[Venous ulcus cruris-Surgical treatment]. / Ulcus cruris venosum ­ chirurgische Therapie.

Venous ulcus cruris is usually a chronic disease and an extreme burden for patients and their families. An analysis based on a random statutory health insurance sample of the AOK Hessen/KV Hessen estimated the number of affected people to be 400,000 in Germany. A venous ulcus cruris is always caused by an underlying chronic venous insufficiency (CVI). A spontaneous healing of this chronic disease without treatment is not to be expected. The conservative treatment includes an adequate compression treatment and exudate management. Surgical treatment is based on three pillars: an open surgical or endovenous approach to resolve the pathological venous reflux, uIcer surgery and in rare cases the various procedures of fascia surgery as well as defect coverage by a combination of negative pressure wound therapy and skin transplantation.

Effect of topical application of platelet-rich plasma on chronic venous leg ulcerations.

Wound products that reliably support healing of chronic leg ulcers remain a huge unmet need in clinical practice. Due to the lack of standardized comparable protocols and different systems for platelet-rich plasma (PRP) preparation, there is limited data on healing rates in chronic venous ulcers. In our case series with a total of seven chronic leg ulcers in four patients, we investigated the healing rates based on standardized digital photographs of chronic venous ulcers after application of topical PRP using a digital imaging software. In 5 out of 7 ulcers, the PRP-treated wound half showed faster healing as compared the control half of the wound. In this case series, PRP-treated sides of chronic venous leg ulcers showed a tendency for accelerated healing as compared to nontreated collateral wound side. Our data support the evaluation of topical PRP treatment in the management of chronic venous leg ulcers.

Growth factors for treating chronic venous leg ulcers: A systematic review and meta-analysis.

Chronic venous leg ulcers (VLU) are wounds that commonly occur due to venous insufficiency. Many growth factors have been introduced over the past two decades to treat VLU. This systematic review and meta-analysis evaluates the impact of growth factor treatments of VLU in comparison to control for complete wound healing, percent reduction in wound area, time to wound healing, and adverse events. A systematic review and meta-analysis of randomised trials was conducted. MEDLINE and EMBASE were searched up to December 2020. Studies were included if they compared a growth factor versus placebo or standard care in patients with VLU. From 1645 articles, 13 trials were included (n = 991). There was a significant difference between any growth factor and placebo in complete wound healing (P = 0.04). Any growth factor compared to placebo significantly increased the likelihood of percent wound reduction by 48.80% (P = <0.00001). There was no difference in overall adverse event rate. Most comparisons have low certainty of evidence according to Grading of Recommendations, Assessment, Development, and Evaluation. This meta-analysis suggests that growth factors have a beneficial effect in complete wound healing of VLU. Growth factors may also increase percent reduction in wound area. The suggestion of benefit for growth factors identified in this review is not a strong one based on the low quality of evidence.

[German national consensus on wound documentation of leg ulcer : Part 1: Routine care - standard dataset and minimum dataset]. / Nationaler Konsensus zu Wunddokumentation beim Ulcus cruris : Teil 1: Routineversorgung ­ "Standard-Dataset" und "Minimum-Dataset".

BACKGROUND: Standards for basic documentation and the course of treatment increase quality assurance and efficiency in health care. To date, no standards for the treatment of patients with leg ulcers are available in Germany. OBJECTIVES: The aim of the study was to develop standards under routine conditions in the documentation of patients with leg ulcers. This article shows the recommended variables of a "standard dataset" and a "minimum dataset". MATERIALS AND METHODS: Consensus building among experts from 38 scientific societies, professional associations, insurance and supply networks (n = 68 experts) took place. After conducting a systematic international literature research, available standards were reviewed and supplemented with our own considerations of the expert group. From 2012-2015 standards for documentation were defined in multistage online visits and personal meetings. RESULTS: A consensus was achieved for 18 variables for the minimum dataset and 48 variables for the standard dataset in a total of seven meetings and nine online Delphi visits. The datasets involve patient baseline data, data on the general health status, wound characteristics, diagnostic and therapeutic interventions, patient reported outcomes, nutrition, and education status. DISCUSSION: Based on a multistage continuous decision-making process, a standard in the measurement of events in routine care in patients with a leg ulcer was developed.

Capacidade funcional de pacientes com úlceras venosas no município de Petrópolis-RJ / Functional capacity of patients with venous ulcers in the city of Petrópolis-RJ

O objetivo do estudo foi avaliar a capacidade funcional de pacientes com úlceras venosas. Trata-se de um estudo observacional com enfoque transversal e com abordagem quantitativa. Os participantes foram pacientes adultos e idosos com úlceras venosas, atendidos em dois Ambulatórios. No processo de seleção, foi adotada amostragem por conveniência. Para coleta de dados, foram utilizados os seguintes instrumentos: Protocolo I Adaptado­Perfil dos clientes com úlcera; Escala de LAWTON AIVDs; Escala KATZ AVDs e Escala do Índice de Tinetti. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa. Na análise, foi utilizada a estatística descritiva, composta pelo Teste de χ2 ou exato de Fisher para dados categóricos e o teste Mann-Whitney para dados numéricos, a fim de verificar se existe diferença significativa entre as variáveis e os escores das escalas de cada grupo estudado. O teste Mann-Whitney e o coeficiente de correlação de Spearman foram utilizados para examinar se existe correlação significativa, e a intensidade da correlação entre as variáveis (faixa etária, Medicação em uso, IMC, Número de lesões, Tempo das lesões (anos) e Tratamento utilizado) e os escores (total) das escalas Katz, Lawton e Tinetti de cada grupo. Os resultados referentes às características demográficas e socioeconômicas demonstraram que houve predominância do sexo feminino (57,4%), faixa etária a partir dos 60 anos (57,4%), renda familiar de 1 a 2 salários mínimos (75,9%). As características clínicas evidenciaram fatores de risco, como longos períodos em pé ou sentado (79,6%), história familiar de doença venosa (53,7%), Flebite (37,0%). As características gerais apontam a existência de obesidade I (42,6%), pressão arterial normal no momento (38,9%) e glicemia capilar normal (55,6%). Verificamos, através das características gerais das lesões a existência da lesão no MIE (38,9%) e no MID (38,9%), presença de apenas uma lesão (68,5%), de uma a duas recidivas (50%) e lesão há mais de 10 anos (50%). Na avaliação funcional, foi identificado, através da escala de Lawtom, dependência parcial (90,7%); na escala de Katz, foi identificado independência para todas as atividades (66,7%); e na escala de Tinetti, foi evidenciado baixo risco de queda (44,4%). Conclusão: O estudo mostrou que existem limitações em pacientes com úlceras venosas, tanto adultos como idosos de ambos os sexos, porém o sexo feminino é o mais afetado, assim como está mais presente nos idosos. Em relação à capacidade funcional, foi evidenciado que, nas atividades de vida diária, ela se mantém mais preservada do que nas demais atividades; nas atividades instrumentais de vida diária e atividades referentes ao equilíbrio e marcha, houve um percentual a ser considerado de dependência parcial e risco de quedas, sinalizando a necessidade de investimento do poder publico e atenção dos profissionais para essas questões

The aim of the present study was to evaluate the functional capacity of patients with venous ulcers. This is an observational study with cross-cutting and quantitative approaches. Participants were adults and elderly patients with venous ulcers treated at two ambulatories. In the process of selection, convenience sampling was adopted. For data collection, the following instruments were used: Protocol I Adapted-profile clients with ulcer; LAWTON IADL scale; Scale KATZ ADL scale and the Tinetti Index. The study was approved by the Research Ethics Committee. In the analysis, descriptive statistics were used, made by Fisher χ2 or exact test for categorical data, and the Mann-Whitney test for numerical data in order to verify a significant difference between the variables and the scores of the scales of each group. The Mann-Whitney test and Spearman correlation coefficient were used to examine whether there is a significant correlation, and the intensity of the correlation between variables (age, medication in use, BMI, number of lesions, time of injuries (years) treatment used) and scores (total) of Katz scales, Lawton and Tinetti of each group. The results of the demographic and socioeconomic characteristics highlighted that there was a predominance of women (57,4%), aged from 60 (57,4%) and with a family income of 1 to 2 minimum wages (75,9%). The clinical features showed risk factors, such as long periods of standing or sitting (79,6%), family history of venous disease (53,7%) and phlebitis (37,0%). The overall characteristics suggest the existence of obesity I (42,6%), normal blood pressure at the moment(38,9%) and a normal blood glucose (55,6%). Through the overall characteristics of the lesions, were verified the presence of injury MIE (38,9%) and MID (38,9%), presence of only one lesion (68,5%), one or two recurrences (50%) and injury for more than 10 years (50%). In the functional assessment, was identified: by Lawtom scale, partial dependence (90,7%); by the Katz scale, independence has been identified for all activities (66,7%); and Tinetti scale evidenced low risk of falling (44,4%). Conclusion: The study showed that there are limitations in patients with venous ulcers, both adults and elderly of both sexes, but women are the most affected, most of them elderly. Regarding to functional capacity, it was enhanced that, in the activities of daily living, it remains more preserved than in other activities; in instrumental activities of daily living and activities related to balance and gait, there was a percentage to be considered partial dependence and risk of falls, signaling the need for government investment and professionals' attention to these issues

El objetivo del estudio fue evaluar la capacidad funcional de los pacientes con úlceras venosas. Se trata de un estudio observacional con enfoque transversal y un enfoque cuantitativo. Los participantes eran adultos y pacientes de edad avanzada tratados con úlceras venosas en dos clínicas ambulatorias. En el proceso de selección, se adoptó un muestreo de conveniencia. Para la recogida de datos, se utilizaron los siguientes instrumentos: los clientes Protocolo I-perfil Adaptado con úlcera; AIVD de Lawton; Escala Escala KATZ ADL y el Índice de Tinetti. El estudio fue aprobado por el Comité de Ética de la Investigación. En el análisis, se utilizó estadística descriptiva, realizado por Fisher χ2 o la prueba exacta para los datos categóricos y la prueba de Mann-Whitney para datos numéricos con el fin de verificar que no existe una diferencia significativa entre las variables y las puntuaciones de las escalas de cada grupo estudiado. La prueba de Mann-Whitney y el coeficiente de correlación de Spearman se utilizaron para examinar si existe una correlación significativa, y la intensidad de la correlación entre las variables (edad, los medicamentos en uso, índice de masa corporal, número de lesiones, el tiempo de las lesiones (años) tratamiento utilizado) y anota (total) de las escalas de Katz, Lawton y Tinetti de cada grupo. Los resultados de las características demográficas y socioeconómicas mostraron que hubo un predominio del sexo femenino (57,4%), con edades comprendidas entre 60 (57,4%), los ingresos familiares de entre 1 y 2 salarios mínimos (75,9%). Las características clínicas mostraron factores de riesgo, tales como largos períodos de pie o sentado (79,6%), antecedentes familiares de enfermedad venosa (53,7%), flebitis (37,0%). Las características generales sugieren la existencia de la obesidad I (42,6%), la presión normal de la sangre cuando (38,9%) y una glucosa en la sangre normal (55,6%). A cuadros a través de las características generales de las lesiones, la presencia de lesión MIE (38,9%) y MID (38,9%), la presencia de una sola lesión (68,5%) de un dos recurrencias (50 %) y la lesión por más de 10 años (50%). La evaluación funcional, fue identificado por Lawtom escala, la dependencia parcial (90,7%); la escala de Katz, la independencia ha sido identificado para todas las actividades (66,7%); y la escala de Tinetti, se evidencia un bajo riesgo de caídas (44,4%). Conclusión: El estudio mostró que existen limitaciones en los pacientes con úlceras venosas, los adultos y los ancianos de ambos sexos, pero las mujeres son las más afectadas, como es más común en los ancianos. En cuanto a la capacidad funcional, se demostró que, en las actividades de la vida diaria, sigue siendo más conservado que en otras actividades; en las actividades instrumentales de la vida y las actividades relacionadas con el equilibrio y la marcha diaria, hubo un porcentaje que se considera la dependencia parcial y el riesgo de caídas, lo que indica la necesidad de inversión del poder público y de los profesionales de la atención a estas cuestiones

[Cutaneous polyarteritis nodosa: A rare cause of chronic ulcers]. / Kutane Polyarteriitis nodosa : Eine seltene Ursache chronischer Ulzera.

Cutaneous polyarteritis nodosa, a special form of polyarteritis nodosa (PAN) without systemic involvement, is classified as one of the ANCA-negative vasculitides of small and medium-sized vessels. It is a very rare disease with unknown etiology and occurs more commonly in women over the age of 40. Typical skin lesions are subcutaneous nodules, livedo racemosa, and ulcerations. We report the case of a 46-year-old woman presenting to our outpatient department who reported having very painful ulcerations of the lower legs with unknown origin for 6 months.

Estilo de vida da pessoa com úlcera venosa: implicações no cuidado com a saúde / Lifestyle of the person with venous ulcer: implications for health care

Ainda nos dias atuais úlcera venosa é considerada como um problema de saúde pública causando prejuízos na vida do indivíduo que a possui e para a economia do país. Contudo, é notória a preocupação por parte da comunidade científica quanto ao estímulo às pesquisas com especialidades focadas para o desenvolvimento de produtos cada vez mais eficazes vislumbrando o processo de cicatrização e a cura. Independente da faixa etária acometida, a ferida pode gerar situações limitantes como odor, dor, a falta de mobilidade, interferindo assim no desenvolvimento de suas atividades diárias, podendo levar à exclusão social e a solidão. Assim, definimos como objeto de estudo: O estilo de vida de pessoas com úlcera venosa e suas implicações no cuidado em saúde. Como problema de pesquisa, apresentamos o seguinte questionamento: de que maneira o estilo de vida interfere no cuidado com a saúde da pessoa com úlcera venosa? Como questões de pesquisa: o estilo de vida adotado pelo indivíduo pode ser um fator que contribui para o desenvolvimento de úlcera venosa? Quais as formas do cuidado com saúde realizada pela pessoa com úlcera venosa? A pessoa com úlcera venosa necessita de cuidados apropriados e de forma resolutiva, com vista ao restabelecimento da saúde e o retorno as suas atividades cotidianas, pois o desenvolvimento da ferida pode trazer implicações aos usuários em relação ao tempo de cicatrização, refletindo em sua qualidade de vida além dos gastos aos cofres públicos. Como objetivos da pesquisa: Descrever as características socioculturais da pessoa com úlcera venosa e discutir a repercussão da úlcera venosa no do estilo de vida da pessoa com a ferida. Trata-se de uma pesquisa quantitativa, um estudo observacional do tipo transversal com análise descritiva. Trinta e cinco pessoas participaram da pesquisa respondendo um formulário com perguntas fechadas apresentando os seguintes: dados sócio demográficos, doenças pregressas, exame físico, crenças e religiosidade, residência (condições de moradia), integridade tissular/avaliação da ferida, palpação do pulso pedioso, como são realizados os curativos pelos sujeitos, aspectos relacionas, auto imagem corporal; todos com úlcera venosa, com idade entre 21 e 84 anos, moradores do município de Niterói- RJ, atendidos nas salas de curativos de duas Policlínicas de Saúde deste município. A escolha dos participantes ocorreu de forma probabilística casual, sem distinção de sexo. Os dados foram analisados através do programa estatístico R. Trata-se de um sistema o qual foi desenvolvido a partir da linguagem S (que também é usada numa versão comercial (o S-Plus). Com posse dos resultados obtidos, foi observado que 80% dos participantes apresentam úlcera venosa somente e 20% úlcera mista (arterial e venosa). Com relação às atividades laborais, 48,5% afirmam que estão aptos para realização do seu labor e 51,5% abandonaram seus empregos após o desenvolvimento da ferida. O estilo de vida adotado pode ser um fator colaborador para a manutenção de uma vida saudável, pois a maioria dos sujeitos compreende a sua importância. Todavia, a desgastante jornada de trabalho vivenciada pelos indivíduos, pouco favorece para a realização de atividade física e para adoção de uma dieta balanceada. O presente estudo buscou compreender o estilo de vida e suas implicações no cuidado em saúde da pessoa com úlcera venosa, com o intuito de contribuir para a ampliação de estudos focados nesta temática colaborando para formação e informação de enfermeiros, proporcionando o aprimoramento de seus conhecimentos, promovendo assim uma assistência holística e integral

Still nowadays Ulcus Cruris is considered as a public health problem causing damages in the life of the individual who has and for the country's economy. However, it is notorious the concern on the part of the scientific community regarding the stimulus to research with specialities focused to the development of increasingly effective products glimpsing the healing process and the cure. Regardless of the age group affected, the wound can generate limiting situations such as odor, pain, lack of mobility, thus interfering in the development of their daily activities, and can lead to social exclusion and loneliness. Thus, we define as object of study: the lifestyle of people with venous ulcer and its implications on health care. As a search problem, We present the following question: how lifestyle interferes with the person's health with Ulcus Cruris? As research issues: the lifestyle adopted by the individual may be a factor that contributes to the development of venous ulcer? What forms of health care held by the person with Ulcus Cruris? The person with Ulcus Cruris requires proper care and determined manner, with a view to the restoration of health and return their daily activities, because the development of the wound can bring users implications in relation to healing time, reflecting on their quality of life than spending to the public coffers. Research objectives: Describe the socio-cultural characteristics of the person with Ulcus Cruris and discuss the impact of the Ulcus Cruris in the lifestyle of the person with the wound. It is a quantitative research, an observational study of transverse type with descriptive analysis. Thirty-five people participated in the survey by answering a form with close-ended questions showing the following: socio demographic data, prior diseases, physical exam, beliefs and religiousness, residence (housing conditions), tissue integrity/evaluation of the wound, palpation of pulse pedioso, as are the bandages by subject, body image, auto-related aspects; all with Ulcus Cruris, aged 21 and 84 years, residents of the municipality of Niterói-RJ, served in the dressing rooms of two Polyclinics of Health of this municipality. The choice of participants of probabilistic form occurred irrespective of casual sex. Data were analyzed through the statistical program R. This system which was developed from the S language (which is also used in a commercial version (S-Plus). With the obtained results, it was observed that 80% of the participants present and only 20% venous ulcer Ulcer (arterial and venous) joint. With respect to industrial activities, 48.5% claim they are able to perform your labor and 51.5% abandoned their jobs after the development of the wound. The lifestyle adopted may be a contributor to the maintenance of a healthy life, because most guys understand its importance. However, the exhausting journey of work experienced by individuals, little favors for the realization of physical activity and a balanced diet. The present study sought to understand the lifestyle and its implications in the health care of the person with Ulcus Cruris, in order to contribute to the expansion of studies focused on this theme collaborating to training and information of nurses, providing improved their knowledge, thereby promoting a holistic and integral assistance

[The value of radial shock wave therapy in the management of extended crural ulceration. Case report]. / A radiális lökéshullám-kezelés szerepe a nagyméretu ulcus cruris gyógyításában.

The authors present the history of a 36-year-old woman who had crural ulceration in the ventral side of the left lower limb due to venous circulatory failure for 5 years. In addition to the application of dressing adapted to the actual status of the wound, the authors applied an extracorporal shock wave therapy two times per week. After this treatment the size of the ulcer significantly decreased and it became suitable for mesh-graft cover. The patient is currently asymptomatic. The authors draw attention to the fact that the number of patients having crural ulcer is increasing in developed countries including Hungary. Lower limb ulcers occur in 1-5% of the adult population. Predisposing factors include older age and civilization hazards such as obesity, diabetes and sedentary lifestyle. The main cause of the disease is circulatory failure; venous insufficiency occurs in about two-thirds of the patients, arterial ischemia in 15% and diabetic angiopathy in 15% of the cases. Infections, metabolic diseases and immunological disorders may be also an underlying cause in a small number of patients. In several patients the causative factors occur simultaneously making difficult to find and effective treatment. Despite the use of numerous preventive and therapeutic protocols, treatment is usually long and does not always match expectations of the patients.