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1.
Cambios rev. méd ; 20(1): 87-93, 30 junio 2021. ilus.
Article in Spanish | LILACS | ID: biblio-1292972

ABSTRACT

INTRODUCCIÓN. Los defectos de la fosa poplítea suponen un desafío reconstructivo para el cirujano plástico, dada la relación íntima de esta área con la articulación de la rodilla y la neurovasculatura vital subyacente. El propósito de éste informe fie compartir la experiencia en la utilización de un colgajo fasciocutaneode la arteria safena. CASO CLÍNICO. Paciente de 5 años de edad que sufrió quemadura térmica en miembros inferiores con dos años y medio de evolución, ameritó injertos, presentó contractura por tejido cicatricial en fosa poplítea, dificultó la deambulación y desarrollo neuro osteomuscular. Se realizó reconstrucción de la fosa poplítea con colgajo fasciocutáneo de la arteria safena. RESULTADOS. El colgajo fasciocutáneo de la arteria safena dio cobertura al defecto en fosa poplítea izquierda tras retiro del tejido cicatricial que producía contractura, limitaba la marcha y el desarrollo neuro osteo-muscular. Seis meses postquirúrgicos brindó cobertura cutánea definitiva y estable en el área crítica, que permitió la deambulación con movimientos de extensión y flexión de rodilla conservados. DISCUSIÓN. Este colgajo al igual que en otros estudios que respaldan su ejecución brindó excelentes resultados en defectos de partes blandas a nivel de la articulación de la rodilla. CONCLUSIÓN. El colgajo fasciocutáneo de la arteria safena demostró utilidad para la reconstrucción del defecto de la fosa poplítea, posibilitó una cobertura definitiva, funcional y estética, restableció los ángulos de movilidad y favoreció el desarrollo pondoestatural del paciente.


INTRODUCTION. Defects of the popliteal fossa pose a reconstructive challenge for the plastic surgeon, because of the intimate relation of this area with the knee joint and the near vital neurovasculature; the purpose of this report was to share the experience of using a fasciocutaneous flap of the saphenous artery. CLINICAL CASE. A 5 year old patient who suffered thermal burn in lower limbs with two and a half years of evolution, he nedeed grafts and presented tissue contracture because the scar in the popliteal fossa hindered ambulation and neuro-osteomuscular growth. Reconstruction of the popliteal fossa was made it with a fasciocutaneous flap of the saphenous artery. RESULTS. The fasciocutaneous flap of the saphenous artery covered the defect in the left popliteal fossa after removal of the scar tissue that caused contracture, limited to walk and growth. Six months after surgery the flap provided definitive and secure skin coverage in the critical area, which allowed to walk with preserved knee extension and flexion movements. DISCUSSION. This flap was useful for the recons-truction of the defect of the popliteal fossa and provided excellent results in soft tissue defects in this area of the knee joint. CONCLUSION. The fasciocutaneous flap of the saphenous artery proved useful for the reconstruction of the popliteal fossa defect, it permited a definitive, functional and esthetic coverage, reestablished the angles of mobility and helped with the patient growth


Subject(s)
Humans , Male , Child, Preschool , Arteries , Regeneration , Surgical Flaps , Burns , Lower Extremity/injuries , Pediatrics , Child Development , Skin Transplantation , Motor Skills Disorders , Knee , Knee Joint
2.
Rev. argent. cir. plást ; 27(2): 67-70, 20210000. graf, fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1357667

ABSTRACT

Introducción. Hasta un 90% de las mordeduras de animales son producidas por perros. Los niños son la población más vulnerable frente a las mordeduras ya que suelen afectar una mayor proporción de superficie corporal. Objetivo. Analizar la casuística de mordeduras de perro y su repercusión en nuestro entorno. Métodos. Estudio observacional, descriptivo, retrospectivo de un período de 8 años, que incluyó a todos los pacientes de 0 a 18 años con diagnóstico de mordedura de perro. Resultados. Se incluyeron 183 pacientes con diagnóstico de mordedura de perro. El promedio de edad fue de 6,1 años, y el grupo etario más afectado fue el de los niños de 3 a 5 años (38,3%). El tratamiento quirúrgico fue dividido en pacientes que requirieron rafia por planos (84,6%), colgajos (11,4%), injertos (3,4%) y puntos de aproximación (1%). Se reportaron 8 pacientes con complicaciones (4,4%). Conclusión. Los niños de 3 a 5 años son los más afectados por mordeduras de perro y la zona de cabeza y cuello es la más común. Un porcentaje importante de pacientes requirieron colgajos e injertos con buenos resultados.


Introduction. Up to 90% of animal bites are produced by dogs. Children are the most vulnerable population because bites tend to affect greater body surface area. Outcome. Analyze dog bites cases and their impact on our environment. Methods. An observational, descriptive, retrospective study during an 8 year period was carried out, which included all patients from 0 to 18 years with a diagnosis of dog bite. Results. A total of 183 patients with a diagnosis of dog bite were found. The average age was 6.1 years, and the age group most affected was children from 3 to 5 years old (38.3%). Surgical treatment was divided into: patients who required suture by planes (84.6%), flaps (11.4%) and grafts (3.4%) and approximation stitches (1%). Complications were reported in 8 patients (4.4%). Conclusion. Children from 3 to 5 years old are the most affected by dog bites, the head and neck area is the most common. A significant percentage of patients required flaps and grafts with good results.


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Wounds and Injuries/surgery , Bites and Stings/therapy , Epidemiology, Descriptive , Retrospective Studies , Vaccination , Neck Injuries/therapy , Transplants/surgery , Lower Extremity/injuries , Upper Extremity/injuries , Dogs/injuries , Facial Injuries/therapy , Wound Closure Techniques , Anti-Bacterial Agents/therapeutic use
3.
Medisan ; 24(3)mayo.-jun. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1125123

ABSTRACT

Introducción: La trombosis venosa profunda consiste en la formación de un trombo en un trayecto de una vena profunda, lo que provoca la oclusión total o parcial de esta. Objetivo: Caracterizar una población de afectados por esta entidad clínica, según variables de interés. Métodos: Se efectuó un estudio observacional y descriptivo de serie de casos, de pacientes con presunto diagnóstico clínico de trombosis venosa de miembros inferiores, atendidos en el Servicio de Angiología y Cirugía Vascular del Hospital Provincial Clinicoquirúrgico Docente Saturnino Lora Torres de Santiago de Cuba desde enero de 2015 hasta junio de 2017, en quienes se realizó ecografía Doppler para confirmar la presencia de este episodio vascular. Resultados: La enfermedad primó en el grupo etario de 65 y más años (32,1 %) y en el sexo femenino (74,1 %). La inmovilidad de miembros inferiores constituyó el factor de riesgo predominante (27,0 %), en tanto el dolor, el edema y la taquicardia resultaron las manifestaciones clínicas más frecuentes (20,5 % en cada una), y el miembro inferior izquierdo fue el más afectado (69,0 %). Conclusiones: La trombosis venosa de los miembros inferiores se presentó como propia de las edades avanzadas de la vida, fundamentalmente en mujeres, con un cuadro clínico que indicaba claramente su existencia.


Introduction: The deep venous thrombosis consists on the formation of a clot in a deep vein way, what causes its total or partial occlusion. Objective: To characterize a population affected by this clinical entity, according to variables of interest. Methods: An observational and descriptive study of a serial cases, of patients with presumed clinical diagnosis of venous thrombosis of the lower limbs, assisted in the Angiology and Vascular Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba from January, 2015 to June, 2017, to whom a Doppler echography to confirm the presence of this vascular episode was carried out. Results: The disease prevailed in the 65 and more age group (32.1 %) and in the female sex (74.1 %). The immobility of lower limbs constituted the predominant risk factor (27.0 %), as long as pain, edema and tachycardia were the most frequent clinical manifestations (20.5 % in each one), and the left lower limb was the most affected (69.0 %). Conclusions: The venous thrombosis of lower limbs was presented as characteristic of the advanced ages of life, mainly in women, with a clinical pattern that indicated with high clarity its existence.


Subject(s)
Ultrasonography, Doppler , Venous Thrombosis , Venous Thrombosis/epidemiology , Lower Extremity/injuries
4.
Rev. argent. cir. plást ; 26(1): 9-16, ene-mar 2020. tab, fig, graf
Article in Spanish | LILACS | ID: biblio-1120366

ABSTRACT

El dolor asociado a heridas complejas se erige como una gran barrera para la resolución de estas, debido a la complejidad de abordaje y a la imposibilidad de establecer un patrón de algoritmo por diversos factores y su carácter heterogéneo, así como por la presencia de manifestaciones múltiples asociadas. Este dolor provoca al paciente un daño no solo físico sino también psicosocial, porque la escasa respuesta a los tratamientos habituales, y si bien es sensible a la medicación con opiáceos, los resultados son insufi cientes a largo plazo en un significativo número de pacientes, en quienes provoca además efectos no deseables. Se establece en el presente trabajo la administración subcutánea de dextrosa 5% a través de una técnica de infiltración perineural para el tratamiento de la infl amación neurogénica responsable del mencionado padecimiento, en las terminaciones libres de los nervios sensitivos cutáneos. Para ello se decidió realizar un estudio descriptivo multicéntrico a partir de junio del 2016 hasta mayo del 2017 en 60 pacientes que presentaban dolor crónico en ulceras de miembro inferior de diferente etiología con antecedente de medicación analgésica previa con resultado parcial (no controlado) y que tuviera evolución de su dolor entre 3 meses y 4 años.


The pain associated with complex wounds is established as a great barrier for the irresolution, due to the complexity of the approach and the impossibility of establishing an algorithm pattern due to various factors and their heterogeneous nature, as well as the presence of associated multiple manifestations. . This pain causes not only physical but psychosocial damage to the patient, because of the poor response to the usual treatments, and although it is sensitive to medication with opiates, the results are insufficient in the long-term in a significant number of patients, in whom it also causes undesirable effects. The present work establishes the subcutaneous administration of 5% dextrose through a perineural infi ltration technique for the treatment of the neurogenic inflammation responsible for the afore mentioned condition, in the free terminations of the cutaneous sensory nerves. For this, it was decided to carry out a multicenter descriptive study from June 2016 to May 2017 in 60 patients who presented chronic pain in lower limb ulcers of different etiology with a history of previous analgesic medication with partial (uncontrolled) outcome and had evolution of your pain between 3 months and 4 years.


Subject(s)
Humans , Male , Female , Ulcer/therapy , Wound Healing , Infiltration-Percolation , Lower Extremity/injuries , Chronic Pain/diagnosis , Prolotherapy/methods
5.
Rev. argent. cir. plást ; 26(1): 31-35, ene-mar 2020. tab, fig
Article in Spanish | LILACS | ID: biblio-1120491

ABSTRACT

El nevus melanocítico gigante es una entidad poco frecuente. En los primeros meses o años de vida, pueden aparecer nódulos dérmicos pequeños o grandes, muy pigmentados, que pueden crecer rápidamente o incluso ulcerarse. Esto obliga a realizar diagnóstico diferencial con el melanoma. Se presenta el caso de una paciente de 3 años de edad, con gran lesión pigmentada en pierna izquierda, con nódulos de rápido crecimiento, compatibles con nódulo proliferativo.


Giant melanocytic nevi are rare. In the fi rst few months or even years of life, they may develop small or large dermic nodules, very pigmented, with rapid growth o even ulcer formation. This forces the diff erential diagnosis with melanoma. We present a case of a 3 year old female patient, with a large pigmented lesion on the left leg, with nodules compatible with proliferative nodules.


Subject(s)
Humans , Female , Child, Preschool , Transplants/surgery , Lower Extremity/injuries , Therapy, Soft Tissue , Nevus/therapy , Nevus, Pigmented/surgery
6.
Cienc. act. fís. (Talca, En línea) ; 21(1): 1-10, ene. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1123686

ABSTRACT

El objetivo es verificar si existe relación entre la probabilidad de lesión en extremidades del tren inferior y el índice de grasa corporal en estudiantes que participan de talleres deportivos en la Universidad Adventista de Chile. Participaron 66 alumnos entre las áreas deportivas voleibol, básquetbol, fútbol y hándbol por un método de muestreo censal. Todos los participantes de la investigación fueron evaluados por medio del instrumento "Y balance Test", para verificar si son propensos a sufrir una lesión de tren inferior y además se les realizó una evaluación antropométrica para conocer su índice de grasa corporal. Los resultados no encontraron correlación entre porcentaje de grasa y probabilidad de lesión, sin embargo, se encontró correlación entre probabilidad de lesión entre una pierna y otra


The objective is to verify if there is a relationship between the likelihood of limb injury in the lower body and the body fat index in students participating in sports workshops at the Adventist University of Chile. 66 students participated in sports areas such as volleyball, basketball, soccer and handball by a census sampling method. All the participants of the investigation were evaluated by means of the "Y balance Test" instrument, to verify if they are prone to suffer a lower train injury and also an anthropometric evaluation was done to know their body fat index. The results did not find correlation between fat percentage and injury probability, however, a correlation was found between the injury probability between one leg and the another


Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Sports , Students , Adipose Tissue , Lower Extremity/injuries , Universities , Cross-Sectional Studies , Probability
7.
Rev. cuba. cir ; 58(2): e645, mar.-jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1093165

ABSTRACT

RESUMEN La amputación traumática completa se define como la separación total de un segmento del miembro del resto del cuerpo. El segmento cercenado algunas veces se puede reconectar, siempre que ambas partes de la extremidad hayan sido correctamente tratadas y se cumplan determinadas condiciones. Se presentan dos casos de amputación traumática de ambos miembros inferiores: el primero, una paciente femenina de 49 años de edad, debido a un accidente de trabajo y, el segundo, un paciente masculino de 39 años, víctima de un accidente en las vías férreas. Se expone la sintomatología presentada por ambos pacientes, su tratamiento quirúrgico y evolución(AU)


ABSTRACT Complete traumatic amputation is defined as the total separation of a limb segment from the rest of the body. The severed segment can sometimes be reconnected, provided that both parts of the limb have been correctly treated and certain conditions are met. Two cases of traumatic amputation of both lower limbs are presented: the first, a female patient of 49 years of age, due to an accident at work; and the second, a male patient of 39 years, victim of a railroad accident. The symptoms presented by both patients, their surgical treatment and evolution are exposed(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Accidents, Occupational , Lower Extremity/injuries , Amputation, Traumatic/surgery
8.
Rev. bras. cir. plást ; 34(2): 243-249, apr.-jun. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1015978

ABSTRACT

Introdução: Lesões no terço distal dos membros inferiores, com exposição de ossos, articulações, tendões e vasos sanguíneos, não são passíveis do uso de enxertos de pele. Isto ocorre porque o leito vascular é exíguo e pela pobre granulação das feridas, podendo apenas ser corrigidas com retalhos musculares, miocutâneos, fasciocutâneos ou transferência microcirúrgica. Métodos: O retalho em seu limite inferior é demarcado a partir de 5 cm acima dos maléolos. Superiormente, é marcado num comprimento suficiente para cobertura total da lesão. Realizada incisão em demarcação prévia, e elevados pele e tecido subcutâneo juntamente com a fáscia muscular. O nervo sural é preservado em seu leito original. A elevação do retalho se dá até o ponto inferior marcado (o pedículo). Neste ponto, o retalho é transposto numa angulação suficiente para alcançar a lesão. Resultados: Oito casos foram operados utilizando o retalho descrito. Todos apresentavam exposição de ossos e tendões em região distal da perna, dorso do pé ou ambos, nos quais foram utilizados o retalho fasciocutâneo reverso da perna com a técnica proposta por Carriquiry. Os casos apresentaram resultados estético e funcional satisfatórios. Conclusão: O retalho utilizado se presta à correção de lesões do terço inferior da perna e do pé. É relativamente fácil de ser confeccionado, com bom suprimento vascular, e não há perda funcional do leito doador.


Introduction: Skin grafts are not effective to cover lesions in the distal third of the lower limbs that expose the bones, joints, tendons, and blood vessels due to a limited vascular bed and poor granulation of the wounds. These lesions can only be corrected with microsurgical transfer or muscle, myocutaneous, or fasciocutaneous flaps. Methods: The lower border of the flap was marked 5 cm above the malleolus. The upper border was marked after providing sufficient length for complete coverage of the lesion. The incision was performed at the marked upper border, and the skin and subcutaneous tissue were elevated together with muscle fascia. The sural nerve was preserved in its original bed. The flap was lifted to the marked lower border (the pedicle). At this point, the flap was transposed at a sufficient angle to cover the lesion. Results: Eight cases of surgery were conducted using the flap described above. All cases had exposed bones and tendons in the distal region of the limb, back of the foot, or both, in which the reverse sural fasciocutaneous flap with the technique proposed by Carriquiry was used. The cases showed satisfactory esthetic and functional results. Conclusion: The used flap can correct lesions of the lower third of the limbs and foot. It is relatively easy to make, with good vascular supply, and there is no functional loss of the donor area.


Subject(s)
Humans , Sural Nerve/surgery , Sural Nerve/injuries , Surgical Flaps/surgery , Foot Bones/surgery , Reconstructive Surgical Procedures/methods , Lower Extremity/surgery , Lower Extremity/injuries , Leg Bones/surgery
9.
Acta cir. bras ; 33(4): 296-305, Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-886282

ABSTRACT

Abstract Purpose: To evaluate the effect of the cilostazol on the evolution of partially avulsed flaps, using experimental model of cutaneous degloving in rat limbs. Methods: A controlled and randomized experimental study was carried out in which the blood flow and the percentage of flap necrosis were evaluated. We compared the study group, which received cilostazol, and the control group, which received enteral saline solution in the postoperative period. The blood flow in the flap was evaluated through Laser Doppler flowmetry, and a planimetry using the IMAGE J® software was employed for the calculation of the area of necrosis. Results: Enteral administration of cilostazol was associated with a higher mean blood flow in all regions of the flap, with a statistically significant difference in the proximal and middle regions (p<0.001) and a lower percentage of necrotic area in the flap (p<0.001). Conclusion: Postoperative enteral administration of cilostazol increased blood flow and decreased the total area of necrosis of avulsed cutaneous flaps of rat limbs.


Subject(s)
Humans , Animals , Male , Tetrazoles/therapeutic use , Disease Models, Animal , Phosphodiesterase 3 Inhibitors/therapeutic use , Degloving Injuries/drug therapy , Reference Values , Regional Blood Flow/drug effects , Surgical Flaps , Tetrazoles/pharmacology , Time Factors , Random Allocation , Reproducibility of Results , Treatment Outcome , Rats, Wistar , Laser-Doppler Flowmetry , Lower Extremity/blood supply , Lower Extremity/injuries , Lower Extremity/pathology , Phosphodiesterase 3 Inhibitors/pharmacology , Degloving Injuries/surgery , Degloving Injuries/pathology , Necrosis/drug therapy
10.
Einstein (Säo Paulo) ; 16(1): eAO4137, 2018. tab, graf
Article in English | LILACS | ID: biblio-891463

ABSTRACT

Abstract Objective To analyze the combined effects of the silk protein sericin and swimming exercise on histomorphometry of the plantar muscle in Wistar rats. Methods Forty adult rats were randomly allocated into 5 groups comprising 8 animals each, as follows: Control, Injury, Sericin, Swim, and Swim plus Sericin. Three days after crushing of the sciatic nerve the rats in the Swim and Swim plus Sericin Groups were submitted to swimming exercise for 21 days. Rats were then euthanized and the plantar muscle harvested and processed. Results Cross-sectional area, peripheral nuclei and muscle fiber counts, nucleus/fiber ratio and smallest muscle fiber width did not differ significantly between groups. Morphological analysis revealed hypertrophic fibers in the Swim Group and evident muscle damage in the Swim plus Sericin and Injury Groups. The percentage of intramuscular collagen was apparently maintained in the Swim Group compared to remaining groups. Conclusion Combined treatment with sericin and swimming exercise did not improve muscle properties. However, physical exercise alone was effective in maintaining intramuscular connective tissue and preventing progression of deleterious effects of peripheral nerve injury.


RESUMO Objetivo Analisar o efeito da proteína sericina associada ao exercício físico de natação na histomorfometria do músculo plantar de ratos Wistar. Métodos Foram utilizados 40 ratos adultos divididos aleatoriamente em 5 grupos, com 8 animais cada: Controle, Lesão, Sericina, Natação, Natação e Sericina. Três dias após a compressão do nervo isquiático, os Grupos Natação e Exercício e Sericina foram submetidos ao exercício físico de natação durante 21 dias. Após, os animais foram sacrificados, e o músculo plantar foi processado. Resultados Não houve diferença da área da secção transversa entre os grupos, quantidade de núcleos periféricos, quantidade de fibra, relação núcleo/fibra e diâmetro menor. A análise morfológica revelou que no Grupo Natação ocorreu hipertrofia das fibras, assim como nos Grupos Exercício e Sericina e Lesão, o dano muscular foi evidente. O percentual de conjuntivo intramuscular parece ter sido mantido no Grupo Exercício em relação aos demais grupos. Conclusão A associação da proteína sericina e exercício físico de natação não foi eficiente na melhora das propriedades musculares, embora a aplicação do exercício físico tenha sido eficiente na manutenção do conjuntivo intramuscular, e no não agravamento dos efeitos deletérios consequentes da lesão nervosa periférica.


Subject(s)
Animals , Rats , Physical Conditioning, Animal/physiology , Swimming/physiology , Muscle, Skeletal/innervation , Lower Extremity/innervation , Sericins/pharmacology , Random Allocation , Rats, Wistar , Muscle, Skeletal/injuries , Muscle, Skeletal/pathology , Lower Extremity/injuries , Lower Extremity/pathology , Disease Models, Animal , Nerve Crush
11.
Rev. bras. cineantropom. desempenho hum ; 19(6): 644-651, Nov.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-897885

ABSTRACT

Abstract Prospective studies have indicated that assessing muscle function by the isokinetic test in the preseason is able to identify muscle strength variables that can be associated with injuries in the hamstring muscles of professional soccer players. However, the results are conflicting and could be related to the different cutoff points for the categorization of athletes in asymmetric or symmetric. Based on these conflicting results, the present study aims to: i) Identify the cutoff points of lateral asymmetry (LA) of the 95% confidence interval for the peak torque in soccer players, evaluated by the isokinetic test, taking into consideration the mean population value; ii) Compare LA between 15% cutoff point proposed in literature and the upper limit of 95% confidence interval (UP) of the study population. Sixty-four professional soccer players performed five knee flexion and extension repetitions at rate of 60°/s, with a one-minute interval. To determine the cutoff point for strength asymmetries, the UP was used, and for the purpose of diagnostic concordance of information among the different values, the McNemar's χ2 test was applied. The proportion between symmetric and asymmetric athletes was not different from the 15% cutoff point and the general population, both for knee flexors (χ2 = 0.5, p = 0.250) and the knee extensors (χ2 = 2.0, p = 0.125). It was concluded that the cutoff point of 15% referenced in literature for the general population provides similar diagnostic information for the classification of professional soccer players.


Resumo Estudos prospectivos têm indicado que avaliar a função muscular pelo teste isocinético na pré-temporada é capaz de identificar variáveis da força muscular que se associam a lesões nos músculos posteriores da coxa em jogadores de futebol, entretanto, os resultados são conflitantes e podem estar relacionados aos diferentes pontos de corte para categorização do atleta em assimétrico. Diante de resultados antagônicos, o presente estudo objetivou: i) Identificar o ponto de corte da assimetria lateral (AL) do intervalo de confiança de 95% para o pico de torque em jogadores de futebol, avaliado no teste isocinético, levando em consideração a média populacional; ii) Comparar a AL entre o valor de corte de 15%, proposto pela literatura, e o limite superior do intervalo de confiança de 95% (LS) da população estudada. 64 jogadores de futebol profissional realizaram cinco repetições máximas de flexão e extensão do joelho na velocidade de 60°/s com intervalo de um minuto entre repetições. Para determinação do ponto de corte da AL, utilizou-se o LS e para a concordância da informação diagnóstica entre os diferentes valores de corte foi aplicado o teste χ2 de McNemar. A proporção entre simétricos e assimétricos não foi diferente entre os valores de corte de 15% e o populacional, tanto para os flexores do joelho (χ2 = 0.5; p = 0.250) quanto para os extensores do joelho (χ2 = 2.0; p = 0.125). Conclui-se que, o ponto de corte populacional proporciona uma classificação dos atletas de futebol profissional similar ao valor de 15% referenciado na literatura.


Subject(s)
Humans , Male , Adult , Soccer , Lower Extremity/injuries
12.
Rev. Col. Bras. Cir ; 44(5): 444-451, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-896615

ABSTRACT

ABSTRACT Objectives: to evaluate the epidemiological profile, the surgical treatment and the postoperative results of patients with complex traumatic injuries to the lower limbs. Methods: we conducted a retrospective study of patients with traumatic complex injuries treated by the Plastic Surgery Service of a regional hospital in Brasília. We analyzed clinical-epidemiological data, type of surgical procedure and functional recovery of the limb after six months of treatment. Results: 119 patients were treated, with a mean age of 29 years, predominantly men (76.4%). Motorcycle accident was responsible for most of the injuries, in 37.8% of cases. The most frequent surgical treatment was skin grafting (62.1%), followed by the fasciocutaneous flap (21.9%), muscular flap (12.6%) and microsurgical flap (3.4%). Six months after completion of the surgical treatment, 35.3% of the patients needed crutches to move, characterizing a delay in limb functional recovery that, however, was significantly related to the presence of fractures, external fixation or bone exposure in the preoperative period. Conclusion: the profile of the patient with complex traumatic lower limb injury was a male, motorcycle accident victim, and grafting was the most used treatment. Orthopedic trauma with bone fracture, bone exposure and the presence of external fixator were significantly associated with a higher risk of limb functional impairment, requiring locomotion crutches after six months of treatment.


RESUMO Objetivo: avaliar o perfil epidemiológico, o tratamento cirúrgico e os resultados pós-operatórios de pacientes com feridas complexas traumáticas de membros inferiores. Método: estudo retrospectivo dos pacientes com ferimentos complexos traumáticos tratados pelo Serviço de Cirurgia Plástica de um hospital regional de Brasília. Foram analisados os dados clínico-epidemiológicos, o tipo de procedimento cirúrgico e a recuperação funcional do membro após seis meses do tratamento. Resultados: foram tratados 119 pacientes, com média de idade de 29 anos, predominantemente homens (76,4%). O acidente moto ciclístico foi responsável pela maioria das lesões, em 37,8% dos casos. O tratamento cirúrgico mais realizado foi o enxerto de pele (62,1% dos casos), seguido pelo retalho fascio-cutâneo (21,9%), o retalho muscular (12,6%) e o retalho microcirúrgico (3,4%). Seis meses após a conclusão do tratamento cirúrgico, 35,3% dos pacientes necessitavam de muletas para se locomover, caracterizando um atraso na recuperação funcional do membro que, no entanto, estava relacionado significativamente à presença de fratura, de fixador externo ou de exposição óssea no pré-operatório. Conclusão: o perfil do paciente com ferida complexa traumática de membros inferiores foi homem, vítima de acidente motociclístico e o enxerto foi o tratamento mais utilizado. O trauma ortopédico com fratura óssea, exposição óssea e a presença de fixador externo estiveram associados significativamente a um maior risco de prejuízo funcional do membro com necessidade de muletas para locomoção após seis meses de tratamento.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Aged , Young Adult , Lower Extremity/surgery , Lower Extremity/injuries , Wounds and Injuries/epidemiology , Retrospective Studies , Treatment Outcome , Middle Aged
13.
Rev. Hosp. Ital. B. Aires (2004) ; 37(3): 98-100, Sept. 2017. ilus.
Article in Spanish | LILACS | ID: biblio-1087805

ABSTRACT

Antecedentes: la amiloidosis es una enfermedad sistémica que resulta del depósito de proteínas mal plegadas; en la amiloidosis de cadena ligera de la inmunoglobulina (AL), las fibrillas están compuestas de fragmentos de cadenas ligeras monoclonales. En la Argentina, la densidad de incidencia de amiloidosis AL es 4,54 cada millón de personas/año. Caso: paciente femenina de 71 años que consulta por dolor neural localizado en miembro superior izquierdo, asociado a edemas en ambos miembros inferiores y disnea de esfuerzo, pérdida de peso, constipación y macroglosia. Al examen físico presenta tensión arterial de 100/60 mm Hg; está afebril, saturando 98% de aire ambiente; peso de 46 kg y un índice de masa corporal de 18,9. Se constatan cadenas livianas libres Kappa: 5,8 mg/L, Lambda: 430 mg/L y con relación K/L: 0,13 mg/L y un ProBNP de 1686 pg/mL. La biopsia de grasa abdominal informó depósitos de amiloide, tinción de rojo Congo positivo. Resonancia magnética (RM) de corazón con contraste (gadolinio), compatible con amiloidosis cardíaca. La tomografía computarizada (TC) de tórax demostró un área de consolidación en lóbulo superior del pulmón derecho, rojo Congo positivo focal. Ante el diagnóstico de amiloidosis AL se realiza tratamiento con CYBORD. Se consolidó el tratamiento con un trasplante autólogo de médula ósea. Discusión: la afectación cardíaca es la principal causa de morbilidad y mortalidad dentro de la amiloidosis. (AU)


Background: amyloidosis is a systemic disease resulting from the deposition of misfolding proteins, in immunoglobulin light chain amyloidosis (AL) fibrils are composed of fragments of monoclonal light chains. In Argentina the incidence density of AL amyloidosis is 4.54 per million people year. Case: a 71-year-old female patient who consults for neural pain located in the left upper limb, associated with edemas in both lower limbs and exertional dyspnea, weight loss, constipation and macroglossia. On physical examination she had blood pressure of 100/60 mmHg, afebrile, saturating 98% of ambient air, weight of 46 kg and body mass index of 18.9. The peripheral blood laboratory has Kappa free light chains: 5.8 mg/L, Lambda: 430 mg/L with K L ratio: 0.13 mg/L and a ProBNP of 1686 pg/mL. Abdominal fat biopsy reports positive Congo red staining. Cardiac magnetic resonance with contrast (gadolinium) has been performed and result compatible with cardiac amyloidosis. Chest CT showed an area of consolidation in the upper lobe of the right lung; positive congo red. With the diagnosis of AL amyloidosis she was treated with CYBORD. Autologous stem cell transplantation was performed. Discussion: cardiac involvement is the main cause of morbidity and mortality by amyloidosis. (AU)


Subject(s)
Humans , Female , Aged , Immunoglobulin Light-chain Amyloidosis/drug therapy , Heart Failure/mortality , Pain , Quality of Life , Transplantation, Autologous , Dexamethasone/therapeutic use , Weight Loss , Body Mass Index , Bone Marrow Transplantation , Constipation , Cyclophosphamide/therapeutic use , Lower Extremity/injuries , Upper Extremity/injuries , Dyspnea , Edema , Bortezomib/therapeutic use , Immunoglobulin Light-chain Amyloidosis/etiology , Immunoglobulin Light-chain Amyloidosis/epidemiology , Immunoglobulin Light-chain Amyloidosis/diagnostic imaging , Survivorship , Macroglossia
14.
Rev. Col. Bras. Cir ; 44(1): 9-16, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-842635

ABSTRACT

ABSTRACT Objective: to evaluate the management of lower limbs complex traumatic injuries by analyzing their characteristics, types, conduct and evolution, with emphasis on surgical treatment. Methods: we conducted a prospective study of patients treated by Plastic Surgery at a regional hospital of the Federal District during a one-year period. We collected data through serial evaluations and telephone contact records. Results: we studied 40 patients, with a mean age of 25.6 years, predominantly male (62.5%). The most frequent wounds were of the distal third of the lower limb (37.5%). Bone or tendon exposures occurred in 55% had and there was a 35% rate of exposed lower limb fractures. The treatments employed were skin grafting (57.5%), local fasciocutaneous flap (15%), muscle flap (12.5%), cross-leg fasciocutaneous flap, reverse sural flap (12.5%) and microsurgical flap (2.5%). Short-term evaluation showed that 35 patients had excellent or good results (87.5%), four had a regular result (10%), and one had an unsatisfactory result (2.5%). In the long term, of the 18 patients who answered the questionnaire, ten resumed walking, even with support, in the first three months after surgery (55.6%). Conclusion: young men involved in motorcycle accidents during leisure time represented the profile of patients with lower limb trauma requiring surgical reconstruction; the distal third of the leg was the most affected region. Grafting was the most used technique for reconstruction and postoperative functional evaluation showed that, despite complex lesions, most patients evolved with a favorable healing process and successful functional evolution.


RESUMO Objetivo: avaliar o tratamento de feridas traumáticas complexas de membros inferiores analisando suas características, tipos, condutas e evolução, com ênfase no tratamento cirúrgico. Métodos: estudo prospectivo de pacientes tratados pela Cirurgia Plástica em um hospital regional do Distrito Federal no período de um ano. Os dados foram coletados através de avaliações seriadas e registro de contatos telefônicos. Resultados: foram estudados 40 pacientes com média de idade de 25,6 anos, predominantemente homens (62,5%). As feridas do terço distal do membro inferior foram mais frequentes (37,5%). 55% apresentavam exposições óssea ou tendinosa e 35%, fraturas expostas do membro inferior. O tratamento foi enxerto de pele (57,5%), retalho fascio-cutâneo local (15%), retalho muscular (12,5%), retalho fascio-cutâneo de perna cruzada, retalho sural reverso (12,5%) e retalho microcirúrgico (2,5%). A avaliação em curto prazo evidenciou que 35 pacientes tiveram resultado excelente ou bom (87,5%), quatro tiveram resultado regular (10%), e um teve resultado insatisfatório (2,5%). Em longo prazo, dos 18 pacientes que responderam ao questionário, dez deambularam, mesmo que com apoio, no primeiro trimestre após a cirurgia (55,6%). Conclusâo: nosso estudo mostrou que o perfil dos pacientes com trauma de membros inferiores que necessitaram de reconstrução cirúrgica foi representado por homens jovens, envolvidos em acidentes motociclísticos, durante situação de lazer, sendo o terço distal da perna a região mais acometida. A enxertia foi a técnica mais utilizada para reconstrução e a avaliação funcional pós-operatória demonstrou que, apesar de lesões complexas, a maioria dos pacientes evoluiu com processo de cicatrização favorável e sucesso na evolução funcional.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Young Adult , Lower Extremity/surgery , Lower Extremity/injuries , Wounds and Injuries/surgery , Wounds and Injuries/epidemiology , Brazil , Prospective Studies , Treatment Outcome , Reconstructive Surgical Procedures , Hospitals , Middle Aged
15.
Rev. chil. cir ; 69(1): 16-21, feb. 2017. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-844319

ABSTRACT

Objetivos: Establecer la utilidad del índice de presión arterial tobillo-tobillo (ITT) en los pacientes con trauma de extremidades inferiores y signos blandos de lesión vascular en términos de sensibilidad, especificidad y valores predictivos según el mejor punto de corte detectado. Material y método: Se incluyeron 120 pacientes con trauma en extremidades inferiores y signos blandos de lesión vascular que ingresaron al Hospital Universitario de Santander (Bucaramanga, Colombia) durante los años 2012 a 2015, a los cuales se les calculó el índice tobillo-brazo (ITB) e ITT. Resultados: Un total de 21 (17,5%) pacientes tuvieron ITB menor a 0,9 al ingreso, los cuales fueron llevados a intervención quirúrgica inmediata, encontrando lesión vascular; 2 (1,6%) pacientes tuvieron ITB menor a 0,9 en el control realizado a las 6 h, los cuales también fueron llevados a intervención quirúrgica, encontrando lesión vascular. Por tanto, se encontraron 23 pacientes con lesión vascular. Las curvas ROC tanto de ITB como de ITT señalan que ambas tienen un muy buen desempeño para diagnosticar las lesiones vasculares en pacientes con signos blandos cuando se emplean una única vez. En ambos casos, el punto de corte propuesto tradicionalmente de 0,90 tiene una capacidad discriminatoria adecuada, con sensibilidad de 91% (IC 95%: 0,71-0,98), especificidad de 100% (IC 95%: 0,96-1,0), valor predictivo positivo de 100% (IC 95%: 0,83-1,0) y valor predictivo negativo de 97% (IC 95%: 0,92-0,99). Conclusión. El índice tobillo-tobillo (ITT) permite descartar lesión vascular en el paciente con trauma en extremidades inferiores y signos blandos.


Objectives: We pretend to establish the utility of the ankle-ankle systolic pressure index (AAI) in patients with trauma in the inferior limbs and soft signs of vascular injury describing its sensitivity, specificity and predictive values according to the best cut-off point. Material and method: The cohort included 120 patients with trauma in the inferior limbs and soft signs of vascular injury who attended the University Hospital of Santander (Bucaramanga, Colombia) over a period of 4 years (2012-2015). Results: 21 (17.5%) patients had an ankle brachial pressure index (ABI) < .9 at the admission and they received immediately surgical management, finding vascular injury in the operating room; 2 (1.6%) patients had an ABI < .9 in the 6 h monitoring control and they also received surgical management finding vascular injury. Therefore, we found 23 patients with vascular injury. The ROC curves for the ABI and AAI show that they both have a good achievement for the diagnosis of vascular injury in patients with soft signs when they were used one time. In both cases, the traditionally point of .90 has a good discriminatory capacity with a sensitivity of 91% (95% CI: .71-.98), specificity of 100% (95% CI: .96-1.0), positive predictive value of 100% (95% CI: .83-1.0) and negative predictive value of 97% (95% CI: .92-.99). Conclusion. The ankle-ankle systolic pressure index (AAI) allows to rule out vascular injury in the patient with trauma in the inferior limbs and soft signs.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Ankle Brachial Index , Blood Vessels/injuries , Lower Extremity/injuries , Wounds and Injuries/diagnosis , Predictive Value of Tests , ROC Curve , Sensitivity and Specificity
16.
Rev. bras. cir. plást ; 32(1): 116-122, 2017. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-832685

ABSTRACT

Introdução: Lesões extensas em membros inferiores sempre foram desafiadoras devido a sua difícil resolução. Retalhos livres microcirúrgicos se mostraram como excelente opção cirúrgica, todavia, por carecer de equipe capacitada e serviços estruturados, têm seu uso restrito. Os retalhos fasciocutâneos, especificamente os de fluxo reverso, têm se mostrado excelente opção na abordagem de lesões de membros inferiores, numa alternativa aos complexos retalhos livres microcirúrgicos. Métodos: De janeiro de 2012 a junho de 2015, nove pacientes foram submetidos à reconstrução de membros inferiores com retalhos reversos fasciocutâneos. Todos eram portadores de lesões extensas nos referidos membros. Resultados: Em oito pacientes o resultado foi satisfatório, sem complicações maiores. Em um paciente houve necrose total do retalho. Conclusão: Pela sua relativa simplicidade técnica, os retalhos fasciocutâneos de fluxo reverso vêm se consolidando como opção bastante viável na reconstrução de feridas complexas dos membros inferiores, sendo mais uma opção terapêutica para os pacientes portadores destas lesões.


Introduction: Complex lesions on the lower limbs have always been challenging because of their difficult resolution. Microsurgical free flaps have been an excellent surgical option; however, they have limited use because there are an insufficient number of clinicians trained in such structured services. Fasciocutaneous flaps, specifically reverse flow, have been shown to be an excellent option in treating lower limb injuries as an alternative to complex microsurgical free flaps. Methods: From January 2012 to June 2015, nine patients underwent reconstruction of the lower limbs with reverse fasciocutaneous flaps. All had extensive lesions on these limbs. Results: In eight patients, the results were satisfactory, and there were no major complications. In one patient, there was total necrosis of the flap. Conclusion: Because of the relative technical simplicity of performing such a technique, fasciocutaneous flaps are a viable option for the reconstruction of complex wounds of the lower limbs and are an additional therapeutic option for patients with these lesions.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , History, 21st Century , Surgical Flaps , Wounds and Injuries , Retrospective Studies , Journal Article , Reconstructive Surgical Procedures , Lower Extremity , Microsurgery , Surgical Flaps/surgery , Surgical Flaps/transplantation , Wounds and Injuries/surgery , Wounds and Injuries/therapy , Reconstructive Surgical Procedures/methods , Lower Extremity/surgery , Lower Extremity/injuries , Microsurgery/methods
17.
Bahrain Medical Bulletin. 2017; 39 (3): 159-161
in English | IMEMR | ID: emr-188422

ABSTRACT

Background: The incidence rates of major amputations vary greatly between different countries. Amputation carries a significant psychological and socioeconomic burden on the individual and the community


Despite that, major lower limb amputation is a relatively frequent procedure in our center. To date, there has been no study published to identify the major cause of amputation and the personal characteristics of the patients


Objective: To identify the causes, patient characteristics and complications of major lower limb amputation


Design: A Prospective Study


Setting: Vascular and Thoracic Surgery Unit, Department of Surgery, Salmaniya Medical Complex, Kingdom of Bahrain


Method: All patients who underwent major amputation of the lower limb/s from 1 May 2015 to 30 April 2016 were included in the study


Result: Forty-five patients were included in this study. Forty-seven major lower limb amputations were performed during the study period. Forty-one [91.1%] patients were Bahrainis. Twenty-nine [64.4%] patients were males and the median age was 66 years. Thirty [66.7%] patients had no university education


Thirty-eight [84.4%] patients underwent amputations due to diabetes mellitus [DM] and its related complications. Seventeen [37.8%] patients had postoperative complications. Surgical site wound infection [SSI] was the most common postoperative complication, 8 [17.8%] patients


The overall 30-day mortality was 10.6%


Conclusion: Diabetes mellitus and its related complications is the main cause for major lower limb amputation in our study


Subject(s)
Humans , Female , Male , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Lower Extremity/injuries , Incidence , Diabetes Complications , Surgical Wound Infection , Prospective Studies , Bahrain
18.
Motriz (Online) ; 23(3): e101760, 2017. tab, graf, ilus
Article in English | LILACS | ID: biblio-894999

ABSTRACT

AIMS: To verify the incidence of injuries in professional soccer athletes in Aracaju-SE and to identify associated factors. METHODS: This was an observational, prospective cohort study involving 39 healthy athletes, followed for seven months and evaluated on four occasions (start on preseason and two evaluations with three months of interval between each) through data collection sheet and orthopedic physical examination. RESULTS: Participants were 20 athletes from Club Sportivo Sergipe and 19 from Associação Desportiva Confiança, with mean age of 26 years (CI 95%: 25.2-28 years), and mean career time of 9.6 years (CI 95%: 7.9-11.3 years). The 13 (2.4 / 1000 hours) diagnosed injuries occurred almost exclusively in the lower limbs and thigh muscle stretch was the most common injury. Injuries were mostly mild to moderate (69%). There was no significant association with any of the variables analyzed. CONCLUSION: Low incidence of injuries was observed in this study. Predominantly, lesions occurred on non-rainy days and were due to trauma. Lower limbs were the most affected location and thigh stretch was the most common injury.(AU)


Subject(s)
Humans , Male , Adult , Athletic Injuries/epidemiology , Soccer , Lower Extremity/injuries
19.
J. vasc. bras ; 15(4): 268-274, Oct.-Dec. 2016. tab, graf
Article in Portuguese | LILACS | ID: biblio-841387

ABSTRACT

Resumo Contexto A insuficiência venosa crônica (IVCr) é frequente e predomina nas mulheres, mas ainda há poucas informações sobre o refluxo nas veias safenas na população masculina. Objetivos Identificar os diferentes padrões de refluxo nas veias safenas magnas (VSMs) e parvas (VSPs) em homens, correlacionando esses dados com a apresentação clínica conforme a classificação Clínica, Etiológica, Anatômica e Fisiopatológica (CEAP). Métodos Foram avaliados 369 membros inferiores de 207 homens pela ultrassonografia vascular (UV) com diagnóstico clínico de IVCr primária. As variáveis analisadas foram a classificação CEAP, o padrão de refluxo nas VSMs e VSPs e a correlação entre os dois. Resultados Nos 369 membros avaliados, 72,9% das VSMs apresentaram refluxo com predominância do padrão segmentar (33,8%). Nas VSPs, 16% dos membros inferiores analisados apresentaram refluxo, sendo o mais frequente o padrão distal (33,9%). Dos membros classificados como C4, C5 e C6, 100% apresentaram refluxo na VSM com predominância do refluxo proximal (25,64%), e 38,46% apresentaram refluxo na VSP com equivalência entre os padrões distal e proximal (33,3%). Refluxo na junção safeno-femoral (JSF) foi detectado em 7,1% dos membros nas classes C0 e C1, 35,6% nas classes C2 e C3, e 64,1% nas classes C4 a C6. Conclusões O padrão de refluxo segmentar é predominante na VSM, e o padrão de refluxo distal é predominante na VSP. A ocorrência de refluxo na JSF é maior em pacientes com IVCr mais avançada.


Abstract Background Chronic venous insufficiency (CVI) is frequent and predominantly affects women, but there is a lack of information about saphenous vein reflux in the male population. Objective To identify different patterns of reflux in the great and small saphenous veins of men and correlate them with clinical presentation graded according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. Methods A total of 369 lower limbs in 207 men with a clinical diagnosis of primary CVI of the lower limbs were evaluated using vascular ultrasound (VU). The variables analyzed were CEAP clinical classification, patterns of reflux in the great and small saphenous veins, and the correlations between them. Results A total of 369 limbs were evaluated and in 72.9% of them the great saphenous vein (GSV) had reflux, predominantly the segmental pattern (33.8%), while in 16% of the lower limbs analyzed the small saphenous vein (SSV) had reflux, among which the most frequent pattern was distal (33.9%). All limbs classified as C4, C5, or C6 had GSV reflux, predominantly proximal (25.64%), while 38.46% had SSV reflux compatible with distal and proximal reflux patterns (33.3%). Reflux was detected at the saphenofemoral junction (SFJ) in 7.1% of limbs graded C0 and C1, in 35.6% of C2 and C3 limbs and in 64.1% of C4 to C6 limbs. Conclusion The predominant reflux patterns are segmental at the GSV and distal at the SSV. The frequency of SFJ reflux is higher in patients with more advanced CVI.


Subject(s)
Humans , Male , Female , Adult , Lower Extremity/injuries , Saphenous Vein/anatomy & histology , Saphenous Vein/physiopathology , Venous Insufficiency/diagnostic imaging , Venous Insufficiency/pathology , Cross-Sectional Studies/methods
20.
Rio de Janeiro; s.n; dez. 2016. 192 f p. graf.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-846880

ABSTRACT

Introdução: Conhecer as demandas de cuidados das pessoas que são afetadas por úlceras crônicas de membros inferiores a partir de uma perspectiva de apreensão integral do ser humano entusiasma a ponderação sobre a natureza do cuidado na área em tela, o que é essencial para a enfermagem como disciplina e profissão. Objetivo geral: Analisar os significados atribuídos as demandas de cuidado pelas pessoas com úlcera crônica de membro inferior. O Interacionismo simbólico foi utilizado como referencial teórico, tendo aproximação com a enfermagem a partir do momento que cria possibilidades para o desenvolvimento do cuidado humano interativo. Referencial Metodológico: A Teoria Fundamentada nos Dados assumiu o pólo morfológico e o pólo técnico do estudo. As cenas sociais foram as unidades de saúde de Jardim Camburi e de Maruípe. Para a produção dos dados foram realizadas entrevistas utilizando o roteiro semi-estruturado, com 4 grupos amostrais, totalizando 20 pessoas que atenderam aos critérios de inclusão. Resultados: Após o processo de codificação dos dados, apresenta-se como fenômeno central: Protagonizando a vida com úlceras crônicas de membros inferiores a partir do significado das demandas de cuidado, gerando a Tese: As pessoas afetadas por úlceras crônicas de membros inferiores expressam suas demandas de cuidado valorizando majoritariamente a dimensão biofisiológica, o que implica negativamente no cuidado de si, favorecendo a cronicidade do agravo, sendo necessárias ações e atitudes profissionais de cuidado, que compartilhem o conhecimento, os saberes e as práticas, em prol do advento da consciência crítica, da autonomia libertadora, da postura cidadã e da ressignificação multidimensional do ser. Considerações finais: Observa-se a complexidade e ao mesmo tempo o desafio em apontar que para além da reflexão se faz necessária uma reorganização individual e coletiva que supere/desconstrua um processo de aprendizado e significados centrado no cuidado técnico, para um processo de subjetivação que supõe alterar atitudes, mobilizar para novos significados, em uma nova relação de compromisso, colaborando para a mudança no sistema de cuidados na atenção básica de saúde.(AU)


Subject(s)
Humans , Lower Extremity/injuries , Nursing Care , Wounds and Injuries/nursing
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