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      Efeitos da terapia física descongestiva na cicatrização de úlceras venosas Translated title: Effects of the decongestive physiotherapy in the healing of venous ulcers Translated title: Efectos de la terapia física descongestiva en la cicatrización de úlceras venosas

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          Abstract

          Objetivou-se neste estudo verificar os efeitos da terapia física descongestiva (TFD) na cicatrização de úlceras venosas. Trata-se de um estudo intervencionista, quase experimental, do qual participaram 20 clientes, divididos em 2 grupos: o grupo controle (n=10) e o grupo de intervenção (n=10). Os clientes do primeiro grupo foram tratados apenas com curativo convencional e os do segundo grupo, com curativo convencional e terapia física descongestiva (associação de técnicas: drenagem linfática manual, enfaixamento compressivo, elevação dos membros inferiores, exercícios miolinfocinéticos e cuidados com a pele). Ambos os grupos foram tratados durante seis meses. Os clientes submetidos à TFD apresentaram significante redução de edema e da dor, além de melhora no processo cicatricial. Os resultados permitiram verificar que a terapia descongestiva estimula o processo de cicatrização de úlceras venosas, melhorando a qualidade de vida dos indivíduos.

          Translated abstract

          The objective of this study was to verify the effects of the decongestive physiotherapy (DP) in the healing of venous ulcers. It is an interventionist, and almost experimental, study with the participation of 20 clients who were divided into 2 groups: the control group (n=10) and the intervention group (n=10). Clients from the first group were only treated with conventional dressing and those in the second group were treated with conventional dressing and decongestive physiotherapy (association of techniques: manual lymph drainage, compressive bandaging, elevation of the lower limbs, myolymphokinetic exercises and skin care). Both groups were treated during six months. The clients submitted to DP presented significant reduction of the edema and the pain, besides an improvement in the healing process. Results allowed to verify that the decongestive therapy stimulated the healing process of venous ulcers, improving the quality of life of the subjects.

          Translated abstract

          En este estudio se objetivó verificar los efectos de la terapia física descongestiva (TFD) en la cicatrización de úlceras venosas. Se trató de un estudio intervencionista, casi experimental, del cual participaron veinte pacientes que constituyeron dos grupos: el grupo control (n=10) y el grupo de intervención (n=10). Los pacientes del primer grupo fueron tratados apenas con curaciones convencionales, mientras que los del segundo grupo recibieron curación convencional y terapia física descongestiva (asociación de técnicas: drenaje linfático manual, fajamiento compresivo, elevación de los miembros inferiores, ejercicios miolinfocinéticos y cuidados con la piel). Ambos grupos fueron tratados durante seis meses. Los pacientes sometidos a TFD presentaron significativa reducción de edema y dolor, y mejora en el proceso cicatricial. Los resultados permitieron verificar que la terapia descongestiva estimula el proceso de cicatrización de úlceras venosas, mejorando la calidad de vida de los individuos.

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          Most cited references20

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          Risk factors for chronic venous insufficiency: a dual case-control study.

          Most epidemiologic studies on chronic venous insufficiency (CVI) are cross-sectional surveys that suggest potential risk factors by describing their population. However, these relationships could be due to the CVI population's older age. We performed a dual case-control study with multivariate analysis to address this issue.
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            A brief history of wound care.

            Since the caveman, man has been tending to his wounds. Wound care evolved from magical incantations, potions, and ointments, to a systematic text of wound care and surgery from Hippocrates and Celsus. These advances were lost after the fall of the Roman Empire. In Europe, the Middle Ages were a regression of wound care back to potions and charms. It was'nt until the time of large armies using muskets and cannons that surgical wound care emerged again. This article will briefly highlight major milestones in wound care.
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              Compression for venous leg ulcers.

              Around one percent of people in industrialised countries will suffer from a leg ulcer at some time. The majority of these leg ulcers are due to problems in the veins, resulting in an accumulation of blood in the legs. Leg ulcers arising from venous problems are called venous (varicose or stasis) ulcers. The main treatment has been a firm compression garment (bandage or stocking) in order to aid venous return. There is a large number of compression garments available and it is unclear whether they are effective in treating venous ulcers and which compression garment is the most effective. To undertake a systematic review of all randomised controlled trials of the clinical effectiveness of compression bandage or stocking systems in the treatment of venous leg ulceration.Specific questions addressed by the review are:1. Does the application of compression bandages or stockings aid venous ulcer healing? 2. Which compression bandage or stocking system is the most effective? For this update we searched the Cochrane Wounds Group Specialised Register (14/10/08); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4 2008); Ovid MEDLINE (1950 to October Week 1 2008); Ovid EMBASE (1980 to 2008 Week 41) and Ovid CINAHL (1982 to October Week 1 2008). No date or language restrictions were applied. Randomised controlled trials recruiting people with venous leg ulceration that evaluated any type of compression bandage system or compression hosiery were eligible for inclusion. Comparators included no compression (e.g. primary dressing alone, non-compressive bandage) or an alternative type of compression. Trials had to report an objective measure of ulcer healing in order to be included (primary outcome for the review). Secondary outcomes of the review included ulcer recurrence, costs, quality of life, pain, adverse events and withdrawals. There was no restriction on date, language or publication status of trials. Details of eligible studies were extracted and summarised using a data extraction table. Data extraction was performed by one review author and verified independently by a second review author. Overall, 39 RCTs reporting 47 comparisons were included.Review question 1: there was reasonable evidence from seven RCTs that venous ulcers heal more rapidly with compression than without.Review question 2: findings from six trials of single-component compression suggested that this strategy was less effective than multi-component compression. Evidence from compression systems with two components (3 trials) and three components (4 trials) suggested better outcomes when an elastic component was included. Different versions of compression with four-components (based on the Charing Cross four-layer bandage system) have similar effectiveness (3 trials). Compression with four components (variants of the Charing Cross four-layer bandage) is more effective than multi-component compression that includes a short-stretch bandage (6 trials). It is difficult to determine the relative effectiveness of the four-layer bandage compared with paste bandage systems because of differences in the paste systems (5 trials). There was no difference in effectiveness between the adjustable compression boot and compression bandages (2 trials) or between single-layer compression stockings and paste bandages (2 trials). Two-layer stockings appeared more effective than the short-stretch bandage (2 trials). The relative effectiveness of tubular compression when compared with compression bandages was not clear from current evidence (2 trials).Three trials reported ulcer recurrence; because of sparseness of data and trials not being primarily designed to assess this outcome, firm conclusions could not be drawn. Although several trials included cost data, only one reported a rigorously conducted cost-effectiveness analysis with findings suggesting that the four-layer bandage was more cost-effective than multi-component compression comprising a short-stretch bandage. Seven trials assessed health-related quality of life and none observed significant differences between treatment groups. Several trials evaluated pain either as a stand-alone outcome, or as part of the assessment of adverse events. In general, the data did not indicate clear differences between treatment groups. It is possible that stockings could be associated with less pain than bandages but in view of scarcity of available data this requires further evaluation. Many of the trials reported adverse events and / or withdrawals. Overall, these outcomes appeared similar across different treatment groups. Compression increases ulcer healing rates compared with no compression. Multi-component systems are more effective than single-component systems. Multi-component systems containing an elastic bandage appear more effective than those composed mainly of inelastic constituents.
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                Author and article information

                Journal
                reeusp
                Revista da Escola de Enfermagem da USP
                Rev. esc. enferm. USP
                Universidade de São Paulo, Escola de Enfermagem (São Paulo, SP, Brazil )
                0080-6234
                1980-220X
                December 2010
                : 44
                : 4
                : 1085-1092
                Affiliations
                [02] Jequié BA orgnameUniversidade Federal do Rio Grande do Norte Brasil
                [04] Natal RN orgnameUniversidade Federal do Rio Grande do Norte Brasil gvt@ 123456ufrnet.br
                [06] Jequié BA orgnameSociedade Brasileira de Geriatria e Gerontologia Brasil
                [01] orgnameUniversidade Estadual do Sudeste da Bahia orgdiv1Departamento de Saúde
                [10] Jequié BA orgnameUniversidade Estadual do Sudeste da Bahia orgdiv1Departamento de Saúde Brasil
                [03] orgnameUniversidade Federal do Rio Grande do Norte orgdiv1Departamento de Enfermagem
                [05] orgnameUniversidade Estadual do Sudoeste da Bahia orgdiv1Departamento de Saúde
                [09] orgnameUniversidade Federal do Rio Grande do Norte
                [08] Jequié BA orgnameCuidados Fisioterapêuticos nas Ulcerações dos Membros Inferiores Brasil
                [07] orgnameUniversidade Estadual do Sudeste da Bahia orgdiv1Departamento de Saúde
                Article
                S0080-62342010000400033 S0080-6234(10)04400433
                10.1590/S0080-62342010000400033
                0d1b847c-99e2-41af-a496-f80fb912f7f0

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 02 December 2008
                : 02 April 2010
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 8
                Product

                SciELO Revista de Enfermagem

                Categories
                Artigo Original

                Varicose ulcer,Wound healing,Physical therapy modalities,Nursing care,Úlcera varicosa,Cicatrización de heridas,Modalidades de terapia fisica,Cuidados de enfermería,Cicatrização de feridas,Modalidades de fisioterapia,Cuidados de enfermagem

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