OBJETIVO: Analisar os resultados obtidos no Serviço de Cirurgia Geral do Hospital Universitário Cajuru - PUCPR, com o tratamento da gangrena de Fournier. MÉTODOS: Foram revisados os prontuários de 40 pacientes com diagnóstico de Gangrena de Fournier internados no hospital universitário Cajuru de Novembro de 1999 a Abril de 2006, analisando-se as variáveis: sexo, idade, fatores predisponentes, etiologia, localização da lesão, exames laboratoriais, procedimentos cirúrgicos realizados, antibioticoterapia e utilização de câmara hiperbárica. RESULTADOS: A etiologia mais comum foi de origem anorretal. O agente etiológico mais prevalente foi a E. coli. O fator predisponente predominantes foi a diabetes mellitus, A maioria dos pacientes eram do sexo masculino. A localização e extensão da lesão mais freqüente foi a perineal. Todos foram submetidos à desbridamento cirúrgico, 17 à colostomia e dois à cistostomia. Todos os pacientes utilizaram antibiótico, sendo os mais usados: metronidazol e gentamicina. Vinte e seis pacientes submeteram-se à terapia hiperbárica. A mortalidade global foi de 20%. CONCLUSÃO: A Síndrome de Fournier, apesar de todos os avanços terapêuticos atuais, continua apresentando altos índices de mortalidade. O reconhecimento precoce da infecção associado a tratamento agressivo e invasivo são medidas essenciais para se tentar diminuir esses índices prognósticos.

With one person dying from diabetes-related preventable complications, including foot complications, every 7 seconds across the world, it is clear this is a major health challenge. Foot ulceration in diabetes remains the commonest reason for hospital admission in Western countries. From neuropathy to peripheral vascular disease, the challenges are significant and can result in premature death, but early diagnosis by aware health-care professionals, combined with supporting people in self-care, can help reduce the problems of diabetes to manageable proportions.

Objective: to evaluate the use of the 2D-FlexRuler as a facilitating tool for the early calculation of the predictive scar factor of chronic wounds. Method: a descriptive study with a quantitative, experimental, longitudinal and prospective approach. The sample consisted of 22 outpatients. 32 chronic wounds were analyzed. The wound edges were identified and drawn on the 2D-FlexRuler. The calculations of the areas of chronic wounds were obtained by manual, traditional methods, by software and Matlab algorithm. These areas were compared with each other to determine the efficiency of the proposed ruler in relation to traditional methods. Results: the calculation of the wound area by the traditional method and Kundin’s coefficient show average errors greater than 40%. The manual estimation of the area with the 2D-FlexRuler is more accurate in relation to traditional measurement methods, which were considered quantitatively disqualified. When compared with the reference method, for example, the Klonk software, the data obtained by 2D-FlexRuler resulted in an error of less than 1.0%. Conclusion: the 2D-FlexRuler is a reliable metric platform for obtaining the anatomical limits of chronic wounds. It facilitated the calculation of the wound area under monitoring and allowed to obtain the scar predictive factor of chronic wounds with precocity in two weeks.

Objective: We evaluated the effects of a specialised oral nutritional supplement (ONS) containing arginine and proline, with high vitamin A, C and E, zinc and selenium content, on the repair of hard-to-heal wounds. Method: Patients with hard-to-heal wounds were evaluated at five timepoints (S0–S4) over four consecutive weeks. At S0 patients were randomised to the specialised ONS (n=15; 25 wounds) or control (n=15; 25 wounds) groups. Posology was 200ml twice daily over the research period. Wound surface area and perimeter were monitored. In addition to the metric data, it was also possible to calculate the rate of wound contraction and the linear growth of the wound edges, looking for wound-healing predictive factors. Results: A total of 30 patients took part in the study. Mean age was 65 years and 50% of patients had diabetes. Of the total evaluated wounds, 78% were <50cm2, 14% were 50–150cm2 and 8% were >250cm2. In 96% of cases, the wounds were in the lower limbs. A statistically significant reduction (p=0.004) in surface area of the wounds due to the specialised ONS, with a performance peak between S1 and S2, was observed. This specialised ONS did not induce changes in blood pressure, blood glucose level or renal function. A mean weekly wound edge growth of 1.85mm in patients with diabetes and 3.0mm in those without diabetes was observed. These results were 2.9 and 4.6 times, respectively, higher than expected, according to the literature. Conclusion: Specialised ONS can be a therapeutic option for hard-to-heal wounds.

Pressure ulcer (PU) can be classified according to tissue impairment, etiology, healing time and tissue characteristics. Currently, it is the third type of adverse event most reported by the patient safety centers of health services in the country, according to the National Report of Incidents Related to Health Care. The classification and the identification of risk factors are essential for implementation of preventive and therapeutic actions in susceptible patients. Nutritional status is a fundamental piece for the prevention and development of PU, making it essential to integrate the interdisciplinary team in the prevention and treatment of PU, with a focus on quality, safety and patient experience. In this sense, the objective of this campaign is to disseminate knowledge, providing technical support for patient care and reducing PU rates. A mnemonic was developed with the word “CICATRIZATION”, in which each letter proposes steps that help in the identification of risk, assessment, treatment and monitoring of PU. Thus, the sequence of 12 steps established in this campaign is suggested as a measure to assist health professionals in this management