used: Nursing Database (BDENF), CINAHL, LILACS, MEDLINE (via PUBMED), SCIELO, SCOPUS, Cochrane Library, EMBASE, and Web of Science, in addition to the grey literature. Blinded peers will carry out the search process, evaluation, selection, and data extraction, and in case of disagreement, a third reviewer will be consulted. The results will be presented in narrative format and using flow diagrams aligned with the proposed research question. The protocol was registered in the Open Science Framework (OSF): osf.io/y7ckp.

Qualidade de vida de idosos com úlcera venosa na atenção primária à saúde: características associadas* / Calidad de vida de ancianos con úlceras venosas en atención primaria: características asociadas / Quality of life of elderly patients with venous ulcers in primary health care: associated characteristics

Objetivo: analisar a qualidade de vida (QV) e sua associação com as características sociodemográficas, de saúde, clínicas e assistenciais de idosos com úlcera venosa. Método: pesquisa transversal, realizada com 40 idosos atendidos na Atenção Primária à Saúde. Os dados foram coletados com formulário de caracterização e Charing Cross Venous Ulcer Questionnaire. Aplicou-se a estatística descritiva e inferencial (p <0,05). Resultados: a QV do idoso com úlcera venosa esteve comprometida, principalmente no Estado Emocional. Constataram-se associações significativas entre a dor e os domínios Atividades Domésticas, Estado Emocional e Escore Total; quem realiza o curativo e Estado Emocional; uso de terapia compressiva e Atividades Domésticas; e entre número de consultas e os domínios Interação Social, Atividades Domésticas, Estado Emocional e Escore Total. Conclusão: ausência de dor, realizar seu curativo, tratamento com terapia compressiva e três ou mais consultas ao ano foram as características que favoreceram a QV de idosos com úlcera venosa.

Objective: to assess the quality of life (QoL) and its association with the sociodemographic, health, clinical and care characteristics of elderly patients with venous ulcers. Method: cross-sectional study, conducted with 40 elderly people attended in Primary Health Care. Data were collected using the characterization form and Charing Cross Venous Ulcer Questionnaire. Descriptive and inferential statistics were applied (p <0.05). Results: the QoL of the elderly with venous ulcer was compromised, especially in the Emotional State. Significant associations were found between pain and the domains Domestic Activities, Emotional State and Total Score; who performs the dressing and Emotional State; use of compressive therapy and domestic activities; and between the number of consultations and the domains Social Interaction, Domestic Activities, Emotional State and Total Score. Conclusion: absence of pain, dressing, treatment with compressive therapy and three or more visits per year were the characteristics that favored the QoL of elderly patients with venous ulcers.

Objetivo: Analizar la calidad de vida (CV) y su asociación con las características sociodemográficas, de salud, clínicas y asistenciales de los ancianos con úlceras venosas. Método: estudio transversal, realizado con 40 ancianos atendidos en Atención Primaria de Salud. Los datos fueron recolectados utilizando el formulario de caracterización y el Cuestionario de Úlcera Venosa de Charing Cross. Se aplicó estadística descriptiva e inferencial (p <0,05). Resultados: La CV de los ancianos con úlcera venosa estaba comprometida, especialmente en el Estado Emocional. Se encontraron asociaciones significativas entre el dolor y los dominios Actividades Domésticas, Estado Emocional y Puntaje Total; quién realiza el vestuario y el estado emocional; uso de terapia compresiva y actividades domésticas; y entre el número de consultas y los dominios Interacción Social, Actividades Domésticas, Estado Emocional y Puntaje Total. Conclusión: ausencia de dolor, vendaje, tratamiento con terapia compresiva y tres o más visitas por año fueron las características que favorecieron la CV de ancianos con úlceras venosas.

Association between physical activity levels and healing in people with venous leg ulcers: secondary analysis of prospective cohort data.

Aim: To explore the relationship between physical activity levels and wound healing and recurrence in people with venous leg ulcers. Methods: Questionnaires and medical records were used to collect data, with responses used to group participants into different physical activity groups. The differences in healing and recurrence outcomes of ulcers among different physical activity groups were compared using Chi-square, Kaplan Meier survival analysis, Cox proportional hazards regression analysis, and Kruskal-Wallis test. To measure the strength of the association between physical activity levels and patient outcomes, Spearman's Rho tests were used. We used descriptive analysis to examine how physical activity levels change over 24 weeks. Results: Participants were classified into four distinct groups based on physical activity levels reported at baseline and week 12. The survival analysis showed higher physical activity level was associated with a shorter time to healing (log-rank test = 14.78, df = 3; p = 0.002). The persistently moderate-to-vigorous group had a 7.3-fold increased likelihood of healing compared to the persistently sedentary group. High levels of physical activity were also associated with a better quality of life score at baseline (ρ = 0.41, p < 0.000), week 12 (ρ = 0.36, p < 0.001), and week 24 (ρ = 0.49, p < 0.000). Most participants (48.5%) reported low levels of physical activity, which remained low for the entire study period. Conclusion: An increased level of physical activity was linked to a shorter healing time and enhanced quality of life. Low levels of physical activity appeared common among people with venous leg ulcers.

RESVECH 2.0: cross-cultural adaptation for Brazil, reliability and validity for the evaluation of venous ulcers / RESVECH 2.0: adaptación transcultural para Brasil, fiabilidad y validez para evaluar úlceras varicosas / RESVECH 2.0: adaptação transcultural para o Brasil, confiabilidade e validade para avaliação de úlceras venosas

ABSTRACT Objectives: to cross-culturally adapt the scale Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 for Brazilian Portuguese; to estimate the internal consistency and construct and criterion validity of the scale in the evaluation of venous ulcers. Methods: methodological study, based on international guidelines for studies of this type. Wounds were evaluated using the RESVECH 2.0 and Pressure Ulcer Scale of Healing 3.0 (PUSH). Descriptive analysis, confirmatory factor analysis, Cronbach's alpha and Spearman's correlation (p<0.05) were used. Results: 12 nurses and 77 people with 153 venous ulcers participated in the study. The translation was successful, the proposed factor model was validated, and Cronbach 's alpha = 0.832 (95%CI, 0.780-0.880) and correlation coefficient (RESVECH 2.0 and PUSH 3.0) = 0.74 were obtained. Conclusions: the adaptation of RESVECH 2.0 to Brazilian Portuguese is robust. Reliability and validity show compatibility for use in the country in the evaluation of venous ulcers.

RESUMEN Objetivos: adaptar transculturalmente la escala "Resultados en la valoración y evolución de la cicatrización de heridas", RESVECH 2.0 al portugués de Brasil; estimar su consistencia interna, validez de constructo y de criterio para su utilización en úlceras varicosas. Métodos: es un estudio metodológico, basado en directivas internacionales sobre investigaciones de esta naturaleza. Se evaluaron las heridas por medio de la RESVECH 2.0 y de la Escala de Cicatrización de Úlceras por Presión 3.0 (PUSH). Se llevó a cabo con análisis descriptivo, análisis factorial confirmatorio, alfa de Cronbach y correlación de Spearman (p<0,05). Resultados: participaron 12 enfermeros y 77 personas que tenían 153 úlceras venosas. La traducción fue exitosa, el modelo factorial propuesto fue validado, el alfa de Cronbach = 0,832 (95%CI=0,780-0,880) y el coeficiente de correlación (RESVECH 2.0 y PUSH 3.0) = 0,74. Conclusiones: la adaptación de la RESVECH 2.0 al portugués brasileño es sólida. La fiabilidad y la validez demuestran la compatibilidad para su utilización en el país en la evaluación de las úlceras varicosas.

RESUMO Objetivos: adaptar transculturalmente a escala Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 para o português do Brasil; estimar sua consistência interna, validade de construto e de critério para utilização em úlceras venosas. Métodos: estudo metodológico, baseado em diretrizes internacionais para estudos dessa natureza. Realizou-se avaliação das feridas por meio da RESVECH 2.0 e da Pressure Ulcer Scale of Healing 3.0 (PUSH). Empregou-se análise descritiva, análise fatorial confirmatória, alfa de Cronbach e correlação de Spearman (p<0,05). Resultados: participaram 12 enfermeiros e 77 pessoas com 153 úlceras venosas. A tradução foi bem-sucedida, o modelo fatorial proposto foi validado, obteve-se alfa de Cronbach = 0,832 (IC95%=0,780-0,880) e coeficiente de correlação (RESVECH 2.0 e PUSH 3.0) = 0,74. Conclusões: a adaptação da RESVECH 2.0 para o português do Brasil é robusta. A confiabilidade e validade evidenciam compatibilidade para utilização no país e avaliação de úlceras venosas.

RESVECH 2.0: cross-cultural adaptation for Brazil, reliability and validity for the evaluation of venous ulcers / RESVECH 2.0: adaptación transcultural para Brasil, fiabilidad y validez para evaluar úlceras varicosas / RESVECH 2.0: adaptação transcultural para o Brasil, confiabilidade e validade para avaliação de úlceras venosas

ABSTRACT Objectives: to cross-culturally adapt the scale Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 for Brazilian Portuguese; to estimate the internal consistency and construct and criterion validity of the scale in the evaluation of venous ulcers. Methods: methodological study, based on international guidelines for studies of this type. Wounds were evaluated using the RESVECH 2.0 and Pressure Ulcer Scale of Healing 3.0 (PUSH). Descriptive analysis, confirmatory factor analysis, Cronbach's alpha and Spearman's correlation (p<0.05) were used. Results: 12 nurses and 77 people with 153 venous ulcers participated in the study. The translation was successful, the proposed factor model was validated, and Cronbach 's alpha = 0.832 (95%CI, 0.780-0.880) and correlation coefficient (RESVECH 2.0 and PUSH 3.0) = 0.74 were obtained. Conclusions: the adaptation of RESVECH 2.0 to Brazilian Portuguese is robust. Reliability and validity show compatibility for use in the country in the evaluation of venous ulcers.

RESUMEN Objetivos: adaptar transculturalmente la escala "Resultados en la valoración y evolución de la cicatrización de heridas", RESVECH 2.0 al portugués de Brasil; estimar su consistencia interna, validez de constructo y de criterio para su utilización en úlceras varicosas. Métodos: es un estudio metodológico, basado en directivas internacionales sobre investigaciones de esta naturaleza. Se evaluaron las heridas por medio de la RESVECH 2.0 y de la Escala de Cicatrización de Úlceras por Presión 3.0 (PUSH). Se llevó a cabo con análisis descriptivo, análisis factorial confirmatorio, alfa de Cronbach y correlación de Spearman (p<0,05). Resultados: participaron 12 enfermeros y 77 personas que tenían 153 úlceras venosas. La traducción fue exitosa, el modelo factorial propuesto fue validado, el alfa de Cronbach = 0,832 (95%CI=0,780-0,880) y el coeficiente de correlación (RESVECH 2.0 y PUSH 3.0) = 0,74. Conclusiones: la adaptación de la RESVECH 2.0 al portugués brasileño es sólida. La fiabilidad y la validez demuestran la compatibilidad para su utilización en el país en la evaluación de las úlceras varicosas.

RESUMO Objetivos: adaptar transculturalmente a escala Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 para o português do Brasil; estimar sua consistência interna, validade de construto e de critério para utilização em úlceras venosas. Métodos: estudo metodológico, baseado em diretrizes internacionais para estudos dessa natureza. Realizou-se avaliação das feridas por meio da RESVECH 2.0 e da Pressure Ulcer Scale of Healing 3.0 (PUSH). Empregou-se análise descritiva, análise fatorial confirmatória, alfa de Cronbach e correlação de Spearman (p<0,05). Resultados: participaram 12 enfermeiros e 77 pessoas com 153 úlceras venosas. A tradução foi bem-sucedida, o modelo fatorial proposto foi validado, obteve-se alfa de Cronbach = 0,832 (IC95%=0,780-0,880) e coeficiente de correlação (RESVECH 2.0 e PUSH 3.0) = 0,74. Conclusões: a adaptação da RESVECH 2.0 para o português do Brasil é robusta. A confiabilidade e validade evidenciam compatibilidade para utilização no país e avaliação de úlceras venosas.

Comparison of the efficacy of novel non-invasive mechanical debridement methods - sterile sponge, monofilament fibre cloth and non-woven cloth impregnated with sodium hyaluronate and phospholipids in relation to traditional sterile gauze.

Introduction: According to the European guidelines, the first step for local wound preparation is debridement, which stands for removing of devitalized tissue such as slough or necrosis. There are numerous types of debridement, but not all of them can be performed by non-specialists. Most of the research investigating efficiency of novel debridement products are carried out or funded by pharmaceutical companies. Aim: To compare the efficacy of relative necrotic tissue removal after 30 days on patients subjected to debridement with sterile sponge, monofilament fibre cloth, non-woven cloth impregnated with sodium hyaluronate and phospholipids and traditional sterile gauze. Material and methods: By use of photographic documentation at 7 days' intervals and planimetry methods, the total wound surface area and sloughy tissue area was measured. Results: Results have shown that monofilament cloth was the most effective, removing on average 63.44 ±32.91% of necrotic tissue after the first procedure and 74.65 ±30.95% within 30 days of application, in comparison to the sterile gauze group that had on average only 23.53 ±19.16% of necrotic tissue removed at day 0 and 44.95 ±31.47% removed at day 30. Moreover, patients using all 3 products tested reported higher satisfaction with that treatment than those treated with gauze. Conclusions: Results imply that all those methods could be considered as they are well accepted by patients and cause less pain during the procedure, which is essential for good compliance and complete resolution of the lesions.

Effects of Oral Nutritional Supplementation on Patients with Venous Ulcers: A Clinical Trial.

Background: The dosage and safety of nutritional supplements for patients with venous ulcers are still not well established. Aim: To evaluate the effects of a high calorie, high protein, arginine-, zinc-, and vitamins A, C, and E-enriched nutritional supplement on the biochemical profile, dietary intake, anthropometry, muscle strength, and characteristics of lesions of patients with venous ulcers. Methods: A controlled before−after clinical trial with a four-week follow-up involved 27 patients with venous ulcers under outpatient treatment in Brazil. It was administered in two to three doses per day (200 mL each) of a high-calorie and high-protein supplement enriched with arginine, zinc, and vitamins A, C, and E. Patients were assessed for anthropometric parameters, dietary intake, biochemical tests, and healing conditions according to the Pressure Ulcer Scale for Healing (PUSH). Results: It was observed that an increase in energy and protein supply led to an adequate intake of immunonutrients (zinc and vitamins A, C, and E), increased body weight, increased body mass index, and stronger handgrip strength. The injury area and the score on the PUSH notably decreased after the intervention (p < 0.001). Conclusions: The administered supplement, at the tested dosage, improved the nutritional status and characteristics of lesions in patients with venous ulcers.

Dystrophic calcinosis cutis in chronic venous disease of the lower limbs.

Lower limb ulcers secondary to chronic venous disease (CVD) are a significant public health problem in Brazil and account for about 70% of these ulcers. Despite recent technological advances and the various therapeutic options for treatment of these chronic injuries, several factors may be involved in resistance to treatment. Dystrophic calcinosis cutis (DCC) is a rare and often underdiagnosed condition that, when in conjunction with CVD, may be associated with a refractory healing process. In this article, we report a case of DCC in a patient with CVD and discuss its etiology, pathophysiology and possible treatment options.

Barriers and enablers to physical activity in people with venous leg ulcers: A systematic review of qualitative studies.

BACKGROUND: Venous leg ulceration is caused by chronic venous insufficiency and affects millions of adults worldwide who suffer prolonged healing episodes and due to underlying pathophysiology ulcer recurrence is common after healing. Compression therapy is the current best practice for managing venous leg ulcer since it provides constant pressure, which promotes circulation in the lower limbs. Nevertheless, the healing outcomes of venous leg ulcer vary considerably. Physical activity may be an effective adjunct treatment to improve ulcer healing outcomes. However, a low level of physical activity level is observed in this cohort. OBJECTIVE: To identify the barriers and enablers that affect physical activity participation in people with venous leg ulcers. DESIGN: A systematic review of qualitative studies using the mega-aggregation approach. METHODS: We followed the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. We searched MEDLINE, CINAHL PLUS, PsycINFO and Emcare to identify relevant articles published in English from 1806 to January 2021. Two reviewers independently screened and selected articles against inclusion criteria. Eligible studies were appraised for methodological quality using Joanna Briggs Institute Critical Appraisal tool. Qualitative data were extracted manually. Theoretical Domain Framework was used to map barriers and enablers to physical activity participation. RESULTS: Eighteen studies were included in this review. The main barriers and enablers identified in this review that influence physical activity engagement in people with venous leg ulcers are as follows: understanding the chronic nature of venous leg ulcers and the reasons for undertaking physical activities; specific beliefs that people hold about their own capabilities; pain related to wound and compression therapy; information and supports received from treating clinicians; feeling of fear and embarrassment. The confidence level for most of the synthesis findings was moderate to low. CONCLUSIONS: Our review identified people with venous leg ulcers experience significant challenges preventing them from engaging in physical activity. Factors such as knowledge of physical activity, availability of information, and self-belief may be particularly important for promoting physical activity in this cohort. Future interventions are recommended to provide educational information and clear instructions to improve participation. Further research is needed to explore potential interventions that may change physical activity behaviour in this population group. REGISTRATION: PROSPERO CRD42021238579.