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1.
Hautarzt ; 71(1): 24-31, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31845297

RESUMO

For the treatment of phlebological and lymphological diseases as well as constitutional edema diseases, a discussion of innovative concepts of medical compression therapy is essential. It is recommended that medical compression stockings should always be prescribed based on symptoms and with the lowest effective interface pressure to optimize the tolerability of compression therapy. Likewise, medical compression stockings with an integrated care formula, but also the application of additional skincare can improve the quality of life and compliance in patients with chronic venous insufficiency. Optimization of ulcer therapy can be achieved by using two-component compression stocking systems. These consist of an understocking and a firm outer compression stocking, which improve the venous and capillary hemodynamics with good wearing comfort and lead to the healing of venous ulcerations. Multicomponent compression bandages and short stretch bandages are proven in the decongestion phase of edema. Multicomponent bandages ensure a sustained interface pressure for at least 5 days and are ideal for outpatient treatment with less frequent dressing changes. For compression therapy in patients with arterial-venous leg ulcers (ABI [ankle brachial index] >0.5), specially developed "lite" versions of the multicomponent dressings can be used.


Assuntos
Meias de Compressão , Úlcera Varicosa , Insuficiência Venosa , Bandagens Compressivas , Humanos , Qualidade de Vida , Úlcera Varicosa/terapia , Insuficiência Venosa/terapia
2.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1219-1225, out.-dez. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022336

RESUMO

Objetivo: Avaliar os efeitos da irradiação ultrassônica de baixa frequência no tratamento de úlcera venosa. Método: Estudo de aplicação de tecnologia em saúde, realizado com indivíduos com lesões venosas, no ano de 2017 entre os meses de abril a agosto, utilizado formulário estruturado para coleta, analisados no programa Excel e representados em tabela e estatística descritiva. Resultados: Participaram cinco pacientes, três mulheres entre 65 e 88 anos de idade. Os participantes apresentaram cinco úlceras venosas, maioria localizada na porção inferior da perna. Houve redução mínima de 2,5% e máxima de 35,8% sobre a área das lesões. Um participante apresentou 100,0% de epitelização e os demais apresentaram tecido de granulação maior ou igual a 70,0%. Encontrou-se redução máxima de 10 pontos na PUSH, redução mínima de 2 pontos. Conclusão: A terapia ultrassônica traz aspectos positivos para o processo de reparação tecidual


Objective: The study's purpose has been to assess the effects of low-frequency ultrasound irradiation in the treatment of venous ulcer. Methods: It is a health technology application study, which was performed with individuals bearing venous lesions. The research was carried out over 2017 from April to August, using a structured form for data collection, where such data was analyzed in the Excel program and represented through tables and descriptive statistics. Results: Five patients have participated, being three women within the age group from 65 to 88 years old. The participants had five venous ulcers, predominantly located in the leg's lower portion. There was a reduction in the lesion area ranging from 2.5% (minimum) to 35.8% (maximum). One participant achieved 100% epithelization, and the others showed granulation tissue greater or equal to 70.0%. There was a maximum reduction of 10 points in the Pressure Ulcer Scale for Healing (PUSH), and a minimum reduction of 2 points. Conclusion: The low-frequency ultrasound therapy produces positive aspects to the tissue healing process


Objetivo: Evaluar los efectos de la irradiación ultrasónica de baja frecuencia en el tratamiento de úlcera venosa. Método: Estudio de aplicación de tecnología en salud, realizado con individuos con lesiones venosas, en el año 2017 entre los meses abril a agosto, utilizado formulario estructurado para recolección, analizados en el programa Excel y representados en tabla y estadística descriptiva. Resultados: Participaron cinco pacientes, tres mujeres entre 65 y 88 años de edad. Presentaron cinco úlceras venosas, mayoría localizada en la porción inferior de la pierna. Se observó una reducción mínima del 2,5% y una máxima del 35,8% sobre el área de las lesiones. Un participante presentó 100,0% de epitelización y los demás presentaron tejido de granulación mayor o igual al 70,0%. Se encontró reducción máxima de 10 puntos en la PUSH, reducción mínima de 2 puntos. Conclusión: La terapia ultrasónica trae aspectos positivos para el proceso de reparación del tejido


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Terapia por Ultrassom/enfermagem , Úlcera Varicosa/terapia , Cicatrização , Ferimentos e Lesões/enfermagem , Ferimentos e Lesões/terapia , Tecnologia Biomédica/métodos
3.
J Wound Care ; 28(5): 268-277, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31378130

RESUMO

OBJECTIVE: A new test method is described which provides a convenient technique for assessing the combined effects of gravity and compression on the fluid handling characteristics of surgical dressing which can have important implications for their use in the treatment of venous ulcers. Simple ways of improving use of the fluid handling capacity of products currently used clinically are suggested, and the possibility of developing a dressing specifically designed to resist gravitational effects is discussed.


Assuntos
Bandagens Compressivas , Gravitação , Teste de Materiais/instrumentação , Teste de Materiais/métodos , Úlcera Varicosa/terapia , Cicatrização/fisiologia , Humanos
4.
Sensors (Basel) ; 19(13)2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31261767

RESUMO

Intermittent pneumatic compression (IPC) is a proactive compression therapeutic technique in the prophylaxis of deep vein thrombosis, reduction of limb edema, and treatment of chronic venous ulcers. To appropriately detect and analyze biomechanical pressure profiles delivered by IPC in treatment, a dynamic interface pressure monitoring system was developed to visualize and quantify morphological pressure mapping in the spatial and temporal domains in real time. The system comprises matrix soft sensors, a smart IPC device, a monitoring and analysis software, and a display unit. The developed soft sensor fabricated by an advanced screen printing technology was used to detect intermitted pressure by an IPC device. The pneumatic pressure signals inside the bladders of the IPC were also transiently collected by a data acquisition system and then transmitted to the computer through Bluetooth. The experimental results reveal that the developed pressure monitoring system can perform the real-time detection of dynamic pressures by IPC and display the morphological pressure mapping multi-dimensionally. This new system provides a novel modality to assist in the effective evaluation of proactive compression therapy in practice. The study results contribute to understanding the working mechanisms of IPC and improving its functional design based on intuitive biomechanical characteristics of compression delivery profiles.


Assuntos
Técnicas Biossensoriais , Dispositivos de Compressão Pneumática Intermitente/normas , Monitorização Fisiológica/instrumentação , Edema/terapia , Humanos , Úlcera Varicosa/terapia , Trombose Venosa/terapia
5.
J Wound Care ; 28(Sup6a): 1-44, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31173547

RESUMO

The following supplement is a rare example of a paper that combines clinical experience and theoretical knowledge on textiles used in compression therapy. The authors' intention is to propose a decision support system for choosing specific compression devices, which can be adjusted to counteract the individual signs and symptoms in an optimally adopted way. The document concentrates on compression devices which can be self-applied by the patients-compression stockings and adjustable wraps. The acronym 'S.T.R.I.D.E.', incorporating both textile characteristics and clinical presentation, stands for: Shape, Texture, Refill, Issues, Dosage and Etiology. The intent of the mnemotechnical value is to highlight that successful compression includes more than dosage alone. In addition to dosage, etiology and patient presentation need to be incorporated, including a patient's physical ability to use compression effectively as part of the daily routine, thereby promoting adherence. The suggested algorithms provide a valuable guide to stride across the important, but still underestimated field of medical compression therapy and will help to put the prescription of a specific product on a more rational basis. Enjoy reading! Hugo Partsch Emeritus Professor Medical University of Vienna, Austria.


Assuntos
Bandagens Compressivas , Edema/terapia , Linfedema/terapia , Úlcera Varicosa/prevenção & controle , Técnicas de Apoio para a Decisão , Humanos , Cooperação do Paciente , Meias de Compressão , Úlcera Varicosa/terapia
6.
Rev Gaucha Enferm ; 40: e20180024, 2019 Jun 10.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31188978

RESUMO

OBJECTIVE: To understand the experience of adults and older people with adherence to venous ulcer care. METHOD: A qualitative study based on the concepts of Alfred Schütz's social phenomenology was carried out with 12 adults and older people undergoing venous ulcer treatment in a specialized service in the state of Minas Gerais. The interviews were carried out from October to November 2015, analyzed, categorized, and discussed based on the theoretical-philosophical framework adopted and on thematic literature. RESULTS: The following thematic categories emerged from the interviews: "beliefs and personal and social activities hindering adherence to care"; "being protagonists in the care relationship with venous ulcers", and "motivation for adherence to care". CONCLUSIONS: The intersubjective relationship established between patients with venous ulcers and healthcare professionals emerged as a driving force for adherence to care. Promoting the reciprocity relationship of perspectives between these social actors may promote greater adherence to venous ulcer care.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Motivação , Cooperação do Paciente , Úlcera Varicosa/terapia , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relações Enfermeiro-Paciente , Cooperação do Paciente/psicologia , Participação do Paciente , Satisfação do Paciente , Pesquisa Qualitativa , Qualidade de Vida , Comportamento Social , Úlcera Varicosa/psicologia
7.
Br J Nurs ; 28(12): S32-S37, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31242115

RESUMO

The prevalence of venous leg ulcers and chronic oedema is increasing because of the rise in the older population who have comorbidities. Managing and living with these conditions is extremely costly in resource and human terms and there is often a cyclical process of ulceration, healing and recurrence, resulting in significant physical and psychosocial morbidity. Identifying those at risk and advising on lifestyle changes to prevent progression of these conditions will help in avoiding high wound management and compression costs, nursing input and associated patient morbidity. Compression bandaging is the linchpin in managing these conditions and it must be started as early as possible. However, many patients find it difficult to tolerate bandaging because of issues such as pain, the inability to wear shoes and itch. Therefore, if compliance is to be achieved, it is important to select a compression bandaging system that addresses the issues that patients have difficulty with. AndoFlex TLC Calamine is a compression bandaging system that deals with many of these problems, and is easy to apply and remove. Testimonials by practitioners treating patients with chronic oedema, ulceration and/or skin problems will demonstrate the benefits and effectiveness of AndoFlex TLC Calamine.


Assuntos
Bandagens Compressivas , Edema/terapia , Úlcera Varicosa/terapia , Doença Crônica , Humanos , Resultado do Tratamento
8.
Adv Exp Med Biol ; 1176: 109-117, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31134552

RESUMO

The study investigated whether the application of dressings with autologous platelet-rich plasma (PRP) would reduce the healing time in patients with chronic venous leg ulcers. This is a prospective observational study that included 100 patients diagnosed with lower extremity venous insufficiency complicated by ulceration of a leg or foot, who had been after angioplasty of stenotic artery. Patients were divided into two groups of 50 each: treated with PRP (study group) and treated with conventional hydrocolloid dressings (control group). We followed the wound changes at Day 10, Day 20, and Day 30 of treatment and compared them with the baseline appearance at Day 0. We evaluated the appearance, area, and depths of wounds with ultrasound. The granulation process was examined histologically to document skin formation and wound tissue neovascularization. The findings were that treatment with PRP dressings resulted in a significant progressive reduction in ulcer size, irrespective of the ulcer's initial size, compared to treatment with conventional dressings. Further, the best effect of PRP was noticed in the category of largest wounds. After a month of treatment with PRP dressings, more than 50% of all ulcers were completely healed. The young epidermis appeared together with the granulation tissue, and the formation of dermis took shape after 20 days of treatment. We conclude that the use of PRP dressings is a safe, nonsurgical adjunctive procedure for treating chronic venous leg ulcers. The potential benefit of PRP dressings over conventional ulcer treatment requires further in-depth exploration.


Assuntos
Úlcera da Perna , Plasma Rico em Plaquetas , Úlcera Varicosa , Cicatrização , Bandagens/normas , Humanos , Úlcera da Perna/terapia , Estudos Prospectivos , Fatores de Tempo , Úlcera Varicosa/terapia
9.
Int Wound J ; 16(4): 940-945, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31016851

RESUMO

This was a prospective observational pilot study of a unique intermittent pneumatic compression (IPC) device designed to be applied in the thigh region of the affected limb in patients with lower limb ulceration of both venous and mixed (venous and arterial) aetiologies. This compression system consists of a circumferential three-chamber thigh garment and an electronic pneumatic compression pump operating over a repeated 4-minute cycle. Patients were recruited from outpatient wound clinics. Those recruited were treated with standard therapy in addition to IPC, which was applied for 2 hours per day, and followed up for a total of 8 weeks. The primary objective of the study was to examine the effects of IPC on wound healing over an 8-week period. The other objectives were to assess patients' experiences of pain and the acceptability of IPC device. Twenty-one patients were recruited, and wounds progressed towards healing in 95.24% (20/21) of the patients. Pain scores decreased in 83.33% (15/18) of the patients. Most patients felt that the thigh-applied IPC device was comfortable and easy to apply and remove. The thigh-administered IPC device can be recommended for use in routine clinical practice, especially when other treatment options are limited.


Assuntos
Dispositivos de Compressão Pneumática Intermitente , Extremidade Inferior/fisiopatologia , Coxa da Perna/fisiologia , Úlcera Varicosa/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
10.
J Tissue Viability ; 28(2): 115-119, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30824264

RESUMO

BACKGROUND: Venous leg ulceration is common in older adults in the United Kingdom. The gold-standard treatment is compression therapy. There are several compression bandage and hosiery systems that can be prescribed or purchased, but it was unclear what types of compression systems are currently being used to treat venous leg ulceration within the UK. This online scoping survey of registered nurses sought to (1) to identify what compression systems are available across the UK, (2) how frequently these are in use and (3) if there are any restrictions on their use. RESULTS: The results showed that registered nurses who treat patients with venous leg ulceration use a wide range of compression systems. The most frequently used systems are the 'less bulky' two-layer elastic and inelastic compression bandaging systems whilst two-layer hosiery was used less frequently and four-layer bandaging used infrequently. Nurses report that certain compression systems are less accessible through the usual procurement routes but this appears to be related to concerns about competency in application techniques. CONCLUSIONS: The data in this survey provides some important insights into the issues around the use of compression therapy for venous leg ulceration in the UK. Limiting access to certain types of compression may promote patient safety but limit patient choice. There may be underuse of the types of compression that promote patient independence, such as hosiery, and over-use of potentially sub-therapeutic therapy such as 'reduced compression'. Overall, this study suggests that further consideration is needed about the provision of compression therapy to UK patients with venous leg ulceration to optimise care and patient choice.


Assuntos
Bandagens Compressivas/normas , Enfermeiras e Enfermeiros/psicologia , Úlcera Varicosa/terapia , Estudos de Coortes , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiopatologia , Enfermeiras e Enfermeiros/tendências , Estudos Retrospectivos , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos , Inquéritos e Questionários , Reino Unido , Úlcera Varicosa/prevenção & controle , Cicatrização/fisiologia
11.
Wounds ; 31(4): 97-102, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30924793

RESUMO

INTRODUCTION: Cryopreserved placental membrane containing viable cells (vCPM) in conjunction with standard of care (SOC) has shown clinical effectiveness in several studies for the management of acute and chronic wounds. Recently, a new lyophilization technique has been developed that allows viable tissues to be stored at room temperature as a structural and functional equivalent to vCPM. OBJECTIVE: This case series evaluates the clinical outcomes of a lyopreserved placental membrane containing viable cells (vLPM) for the management of chronic wounds of various etiologies. MATERIALS AND METHODS: Eleven patients (11 wounds: 5 diabetic foot ulcers, 5 venous leg ulcers, and 1 pressure ulcer) received weekly vLPM applications adjunct to SOC. RESULTS: By week 12 of treatment, 63.6% (7/11) of patients achieved complete wound closure, with a mean time to closure of 47.1 days and a mean of 6 vLPM applications. Further, there were no adverse events attributed to vLPM. CONCLUSIONS: This is the first case series reporting the clinical outcomes of vLPM for the management of chronic wounds. Results of this study demonstrate similar closure rates to those previously reported for vCPM. These results suggest potential clinical equivalence between the 2 formulations, with vLPM providing the added convenience of long-term room-temperature storage (current shelf life of 12 months).


Assuntos
Pé Diabético/terapia , Placenta/citologia , Placenta/transplante , Úlcera Varicosa/terapia , Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Adulto , Idoso , Criopreservação , Pé Diabético/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Resultado do Tratamento , Úlcera Varicosa/patologia , Ferimentos e Lesões/patologia
12.
Int Wound J ; 16(4): 903-908, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30900365

RESUMO

Compression therapy is the mainstay of treatment for patients with venous leg ulcers. Current gold standard is 4 layer bandaging, which has a significant impact on patients comfort, ability to wear their own shoes, and quality of life, as well as taking significant time to apply, and losing compression over time. This systematic review aims to evaluate the use of Velcro wrap devices for the treatment of venous ulceration. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to identify articles reporting the use of Velcro wrap devices in patients with venous ulceration. Sixteen articles were identified (14 case series, 1 randomised trial, and 1 audit) reporting on 192 patients. There were reports of improved time to healing, reduced cost by >50%, reduced number and duration of nursing appointments, and improved quality of life in patients in Velcro wrap devices. Although the evidence remains poor, Velcro devices have potential to improve outcomes for patients with venous ulceration and further good quality studies should be undertaken to evaluate these further.


Assuntos
Bandagens Compressivas , Úlcera Varicosa/terapia , Cicatrização/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Int Wound J ; 16(3): 788-792, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30864220

RESUMO

The overall quality of evidence of autologous platelet-rich plasma (PRP) for treating chronic wounds remains low. While further well-designed clinical studies are clearly required to convincingly demonstrate the efficacy of autologous PRP in improved healing of venous leg ulcers (VLUs) and other chronic wounds, there is also an increasing need to better define the underlying mechanisms of action and whether positive outcomes can be predicted based on the analysis of PRP. This brief review will discuss the current understanding of autologous PRP in VLUs and whether molecular evaluation of PRP at the time of collection could potentially be informative to clinical outcomes. Benefits of the autologous PRP treatment strategy include that PRP is easily accessible and is relatively inexpensive and safe. Better understanding of the mechanisms involved could improve treatment, enable supplementation, and/or lead to gains in product development. Analysis of PRP could also add value to future clinical trials on efficacy and potentially personalised treatment regimens.


Assuntos
Transfusão de Sangue Autóloga/métodos , Plasma Rico em Plaquetas , Úlcera Varicosa/terapia , Cicatrização/fisiologia , Humanos , Resultado do Tratamento
15.
Int Wound J ; 16(3): 761-767, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30864259

RESUMO

Statistical interpretation of data collected in a randomised controlled trial (RCT) is conducted on the intention-to-treat (ITT) and/or the per-protocol (PP) study populations. ITT analysis is a comparison of treatment groups including all patients as originally allocated after randomisation regardless if treatment was initiated or completed. PP analysis is a comparison of treatment groups including only those patients who completed the treatment as originally allocated, although it is often criticised because of its potential to instil bias. A previous report from an RCT conducted to evaluate the efficacy of dehydrated human amnion/chorion membrane allograft (EpiFix) as an adjunct to standard comprehensive wound therapy consisting of moist dressings and multi-layer compression in the healing of venous leg ulcers (VLUs) only reported PP study results (n = 109, 52 EpiFix and 57 standard care patients), although there were 128 patients randomised: 64 to the EpiFix group and 64 to the standard care group. Primary study outcome was the incidence of healing at 12 weeks. The purpose of the present study is to report ITT results on all 128 randomised subjects and assess if both ITT and PP data analyses arrive at the same conclusion of the efficacy of EpiFix as a treatment for VLU. Rates of healing for the ITT and PP populations were, respectively, 50% and 60% for those receiving EpiFix and 31% and 35% for those in the standard care cohort. Within both ITT and PP analyses, these differences were statistically significant; P = 0.0473, ITT and P = 0.0128, PP. The Kaplan-Meier plot of time to heal within 12 weeks for the ITT and PP populations demonstrated a superior wound-healing trajectory for EpiFix compared with VLUs treated with standard care alone. These data provide clinicians and health policymakers an additional level of assurance regarding the effectiveness of EpiFix.


Assuntos
Aloenxertos/transplante , Âmnio/transplante , Córion/transplante , Análise de Dados , Pé Diabético/terapia , Resultado do Tratamento , Úlcera Varicosa/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Estudos Prospectivos , Cicatrização
16.
Wounds ; 31(4): 91-96, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30802208

RESUMO

OBJECTIVE: This study evaluates the effects of topical and systemic N-acetyl cysteine (NAC) treatment on wound healing in a diabetic rat model. MATERIALS AND METHODS: A total of 48 male Wistar Albino rats were randomly divided into 4 groups of 12. Diabetes was induced with an intraperitoneal injection of 60 mg/kg streptozotocin. A 2-cm x 1-cm full-thickness wound was created on the back of each animal. In group 1 (control) and group 3 (systemic NAC), the wounds were closed with 0.9% sodium chloride-treated sterile gauze. In group 2 (topical NAC) and group 4 (topical + systemic NAC), the wounds were closed with sterile gauze treated with 3 mL (300 mg) of NAC. The animals in groups 3 and 4 were administered 200 mg/kg of NAC once daily through an orogastric tube. On days 1 and 14, the wounded areas were measured. Tissue and blood samples were taken on day 14 for histopathological and biochemical examination. RESULTS: On day 14, the wounded area in groups 2, 3, and 4 was found to be smaller than in group 1 (control). Histopathologically, epithelialization and fibrosis scores were significantly lower, whereas the inflammation score was higher in group 1 than in the other groups. Tissue oxidative stress parameters (malondialdehyde, fluorescent oxidation products, total oxidative stress) were higher in the control group than in the other groups. In groups 3 and 4 (which received systemic NAC), the oxidative stress parameters in serum samples were lower than those of the control group and group 2. Serum sulphydryl levels were the lowest in group 1. CONCLUSIONS: The results of this study show that both topical and systemic administration of NAC improved wound healing in a diabetic rat model. This effect of NAC may be related to its antioxidant properties since a reduction in oxidative stress parameters in both tissue and serum were shown in the present study.


Assuntos
Derme Acelular , Transplante de Pele/métodos , Úlcera Varicosa/patologia , Úlcera Varicosa/terapia , Tratamento Conservador , Desbridamento , Sobrevivência de Enxerto , Humanos , Projetos Piloto , Transplante Autólogo , Resultado do Tratamento , Úlcera Varicosa/fisiopatologia , Cicatrização
17.
Wounds ; 31(4): 103-107, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30802209

RESUMO

BACKGROUND: Chronic ulcers pose a significant health concern and economic burden. Numerous products, including animal-derived collagen products, have been designed to provide the injured site with a biocompatible structural matrix that promotes tissue regeneration. Yet, animal-derived collagens can evoke immune responses, bear risk of disease transmission, and fail to closely mimic the function of native collagen. OBJECTIVE: This study aims to assess the safety and performance of a novel flowable wound matrix, formulated from tobacco plant-purified fibrillated recombinant human type I collagen (rhCollagen), in patients with chronic lower limb ulcers. MATERIALS AND METHODS: This single-arm, open-label, multicenter trial took place at 5 treatment centers. Wounds were photographed and preliminary surgical debridement was performed prior to rhCollagen application. Patients received a single application of rhCollagen to the wound bed, followed by weekly assessments of the wound. RESULTS: Twenty patients (mean age, 63 years), presenting with a chronic ulcer of neuropathic (45%), posttraumatic (35%), postoperative (10%), and venous (10%) origin, underwent rhCollagen treatment. Initial wound area ranged between 0.2 cm3 to 9.2 cm3. At 4-weeks posttreatment, median wound area reduction was 94%. Fifteen ulcers exhibited ≥ 70% wound closure, 9 of which achieved complete closure. Only 1 participant suffered a local self-resolving wound infection. No significant device-related adverse events were reported throughout the study. CONCLUSIONS: A single, easy-to-use rhCollagen flowable gel application for chronic lower limb ulcers may promote wound closure with minimal adverse events.


Assuntos
Colágeno/química , Hidrogel de Polietilenoglicol-Dimetacrilato/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Úlcera Varicosa/terapia , Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Idoso , Colágeno/metabolismo , Desbridamento , Humanos , Extremidade Inferior , Pessoa de Meia-Idade , Resultado do Tratamento , Úlcera Varicosa/patologia , Ferimentos e Lesões/patologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-30769943

RESUMO

BACKGROUND: Venous leg ulcers (VLUs), the most common type of leg ulcerations, have long healing times and high recurrence rates; reimbursement rules and a general shortage of nursing staff have put self-treatment into focus. The study aimed to investigate why and how patients with VLUs self-treat their ulcers. METHODS: Patients with VLUs (N = 32) were selected by criterion sampling for a multicentric qualitative study using semi-structured interviews. The interviews were analyzed via inductive qualitative content analysis. RESULTS: More than two-thirds of participants sometimes self-treated VLU and one quarter changed their prescribed treatment. Experiences were expressed through four themes as follows: (a) current local VLU therapy; (b) VLU self-treatment; (c) patient education; and (d) psychosocial issues. The main reasons for self-treatment were a lack of healthcare resources, reimbursement restrictions, and dissatisfaction with conventional treatment together with insufficient knowledge about the wound-healing process and possible side effects. No educational materials were provided for patients or caregivers. Many patients adopted homemade remedies. CONCLUSION: Patients with VLUs practice self-care due to limited healthcare availability, a low awareness of the causes of their condition, and the effects of therapy on VLU healing. Future educational intervention is needed to enhance self-treatment.


Assuntos
Autocuidado , Úlcera Varicosa/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Cicatrização
19.
Wounds ; 31(3): 68-74, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30720443

RESUMO

INTRODUCTION: Venous leg ulcers (VLUs) are often chronic and difficult to treat, which makes alternative options to conventional care necessary to improve ulcer healing rates. While human acellular dermal matrices (ADMs) have shown promise in treating diabetic foot ulcers, no comparative studies have been published regarding VLU treatment. Decellularized ADMs (D-ADMs) have been used successfully in the treatment of a wide variety of wound repairs and may be effective in treating VLUs. OBJECTIVE: This study is a multicenter, randomized, controlled, open-label trial designed to evaluate the safety and efficacy of D-ADM compared with conventional wound care management in patients with chronic ulcers of the lower extremity. MATERIALS AND METHODS: Patients were randomly assigned to receive either D-ADM or standard of care (control) in a 2:1 ratio. Treatment began at week 0 and wounds were evaluated on a weekly basis until wound closure was observed or the patient completed 24 weekly follow-up visits. RESULTS: Eighteen patients were included in the D-ADM arm and 10 patients in the control arm. There was a strong trend of reduction in percent wound area for D-ADM patients with an average reduction of 59.6% at 24 weeks versus 8.1% at 24 weeks for control patients. In addition, healed ulcers in the D-ADM arm remained closed at a substantially higher rate after termination than healed ulcers in the control. CONCLUSIONS: In this report, the authors note the successful increase in healing rates and rate of percent wound closure as compared with conventional care options.


Assuntos
Derme Acelular , Pé Diabético/terapia , Tratamento de Ferimentos com Pressão Negativa , Transplante de Pele , Úlcera Varicosa/terapia , Cicatrização/fisiologia , Idoso , Pé Diabético/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Úlcera Varicosa/fisiopatologia
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