doi:10.3900/fpj.4.1.16.e
EISSN 1676-5133
Therapeutic resources applied at the
decubitus ulcer treatment
Original Article
Alessandro V. C. Vitoreti (CREFITO 4 nº 7668 LTF)
Graduado em fisioterapia pela Universidade Presidente Antonio Carlos - Barbacena
MG
Pós-Graduando em Reabilitação do membro superior pela Faculdade de Ciências
Médicas
de Minas Gerais. Belo Horizonte M.G.
Geysiane Kátia do Nascimento (CREFITO 4 nº 7752 LTF)
Graduada em Fisioterapia pela Universidade Presidente Antônio Carlos Barbacena M.G.
Pós-graduanda em Ergonomia pela Universidade Federal de Juiz de Fora M.G.
[email protected]
VITORETI, A. V. C. ; NASCIMENTO, G. K. Therapeutic resources applied at the decubitus ulcer treatment. Fitness & Performance
Journal, v. 4, n. 1, p. 16 - 18, 2005.
ABSTRACT: The aim of this research was to show, in a simple way, the therapeutic effects of the HeNe laser of low intensity, together
with the direct appliance of infra-red and the traditional medicines that were already being used by the patient at the decubitus ulcer
treatment. The volunteer for this research was an eight-six female, who presented two decubitus ulcers: one in the right heel region
and another in the posterior thoracic region. The injuries did not show traces of cicatrisation nor infective processes, and were already being treated with the traditional drugs, prescribed by the doctor in charge of the patient (the doctor’s procedure was kept during
the all the research). This research had a satisfactory result and has allowed us to confirm the effectiveness of the resources used in
the decubitus ulcer’s cicatrisation process, once the right hell injury has showed a layer of cicatrisation tissue all over its extension,
and the one in the posterior thoracic region was in the final cicatrisation process at the end of this research.
Keywords: Decubitus ulcer, HeNe laser, Cicatrisation process.
Correspondence to:
Leonardo Antônio dos Santos Galdino Rua Sabino José Ferreira, 394, Carmo, Barbacena M.G.
Submitted: July / 2004
Accepted: November / 2004
Copyright© 2008 por Colégio Brasileiro de Atividade Física, Saúde e Esporte
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Fit Perf J
Rio de Janeiro
4
1
16-18
Jan/Feb 2005
RESUMO
RESUMEN
Recursos terapêuticos utilizados no tratamento de úlceras de
decúbito
Recursos terapéuticos utilizados en el tratamiento de úlceras de
decúbito
O objetivo desta pesquisa foi demonstrar os efeitos terapêuticos da aplicação
direta do laser HeNe de baixa intensidade, juntamente com o infravermelho,
sobre úlceras de decúbito, sem interromper os medicamentos tradicionais que
já estavam em uso pela paciente no tratamento dessas lesões. A pesquisa teve
como voluntária uma mulher de 86 anos, apresentando duas úlceras de decúbito,
sendo uma na região calcanear direita e a outra na região torácica posterior. Os
ferimentos não apresentavam indícios de cicatrização ou processos infecciosos
e já estavam sendo tratados com medicamentos tradicionais, prescritos pelo
médico responsável (a conduta médica foi mantida durante toda a pesquisa).
O resultado obtido com a pesquisa foi satisfatório e permitiu a confirmação da
eficácia dos recursos utilizados no processo cicatricial de úlceras de decúbito, uma
vez que o ferimento localizado no calcâneo direito apresentou uma camada de
tecido cicatricial em toda sua extensão e o ferimento da região torácica posterior
mostrou-se em processo de cicatrização final ao término da pesquisa.
El objetivo de esta investigación fue de presentar los efectos terapéuticos del láser
HeNe de baja intensidad juntamente con el infrarrojo con aplicación directa
sobre el local y los medicamientos tradicionales que ya estaban en uso por la
paciente en el tratamiento de úlceras de decúbito. El voluntario de la pesquisa fue
una persona del sexo femenino, 86 años presentando dos úlceras de decúbito,
siendo una en la región Del calcañar derecho y la otra en la región torácica
posterior. Las heridas no presentaban indicios de cicatrización o procesos infecciosos y ya estaban siendo tratados com medicamientos tradicionales, prescritos
por el médico responsable (la conducta médica fue mantenida durante toda la
pesquisa). El resultado obtenido con la pesquisa fue satisfactorio y permitió la
confirmación de la eficacia de los recursos utilizados en el proceso cicatrizal de
úlceras de decúbito, una vez que la herida localizada en el calcáneo derecho
presentó una capa de tejido cicatrizal en toda su extensión y la herida de la
región torácica posterior se encontró en proceso de cicatrización final al término
de la pesquisa.
Palavras-chave: Úlcera de decúbito, Laser HeNe, Processo cicatricial.
Palabras clave: úlcera de decúbito, Láser HeNe, Proceso cicatrizal.
INTRODUCTION
Correa and collab. (2003) demonstrate that the human skin is
composed of three layers: dermis, epidermis and subcutaneous
conjunctive tissue. Any obstruction of these three layers may result
in the beginning of a wound. The main factor for the appearance
of decubitus ulcers is an increased pression over the bone protuberances, together with the reduction of twitch fibers of the tissue
deriving from aging. This way, the lack of movement is one of
the troubles for patients who remain bed-ridden for long periods,
for it triggers the increase of pression in some areas of the body,
what can advance the formation of an ulcer.
HeNe were used with doses of up to 4J/cm2. The researchers
obtained a fast and considerable reduction of pain. The use of
lasertherapy by physiotherapists in the treatment of decubitus ulcers
have become popular because of recent studies
Dealey (2001) describes that a decubitus ulcer is an injury in the
skin, caused by the interruption of blood supply for the whole
affected area and which is generally caused by pression, shearing,
friction or by the joint action of this factors.
The female patient I. M., 86, who had the left lower extremity
amputated, presented two areas of pression advancing to dehiscence. She does not present any disease related. She presents an
ulcer in the right calcaneus region and other one in the posterior
thoracic region.
According to Lianza (2001), decubitus ulcers can be found in
several clinical situations, mainly when the patients present lack
of sensibility, movement deficit and increase of the exposure to
pression. Therefore, the opening of a wound by pression can
evolve into advanced infectious conditions. This situation is extremely unpleasant both for patients and family, because the injury
can present fetid odor which may cause psychological problems
to the patient.
And thus, the objective the study herein is contribute, yet modestly,
for the studies on the use of HeNe laser and other therapeutic
resources in the treatment of decubitus ulcers.
MATERIALS AND METHODS
Hygiene of injuries was made using a 0.9% normal saline, gauze,
procedure gloves and scissors duly sterilized.
The laser used in this study was that of helium-neon HeNe, continuous mode, and punctual application and by zone, intensity de
4J/cm2, with automatically programmed timing by the equipment
for 12 seconds per point.
According to KITCHEN (2001), low intensity laser therapy (LILT)
is a general denomination which defines the therapeutic applications of lasers and an array of high intensity super luminous
diodes in the treatment of affections and injuries, considered an
athermic modality.
The infrared was used for 10 minutes in direct application on the
affected regions at a distance of nearly 45 cm.
Kahn (2001) describes that the first gas laser developed was the
helium-neon (HeNe), and the first emits light continually. This
low power is used an intracellular biostimulant which acts in the
cicatrisation process.
PROCEDURE
According to Kitchen (2001), the experiment using human beings
was begun in the late 60s and the early 70s, when sources of
Before each session the bandage was taken off, following the
asepsis of the wound 0.9% normal saline, gauze. Sometimes it
Fit Perf J, Rio de Janeiro, 4, 1, 17, Jan/Feb 2005
A goniometer was used for the mensuration of injuries for subsequent analysis.
After the functional evaluation and anamnesis, it was drawn a
treatment plan for the patient.
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was necessary to conduct the procedure of peripheral debridement
of toneless tissue, using a pair of tweezers and a pair scissors
duly sterilized.
Afterwards, it was carried out the application of infrared for 10
minutes for drying the region, and also to take advantage of the
cicatrizant capacity of this resource.
After the fulfillment of these procedures, it began the LILT application, energetic density of 4J/cm2, using the punctual application in
the periphery of the ulcers and by the zone in the center part.
When the session was over, a new bandage was done using
papain powder, colagenase and gauze. The medicine prescribed
by the doctor responsible helped in the ulcer cicatrisation. The
consultations were performed three times a week and amounted
to eight sessions.
RESULTS
In the initial analysis, an ulcer present in the right calcaneus had
a diameter of 3.0 cm and depth of 0.1 cm. The injury of the
posterior thoracic region measures 3.5 cm of diameter and depth
of 0.7 cm.
At the end of the eighth session, the ulcer on the right calcaneus
closed, as result of good status of hydration and local circulatory
input. The result obtained in the treatment of the ulcer of the
posterior thoracic region was satisfactory, but no total cicatrisation
was accomplished. Such situation may be explained by the short
period of time suggested for conducting the study. This way, at the
end of treatment, this last wound measured 2.0 cm of diameter
and 0.4 cm of depth.
DISCUSSION
According to Lianza (2001), the guidelines for this treatment
proved to be different; virtually all substances had already been
used to achieve cicatrisation faster and more efficient.
According to Azevedo (2002), Bisht (1994), Neiburger (1995)
and Vacca (1993), the application of laser of low power includes
the intensification of fibroblast proliferation and consequent disposition, besides allowing more accentuated neovascularization
in the beginning of the formation of granulation tissue.
According to Takahashi (1992), the epithelialization also seems
to be accelerated in irradiated wounds with HeNe laser.
CONCLUSION
Comparing the data collected in the beginning of the physiotherapeutic treatment with the results obtained after eight applications
in each ulcer, it is possible that there was a significant progress in
relation to the cicatrizant process of decubitus ulcers.
This observed patient reported some improvement about pain,
demonstrating satisfaction with the results obtained in the treatment.
Although many studies have been conducted, the documentation
about the effects of the application of HeNe laser of low power,
together with other therapeutic resources on decubitus ulcer, is
insufficient to prove definitely the benefits brought by the performed procedures.
Contradictory results still persist, making necessary the continuous
studies in search for objective explanations which indicate how the
HeNe laser and infrared can influence the biological tissue.
Thus we suggest that further studies are carried out aiming to gather more data which can confirm the reliability of the therapeutic
action of HeNe laser in the treatment decubitus ulcers.
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