Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.111
Filtrar
1.
BMC Cancer ; 20(1): 1074, 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33167921

RESUMO

BACKGROUND: Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema. METHODS: Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II). RESULTS: Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat. DISCUSSION: It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations. LIMITATIONS: The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation. TRIAL REGISTRATION: This trial was registered in ClinicalTrials.gov ( NCT03762044 ). Date of registration: 23 November 2018. Prospectively Registered.


Assuntos
Linfedema Relacionado a Câncer de Mama/reabilitação , Modalidades de Fisioterapia , Linfedema Relacionado a Câncer de Mama/terapia , Bandagens Compressivas , Edema/reabilitação , Terapia por Exercício , Feminino , Humanos , Drenagem Linfática Manual , Massagem , Método Simples-Cego , Resultado do Tratamento , Extremidade Superior
3.
J Med Vasc ; 45(5): 288-293, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862987

RESUMO

BACKGROUND: The incidence of upper extremity deep vein thrombosis (UEDVT) is increasing. Its management is sometimes complex and difficult due to its complications and the lack of strong recommendations. The aim was to describe the practice of vascular physicians in Occitanie region in the management of upper extremity deep vein thrombosis. MATERIAL AND METHODS: We used a descriptive observational study in the form of a declarative survey by means of a questionnaire from April to May 2019 among vascular physicians. RESULTS: Of the 142 physicians contacted, 84 responded, with a reply rate of 59.1%. The majority of physicians introduced low-molecular-weight heparin treatment (60.71%) and 29.76% direct oral anticoagulation after a diagnosis of UEDVT. Three months of anticoagulation was chosen by 69% of physicians against 27.4% for a duration of 6 months. Diagnostic work-up included biological risk factors, chest and/or cervical radiography and ultrasonography with dynamic maneuvers. Three quarters of doctors recommended venous compression. A control ultrasonography was performed for 67.86% of patients at one month and at the end of treatment. After the acute phase, 63% of physicians introduced direct oral anticoagulation and 11% recommended venous revascularization. DISCUSSION AND CONCLUSIONS: The mobilization of vascular physicians reflects their interest for this pathology. The management of UEDVT requires specific studies to address therapeutic modalities, the duration of anticoagulation or the place of venous compression in the acute phase.


Assuntos
Anticoagulantes/administração & dosagem , Bandagens Compressivas/tendências , Heparina de Baixo Peso Molecular/administração & dosagem , Padrões de Prática Médica/tendências , Trombose Venosa Profunda de Membros Superiores/terapia , Procedimentos Cirúrgicos Vasculares/tendências , Administração Oral , Adulto , Esquema de Medicação , Inibidores do Fator Xa/administração & dosagem , França/epidemiologia , Pesquisas sobre Serviços de Saúde , Disparidades em Assistência à Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Trombose Venosa Profunda de Membros Superiores/epidemiologia
4.
Rehabilitacion (Madr) ; 54(4): 276-283, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32863012

RESUMO

The COVID-19 pandemic poses a challenge to the management of non-COVID pathologies such as lymphatic diseases and lipoedema. The use of telemedicine can prevent the spread of the disease. A system is needed to help determine the clinical priority and selection of face-to-face or telemedicine options for each patient and how to carry them out during the pandemic. The Spanish Lymphology Group has drafted a consensus document with recommendations based on the literature and clinical experience, as clinical practice guidelines for the management of lymphatic abnormalities and lipoedema during the COVID-19 pandemic. These recommendations must be adapted to the characteristics of each patient, the local conditions of the centres, and the decisions of health care professionals. The document contains minimum criteria, subject to modifications according to the evolution of the pandemic, scientific knowledge and instructions from health authorities.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Lipedema/terapia , Doenças Linfáticas/terapia , Pandemias , Pneumonia Viral , Telemedicina , Comorbidade , Bandagens Compressivas , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Gerenciamento Clínico , Emergências , Desenho de Equipamento , Necessidades e Demandas de Serviços de Saúde , Humanos , Lipedema/complicações , Lipedema/reabilitação , Doenças Linfáticas/complicações , Doenças Linfáticas/reabilitação , Drenagem Linfática Manual , Visita a Consultório Médico , Pandemias/prevenção & controle , Educação de Pacientes como Assunto , Participação do Paciente , Modalidades de Fisioterapia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Medicina de Precisão , Telefone , Triagem , Comunicação por Videoconferência
5.
N Engl J Med ; 383(7): 630-639, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32786188

RESUMO

BACKGROUND: Chronic edema of the leg is a risk factor for cellulitis. Daily use of compression garments on the leg has been recommended to prevent the recurrence of cellulitis, but there is limited evidence from trials regarding its effectiveness. METHODS: In this single-center, randomized, nonblinded trial, we assigned participants with chronic edema of the leg and recurrent cellulitis, in a 1:1 ratio, to receive leg compression therapy plus education on cellulitis prevention (compression group) or education alone (control group). Follow-up occurred every 6 months for up to 3 years or until 45 episodes of cellulitis had occurred in the trial. The primary outcome was the recurrence of cellulitis. Participants in the control group who had an episode of cellulitis crossed over to the compression group. Secondary outcomes included cellulitis-related hospital admission and quality-of-life assessments. RESULTS: A total of 183 patients were screened, and 84 were enrolled; 41 participants were assigned to the compression group, and 43 to the control group. At the time of a planned interim analysis, when 23 episodes of cellulitis had occurred, 6 participants (15%) in the compression group and 17 (40%) in the control group had had an episode of cellulitis (hazard ratio, 0.23; 95% confidence interval [CI], 0.09 to 0.59; P = 0.002; relative risk [post hoc analysis], 0.37; 95% CI, 0.16 to 0.84; P = 0.02), and the trial was stopped for efficacy. A total of 3 participants (7%) in the compression group and 6 (14%) in the control group were hospitalized for cellulitis (hazard ratio, 0.38; 95% CI, 0.09 to 1.59). Most quality-of-life outcomes did not differ between the two groups. No adverse events occurred during the trial. CONCLUSIONS: In this small, single-center, nonblinded trial involving patients with chronic edema of the leg and cellulitis, compression therapy resulted in a lower incidence of recurrence of cellulitis than conservative treatment. (Funded by Calvary Public Hospital Bruce; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000412336.).


Assuntos
Celulite (Flegmão)/prevenção & controle , Bandagens Compressivas , Edema/complicações , Idoso , Celulite (Flegmão)/epidemiologia , Celulite (Flegmão)/etiologia , Doença Crônica , Edema/terapia , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Estimativa de Kaplan-Meier , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Qualidade de Vida , Prevenção Secundária/métodos
6.
Mayo Clin Proc ; 95(8): 1660-1670, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32605782

RESUMO

OBJECTIVE: To compare elastic bandage (EB) vs hypertonic albumin solution administration to increase fluid removal by enhancing loop diuretic efficiency (DE) in patients with volume overload and diuretic resistance. PATIENTS AND METHODS: In this historic cohort study with propensity matching, we included diuretic-resistant adult (≥18 years) patients with volume overload after fluid resuscitation admitted in the intensive care unit from January 1, 2006, through June 30, 2017. Regression models and propensity matching were used to assess the associations of these interventions with changes in DE and other clinical outcomes. RESULTS: Of 1147 patients (median age, 66; interquartile range [IQR], 56-76 years; 51% [n=590] men), 384 (33%) received EB and 763 (67%) received hypertonic albumin solution. In adjusted models, EB was significantly associated with higher DE compared with hypertonic albumin solution (odds ratio, 1.37; 95% CI, 1.04 to 1.81; P=.004). After propensity matching of 345 pairs, DE remained significantly different between the 2 groups (median, 2111; IQR, 1092 to 4665 mL for EB vs median, 1829; IQR, 1032 to 3436 mL for hypertonic albumin solution; P=.02). EB, male sex, lower baseline serum urea nitrogen level, lower Charlson Comorbidity Index score, and higher baseline left ventricular ejection fraction were DE determinants. The lowest DE quartile (<1073 mL/40-mg furosemide equivalent) following adjustment for known predictors of mortality remained independently associated with higher 90-day death rate (odds ratio, 1.64; 95% CI, 1.13 to 2.36; P=.009). CONCLUSION: EB use is associated with greater DE than hypertonic albumin solution during the deescalation phase of sepsis resuscitation. Prospective clinical trials would validate the findings of this hypothesis-generating study.


Assuntos
Albuminas/uso terapêutico , Bandagens Compressivas/estatística & dados numéricos , Diuréticos/uso terapêutico , Unidades de Terapia Intensiva/estatística & dados numéricos , Solução Salina Hipertônica/uso terapêutico , Desequilíbrio Hidroeletrolítico/terapia , Idoso , Feminino , Hidratação/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Resultado do Tratamento
7.
PLoS One ; 15(7): e0236663, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726364

RESUMO

This study assessed the efficacy of strength training using augmented eccentric loading to provoke increases in leg strength in well-trained athletes, and sprint track cyclists, using a novel leg press device. Twelve well-trained athletes were randomly allocated traditional resistance training (TRAD, n = 6), or resistance training using augmented eccentric loading (AEL, n = 6). A further 5 full-time, professional sprint track cyclists from a senior national squad programme also trained with augmented eccentric loading (AEL-ATH) alongside their usual sport-specific training. Participants completed four weeks of twice-weekly resistance training using the leg press exercise. In TRAD the lowering phase of the lift was set relative to concentric strength. In AEL and AEL-ATH the lowering phase was individualised to eccentric strength. Concentric, eccentric, isometric and coupled eccentric-concentric leg press strength, and back squat 1 repetition maximum (1RM), were assessed pre- and post-training. The AEL and AEL-ATH groups performed the eccentric phase with an average 26 ± 4% greater load across the programme. All groups experienced increases in concentric (5%, 7% and 3% for TRAD, AEL & AEL-ATH respectively), eccentric (7%, 11% and 6% for TRAD, AEL & AEL-ATH respectively), and squat 1RM (all p < 0.05), where the AEL-ATH group experienced relatively greater increases (13% vs. 5% in TRAD and AEL, p < 0.01). The TRAD and AEL groups also increased isometric strength (p < 0.05). A four-week period of augmented eccentric loading increased leg strength in well-trained athletes and track cyclists. The eccentric leg press stimulus was well-tolerated, supporting the inclusion of such training in the preparation programmes of athletes.


Assuntos
Bandagens Compressivas , Força Muscular/fisiologia , Treinamento de Resistência , Adulto , Atletas , Feminino , Humanos , Masculino , Adulto Jovem
8.
J Am Acad Orthop Surg ; 28(18): 737-741, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32618680

RESUMO

Lymphatic flow plays a notable role in the regulation of bone formation and remodeling. Chronic accumulation of the lymph fluid within tissues may lead to issues with proper bone healing after fractures, emphasizing the importance of proper management of lymphedema after trauma. Many associated risk factors place patients at risk for lymphedema, including previous surgery with nodal dissection, radiation therapy, infection, malignancy, family history of congenital lymphedema, and trauma. The benchmark imaging technique for the diagnosis of lymphedema is lymphoscintigraphy. Other modalities include duplex ultrasonography, CT, and MRI. First-line conservative treatment of lymphedema is compression. Complete decongestive therapy or complex physical therapy, also known as decongestive lymphatic therapy (DLT), has shown positive results in reducing lymphedema. Surgical interventions aim to either reconstruct and restore function of the lymphatic system or debulk and reduce tissues and fluids. Understanding the significance of lymphedema on bone healing and techniques available to recognize it are important factors in preventing delay in diagnosis and ensuring proper management of lymphedema after trauma.


Assuntos
Osso e Ossos/lesões , Fraturas Ósseas/complicações , Linfedema/etiologia , Linfedema/terapia , Osso e Ossos/fisiopatologia , Bandagens Compressivas , Tratamento Conservador/métodos , Diagnóstico por Imagem , Fraturas Ósseas/fisiopatologia , Humanos , Linfedema/diagnóstico , Linfedema/cirurgia , Procedimentos Ortopédicos/métodos , Modalidades de Fisioterapia , Cicatrização
9.
BMJ Case Rep ; 13(7)2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32675133

RESUMO

We describe a 40-year-old woman with severe, persistent macroglossia following prone positioning as part of treatment for COVID-19. We used the treatment method of lingual compression with satisfactory results.


Assuntos
Betacoronavirus , Bandagens Compressivas , Infecções por Coronavirus/complicações , Macroglossia/complicações , Macroglossia/terapia , Posicionamento do Paciente/métodos , Pneumonia Viral/complicações , Doença Aguda , Adulto , Feminino , Humanos , Macroglossia/etiologia , Pandemias , Posicionamento do Paciente/efeitos adversos , Solução Salina/uso terapêutico , Língua
10.
Coimbra; s.n; 01-06-2020. 103 p. tab, ilus.
Tese em Português | BDENF - Enfermagem | ID: biblio-1119875

RESUMO

INTRODUÇÃO: Cuidar da pessoa com úlcera venosa constitui uma preocupação no quotidiano dos enfermeiros, por estas serem prevalentes e se tornarem tendencialmente crónicas e recorrentes, com grandes implicações no bem-estar e dia-a-dia da pessoa, traduzindo-se em elevados custos em saúde. Apesar da evidência científica indicar a terapia compressiva como uma medida custo-eficiente no tratamento de úlceras venosas, aumentando as taxas de cicatrização e a qualidade de vida da pessoa, verifica-se que esta não é amplamente implementada. OBJECTIVOS: Pretendeu-se identificar os conhecimentos e as práticas de terapia compressiva de enfermeiros dos cuidados de saúde primários (CSP), relacionando-os com a sua experiência e formação, e identificar as barreiras que estes percecionam na sua implementação. METODOLOGIA: Desenvolveu-se um estudo quantitativo, não-experimental, descritivo correlacional e transversal com uma amostra acidental de 173 enfermeiros dos CSP, aos quais foi aplicado um questionário com questões relativas aos conhecimentos e práticas de terapia compressiva e às barreiras percecionadas na sua implementação. RESULTADOS: A formação em terapia compressiva é referida por 93,1% dos enfermeiros, contudo apenas 60,7% aplica terapia compressiva. Os enfermeiros com formação e prática em avaliar o IPTB aplicam mais a terapia compressiva e demonstram mais conhecimentos e melhores práticas. Por sua vez, os enfermeiros que sentem défice de formação aplicam menos a terapia compressiva e revelam menos conhecimentos. A média dos conhecimentos em terapia compressiva é de 54,7%, sendo relatados mais conhecimentos em quem a aplica e em quem tem autoformação. Verificaram-se boas práticas na implementação da terapia compressiva (média de 80,71%), contribuindo para melhores práticas o aumento dos conhecimentos em terapia compressiva (R2=0,161; p=0,00), sendo que os anos de experiência no tratamento de feridas crónicas estão relacionados com uma diminuição na pontuação das práticas. Os obstáculos à implementação da terapia compressiva são menos sentidos por quem a aplica, sendo, contudo, o défice de recursos materiais e financeiros e o défice de formação os mais sentidos. CONCLUSÃO: A terapia compressiva não é amplamente implementada, contudo os enfermeiros que a aplicam demonstram boas práticas e mais conhecimentos acerca da temática, revelando uma procura da excelência no cuidar da pessoa com úlcera venosa.


INTRODUCTION: Caring for patients with venous ulcers is a concern in nurses' daily lives, as they are prevalent and tend to be chronic and recurrent, with major implications for the patient's well-being and daily life, resulting in high health costs. Although scientific evidence indicates that compressive therapy is a cost-efficient measure in the treatment of venous ulcers, increasing healing rates and quality of life, it is not widely implemented. OBJECTIVES: The aim was to identify the compressive therapy knowledge and practices of primary health care nurses, relating them to their experience and training, and identify the barriers they perceive in its implementation. METHODOLOGY: A quantitative, non-experimental, descriptive, correlational and cross-sectional study was conducted with an accidental sample of 173 primary health care nurses, to whom a questionnaire was applied with questions regarding the knowledge and practices of compressive therapy and the barriers perceived in its implementation. RESULTS: Training in compressive therapy was reported by 93,1% of nurses, but only 60,7% applied compressive therapy. Nurses with training and practice in assessing the IPTB apply compressive therapy more and demonstrate more knowledge and better practices. In turn, nurses who feel training deficit apply less compressive therapy and reveal less knowledge. The average compressive therapy knowledge is 54,7%, with more knowledge being reported on who applies it and who has self-training. Good practices were found in the implementation of compressive therapy (average of 80,71%), contributing to best practices the increase in knowledge in compressive therapy (R2=0,161; p=0,00), and the years of experience in the treatment of chronic wounds are related to a decrease in the score of practices. The obstacles to the implementation of compressive therapy are less felt by those who apply it, however, the lack of material and financial resources and the lack of training are the most felt. CONCLUSION: Compressive therapy is not widely implemented; however, the nurses who apply it demonstrate good practices and more knowledge about the subject, revealing a search for excellence in the care of patients with venous ulcers.


Assuntos
Enfermagem , Bandagens Compressivas , Úlcera da Perna , Cuidados de Enfermagem
11.
Arch. med. deporte ; 37(197): 183-190, mayo-jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-195230

RESUMO

INTRODUCCIÓN: Tanto la inmersión en agua fría como las prendas de compresión han sido usadas rutinariamente para acelerar la recuperación después del ejercicio, sin embargo, hay una falta de conocimiento del uso de ambas técnicas de forma simultánea. Pressurice Compressport, es una herramienta simple, no farmacológica y carente de efectos secundarios que permite aplicar la crioterapia compresiva (CC). OBJETIVO: Investigar el efecto crónico del Pressurice Compressport, tras cada partido, y sesión de entrenamiento, sobre los marcadores de daño muscular, la fuerza muscular y la fatiga. MÉTODOS: Un diseño de cohorte prospectivo. En 24 jugadores de baloncesto masculinos divididos en dos grupos, recuperación (RP) (n = 12) y control (GC) (n = 12). Los marcadores séricos del metabolismo muscular, la fuerza de cuádriceps (FC) y los valores de esfuerzo percibido (RPE) por escala de Borg CR10, se midieron en 3 momentos del estudio: a) día 1, (T1); b) día 28 (T2) y c) día 56 (T3). La CC se aplicó inmediatamente después de cada partido y entrenamiento. RESULTADOS: Se observó una disminución progresiva de todos los marcadores de daño muscular al final de la pretemporada en el grupo RP. Por el contrario, en el GC aumentaron y fueron significativas para la creatina quinasa (CK) (T1 vs. T3 p < 0,05). El curso temporal de la mioglobina (Mb) en el grupo RP (p > 0,05), siguió un patrón diferente al GC (p < 0,05). En RP los RPE disminuyeron significativamente (p < 0,05) en todos los puntos del estudio. La FC fue mayor en el RP que en el GC, además se obtuvieron ganancias a lo largo de la pretemporada en RP y una disminución en GC. CONCLUSIÓN: La CC es potencialmente capaz de promover la recuperación del daño muscular asociada con la competición y el entrenamiento, con reducciones en los marcadores del daño muscular, mejoras de la fuerza muscular y disminución significativa RPE


INTRODUCTION: Both cold water immersion and compression garments have been routinely used to speed recovery after exercise, however, there is a lack of knowledge of applying both techniques simultaneously. Pressurice Compressport, which is a simple tool, non-pharmacological and free of side effects that allows the application of compressive cryotherapy (CC). OBJECTIVE: To investigate the chronic effect of Pressurice Compressport, after each match and training session, on the markers of muscle damage, muscle strength and fatigue. METHODS: A prospective cohort design. In 24 male basketball players divided into two groups, recovery (RP) (n = 12) and control (GC) (n = 12). Serum markers of muscle metabolism, quadriceps strength (FC) and perceived effort values (RPE) by Borg CR10 scale were measured at 3 times in the study: a) day 1, (T1); b) day 28 (T2) and c) day 56 (T3). The CC was applied immediately after each match and training. Results: A progressive decrease in all markers of muscle damage was observed at the end of the pre-season in the RP group. On the contrary, in the GC they increased significantly for creatine kinase (CK) (T1 vs. T3 p < 0.05). The time course of myoglobin (Mb) in the RP group (p > 0.05) followed a pattern different from that of GC (p < 0.05). In RP, the RPE significantly decreased (p < 0.05) in all points of the study. The HR was higher in the RPE than in the GC, in addition gains were obtained throughout the pre-season in RPE and a decrease in GC. CONCLUSION: CC is potentially capable of promoting recovery from muscle damage associated with competition and training, with reductions in markers of muscle damage, improvements in muscle strength and significant decrease in RPE


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Crioterapia/métodos , Traumatismos em Atletas/prevenção & controle , Músculo Esquelético/lesões , Basquetebol/fisiologia , Recuperação de Função Fisiológica/fisiologia , Estudos Prospectivos , Fadiga Muscular/fisiologia , Força Muscular/fisiologia , Bandagens Compressivas , Mioglobina/sangue , Valores de Referência , Fatores de Tempo , Reprodutibilidade dos Testes
13.
J Plast Reconstr Aesthet Surg ; 73(9): 1604-1611, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32563669

RESUMO

INTRODUCTION: Early postoperative compression of free flaps for lower limb reconstruction remains controversial. It may reduce venous congestion and promote the resolution of oedema. However, concerns remain regarding inadvertent pedicle compression, which may lead to flap failure. The aim of this systematic review was to determine the safety and effectiveness of this intervention. METHODS: A systematic review was designed in compliance with PRISMA. MEDLINE and EMBASE databases were searched. Parallel screening, selection of eligible studies, and data gathering were carried out by two independent authors. A formal risk of bias assessment was included along with the appraisal of outcomes. RESULTS: A total of 847 abstracts were retrieved and 262 free flaps for lower limb reconstruction were identified in ten eligible articles. The overall flap failure rate for patients who underwent early postoperative compression was 1.6%. Apart from flap failure rates, there were no other outcomes consistently reported and none of the studies included a no-compression group for comparison. DISCUSSION: All included studies had methodological flaws, resulting in a high risk of bias. Nevertheless, there was consistent reporting of flap failure as a postoperative outcome. Compression of free flaps in the context of lower limb reconstruction does not appear to be associated with a higher flap failure rate compared with other series. Compression bandages may reduce the pain associated with dangling regimes. However, there is no evidence to support that free flap compression in the context of lower limb reconstruction is associated with any other clinical benefit.


Assuntos
Bandagens Compressivas , Retalhos de Tecido Biológico , Extremidade Inferior/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Edema/prevenção & controle , Humanos , Hiperemia/prevenção & controle
15.
Arch Phys Med Rehabil ; 101(10): 1683-1688, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32450063

RESUMO

OBJECTIVE: To determine the effect of a removable rigid dressing (RRD) on the time to residual limb maturation compared with elastic bandage (EB) in transtibial amputees. DESIGN: Experimental single-blinded (assessor-blinded) randomized controlled trial. SETTING: Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. PARTICIPANTS: Transtibial amputees (N=25) with immature residual limb. INTERVENTION: Participants were allocated to use RRD or EB to achieve residual limb maturation, and all participants in both groups were trained with the same preprosthetic program. MAIN OUTCOME MEASURES: The time to residual limb maturation, patient satisfaction, and complications were compared between the 2 groups. RESULTS: Median time to residual limb maturation was significantly lower in the RRD group (median, 28d [interquartile range, 17-51d]) than in the EB group (median, 54d [interquartile range, 30-77d]; P=.020). After accounting for time since amputation, maturation time remained significantly lower in the RRD group (adjusted hazard ratio, 3.32; 95% CI, 1.08-10.20; P=.036). There was no significant difference in complications or patient satisfaction. CONCLUSION: In postoperative management of transtibial amputation, the use of RRD had a significantly shorter period to residual limb maturation when compared with the EB group.


Assuntos
Cotos de Amputação/fisiopatologia , Amputação/reabilitação , Amputados/reabilitação , Bandagens Compressivas , Cicatrização/fisiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Membros Artificiais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Fatores Sexuais , Método Simples-Cego , Tíbia/cirurgia
16.
J Plast Reconstr Aesthet Surg ; 73(9): 1637-1644, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32446570

RESUMO

BACKGROUND: Lipedema is a condition of painful increase in subcutaneous fat affecting almost exclusively women. Several studies have examined the effectiveness of liposuction in the treatment of lipedema, but none has focused on water-jet-assisted liposuction technique. METHODS: A standardized treatment protocol for liposuction in lipedema, which was established over the course of 15 years, is presented. Patients received questionnaires preoperatively and after operative treatment assessing characteristics and symptom severity on visual analog scales in a prospective manner. RESULTS: Pre- and postoperative questionnaires were available for 63 patients. Median age was 35 years and mean (body mass index) BMI 28.4 ± 0.6, all patients had stages I or II lipedema diagnosed by two separate specialists. After a mean follow-up of 22 months after operative treatment, all assessed symptom had decreased significantly in severity. All patients wore compression garments and/or received manual lymphatic drainage preoperatively; this could be reduced to only 44% of patients needing any conservative treatment postoperatively. CONCLUSION: Liposuction in water-jet-assisted technique using the presented treatment protocol is an efficient method of operative treatment of early-stage lipedema patients leading to a marked decrease in symptom severity and need for conservative treatment.


Assuntos
Lipectomia/métodos , Lipedema/terapia , Adulto , Bandagens Compressivas , Drenagem , Seguimentos , Humanos , Lipedema/classificação , Cuidados Pré-Operatórios , Índice de Gravidade de Doença , Escala Visual Analógica
18.
Eur J Vasc Endovasc Surg ; 60(1): 108-117, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32278637

RESUMO

OBJECTIVE: Post-procedure limb compression, hitherto routine following open varicose vein surgery, has been extended to endovenous procedures. However, no robust evidence exists to support this practice. Most of the previous studies have focused on the ideal duration of compression. This study evaluates the clinical and patient reported outcomes with and without post-procedure leg compression following radiofrequency ablation (RFA). METHODS: This single centre, prospective, non-inferiority randomised controlled trial recruited adult patients, into two groups (A: RFA with compression stocking for two weeks, B: RFA alone). The primary outcome was ultrasound determined target vein obliteration at 12 weeks. Secondary outcome measures included a Quality of Life (QoL) score [Aberdeen Varicose Vein Severity Score (AVSS) and Revised Venous Clinical Severity Score (RVCSS)], patient satisfaction, pain score, and complications. RESULTS: In total, 100 consecutive patients were recruited (A: 51; B: 49) classified as clinical class C2-C6 of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. At 12 weeks the occlusion rate of the target vein was similar in both groups at 98% (n = 47) and 98% (n = 45), respectively (p = 1.0). There was no statistically significant difference in mean AVSS 6 vs. 5.0 (mean difference -1, 95% CI -2 - 3, p = .57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI -1 - 2, p = .46) scores at 12 weeks. Comparable patient satisfaction scores were observed (p = .72) and pain score 2.0 vs. 2.0 (p = .92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two weeks follow up (p = 1.0 for above the knee and p = 1.0 for below the knee). CONCLUSION: The clinical and patient reported outcomes following RFA without compression are no worse than with compression. This trial supports the conclusion that the widely practised use of compression after RFA adds no clinical benefit for the patients. However, a much larger study, preferably a multicentre trial, may be required to confirm this conclusion.


Assuntos
Bandagens Compressivas , Ablação por Radiofrequência , Varizes/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Ablação por Radiofrequência/métodos , Resultado do Tratamento , Adulto Jovem
20.
Wounds ; 32(1): 11-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32155127

RESUMO

OBJECTIVE: This study evaluates the clinical and cost effectiveness of a 2-layer compression system (2LBA; 3M Coban Two-Layer Compression System; 3M, St Paul, MN) compared with other 2-layer (2LB) and 4-layer (4LB) compression systems in patients with noninfected venous leg ulcers (VLUs). METHODS: The MEDLINE, EMBASE, CINAHL, Cochrane Library, National Health Service (NHS) Economic Evaluation, and EconLit databases were searched from inception up to January 2017. The MEDLINE search was updated on March 31, 2017. Study selection, quality assessment, and data synthesis were undertaken in accordance with recommended standards. Findings were presented narratively. RESULTS: In total, 5 studies (N = 1509 patients) of mixed methodological quality were included. At 6 months, 2LBA achieved better ulcer healing in comparison with 2LBB (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.10-2.24; P = .03) and 4LBA (OR, 1.93, 95% CI, 1.26-2.97; P = .05) in patients with newly diagnosed ulcers only. For a combined population with newly diagnosed and existing VLUs, healing outcomes were OR, 2.87; 95% CI, 1.06-7.77; P = .04, and OR, 16.51; 95% CI, 2.08-131.37; P = .008, for 2LBs and 4LBs, respectively. Results on slippage were inconclusive. Adverse events were infrequent and did not differ significantly between interventions. Lower 6-month NHS costs for the combined population (£2413 vs. £2707 or £2648) and for newly diagnosed patients (£3045 vs. £3842 or £4480) were observed comparing 2LBA with 2LBB or 4LBA. Also, 2LBA was associated with better health-related quality of life (HRQoL) at 6 months. CONCLUSIONS: Based on these findings, 2LBA may result in lower treatment costs and better ulcer healing and HRQoL compared with other multicomponent therapies, especially in patients with newly diagnosed VLUs. However, further high-quality research is needed, especially for outcomes such as slippage and bandage wear time.


Assuntos
Bandagens Compressivas/economia , Úlcera Varicosa/economia , Úlcera Varicosa/terapia , Bandagens Compressivas/efeitos adversos , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Qualidade de Vida , Resultado do Tratamento , Cicatrização
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA