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Advisor(s)
Abstract(s)
Introdução: Nas últimas décadas, a prevalência da diabetes mellitus tipo 2 aumentou
explosivamente, acompanhando o drástico crescimento da obesidade. No espetro das
complicações associadas à diabetes, destaca-se o pé diabético, definido como o conjunto de
alterações estruturais ou funcionais do pé, incluindo a ulceração, infeção e/ou gangrena,
que precede cerca de 85% das amputações de membro inferior. A sua etiologia é
multifatorial, coexistindo, geralmente, neuropatia periférica, doença vascular periférica,
anomalias biomecânicas e exposição a traumatismos repetidos. O diagnóstico precoce é
fundamental para a estratificação do risco, bem como a sua prevenção. O tratamento
convencional engloba o desbridamento, o uso de pensos, a diminuição da pressão local,
antibióticos, na presença de infeção e revascularização, nos casos de isquemia.
Recentemente, têm surgido uma variedade de terapêuticas adjuvantes, entre as quais a
terapia de pressão negativa, um método não invasivo, que promove a cicatrização de feridas,
através de vários mecanismos: estimulando a formação de tecido de granulação, removendo
o exsudado, melhorando a oxigenação tecidual e reduzindo a carga bacteriana. O objetivo
deste trabalho foi avaliar a eficácia da terapia de pressão negativa, no tratamento das úlceras
de pé diabético, comparativamente aos tratamentos tópicos convencionais.
Metodologia: Foi efetuada uma pesquisa bibliográfica no motor de busca PubMed para
identificar ensaios clínicos sobre a terapia de pressão negativa, nas úlceras de pé diabético,
utilizando os termos “diabetic foot” com “negative pressure”, “negative pressure wound
therapy” ou “VAC therapy”. Foram, ainda, consultadas as listas de referências bibliográficas
dos artigos identificados.
Resultados: Foram identificados 14 ensaios clínicos. A maioria destes revelou uma
superioridade da terapia de pressão negativa face à terapia tópica convencional,
destacando-se, nomeadamente, uma maior taxa de encerramento, um menor tempo até ao
encerramento completo da úlcera, uma diminuição mais significativa das dimensões da
lesão, bem como uma formação de tecido de granulação saudável mais rápida. Alguns
estudos atestaram, ainda, a segurança deste método, não se demonstrando uma maior taxa
de eventos adversos, comparativamente aos pensos tradicionais.
Discussão/Conclusão: A terapia de pressão negativa apresenta uma eficácia superior aos
pensos utilizados convencionalmente, pelo que pode desempenhar um papel adjuvante de
destaque na gestão das úlceras diabéticas neuropáticas, já que nas isquémicas a sua
utilização necessita de ser estudada mais extensamente. Porém, os estudos analisados
apresentam limitações, nomeadamente amostras pequenas, pelo que são necessários estudos de maiores dimensões para o estabelecimento de um benefício definitivo da
aplicação de pressão negativa nas úlceras de etiologia diabética.
Introduction: In the last decades, the prevalence of type 2 diabetes has increased explosively, following the drastic growth of obesity. In the spectrum of diabetes-related complications, the diabetic foot stands out, defined as the set of structural or functional changes of the foot, including ulceration, infection and / or gangrene, which precedes about 85% of lower limb amputations. Its etiology is multifactorial, generally coexisting peripheral neuropathy, peripheral vascular disease, biomechanical abnormalities and exposure to repeated trauma. Early diagnosis is essential for risk stratification, as well as its prevention. The conventional treatment is based on debridement, use of dressings, avoidance of increased local pressure, antibiotics, in the presence of infection and revascularization, in cases of ischemia. Recently, a variety of adjuvant therapies have emerged, including negative pressure therapy, a non-invasive method, that promotes wound healing through various mechanisms: stimulating the formation of granulation tissue, removing exudate, improving tissue oxygenation and reducing the bacterial load. The aim of this work was to evaluate the effectiveness of negative pressure therapy, in the treatment of diabetic foot ulcers, comparatively to conventional topical dressings. Methodology: A bibliographic search was performed in the PubMed search engine to identify clinical trials on negative pressure wound therapy in diabetic foot ulcers, using the terms "diabetic foot" with "negative pressure", "negative pressure wound therapy" or "VAC therapy”. The lists of bibliographic references of the articles identified were also consulted. Results: 14 original articles were identified, where the majority revealed a superiority of negative pressure wound therapy compared to conventional topical therapy, highlighting, namely, a higher rate of closure, a shorter time until complete ulcer closure, a more significant reduction of the ulcer’s dimensions, as well as faster granulation tissue formation. Some studies have also attested the safety of this method, without evidence of a higher rate of adverse events, compared to traditional dressings. Discussion / Conclusion: Negative pressure wound therapy is more effective than dressings used conventionally, so it can play a prominent adjuvant role in the management of diabetic neuropathic ulcers, since its use in ischemic wounds needs to be studied more widely. However, the studies have limitations, namely a small sample, so larger studies are needed to establish a definite benefit from the application of negative pressure on diabetic ulcers.
Introduction: In the last decades, the prevalence of type 2 diabetes has increased explosively, following the drastic growth of obesity. In the spectrum of diabetes-related complications, the diabetic foot stands out, defined as the set of structural or functional changes of the foot, including ulceration, infection and / or gangrene, which precedes about 85% of lower limb amputations. Its etiology is multifactorial, generally coexisting peripheral neuropathy, peripheral vascular disease, biomechanical abnormalities and exposure to repeated trauma. Early diagnosis is essential for risk stratification, as well as its prevention. The conventional treatment is based on debridement, use of dressings, avoidance of increased local pressure, antibiotics, in the presence of infection and revascularization, in cases of ischemia. Recently, a variety of adjuvant therapies have emerged, including negative pressure therapy, a non-invasive method, that promotes wound healing through various mechanisms: stimulating the formation of granulation tissue, removing exudate, improving tissue oxygenation and reducing the bacterial load. The aim of this work was to evaluate the effectiveness of negative pressure therapy, in the treatment of diabetic foot ulcers, comparatively to conventional topical dressings. Methodology: A bibliographic search was performed in the PubMed search engine to identify clinical trials on negative pressure wound therapy in diabetic foot ulcers, using the terms "diabetic foot" with "negative pressure", "negative pressure wound therapy" or "VAC therapy”. The lists of bibliographic references of the articles identified were also consulted. Results: 14 original articles were identified, where the majority revealed a superiority of negative pressure wound therapy compared to conventional topical therapy, highlighting, namely, a higher rate of closure, a shorter time until complete ulcer closure, a more significant reduction of the ulcer’s dimensions, as well as faster granulation tissue formation. Some studies have also attested the safety of this method, without evidence of a higher rate of adverse events, compared to traditional dressings. Discussion / Conclusion: Negative pressure wound therapy is more effective than dressings used conventionally, so it can play a prominent adjuvant role in the management of diabetic neuropathic ulcers, since its use in ischemic wounds needs to be studied more widely. However, the studies have limitations, namely a small sample, so larger studies are needed to establish a definite benefit from the application of negative pressure on diabetic ulcers.
Description
Keywords
Diabetes Encerramento Assistido Por Vácuo Endocrinologia Pé Diabético Pressão Negativa Terapia de Feridas Por Pressão Negativa