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Resumo Objetivo Desenvolver e analisar um aplicativo móvel para avaliação, prevenção e tratamento da lesão por pressão. Métodos Foram quatro as fases para desenvolvimento da estrutura do aplicativo denominado Lesão por Pressão-App. A primeira fase correspondeu à concepção do aplicativo e identificou a necessidade de seu desenvolvimento. A segunda fase foi a elaboração do protótipo do aplicativo, na qual seu conteúdo foi definido com base em revisão integrativa da literatura. A terceira fase foi a da construção do aplicativo, quando o fluxograma foi elaborado, o banco de dados pôde ser estruturado e o software, desenvolvido. Na quarta fase, de transição, os testes de funcionalidade do aplicativo foram realizados. A avaliação do aplicativo foi realizada por 12 enfermeiros (juízes) por meio da técnica de Delphi e com o uso do Índice de Validade de Conteúdo. Resultados A maioria dos juízes considerou o aplicativo, na primeira avaliação, entre inadequado e totalmente adequado, porém, na segunda avaliação, ele foi avaliado entre adequado e totalmente adequado. O Índice de Validade de Conteúdo dos tópicos avaliados variou de 0,83 a 1,0 na primeira avaliação. Após realizar as correções, o aplicativo foi reavaliado, e o Índice de Validade de Conteúdo foi 1,0, caracterizando um excelente conteúdo. Conclusão O aplicativo Lesão por Pressão-App foi validado por profissional com experiência na área, mostrando a concordância do conteúdo entre os juízes na segunda avaliação.

Resumen Objetivo Desarrollar y analizar una aplicación móvil para la evaluación, prevención y tratamiento de la lesión por presión. Métodos Hubo cuatro fases para el desarrollo de la estructura de la aplicación denominada Lesión por Presión-App. La primera fase correspondió a la concepción de la aplicación e identificó la necesidad de desarrollarla. La segunda fase fue la elaboración del prototipo de la aplicación en la que se definió el contenido con base a la revisión integradora de la literatura. La tercera fase fue la de la construcción de la aplicación, en la que se elaboró el diagrama de flujo, se pudo estructurar el banco de datos y el software, desarrollado. En la cuarta fase, de transición, se realizaron los ensayos de funcionalidad de la aplicación. La evaluación de la aplicación la realizaron 12 enfermeros (jueces) a través de la técnica de Delphi y con el uso del Índice de Validez de Contenido. Resultados La mayoría de los jueces consideró que, en la primera evaluación, la aplicación estaba entre inadecuada y totalmente adecuada. Sin embargo, en la segunda evaluación, fue evaluada entre adecuada y totalmente adecuada. El Índice de Validez de Contenido de los tópicos evaluados tuvo una variación de 0,83 a 1,0 en la primera evaluación. Después de realizar las correcciones, la aplicación pasó por nueva evaluación y el Índice de Validez de Contenido fue de 1,0, caracterizándolo como un excelente contenido. Conclusión La aplicación "Lesão por Pressão-App" (Lesión por Presión-App) fue evaluada por un profesional experimentado en el área, evidenciando la conformidad del contenido entre los jueces en la segunda evaluación.

Abstract Objective To develop and analyze a mobile app for pressure injury assessment, prevention, and treatment. Methods There were four phases to develop the structure of an application called Lesão por Pressão-App. The first phase corresponded to the application design and identified the need for its development. The second phase was developing the application prototype, in which its content was defined based on an integrative literature review. The third phase was the application construction, when the flowchart was elaborated, the database could be structured and the software developed. In the fourth phase, transition, application functionality tests were performed. The application was assessed by 12 nurses (judges) using the Delphi technique and using Content Validity Index. Results Most judges considered the application, in the first assessment, between inadequate and totally adequate; however, in the second assessment, it was assessed between adequate and totally adequate. The Content Validity Index of the topics assessed ranged from 0.83 to 1.0 in the first assessment. After making the corrections, the application was re-assessed, and Content Validity Index was 1.0, featuring excellent content. Conclusion The application Lesão por Pressão-App was validated by a professional with experience in the field, showing the agreement of content among judges in the second assessment.

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OBJECTIVE: to identify products/technologies for treating patients with pressure ulcers with an evidence level 1. METHOD: this is an integrative literature review. A survey of studies was carried out using the United States National Library of Medicine Portal, Scientific Electronic Library Online, Virtual Health Library, National Library of Medicine(®), The Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean in Health Sciences, Nursing Database. RESULTS: sixteen articles were selected with level of evidence 1. The findings were categorized into five categories: Topical therapy to promote healing; Alternative therapy to promote healing; Topical therapy to promote debridement; Topical therapy to minimize lesion contamination; Topical therapy to reduce lesion size. FINAL CONSIDERATIONS: the 17 products/technologies identified favor/fast healing, debridement, minimize contamination and reduce lesion size to accelerate healing.

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OBJECTIVE: A pressure ulcer (PU) is an area of tissue trauma caused by continuous and prolonged pressure, often associated with hospitalised patients immobilised due to neurological problems, negatively affecting their quality of life, and burdening the public budget. The aim of this study was to report the follow-up, for 45 weeks, of three patients with neurological lesions due to trauma who subsequently developed PUs, and who were treated with a combination of photodynamic therapy (PDT), low level laser therapy (LLLT) and cellulose membrane (CM). METHOD: PDT was mediated by the photosensitiser curcumin on a 1.5% emulsion base. Blue LED light at 450 nm was delivered continuously for 12 minutes at an irradiance of 30mW/cm2 and total energy delivered to the tissue was 22J/cm2. LLLT was performed with 660 nm laser, punctuated and continuous, twice a week with parameters: spot size 0.04cm2, power of 40mW, 10 seconds per point, fluence of 10J/cm2 and irradiance of 1000mW/cm2. RESULTS: All PUs had a significant reduction (range: 95.2-100%) of their area after 45 weeks of follow-up and two PUs had complete healing at 20 weeks and 30 weeks. All of the PUs showed a reduction in contamination with the PDT treatments in different proportions. CONCLUSION: From the results obtained, we conclude that the combination of PDT, LLLT and CM is a promising treatment for PU healing.

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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.

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This study aimed to estimate the incidence of hospital-acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6-month follow-up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow-up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS-2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04-1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92-6.61); in patients admitted for non-surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12-3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03-1.06); high blood pressure (RR = 1.76; 95% CI 1.17-2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71-7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75-0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI-preventative actions.

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Randomised controlled trials of therapeutic interventions for pressure injuries should include a clear description of outcomes to increase transparency and replicability and improve the construction of scientific evidence. The objective of this study was to assess the completeness of the descriptions of the outcomes of therapeutic interventions in adults with pressure injury (PI) and factors associated with completeness. This was a systematic methodological survey. The completeness of the outcome was assessed according to five criteria: domain (title), specific measure (technique/instrument used), specific metric, or format of the outcome data of each participant that was used for analysis, aggregation (method data from each group were summarised), and time that was used for analysis. Sixty-eight studies were included for analysis. A total of 265 outcomes were reported, and 46 trials (67.6%) had 73 primary outcomes, which were mainly intermediates/substitutes (78.8%). The main outcome evaluated was the ulcer area reduction (36.6%). Approximately 37.2% of the outcomes were incompletely reported, and the least described element was the data aggregation method (72.8%). Only 48.4% of the outcomes with the specified technique had the same reference or validation. Poor quality of reporting outcomes was associated with studies with an older year of publication and a small sample size, single-center studies, and those sponsored by industry. PI studies use many outcomes, mostly surrogates or intermediates, and some of them are incompletely described.

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Introducción: Los pacientes con diabetes pueden presentar úlceras por presión, independientemente de generar las propias de esta enfermedad. Sin embargo, aunque está entre las probabilidades, es poco frecuente que se genere una úlcera por presión en la región occipital. Objetivo: Presentar un caso en el que se aplicó la estimulación eléctrica en el tratamiento de una úlcera por presión en la región occipital. Presentación del caso: Paciente chilena de 56 años de edad, con antecedentes de hipertensión arterial y diabetes mellitus, no especificada, con cetoacidosis. Se ingresó en la Unidad de Cuidados Intensivos debido a la presencia de dolor abdominal en el hipocondrio derecho, difuso y levemente asociado con un episodio de vómito, y posteriormente sin dolor, pero con sensación de angustia y disnea. La permanencia en cama, casi sin movilidad alguna, provocó la aparición de una úlcera por presión en la región occipital. A pesar de la aplicación de diferentes métodos convencionales, no se lograba mejoría con el tratamiento, por lo que se determinó la aplicación de la estimulación eléctrica, que se realizó durante 42 días, con una sesión diaria de 30 minutos cada vez. Conclusiones: Después de la aplicación del tratamiento con estimulación eléctrica, se logró la cicatrización de la úlcera por presión(AU)

Introduction: Patients with diabetes can present pressure ulcers, apart from the ones generated by this disease. However, although it is within the possibilities, it is not too frequent that pressure ulcer appears in the occipital area. Objective: To present a case in which it was used electric stimulation in the treatment of a pressure ulcer in the occipital area. Case presentation: 56 years old, Chilean, female patient with a background of arterial hypertension and diabetes mellitus, non specified, and with ketoacidosis. She was admitted in the Intensive Care Unit due to the presence of abdominal pain in the right hipochondrium which was diffuse and slightly associated with a vomiting episode, and later, she had no pain but a feeling of anxiety and respiratory distress. Staying in bed, almost without mobility provoqued the onset of a pressure ulcer in the occipital area. In spite of the use of different conventional methods, there was no improvement with those treatments, so, it was decided to use electric stimulation that was carried out during 42 days with a daily session of 30 minutes each time. Conclusions: After the application of the treatment with electric stimulation, it was achieved the healing of the pressure ulcer(AU)

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OBJECTIVE: Analyse the social and demographic variables that affect healing in patients with hard-to-heal wounds. METHOD: This retrospective study looked at 349 patient records of people with hard-to-heal wounds at an educational and care centre in San Pablo, Brazil, between 1994 and 2015. Healing was measured using the Pressure Ulcer Scale for Healing (PUSH). RESULTS: A total of 128 patient records were included. Most had identified themselves as white (62%), with an incomplete education (31%), household income under three minimum wages (86%), diabetes mellitus (61%), and systemic hypertension (58.4%). The PUSH scale varied between 4-7. The healing rate was 60%. Patients with white/yellow skin had 3.43 more chances to achieve healing (p<0,001). CONCLUSION: The social determinants observed were similar to Brazil's major inequality indicators. Statistical significance for white/yellow skin colour related to wound healing was observed. Nursing consultations contributed in achieving wound healing.

OBJETIVO: Analizar los determinantes sociodemográficos que influyen en la evolución de los pacientes con heridas de difícil cicatrización. MÉTODO: Este estudio epidemiológico retrospectivo analizó 349 historias clínicas de personas con heridas de difícil cicatrización en un centro de asistencia y educación en enfermería en San Pablo, Brasil, entre 1994 y 2015. Se usó la escala Pressure Ulcer Scale for Healing (PUSH) para evaluar la cicatrización. RESULTADOS: Se analizaron datos de 128 personas, la mayoría, adultos mayores. Los participantes se autodeclararon blancos (62%), con educación básica incompleta (31%), ingresos económicos familiares de hasta tres salarios mínimos (86%), diabetes mellitus (61%), e hipertensión arterial sistémica (58,4%). La escala PUSH varió entre 4 y 17 puntos (0­17 posibles), y el puntaje medio en la última valoración fue de, aproximadamente, 12. La tasa de cicatrización fue 60%. El color de piel blanca/amarilla aumentó 3,43 veces las chances de lograr la cicatrización (p<0,001). CONCLUSIÓN: Los atributos sociales estudiados se asemejan a los principales indicadores de inequidades sociales en salud en Brasil. Se observó significancia estadística para los colores de piel blanca/amarilla, relacionados con la cicatrización de la herida. La consulta de enfermería contribuyó en lograr la cicatrización de las heridas. CONFLICTO DE INTERÉS: Ninguno.

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BACKGROUND: The increasing global use of smartphones has contributed to the growing use of apps for various health conditions, showing promising results. Through mobile apps, it is possible to perform chronological and iconographic follow-up of wounds, such as pressure ulcers, using a simple and practical tool. However, numerous surveys have pointed out issues related to the functionality, design, safety, and veracity of app information. OBJECTIVE: The objective of this study was to perform a systematic review of published studies regarding mobile apps and a systematic survey in app stores looking for apps developed to identify, evaluate, treat, and/or prevent pressure ulcers in adults, and to evaluate those apps based on software quality characteristics. METHODS: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main bibliographic databases were searched between January 1, 2007 and October 15, 2018, and an app survey was performed in app stores. The selected studies were evaluated according to software quality characteristics by the International Organization for Standardization/International Electrotechnical Commission (ie, ISO/IEC 25010:2011) that involve functionality, efficiency, compatibility, usability, reliability, safety, maintenance, and portability. RESULTS: The search in databases and web-based app stores returned a total of 2075 studies. After removal of duplicates and screening of titles and abstracts, 48 complete articles were evaluated for eligibility, and among these, six were included for qualitative synthesis. CONCLUSIONS: In this review, it was observed that all studies involved the initial phase of app development or improvement, and therefore, the apps still need to be evaluated using different software quality characteristics, so that in the future, a gold standard can be approached. Therefore, the prescription of an app for the identification, evaluation, treatment, and/or prevention of pressure ulcers in adults is currently limited. However, the evaluated studies provided important insights for future research. It is of utmost importance that future surveys develop apps jointly with users, using collaborative and cocreative processes and assess patients in real-world situations across different service settings, and they should consider different ethnicities, so that apps are useful to end users, such as patients, family members, health professionals, and students, in the health area. In addition, it is necessary for studies to describe the methodological course of app development in a clear and objective way in order to ensure reproducibility of the study and to offer inputs to allow future research to approach the development of ideal apps that are geared to positively impact the health of end users. TRIAL REGISTRATION: PROSPERO CRD42018114137; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114137.

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Evaluation of photobiomodulation therapy (PBMT) in the treatment of pressure ulcers in adults and the elderly. Systematic review, based on the recommendations of the handbook, proposed by Cochrane. The search was carried out in databases, records of randomized clinical trials, list of references cited in the selected articles, as well as a manual search in meetings and specialized journals. A total of 1342 studies were identified, 18 were preselected and 5 were included in this review. Clinical heterogeneity of the participants was observed, in addition to variation in the laser parameters and predominance of studies of low methodological quality. PBMT with the use of laser (658 nm; 4 J cm-2 ;50 mw) showed complete wound healing (P < 0.001) when compared to lasers (990 nm and 808 nm). However, there was no statistically significant difference in relation to time to complete wound healing and in area reduction compared to standard care. PBMT in the infrared wavelength showed efficacy in the healing of the pressure ulcer, similar to the standard care presented in the different studies. PBMT (658 nm) was effective in promoting healing when compared to standard care. Laser can be a therapy of choice in the treatment of pressure ulcers, since no evidence has been found to refute its clinical application.

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As informações no leito, sobre a necessidade de manobras do paciente, em intervalos de 2 h, para evitar o aparecimento de lesões por pressão podem reduzir o tempo de permanência, diminuir o risco de lesões de pele e os custos de manutenção do paciente.

Bedside information on the need for repositioning the patient at 2 h intervals to avoid the appearance of pressure ulcers can reduce hospitalization time, risk of skin lesions, and maintenance costs.

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Objetivo: Identificar o conhecimento dos enfermeiros assistenciais quanto à prevenção e aos cuidados com lesões por pressão (LPP) em unidades de clínica médica e cirúrgica de um hospital universitário de Brasília. Métodos: Trata-se de estudo descritivo, transversal com análise quantitativa. Os dados foram coletados por meio da aplicação de um instrumento com informações acerca da formação e conhecimento do enfermeiro acerca da LPP. Resultados: A amostra foi de 38 enfermeiros, na qual 78.9%, acertaram entre 70 a 89% do instrumento, e somente dois enfermeiros (5,2%) obtiveram nota igual ou maior a 90% de acerto. Os itens de menor acerto estão relacionados ao uso de dispositivos, como luva d'água (23,6%), almofadas (23,6%), e em relação a posicionamento e reposicionamento, além da massagem em proeminências ósseas. Conclusão: Conclui-se que há um déficit do conhecimento da equipe de enfermagem deste hospital, o que pode comprometer diretamente na assistência principalmente do paciente em risco para LPP

Objective: To identify the knowledge of nursing assistants regarding the prevention and care of pressure lesions (LPP) in medical and surgical clinic units of a university hospital in Brasília. Methods: This is a descriptive, cross-sectional study with quantitative analysis. Data were collected through the application of an instrument with information about nurses' training and knowledge about LPP. Results: The sample consisted of 38 nurses, where 78.9% scored between 70 and 89% of the instrument, and only 2 nurses (5.2%) scored 90% or better. The items with the lowest accuracy are related to the use of devices such as water glove (23.6%), cushions (23.6%), and in relation to positioning and repositioning, in addition to bony prominence massage. Conclusion: It is concluded that there is a lack of knowledge of the nursing team of this hospital, which may directly compromise the care of the patient at risk for LPP

Objetivo: Identificar el conocimiento de los enfermeros asistenciales en cuanto a la prevención y cuidados con lesiones por presión (LPP) en unidades de clínica médica y quirúrgica de un hospital universitario de Brasilia. Métodos: Se trata de un estudio descriptivo, transversal con análisis cuantitativo. Los datos fueron recolectados por medio de la aplicación de un instrumento con informaciones acerca de la formación y conocimiento del enfermero acerca de la LPP. Resultados: La muestra fue de 38 enfermeros, donde 78.9%, acertaron entre 70 a 89% del instrumento, y solamente 2 enfermeros (5,2%) obtuvieron nota igual o mayor al 90% de acierto. Los elementos de menor acierto están relacionados al uso de dispositivos, como guante de agua (23,6%), cojines (23,6%), y en relación al posicionamiento y reposicionamiento, además del masaje en prominencia ósea. Conclusión: Se concluye que hay un déficit del conocimiento del equipo de enfermería de este hospital, lo que puede comprometer directamente en la asistencia principalmente del paciente en riesgo para LPP

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The pressure injury environment is characterized by overproduction of reactive oxygen species and exacerbated inflammation, which impair the healing of these lesions. Mediterranean-like diet may be a good intervention to improve the healing of pressure injury owing to its anti-inflammatory and antioxidant components. Thus, this study evaluated the hypothesis that olive oil, as a main source of lipid in Mediterranean diet, could improve cutaneous wound healing of pressure injury in mice. Male Swiss mice were randomly divided into standard, olive oil, or soybean oil plus olive oil groups and fat represented 10% of total calories in all groups. Four weeks after the beginning of diet administration, 2 cycles of ischemia-reperfusion (IR) by external application of 2 magnets disks were performed in the dorsal skin to induce pressure injury formation. Fourteen days after the end of the second IR cycle, olive oil-based diet reduced neutrophils cells and cyclooxygenase-2 protein expression and increased nitric oxide synthase-2 and protein and lipid oxidation. Olive oil based-diet also increased nuclear factor erythroid 2-related factor 2 protein expression and collagen type I precursor protein expression. In addition, administration of olive oil-based diet promoted wound closure at 7, 10, and 14 days after the end of the second IR cycle. These findings support the hypothesis that olive oil-based diet improves cutaneous wound healing of pressure injury in mice through the reduction of inflammation and stimulation of redox equilibrium.

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Introducción. La úlcera trocantérea es una de las lesiones por presión más frecuente y está asociada generalmente a bursitis, por lo que su tratamiento es complejo. Materiales y Métodos. Se presenta el caso de un paciente masculino de 29 años, con antecedente de lesión medular asociada a paraplejía fláccida con desarrollo de úlcera trocantérea derecha elíptica vertical. Fue abordado de forma multidisciplinaria y resuelto con resección de la patología y reconstrucción con colgajo musculocutáneo de fascia lata. Resultado. El paciente fue dado de alta al 21 día posoperatorio. No presentó dehiscencias, infecciones de la herida ni recidiva al cumplirse 6 meses de la cirugía y el resultado estético y funcional fue satisfactorio. Conclusión. El colgajo musculocutáneo de fascia lata ascendido y con cierre de V en Y es una opción segura, versátil y reproducible para la resolución de úlceras trocantéreas. Sin embargo, deben respetarse todos los pasos de la técnica para evitar así complicaciones y recidivas.

Background. Trochanteric ulcer is one of the most frequent pressure sore and is usually related with bursitis, therefore its treatment is complex. Material and Methods. We present a case of a 29 year-old male patient with medical history of spinalcord injury (SCI) related to flaccid paraplegia and the development of right trochanteric vertical elliptical sore. He was treated by a multidisciplinary team and solved by the resection of the pathology and immediate reconstruction with tensor fascia lata (TFL) musculo cutaneous flap. Results. The patient was discharged from the institution on the 21st postoperative day. With a follow-up of a 6 months period, complications such as wound infection, suture dehiscense or recurrence were not observed. Aesthetic and functional results were satisfactory. Conclusion. Ascended TFL flap with a V-Y closure is a reproducible, reliable and versatile procedure for the coverage of trochanteric pressure sore defects. However all surgical techniques tages must be considered in order to avoid complications and recurrence of the disease

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Pressure ulcers (PUs) have a high incidence, especially in hospital units. Randomised clinical trials (RCTs) of therapeutic interventions for PU should include a clear description of the outcomes and results to enhance transparency and replicability. OBJECTIVES: The primary objective of this study is to assess the completeness of the descriptions of the outcomes of therapeutic interventions in RCTs in adult patients with PU. The secondary objectives are to evaluate the types of reported primary outcomes, measurement methods or tools used to evaluate the outcomes and the results of reported outcomes. METHODS: We will conduct a systematic survey of RCTs published from January 2006 to April 2018. The selection process of the studies will be done in two stages of screening: title and abstract, and full text revision, always by two researchers independently. The completeness of the outcome will be assessed according to five criteria: domain (outcome title), specific measurement or technique/instrument used, specific metric or format of the outcome data that will be used for analysis, method of aggregation (how data from each group will be summarised) and time-points that will be used for analysis. The quality of the results of the outcome will be classified as either complete, incomplete or unreported. We will conduct a descriptive analysis of the number, type and degrees of outcome specification in the included RCTs. The frequency of categories in each domain of the outcomes will also be reported. The median and IQR will be estimated for each element of the specified outcome (out of five). ETHICS AND DISSEMINATION: This will be the first systematic assessment of the outcomes of therapeutic interventions used for pressure ulcers. After completion, this review will be submitted to a peer-reviewed journals.

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INTRODUCTION: Surgical closure of late-stage pressure ulcers (PUs) poses challenges in the immobilized population due to the high rate of complications, including infection, dehiscence, and recurrence. Muscle flap closure is the standard treatment for chronic, late-stage (stage 4) PUs, characterized by the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel as full-thickness tissue loss with exposure of bone, tendon, or muscle. OBJECTIVE: The aim of this study is to evaluate the outcomes associated with the use of a cryopreserved placental membrane containing viable cells (vCPM) graft for the augmentation of surgical flap closure in nonhealing perineal ulcers. MATERIALS AND METHODS: Four paraplegic patients (2 men, 2 women; average age, 61 years; range, 44-77 years) with stage IV PUs (ischial, gluteal, and sacral areas) with a mean duration of 4 years (range, 0.5-10 years) received muscle flap closure augmented with vCPM. Following surgical debridement, vCPM was placed between the wound bed and muscle flap closure prior to skin closure. Patients were kept offloaded in fluid-air beds for 6 weeks followed by a gradual return to mobilization. RESULTS: All 4 patients achieved complete wound closure in an average of 7 weeks (range, 6-8 weeks) without complications or recurrence. All patients demonstrated complete take of the muscle flap and maintained their closed wounds for an average follow-up of 12 months. CONCLUSIONS: Preliminary clinical results indicate vCPM supports surgical wound closure of chronic perineal PUs in immobile, high-risk patients. In an effort to decrease postoperative recovery time and reduce complications, vCPM may be beneficial for patients undergoing perineal muscle flap closure.

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OBJECTIVE: To carry out the cultural adaptation of the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) for use in Brazil and analyze the internal consistency of the adapted version. METHOD: This was a methodological study. The PZ-PUKT is a knowledge test consisting of 72 items, divided into: prevention, staging, and wound description. The present study was developed in two phases: (1) translation of the questionnaire from English to Brazilian Portuguese, back-translation, and assessment of equivalence between the original and back-translated version by an expert panel; (2) pre-testing with nurses. RESULTS: The questionnaire showed face and content validity according to the opinions of the experts. Cronbach's alpha for the total test score was higher than 0.70. The adapted version presented satisfactory internal consistency for the studied sample. CONCLUSION: The adapted version of the instrument for Portuguese can be used in intervention studies as a tool to measure "nursing knowledge about pressure injury/ulcers" as a dependent variable.

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ABSTRACT Objective: To carry out the cultural adaptation of the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) for use in Brazil and analyze the internal consistency of the adapted version. Method: This was a methodological study. The PZ-PUKT is a knowledge test consisting of 72 items, divided into: prevention, staging, and wound description. The present study was developed in two phases: (1) translation of the questionnaire from English to Brazilian Portuguese, back-translation, and assessment of equivalence between the original and back-translated version by an expert panel; (2) pre-testing with nurses. Results: The questionnaire showed face and content validity according to the opinions of the experts. Cronbach's alpha for the total test score was higher than 0.70. The adapted version presented satisfactory internal consistency for the studied sample. Conclusion: The adapted version of the instrument for Portuguese can be used in intervention studies as a tool to measure "nursing knowledge about pressure injury/ulcers" as a dependent variable.

RESUMEN Objetivo: Realizar adaptación cultural del instrumento Pressure Ulcer Knowledge Test (PZ-PUKT) para uso en Brasil y analizar la consistencia interna de la versión adaptada. Método: Estudio metodológico. El PZ-PUKT es un test de conocimiento con 72 ítems divididos en: prevención, estadificación y descripción de la herida. El proyecto se desarrolló en dos fases: (1) traducción del instrumento del Inglés al Portugués brasileño, retrotraducción y evaluación de equivalencia de versiones por un Comité de especialistas; (2) prueba piloto con enfermeros. Resultados: El instrumento demostró validez de apariencia y contenido, según los especialistas. El valor del coeficiente Alfa de Cronbach para el puntaje total fue superior a 0,70. La versión adaptada demostró satisfactoria consistencia interna para la muestra estudiada. Conclusión: El instrumento validado para el Portugués podrá ser utilizado en estudios de intervenciones, como instrumento para mensurar la variable dependiente "Conocimientos del enfermero sobre lesión/úlcera por presión".

RESUMO Objetivo: Realizar adaptação cultural do instrumento Pressure Ulcer Knowledge Test (PZ-PUKT), para uso no Brasil e analisar a consistência interna da versão adaptada. Método: Estudo metodológico. O PZ-PUKT é um teste de conhecimento com 72 itens, distribuídos em: prevenção, estadiamento e descrição da ferida. O projeto foi desenvolvido em duas fases: (1) tradução do instrumento do inglês para o português do Brasil, retrotradução e avaliação de equivalência das versões por um comitê de especialistas; (2) pré-teste com enfermeiros. Resultados: O instrumento demonstrou validade de face e conteúdo na opinião de especialistas. O valor do coeficiente alfa de Cronbach, para o escore total, foi acima de 0,70. A versão adaptada apresentou consistência interna satisfatória para a amostra estudada. Conclusão: O instrumento validado para o português tem possibilidade de ser utilizado em estudos de intervenções como instrumento para mensurar a variável dependente: Conhecimento do enfermeiro sobre lesão/úlcera por pressão.

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