Evaluation of arterial circulation using the ankle/brachial blood pressure index in patients with chronic venous ulcers

Anais Brasileiros de Dermatologia (Impact Factor: 0.72). 03/2006; 81(2):131-135. DOI: 10.1590/S0365-05962006000200003

ABSTRACT FUNDAMENTOS: As úlceras venosas dos membros inferiores são freqüentes e têm grande impacto na qualidade de vida e produtividade do indivíduo, além de alto custo para a saúde pública. OBJETIVOS: Detecção de alterações arteriais em pacientes de úlcera venosa crônica dos membros inferiores com emprego de método não invasivo, de modo a discriminar aqueles em que estaria contra-indicado o tratamento compressivo. MÉTODOS: Foram estudados 40 doentes portadores de úlcera venosa crônica, com o intuito de se avaliar a presença de doença arterial periférica pela medida do índice tornozelo/braço por doppler-ultra-som. RESULTADOS: O índice tornozelo/braço mostrou-se alterado (menor que 1) em 9/22 (40,9%) doentes com úlcera venosa crônica e hipertensão arterial concomitante, e apenas em 1/13 (7,7%) doentes de úlcera venosa crônica sem hipertensão arterial. CONCLUSÕES: Doentes de úlcera venosa crônica e hipertensão arterial concomitantes devem ser submetidos rotineiramente à medida do índice tornozelo/braço para detecção de possível insuficiência arterial periférica associada.

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    ABSTRACT: Nurses are active participants in caring for people with wounds and use their systematic knowledge to plan care. However, to apply adequate treatment, nurses need efficient tools to assess their patients' conditions. The purpose of this study was to characterize the tissue integrity and perfusion of the lower limbs of patients with venous ulcers based on Nursing Outcomes Classification (NOC) indicators. This cross-sectional, exploratory and descriptive study consisted of questionnaire information and physical examination of 49 patients with venous ulcers monitored in an outpatient clinic in the metropolitan region of Maracanaú. The statistical software package SPSS v. 13.0 was used to store and process data. Female patients were predominant; most were 60 years old or older and most were retirees or pension holders living with their partners. Growth of hair and peripheral edema were the most critical operational indicators. The nursing outcome indicators for tissue integrity and perfusion were shown to be moderately compromised. The variable representing age was shown to be inversely related to tissue integrity. The presence of heart disease was also shown to influence tissue integrity. The diastolic blood pressure variable showed a negative correlation with tissue perfusion. The assessment of tissue integrity and perfusion based on NOC indicators presented as advantages the possibility of examining several characteristics of the skin from the many operational indicators, the adaptation of parameters according to the study's results and the quantification of the compromise of these outcomes.
    Journal of vascular nursing: official publication of the Society for Peripheral Vascular Nursing 03/2010; 28(1):14-20. DOI:10.1016/j.jvn.2009.11.001
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    ABSTRACT: Background: Disability and pain were assessed in patients with venous leg ulcers treated with split-thickness skin grafts to evaluate to what extent skin grafting improves functional status in this population. Methods: A prospective, nonrandomized, multicenter case-control study was conducted from July 2008 to December 2010 in two hospitals in Brazil. One hundred patients with venous leg ulcers were divided into two treatment groups of 50 patients each: the control group (conservative treatment) and the surgery group (skin grafting). Patients were assessed at baseline (day 0) and on days 30, 90, and 180. Disability was measured with the Disability Index of the Health Assessment Questionnaire (HAQ-DI). The visual analog scale (VAS) and McGill Pain Questionnaire (MPQ) were used to assess pain. Results: Surgery group patients reported significantly lower (p = 0.0001) overall HAQ-DI scores (lower disability levels) 180 days postoperatively (HAQ-DI = 0.18) compared with baseline (HAQ-DI = 2.65); mean overall HAQ-DI scores for control patients was 1.70 on day 180, with a significant difference between groups (p = 0.0001). The surgery group showed significant improvement on all HAQ-DI categories and reported significantly lower pain intensity (VAS pain scores) on days 30, 90, and 180 compared with controls (p = 0.0001). The MPQ was used to assess the sensory, affective, evaluative, and miscellaneous dimensions of pain in the two groups; there were significant differences between groups on days 30, 90, and 180 (p = 0.0001). Conclusions: Patients with venous leg ulcers treated with split-thickness skin grafts showed improvement in functional status compared with controls.
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    ABSTRACT: The assessment of health-related quality of life in patients with venous leg ulcers provides important information for clinical decision making, evaluation of therapeutic benefits, and prediction of survival probabilities. Health-related quality of life and self-esteem were assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Rosenberg self-esteem (RSE) scale, respectively, in patients with venous leg ulcers treated with split-thickness skin grafts. One hundred patients with venous leg ulcers and indication for skin grafting were divided into two groups of 50 patients each: the control group (patients who received conservative treatment) and surgery group (patients who received split-thickness skin grafts). Patients in the surgery group reported significantly higher SF-36 scores (better health status) than controls one month after surgery, as well as 90 and 180 days postoperatively (p < 0.002). The mean total RSE score was significantly lower (indicating higher self-esteem) in the surgery group (mean RSE score, 17.54) than in the control group (mean RSE score, 24.22). Split-thickness skin grafting resulted in better health-related quality of life and self-esteem in patients with venous leg ulcers than did compression therapy with Unna's boot.
    World Journal of Surgery 09/2013; 38(1). DOI:10.1007/s00268-013-2228-x · 2.64 Impact Factor

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