RESUMO
INTRODUCTION: Chronic plantar ulcers in leprosy are lesions resulting from motor and sensory alterations caused by Mycobacterium leprae. They are lesions refractory to conventional dressings and present high recurrence rates. OBJECTIVE: To evaluate the epidemiological clinical profile of patients with chronic plantar ulcers associated with bony prominences in the lesion bed and to evaluate the efficacy of orthopedic surgical treatment of these lesions. METHODS: This is a descriptive and analytical retrospective study with the evaluation of medical records of patients undergoing surgical treatment of chronic plantar ulcers from 2008 to 2018. The surgical technique applied consisted of corrective resection of bone prominences and the primary closure of the lesion with bipediculated local flap. RESULTS: 234 patients were submitted to surgery, 55.1% male with an average age of 69.5 years old. Of these, 82.9% were illiterate; and 88.5% with open lesions over 10 years. After surgical treatment, total wound healing occurred in an average time of 12 weeks. The variables that contributed to shorter healing time were: Patients' lower age group; regular use of orthopedic shoes and insoles and dressings performed by nurse aides in health units before surgery. Obesity was the factor that correlated with the delay of healing time. CONCLUSION: A higher incidence was observed in males and male and female illiterate patients. The regular use of shoes and insoles and dressings performed by nurse aides in health units contributed to shorter postoperative healing time. Orthopedic surgical treatment with corrective resection of bony prominences proved to be an efficient therapeutic method for the closure of chronic plantar ulcers. It is a reproducible method, justifying the importance of the orthopedic surgeon in the context of the multidisciplinary team to cope with these complex lesions.
Assuntos
Pé Diabético , Úlcera do Pé , Hanseníase , Procedimentos Ortopédicos , Humanos , Masculino , Feminino , Idoso , Úlcera do Pé/epidemiologia , Úlcera do Pé/etiologia , Úlcera do Pé/cirurgia , Estudos Retrospectivos , Hanseníase/complicações , Hanseníase/epidemiologia , Hanseníase/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Retalhos Cirúrgicos/cirurgia , Pé Diabético/cirurgiaRESUMO
Vector-borne diseases are some of the leading public health problems in the tropics, and their association with climatic anomalies is well known. The current study aimed to evaluate the trend of American cutaneous leishmaniasis cases in the municipality of Manaus, Amazonas-Brazil, and its relationship with climatic extremes (ENSO). The study was carried out using a series of secondary data from notifications on the occurrence of several American cutaneous leishmaniasis cases in the municipality of Manaus between 1990 and 2017 obtained through the Sistema de Informação de Agravos de Notificação. Data regarding temperature, relative humidity, and precipitation for this municipality were derived from the Instituto Nacional de Meteorologia (INMET) and the National Oceanic and Atmospheric Administration (NOAA) websites. Coherence and wavelet phase analysis was conducted to measure the degree of relationship of the occurrence of the cases of cutaneous leishmaniasis and the El Niño-Southern Oscillation (ENSO). The results show that during La Niña events, an increase in American cutaneous leishmaniasis (ACL) cases is anticipated after the increase in rainfall from November, resulting in a more significant number of cases in January, February, and March. It was observed that in the municipality of Manaus, the dynamics of ACL cases are directly influenced by ENSO events that affect environmental variables such as precipitation, temperature, and humidity. Therefore, climatic variations consequently change the ACL incidence dynamics, leading to subsequent increases or decreases in the incidence of ACL cases in the area.