Uso da eletroestimulação de alta voltagem na cicatrização de úlceras venosas / Use of high voltage electrical stimulation in healing of venous ulcers

INTRODUÇÃO: A utilização de correntes exógenas como a eletroestimulação de alta voltagem provoca aumento das cargas elétricas no tecido, promovendo efeitos fisiológicos favoráveis que disparam o processo de reparação tecidual. OBJETIVO: Verificar as variações nas áreas das úlceras venosas após a utilização da estimulação elétrica de alta voltagem. MÉTODO: Estudo prospectivo, randomizado e simples cego em que seis indivíduos portadores de úlcera venosa foram divididos aleatoriamente em 2 grupos de tratamento, nos quais foram usados a estimulação elétrica de alta voltagem (20ìs; 100Hz) por 30 minutos em três dias alternados na semana, até atingirem 24 aplicações, sendo o parâmetro da voltagem modulado em zero para o grupo controle e 180 V para o grupo experimental. O programa Autocad foi utilizado para o cálculo das áreas que foram analisadas pelos testes estatísticos de Wilcoxon e Mann-Whitney, com nível de significância de pd"0,05. RESULTADOS: observou-se que não houve diferença estatisticamente significativa entre as áreas das úlceras nos dois grupos pesquisados (p=0,3287), sendo que em apenas um paciente não ocorreu diminuição das áreas das úlceras. CONCLUSÃO: Percebeu-se que a utilização da eletroestimulação de alta voltagem em úlceras venosas de membros inferiores foi ineficaz no tratamento dos pacientes pesquisados.

INTRODUCION: The use of external currents through the high voltage electrical stimulation provokes an increase of electric charges on cells, exercising favorable physiologic effectsthat shoot the process of cellular repairing. OBJECTIVE: to verify the variations in the areas of the venous ulcers after the use of the electrical stimulation of high voltage. METHOD: study prospective, randomized and blind in that six individuals with venous ulcer were divided randomly in 2 groups for treatment and used high voltage electrical stimulation (20μs; 100Hz), 30 minutes of application in three alternate days in the week, until reach 24 applications. The parameter of the voltage was modulated in zero for the group control and 180V for the experimental group. The software Autocad® was used for the calculation ofthe areas, that were analyzed by the statistical tests of Wilcoxon and Mann-Whitney, with level of significant of pd” 0.05. RESULTS: observed that there was no statistically significantdifference between the areas of ulcers in the two groups searched (p = 0.3827), and in just a patient didn’t happen decrease of the areas of the ulcers. CONCLUSION: noticed that theuse of the electrical stimulation of high voltage in venous ulcers of inferior members was ineffective in the treatment of studied patients.

Techniques for covering soft tissue defects resulting from plantar ulcers in leprosy: Part IV - use of medial leg flap and medial knee flap

The medial leg flap, based on the cutaneous branches of the posterior tibial artery is raised from the middle and lower regions of the medial aspect of the leg. It has a long pedicle, and it can be used as a free flap to reconstruct the distant soft tissue and also as an island flap. We have used this retrograde island flap for a surfacing ulcerated areas in six leprosy patients. The flap survived in all cases. At 24 to 60 months follow up examination, ulceration had not recurred in any for them. The medial knee flap consisting of the skin and subcutaneous tissu of lower part of the medial side of the thih and upper part the leg, is suitable for covering soft tissue cushion defects of the extremities because of the constant vessels, long pedicle, wide diameter, well recognizable sensory nerves and less subcutaneous fat. We have used the medial knee flap for the resurfacing sizeable raw areas due to ulceration in there leprosy patients. the flap survived in all cases there was no recurrence of ulceration duriong the 70-148 months follow up period

Lower extremity amputation in scleroderma.

Scleroderma or Systemic Sclerosis (SSC) is a disorder characterized by fibrosis of the skin and multiple internal organs. The pathological lesion is a triad of small artery intimal proliferation, medial thinning and adventitial scarring. Autoamputation of fingers and toes is often seen, but only a few cases of limb amputation in scleroderma patients have been reported. The Pittsburgh Scleroderma databank includes 1,030 patients with SSC. Among these were seven patients who sustained lower limb amputation. There were four patients with the CREST variant of SSC, two with diffuse scleroderma, and one who had SSC/rheumatoid arthritis/polymyositis overlap who sustained limb amputation. Of the seven, three were male and five had a significant smoking history. Ages ranged from 46 to 71 years. All patients underwent amputation for nonhealing ulcerations. No problems with postoperative wound healing were seen. Pathologic changes typical of SSC in addition to atherosclerotic peripheral vascular disease were described in one case. Three patients were successfully fitted with prostheses and became independent ambulators. Four patients could not be fitted with prostheses. No skin problems were reported related to prosthetic use. Our review demonstrates that SSC patients who undergo amputation can become successful prosthetic users and should be considered for prosthetic prescription.