Evidências para tratamento tópico de úlceras de pé em diabéticos

Abstract

The foot ulcer in people with diabetes mellitus (DM) is a matter of prevalent and severe health around the world. The diabetic usually develops a lesion that requires specific care from the health professionals. The topical treatment is done using bandages that are consi dered important components of the ulcer treatment with different kinds of presentation availa ble for the choice of the professional and patient. Nowadays there are in the market several resources for wound treatment. The objective of this study is to establish recommendations based on evidence for the topical treatment of foot ulcers in diabetics. It is an integrated revi sion and has as the theoretical reference the practice based on evidence. Supported by PICO the guiding question was established: What are the scientific evidences available in the litera ture related to treatment of topical ulcers on diabetic foot? The search of the studies was done, electronically, by the Virtual Health Library (BVS) in which was investigated the MEDLINE, LILACS and Cochrane bases. The sample was composed by ten studies that met the inclusion and exclusion criteria. The year of publication varied from 2001 to 2011, 40% were published from 2009. The researches were done in several countries, with predominance in the ones localized in the European Continent, in 80% the sample was not calculated in priori, and it varied from 12 to 317 diabetics, in 60% did not surpass 40 patients. The majority of the pa tients presented only one lesion. In 60% of the studies, the arterial commitment was dis carded, 50% made explicit the use of the Wagner Classification for the inclusion of lesion in the research. Four studies included lesions classified in first and second degree, ulcers from first to third degree and second and third degree. The time of observation of the patients va ried from 21 to 168 days (24 weeks). The evaluated products were diverse, 60% evaluated interactive bandage (hydrofiber with or without silver polyurethane foam, impregnated mesh with povidone iodine) and 10%, bioactive bandage. Other studies evaluated the association of polyherbal, powder phenytoin in 2% and microbial membrane. The cure of the lesions was superior with hydrofiber without silver and when associated with silver, the results were simi lar when compared to calcium alginate. The cure was partial with polyurethane foam with silver, collagen and regenerated cellulose and non-adherent mesh impregnated with povidone iodine and polyherbal medicine. The microbial cellulose membrane offered a reduction of 1,7 times in comparison to the petrolatum gauze. The signs of infection improved with the bioac tive bandage, carboxymethylcellulose without silver and topical phenytoin. Due to the fragili ty of the methods presented by the studies, it can be affirmed only that the use of interactive bandage suggests the improvement of the cure rate, reduction of the area and signs of infec tion. Among the interactive bandages the hydrofiber showed some superiority.