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1.
An Bras Dermatol ; 95 Suppl 1: 1-18, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33371937

RESUMO

BACKGROUND: Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. OBJECTIVE: To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. METHODS: Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. RESULTS: The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. CONCLUSION: This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.


Assuntos
Dermatologia , Úlcera da Perna , Úlcera Varicosa , Adulto , Brasil , Consenso , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/terapia , Qualidade de Vida , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/terapia
2.
Rev. enferm. UERJ ; 28: e50170, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1123447

RESUMO

Objetivo: propor recomendações baseadas em evidências científicas para a prevenção e tratamento da úlcera da perna em pessoas com doença falciforme. Método: estudo de revisão integrativa, realizado a partir de busca nas bases de dados Scopus, Science Direct, Cummulative Index to Nursing and Allied Health Literature, Cochrane Library e Biblioteca Virtual em Saúde, em março de 2020. Resultados: foram publicados dez estudos entre 2010 e 2017. Extraíram-se 20 recomendações com nível de evidência classificado em muito baixo, baixo e moderado, organizadas em cinco temas: avaliação do paciente e da úlcera da perna; manejo da úlcera e do edema; utilização de coberturas no tratamento da úlcera; recomendações para manejo de úlcera recalcitrante; e autocuidado para prevenção de úlcera. Conclusão: o estudo permitiu identificar recomendações para prevenção e tratamento da úlcera da perna em pessoas com doença falciforme, que podem complementar as condutas apresentadas no manual do Ministério da Saúde a respeito do tema.


Objective: to propose scientific evidence-based recommendations for the prevention and treatment of leg ulcers in people with sickle cell disease. Method: this integrative review was performed by searching through the Scopus, Science Direct, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library and Virtual Health Library databases in March 2020. Results: the ten studies found were published from 2010 to 2017. The 20 recommendations extracted offered evidence at levels rated very low, low and moderate, which was organized into five themes: evaluation of the patient and leg ulcer; management of the ulcer and edema; use of dressings in treating ulcers; recommendations for management of recalcitrant ulcers; and self-care for ulcer prevention. Conclusion: the study identified recommendations for prevention and treatment of leg ulcers in people with sickle cell disease, which can complement the conduct described in the Brazilian Ministry of Health handbook on the subject.


Objetivo: proponer recomendaciones basadas en evidencias científicas para la prevención y el tratamiento de las úlceras de pierna en personas con anemia falciforme. Método: esta revisión integradora se realizó mediante la búsqueda a través de las bases de datos Scopus, Science Direct, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library y Virtual Health Library en marzo de 2020. Resultados: los diez estudios encontrados se publicaron de 2010 a 2017. 20 recomendaciones extraídas ofrecieron evidencia en niveles calificados como muy bajo, bajo y moderado, que se organizó en cinco temas: evaluación del paciente y úlcera de pierna; manejo de la úlcera y el edema; uso de apósitos para el tratamiento de úlceras; recomendaciones para el manejo de úlceras recalcitrantes; y autocuidado para la prevención de úlceras. Conclusión: el estudio identificó recomendaciones para la prevención y el tratamiento de las úlceras de pierna en personas con anemia falciforme, que pueden complementar la conducta descrita en el manual del Ministerio de Salud de Brasil sobre el tema.


Assuntos
Humanos , Gerenciamento Clínico , Anemia Falciforme , Úlcera da Perna/terapia , Autocuidado , Protocolos Clínicos , Edema/terapia , Bandagens Compressivas
3.
Hautarzt ; 71(9): 715-723, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32827047

RESUMO

Leg ulcers pose a therapeutic challenge due to a chronic healing process. Conservative wound dressings are initially the treatment of choice, but their effectiveness in therapy-refractory wounds is limited. In these cases, multiple mechanical debridement in combination with split-thickness skin grafts (STSG) are a simple and safe treatment option for ulcer coverage. Additional therapy with negative pressure wound therapy (NPWT) improves the surgical outcome by promoting ulcer granulation, continuous elimination of exsudate and blood as well as increased contact pressure on the skin graft. After transplantation, the split skin graft requires daily wound dressings until it has fully healed after approximately 3 weeks.


Assuntos
Desbridamento , Úlcera da Perna/terapia , Tratamento de Ferimentos com Pressão Negativa , Transplante de Pele , Humanos , Resultado do Tratamento , Cicatrização
6.
Br J Nurs ; 29(5): S14-S18, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32167819

RESUMO

BACKGROUND: Leg ulcers are a significant burden and reduce patients' quality of life. In recent years, a plethora of information has been issued regarding leg ulcer management and 'the demographics of patients affected in the community. However, little is known about the leg ulcer population and how these patients should be managed in acute hospitals. AIM: To compare the demographic data of inpatients with leg ulcers referred to the tissue viability service in a large teaching hospital with data on leg ulcer populations in acute and community settings. METHODS: Inpatient demographic data were retrospectively obtained from electronic patient records. A literature search identified studies regarding leg ulcer populations in acute and community settings. RESULTS: The patient population in acute settings is around 10 years older than that in community settings, with much greater levels of comorbidity and higher mortality rates. CONCLUSION: An improved understanding of inpatients with leg ulcers would allow investigations and interventions to be targeted better, enabling evidence-based, patient-centred referral and care pathways. Further research is required to understand the aetiology and outcomes of leg ulcers for the inpatient population.


Assuntos
Serviços de Saúde Comunitária , Pacientes Internados , Úlcera da Perna/terapia , Cicatrização/fisiologia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
7.
Enferm. clín. (Ed. impr.) ; 30(supl.3): 14-17, mar. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-196102

RESUMO

OBJECTIVES: This study aimed to compare the impact of honey and natural ointment based on honey-Tea Tree Oil. METHODS: This was a quasi-experimental study with a pre-post control group design approach. The sample consisted of 27 respondents in two different wound care clinics. The instruments used were the Leg Ulcer Measurement Tool (LUMT) measured on day 1, 7 and 14. Data was analyzed using paired t-test, pooled t-test, and multiple regression test. RESULTS: Most participants were female, the average age was 50.89 years, the average duration of illness for type II diabetes was 3.56 and had current infection. The results showed a significant difference in LUMT score between before and after treatment of wounds healing in the two intervention groups (p-value=0.000). CONCLUSION: Honey and natural ointment based on honey - tea tree oil significantly contributed to the healing of Diabetic Foot Ulcer


No disponible


Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Pé Diabético/terapia , Mel , Úlcera da Perna/terapia , Apiterapia , Cicatrização , Pomadas/uso terapêutico , Pé Diabético/enfermagem
8.
Cochrane Database Syst Rev ; 1: CD001836, 2020 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-31978262

RESUMO

BACKGROUND: It is estimated that up to 1% of people in high-income countries suffer from a leg ulcer at some time in their life. The majority of leg ulcers are associated with circulation problems; poor blood return in the veins causes venous ulcers (around 70% of ulcers) and poor blood supply to the legs causes arterial ulcers (around 22% of ulcers). Treatment of arterial leg ulcers is directed towards correcting poor arterial blood supply, for example by correcting arterial blockages (either surgically or pharmaceutically). If the blood supply has been restored, these arterial ulcers can heal following principles of good wound-care. Dressings and topical agents make up a part of good wound-care for arterial ulcers, but there are many products available, and it is unclear what impact these have on ulcer healing. This is the third update of a review first published in 2003. OBJECTIVES: To determine whether topical agents and wound dressings affect healing in arterial ulcers. To compare healing rates and patient-centred outcomes between wound dressings and topical agents. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine databases, the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register to 28 January 2019. SELECTION CRITERIA: Randomised controlled trials (RCTs), or controlled clinical trials (CCTs) evaluating dressings and topical agents in the treatment of arterial leg ulcers were eligible for inclusion. We included participants with arterial leg ulcers irrespective of method of diagnosis. Trials that included participants with mixed arterio-venous disease and diabetes were eligible for inclusion if they presented results separately for the different groups. All wound dressings and topical agents were eligible for inclusion in this review. We excluded trials which did not report on at least one of the primary outcomes (time to healing, proportion completely healed, or change in ulcer area). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted information on the participants' characteristics, the interventions, and outcomes using a standardised data extraction form. Review authors resolved any disagreements through discussion. We presented the data narratively due to differences in the included trials. We used GRADE to assess the certainty of the evidence. MAIN RESULTS: Two trials met the inclusion criteria. One compared 2% ketanserin ointment in polyethylene glycol (PEG) with PEG alone, used twice a day by 40 participants with arterial leg ulcers, for eight weeks or until healing, whichever was sooner. One compared topical application of blood-derived concentrated growth factor (CGF) with standard dressing (polyurethane film or foam); both applied weekly for six weeks by 61 participants with non-healing ulcers (venous, diabetic arterial, neuropathic, traumatic, or vasculitic). Both trials were small, reported results inadequately, and were of low methodological quality. Short follow-up times (six and eight weeks) meant it would be difficult to capture sufficient healing events to allow us to make comparisons between treatments. One trial demonstrated accelerated wound healing in the ketanserin group compared with the control group. In the trial that compared CGF with standard dressings, the number of participants with diabetic arterial ulcers were only reported in the CGF group (9/31), and the number of participants with diabetic arterial ulcers and their data were not reported separately for the standard dressing group. In the CGF group, 66.6% (6/9) of diabetic arterial ulcers showed more than a 50% decrease in ulcer size compared to 6.7% (2/30) of non-healing ulcers treated with standard dressing. We assessed this as very-low certainty evidence due to the small number of studies and arterial ulcer participants, inadequate reporting of methodology and data, and short follow-up period. Only one trial reported side effects (complications), stating that no participant experienced these during follow-up (six weeks, low-certainty evidence). It should also be noted that ketanserin is not licensed in all countries for use in humans. Neither study reported time to ulcer healing, patient satisfaction or quality of life. AUTHORS' CONCLUSIONS: There is insufficient evidence to determine whether the choice of topical agent or dressing affects the healing of arterial leg ulcers.


Assuntos
Úlcera da Perna/terapia , Pomadas/uso terapêutico , Cicatrização , Administração Tópica , Artérias , Curativos Hidrocoloides , Humanos , Curativos Oclusivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Úlcera Varicosa/terapia
9.
Ann Vasc Surg ; 64: 246-252, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31634600

RESUMO

BACKGROUND: Today transdermal continuous oxygen therapy (TCOT) is used in wound care to promote healing by improving local hypoxia and preventing infection, and it has been described to reduce local inflammation over 1 month of administration. The present study aims to investigate the effects of this treatment on wound microcirculation through laser speckle contrast analysis (LASCA). METHODS: 20 adult patients (mean age: 76 ± 11.5 years) were prospectively enrolled. Inclusion criteria were presence of venous or mixed lower limb ulcers from three or more months without dimension reduction and without indication to surgery and weekly treatment by our outpatient clinic with silver dressings. Subjects underwent 1 month of TCOT (EPIFLO®) in addition to foam dressing. The primary endpoint was the comparison of ulcer and healthy skin perfusion through LASCA, performed before and after the treatment period. Secondary considered endpoints were wound area, wound area severity index and PUSH Tools 3.0 ulcer severity scales, and pain assessment (Numerical Rating Scale [NRS]). RESULTS: Before treatment, the wound area was significantly more perfused than healthy skin (+45%; P = 0.005). At the end of the study, this difference was not significant anymore (+20.5%; P = 0.11). Ulcer perfusion decreased (-12.5%, P = 0.047), whereas healthy skin perfusion did not vary significantly. A reduction of the wound dimension (median difference: 2 cm; P = 0.009) and pain (median difference: 2 NRS point; P < 0.001) after therapy were assessed. CONCLUSIONS: LASCA shows that 1 month of TCOT can help reduce hyperperfusion of ulcer bed in patients with chronic lower limb ulcers, strengthening the hypothesis that this treatment effectively contrasts inflammation. This could correlate with the area and pain reduction assessed; however, the absence of a control group in this study does not allow a generalization of this hypothesis. Larger, controlled trials are needed to properly assess the relationship between TCOT effects on wound microenvironment and effective healing process.


Assuntos
Fluxometria por Laser-Doppler , Úlcera da Perna/terapia , Oxigênio/administração & dosagem , Imagem de Perfusão , Doença Arterial Periférica/terapia , Pele/irrigação sanguínea , Cicatrização/efeitos dos fármacos , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Doença Crônica , Feminino , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/fisiopatologia , Masculino , Microcirculação , Pessoa de Meia-Idade , Oxigênio/efeitos adversos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
10.
Int Wound J ; 17(1): 167-173, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31713315

RESUMO

The aim of this study was to translate into Mexican Spanish, cross-culturally adapt and validate the wound-specific quality of life (QoL) instrument Cardiff wound impact schedule (CWIS) for Mexican patients. This instrument went through the full linguistic translation process based on the guidelines of Beaton et al (Beaton DE, Bombardier C, Guillemin F, Ferraz MB, Guidelines for the process of cross-cultural adaptation of self-report measures, Spine Phila Pa, 1976, 2000, 318-391). We included a total of 500 patients with chronic leg ulcers. The expert committee evaluated the Face validity and they agreed unanimously that the instrument was adequate to assess the QoL of these patients, covering all relevant areas presented by them. The content validity index obtained was of 0.95. The construct validity demonstrated moderately significant correlations between related sub-scales of CWIS and SF-36 (P = .010 to P < .001). The instrument was able to discriminate between healed and unhealed ulcers. The instrument obtained an overall Cronbach's alpha of .952, corresponding to an excellent internal consistency (.903-.771 alpha range for domains). The CWIS can be appropriately used to assess the health-related QoL of Mexican patients with chronic leg ulcers.


Assuntos
Comparação Transcultural , Úlcera da Perna/psicologia , Úlcera da Perna/terapia , Satisfação do Paciente , Qualidade de Vida/psicologia , Avaliação de Sintomas/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e Questionários , Traduções , Adulto Jovem
12.
J Tissue Viability ; 29(1): 42-47, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31866230

RESUMO

BACKGROUND: The SIS Wound Matrix (SISWM) has been shown to improve healing of chronic ulcers over standard of care. In this study, we tested the hypothesis that chronic venous ulcers responsive to treatment with SISWM would more closely mimic an acute wound state as opposed to unresponsive ulcers. METHODS: Serum and wound exudate were collected at baseline and then weekly for up to 12 weeks from 12 patients receiving multiple applications of the SISWM. Levels of matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-9, and MMP-12), pro-inflammatory cytokines (IL-1ß, TNF-α, IL-8), and transforming growth factor beta (TGF-ß1) were evaluated. A variety of Th1/Th2 cytokines were also assayed, as were systemic anti-SIS and anti-α-gal antibody titers. RESULTS: Seven of the 12 patients eventually healed their wounds. Results showed significant decreases in MMP-1, MMP-2, MMP-3, MMP-9, TNF-α and IL-8, and significant increases in TGF-ß1 in wounds responding to treatment with the SISWM versus wounds that did not respond to treatment. None of the 12 patients formed a measurable serum antibody response to the SISWM. CONCLUSIONS: These data show that SISWM does not lead to immune system recognition or sensitization to the matrix and that wounds that went on to heal following treatment were characterized by a more acute wound state. The study confirms that the wound environment is important to healing and that turning a wound toward an acute biochemical state is key to the healing process.


Assuntos
Úlcera da Perna/terapia , Metaloproteinases da Matriz/administração & dosagem , Adolescente , Adulto , Exsudatos e Transudatos/imunologia , Feminino , Humanos , Úlcera da Perna/sangue , Masculino , Metaloproteinases da Matriz/imunologia , Resultado do Tratamento , Cicatrização , Adulto Jovem
13.
Rev Bras Enferm ; 72(suppl 3): 72-78, 2019 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851237

RESUMO

OBJECTIVE: to identify self-care deficits in women with leg ulcers and sickle cell disease. METHOD: a qualitative, descriptive, exploratory approach with 14 women. The collection was performed from December 2015 to January 2016, while the analysis was supported by Orem's Self-Care Deficit Theory. RESULTS: self-care requirements are not fully met. The following were identified as universal: balance between loneliness and social interaction, rest and proper nutrition; development: inability to perform work, abrupt changes in the environment due to hospitalization, educational deprivation and dropout; health deviations: ulcer recurrences, pain, changes in skin appearance and gait changes. CONCLUSION: nursing care for women with leg ulcers and sickle cell disease requires planned actions for comprehensive care.


Assuntos
Anemia Falciforme , Úlcera da Perna/terapia , Autocuidado , Adulto , Brasil , Feminino , Humanos , Pessoa de Meia-Idade , Serviços de Saúde da Mulher , Adulto Jovem
14.
Gerokomos (Madr., Ed. impr.) ; 30(4): 200-209, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188209

RESUMO

Objetivo: Describir las prácticas habituales en la atención de personas con úlceras en extremidad inferior y su relación con las características profesionales y sociodemográficas de los profesionales de enfermería que trabajan en instituciones sanitarias y sociosanitarias en España. Métodos: Estudio observacional descriptivo, mediante encuesta transversal de ámbito nacional dirigida a profesionales de enfermería que atienden en su práctica habitual a personas con úlceras en extremidades inferiores (EE. II.) distribuidos por toda la geografía española. El cuestionario se distribuyó a través de grupos en redes sociales y a través de correos electrónicos. Resultados: Se recopiló información de un total de 646 encuestas realizadas a profesionales de enfermería. El 36,5% (235) ocupaba un puesto como enfermera referente de heridas. El 55,6% (358) señaló que las úlceras venosas eran las que trataban con más frecuencia. El 92,7% (599) de los participantes afirmó haber recibido formación sobre manejo de úlceras de EE. II. Conclusión: La práctica clínica habitual se basaba en recomendaciones con evidencia científica; cuanto mayor experiencia, mayor nivel de formación y cursos relacionados con el manejo de las heridas realizaban las enfermeras


Objective: To describe the usual practices in the care of people with ulcers in the lower limb and its relationship with the professional and sociodemographic characteristics of the nursing professionals working in health and socio-health institutions in Spain. Method: Descriptive observational study, through a cross-sectional survey of national scope directed to nurses who attend in their usual practice to people with lower-extremity ulcers distributed throughout the Spanish geography. The questionnaire was distributed through groups in social networks and through emails. Results: Information was collected from a total of 646 surveys carried out by nursing professionals. 36.5% (235) occupied a position as a nurse referring to injuries. 55.6% (358) indicated that venous ulcers were the most frequently treated. 92.7% (599) of the participants claimed to have received training in ulcerative ulcer management. Conclusion: The usual clinical practice was based on recommendations with scientific evidence as more experience, higher level of training and courses related to the management of wounds performed by nurses


Assuntos
Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/terapia , Extremidade Inferior/lesões , Cuidados de Enfermagem , Cicatrização , Estudos Transversais , Inquéritos e Questionários , Enfermeiras e Enfermeiros/estatística & dados numéricos , Bandagens , Modelos Logísticos
15.
J Wound Care ; 28(11): 730-736, 2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31721664

RESUMO

OBJECTIVE: The recently completed EUREKA study confirmed the efficacy and safety profile of fluorescent light energy (FLE) in treating hard-to-heal wounds. To supplement the EUREKA prospective, observational, uncontrolled trial results, researchers selected one of the EUREKA clinical centres to conduct a retrospective analysis of matching wound care data for 46 venous leg ulcers (VLU) patients who had received standard wound care over a five-year period, compared with 10 EUREKA VLU subjects. METHOD: The study centre selected 46 patients with VLUs based on the matching criteria (wound age and size, patient's age and gender). They compared the healing rates of these matching VLUs with 10 VLU patients treated at the same centre during the EUREKA study. RESULTS: The EUREKA patients had larger and significantly older wounds (p<0.05) and significantly more risk factors (p<0.05) than the matching wounds. However, they had better outcomes (EUREKA: 40% versus matching group: 7% for full wound closure by 16 weeks). No wound breakdown was observed at 16 weeks in the EUREKA group, compared with 25% in the matching group. No EUREKA patient developed infections requiring antibiotics, compared with 37% in the matching group. EUREKA wounds had a mean relative wound area regression (RWAR) of 32% at week six and 50% at week 16, compared with -3% at week six and -6% at week 16 for the matching group. CONCLUSION: These findings show that the system based on FLE was well-tolerated and efficacious, with better clinical outcome results compared with the wounds analysed in this retrospective matching study and treated with standard of care alone.


Assuntos
Fluorescência , Úlcera da Perna/terapia , Úlcera Varicosa/terapia , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Br J Nurs ; 28(20): S38-S42, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31714815

RESUMO

JOBST® FarrowWrap® is indicated in patients presenting with venous leg ulceration in combination with mild-to-moderate oedema. These symptoms result in significant physical and psychological problems and management can be costly in terms of duration of input and resources. This article will present four case studies demonstrating the benefits and outcomes for patients with lower limb issues and will consider how the product helps improve shape, reduce oedema, heal ulceration, improve quality of life in relation to the lower limb and encourage self-care.


Assuntos
Bandagens Compressivas , Edema/terapia , Úlcera da Perna/terapia , Extremidade Inferior/patologia , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Wounds ; 31(9): E61-E64, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31730514

RESUMO

INTRODUCTION: Several reports state that negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) is useful in the management of intractable ulcers. However, reports comparing the effects of NPWT and NPWTi-d in the same patient are lacking. CASE REPORT: A 76-year-old man with intractable skin ulcers on both lateral malleoli presented to an outpatient clinic. Conservative treatment over a 3-month period had not been effective. The authors applied NPWT to the left leg and NPWTi-d to the right leg with fibular osteomyelitis to encourage granulation for 28 days. Thereafter, they covered both ulcers with split-thickness skin grafts. Negative pressure wound therapy was applied to the both legs for 1 week postoperatively. During periods in which NPWT and NPWTi-d were utilized, the patient received intravenous cefazolin sodium (1 g twice daily), lasting 7 days after skin grafting. Epithelization was completed in the NPWTi-d-treated ulcer in about 3 weeks and in the NPWT-treated ulcer in about 8 weeks due to the difficulty in healing his residual ulcers. In terms of the efficacy of granulation and debridement of infected granulation tissue, NPWTi-d demonstrated better results with increments in the washing amount. Also, NPWTi-d proved superior in terms of the survival status of the skin graft, the time until the residual ulcer disappeared, and the removal of latent bacteria. CONCLUSIONS: From this case report, the authors believe NPWTi-d may be more effective in cases with intractable ulcers associated with infection that need better granulation.


Assuntos
Tecido de Granulação/fisiologia , Úlcera da Perna/patologia , Tratamento de Ferimentos com Pressão Negativa , Reepitelização/fisiologia , Cicatrização/fisiologia , Idoso , Antibacterianos/administração & dosagem , Cefazolina/administração & dosagem , Doença Crônica , Desbridamento , Humanos , Úlcera da Perna/terapia , Masculino , Transplante de Pele , Irrigação Terapêutica , Fatores de Tempo , Resultado do Tratamento
18.
G Ital Nefrol ; 36(5)2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31580546

RESUMO

Calcific uremic arteriolopathy (CUA) is a highly morbid condition usually found in ESRD patients that has rarely been reported after renal transplantation and renal function restoration. Furthermore, little is known about the optimal management of CUA in this setting. Herein, we report on the clinical case of AB, a 70-year-old woman who developed CUA after renal transplantation and renal function restoration. However, other risk factors for CUA such as diabetes and warfarin treatment, due to mechanical aortic valve implantation, were present. Thirty-eight months after renal transplantation she developed erythema and livedo reticularis in both legs and a gradually enlarging skin ulcer in the right leg. A skin biopsy of the ulcer showed features compatible with the CUA, such as sub-intimal calcification and luminal obstruction of the small dermal arterioles, tissue ischemia and signs of adipocytes degeneration. A multidisciplinary approach was adopted, including medical and non-medical treatments such as surgical debridement and vacuum-assisted closure therapy. Medical treatments included a five weeks course of once a week intravenous infusion of pamidronate and intravenous sodium thiosulfate (STS) at increasing doses. Four months after beginning the therapy with STS, a complete healing of the ulcer on the right leg and the disappearance of the livedo reticularis on the left leg was noted. In conclusion, although rare CUA may develop also in renal transplanted patients, a timely and combined therapeutic approach is essential for its resolutive treatment. Sodium thiosulfate therapy has proven to be effective and tolerated.


Assuntos
Calciofilaxia/terapia , Transplante de Rim/efeitos adversos , Úlcera da Perna/terapia , Doenças Raras/terapia , Idoso , Anticoagulantes/uso terapêutico , Conservadores da Densidade Óssea/administração & dosagem , Calciofilaxia/etiologia , Quelantes/administração & dosagem , Terapia Combinada/métodos , Diabetes Mellitus , Feminino , Humanos , Úlcera da Perna/etiologia , Livedo Reticular/etiologia , Livedo Reticular/terapia , Pamidronato/administração & dosagem , Doenças Raras/etiologia , Fatores de Risco , Tiossulfatos/administração & dosagem , Varfarina/uso terapêutico
19.
J Wound Care ; 28(10): 670-675, 2019 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-31600105

RESUMO

OBJECTIVE: The present study describes an ambulatory, free skin micrograft technique with cyanoacrylate as a coadjuvant venous leg ulcer (VLU) healing strategy and its outcomes after one month. METHODS: This prospective study involved Comprehensive Classification System for Chronic Venous Disorders (CEAP) stage C6 patients with good granulation tissue and negative culture results, consecutively recruited in January 2017 in the Hospital Clinico San Carlos. A skin micrograft was harvested from the anterior surface of the patient's thigh with a 0.4cm punch (0.12cm2). The graft was adhered to the ulcer bed with cyanoacrylate. Anti-adherent dressing and double-layer bandaging was applied, with weekly replacements. Measurements were obtained of the surface of the VLU and graft progression (in cm2) using a photographic grid. RESULTS: A total of 12 VLUs in 12 patients were included, with a mean treated surface of 20.32±13.9cm2. A total of 18 grafts were placed and all were found to be viable after one week. Average graft growth was not noticeable after one week but was found to be 0.25±0.08cm2 after week two, 0.41±0.98cm2 after week three, and 0.70±0.15cm2 after week four (p<0.001). There were no complications in the donor zone. CONCLUSION: The findings of this study show that free skin micrografting with cyanoacrylate as outpatient treatment for VLUs was simple, rapid and without complication in this study, and may contribute to its wider application in clinical use.


Assuntos
Autoenxertos , Bandagens , Cianoacrilatos , Úlcera da Perna/terapia , Transplante de Pele , Adesivos Teciduais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Prospectivos , Cicatrização
20.
J Wound Care ; 28(10): 658-667, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31600109

RESUMO

OBJECTIVE: Regenerative medicine products such as autologous platelet-rich plasma (autologous PRP) gel may speed up the process of healing. Clinical studies show promising results in the treatment of diabetic foot ulcers (DFUs), however there is lack of scientific evidence of autologous PRP effectiveness in treating leg ulcers of other aetiology. This study evaluates the effectiveness of autologous PRP gel in the treatment of hard-to-heal leg ulcers compared with existing conventional treatment. METHOD: A prospective, randomised controlled, open-labelled clinical trial was carried out between 2014 and 2018. An eight-week study protocol was chosen or until 100% wound re-epithelialisation was observed. Wound size reduction, granulation tissue formation, microbiological wound bed changes and safety were evaluated. RESULTS: A total of 69 patients (35 in the autologous PRP group and 34 in the control group) were included in the study; 25.71% of the autologous PRP group and 17.64% of control group had ulcers completely re-epithelialised (p>0.05). Wound size reduction in the autologous PRP group was 52.35% and 33.36% in the control group (p=0.003). The autologous PRP group showed superiority over conventional treatment in wound bed coverage with granulation (p=0.001). However, more frequent wound contamination was observed at the end of treatment in the autologous PRP group (p=0.024). No severe adverse events were noted during the study. Both treatment methods were considered equally safe. CONCLUSION: Topical application of autologous PRP gel in leg ulcers of various aetiology show beneficial results in wound size reduction and induces the granulation tissue formation. However, it is associated with more frequent microbiological wound contamination.


Assuntos
Úlcera da Perna/terapia , Plasma Rico em Plaquetas , Administração Cutânea , Idoso , Feminino , Géis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Cicatrização
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