Noninvasive measures of venous ulcer recurrence prevention: integrative review

Objective: This study aimed to identify, in the literature, noninvasive measures for prevention of venous ulcer recurrence (VUs). Methods: An integrative review was carried out in the databases of the Biblioteca Virtual em Saúde (BVS), Public Medline (PubMed), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Excerpta Medica Database (Embase) in the period from 2015 to 2017. the search was performed using the controlled descriptors «varicose ulcer» and «recurrence» and the Boolean operator AND between them in all databases described, in Portuguese, English, and Spanish. After the searches, two reviewers carried out the pre-selection by titles and summary of the articles followed by the full reading of the pre-selected studies. Results: 210 studies were identified, of which 188 were excluded because they did not attend to the guiding question. Two reviewers read in full the 22 pre-selected articles and included in this review nine that were part of the discussion of this paper. Conclusion: Studies in this review suggest that adherence and correct use of compressive therapy with socks associated with education and self-care measures are effective in preventing recurrence of VU. The association of acetylsalicylic acid with standard measures of treatment still lacks conclusive results and new studies to prove efficacy are suggested.

Medidas não invasivas de prevenção da recidiva de úlcera venosa: revisão integrativa

Objetivo: Este estudo teve como objetivo identificar, na literatura, as medidas não invasivas de prevenção da recidiva de úlceras venosas (UVs). Método: Realizou-se revisão integrativa nas bases de dados da Biblioteca Virtual em Saúde (BVS), Public Medline (PubMed), Cumulative Index of Nursing and Allied Health Literature (CINAHL) e Excerpta Medica dataBASE (Embase) no período de 2015 a 2017. A busca bibliográfica foi realizada utilizando-se os descritores controlados “varicose ulcer” e “recurrence” e o operador booleano AND entre eles em todas as bases de dados descritas, em português, inglês e espanhol. Após as buscas, dois revisores realizaram a pré-seleção por títulos e resumo dos artigos seguida da leitura na íntegra dos estudos pré-selecionados. Resultado: Identificaram-se 210 estudos, sendo que 188 foram excluídos por não atenderem à questão norteadora. Dois revisores leram na íntegra os 22 artigos pré-selecionados e incluíram nesta revisão nove que fizeram parte da discussão deste trabalho. Conclusão: Os estudos desta revisão sugerem que a adesão e o uso correto da terapia compressiva com meias associados a medidas de educação e autocuidado são efetivos para prevenção de recidiva da UV. A associação de ácido acetilsalicílico com as medidas padrão de tratamento ainda carece de resultados conclusivos e sugerem-se novos estudos para comprovação da eficácia.

Using bioelectrical impedance analysis to compare the treatment of edema with the Unna's boot and noncompression in individuals with venous ulcers

Venous insufficiency is related to aging. Edema, pathological evolution of venous insufficiency, favors the appearance of venous ulcers as the main complication. Leg ulcers can be treated with compression, the Unna's boot being one of them, and noncompression therapies (conventional dressing). Bioelectrical impedance analysis accurately measures the patient's body fluids. The objective of this study was to evaluate the edema evolution of the venous ulcer-affected lower limb by means of electric bioimpedance with the use of Unna's boot and noncompressive dressing. Fifteen legs with active ulcers were treated from September 2014 to December 2016. The legs were treated with Unna's boot and noncompression therapies on different days with randomized order of events. Bioimpedance was performed in the morning and afternoon to evaluate the increase in edema over the day. All patients were female with ages ranging from 50 to 76 years (mean age: 63 years). According to bioimpedance, the volume of the legs increased with both types of therapy. However, compression therapy was significantly more effective than noncompression therapy. Bioimpedance confirmed that compression therapy (Unna's boot) gives better results than noncompression therapy in relation to the formation of edema over a day in patients with chronic venous ulcers.