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Efectividad de la terapia compresiva de doble capa frente al vendaje de crepé en la cicatrización de úlceras venosas en atención primaria. Ensayo clínico aleatorizado
Effectiveness of double-layered compression therapy against crepe bandage for healing venous ulcers in primary care. Randomized clinical trial
Carmen Folguera-Álvareza,b,
Autor para correspondencia
mcarmen.folguera@salud.madrid.org

Autor para correspondencia.
, Sofía Garrido-Elustondoc,d, Mili Milagros Rico-Blázquezc,e,b, Miren Iranzu Esparza-Garridof, José Verdú-Sorianog, Grupo ECAMulticapa
a Centro de Salud La Paz, Gerencia Asistencial de Atención Primaria de Madrid, Madrid, España
b Facultad de Enfermería, Universidad Complutense, Madrid, España
c REDISECC: Red de Investigación en Servicios de Salud en Enfermedades Crónicas
d Unidad Docente Multiprofesional Sureste, Gerencia Asistencial de Atención Primaria de Madrid, Madrid, España
e Unidad de Investigación, Gerencia Asistencial de Atención Primaria de Madrid, Madrid, España
f Facultad de Medicina. Universidad Francisco de Vitoria, Madrid, España
g Departamento de Enfermería Comunitaria, Medicina Preventiva, Salud Pública e Historia de la Ciencia, Facultad de Ciencias de la Salud, Universidad de Alicante, San Vicente del Raspeig, Alicante, España
Grupo ECAMulticapa
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Su manejo conlleva elevados costes directos e indirectos debido al largo tiempo de cicatrizaci&#243;n&#44; infecciones&#44; recidivas y hospitalizaci&#243;n por complicaciones<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El tratamiento local de las UEV se basa en la cura t&#243;pica de la &#250;lcera y el manejo de la insuficiencia venosa mediante una terapia compresiva<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a>&#46; Existe evidencia acerca de que la terapia compresiva favorece el proceso de cicatrizaci&#243;n de las &#250;lceras venosas<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46; En cuanto al tipo de vendaje&#44; no existe un claro consenso&#44; si bien la mayor&#237;a de los estudios encontrados hasta ahora sugieren que la utilizaci&#243;n de vendaje multicapa es m&#225;s eficaz que la utilizaci&#243;n de vendaje de un solo componente&#46; La mayor&#237;a de estos estudios analizan el vendaje multicapa de 4 capas<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">6&#44;8&#44;9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por otro lado&#44; los estudios que comparan la utilizaci&#243;n de vendaje de 4 capas frente a vendaje de 2 capas&#44; no encuentran diferencias en el porcentaje de cicatrizaci&#243;n de las &#250;lceras<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">10&#8211;13</span></a>&#44; pero s&#237; se observa que los pacientes toleran mejor y muestran preferencias por el vendaje de 2 capas frente al de 4 capas<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">10</span></a>&#44; refieren una percepci&#243;n de calidad de vida mayor<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a>&#44; y su aplicaci&#243;n resulta m&#225;s f&#225;cil para los profesionales<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En este marco&#44; se recomienda realizar nuevos estudios comparando espec&#237;ficamente el vendaje multicapa de 2 capas&#44; realizado en el &#225;mbito donde habitualmente se presta atenci&#243;n sanitaria a estos pacientes y utilizando t&#233;cnicas de enmascaramiento para la evaluaci&#243;n de la variable respuesta<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">No hemos encontrado en nuestro pa&#237;s ning&#250;n estudio que compare&#44; espec&#237;ficamente&#44; la efectividad del vendaje de 2 capas frente al vendaje con compresi&#243;n ligera monocapa el&#225;stica&#44; que ha sido el utilizado habitualmente en atenci&#243;n primaria &#40;AP&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As&#237;&#44; realizamos este estudio&#44; cuyo objetivo principal fue evaluar si el vendaje compresivo multicapa de 2 capas es m&#225;s efectivo que el vendaje con venda de crep&#233; en la cicatrizaci&#243;n de las UEV en pacientes atendidos en AP&#44; medido a trav&#233;s de la incidencia de &#250;lceras con cicatrizaci&#243;n completa a las 12 semanas de seguimiento&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Como objetivos secundarios&#44; comparamos si el vendaje con 2 capas es m&#225;s efectivo en el grado de cicatrizaci&#243;n alcanzado&#44; medido a trav&#233;s del cuestionario Resvech 2&#46;0&#44; y en la mejora de la calidad de vida&#44; medida con el cuestionario <span class="elsevierStyleItalic">Charing Cross Venous Ulcer Questionnaire</span> &#40;CCVUQ-e&#41;&#46; Analizamos los factores sociodemogr&#225;ficos&#44; cl&#237;nicos y de tratamiento&#44; asociados a la cicatrizaci&#243;n completa de las UEV&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Material y m&#233;todos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Desarrollamos un ensayo cl&#237;nico controlado multic&#233;ntrico con grupos paralelos&#44; asignaci&#243;n aleatoria y evaluaci&#243;n ciega de la variable respuesta&#44; de 12 semanas de seguimiento&#46; La metodolog&#237;a del estudio se presenta de forma m&#225;s detallada en la publicaci&#243;n del protocolo<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Participaron enfermeras de 22 Centros de Salud de la Comunidad de Madrid&#46; Los sujetos de estudio fueron mayores de 18 a&#241;os&#44; con diagn&#243;stico de UEV&#44; con &#237;ndice tobillo-brazo &#40;ITB&#41; entre 0&#44;8 y 1&#44;3&#44; atendidos por las enfermeras que colaboraron en el estudio&#44; que dieron su consentimiento informado &#40;CI&#41; para participar&#46; Se excluy&#243; a los que presentaban contraindicaciones de terapia compresiva&#44; diagnosticados de diabetes mellitus mal controlada<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a> y en tratamiento con antineopl&#225;sicos&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Asumiendo un error alfa de 0&#44;05&#44; error beta de 0&#44;2 y una diferencia m&#237;nima a detectar del 20&#37;&#44; se estim&#243; estudiar 97 pacientes en cada grupo&#44; que se ampli&#243; a 108 al contemplar un 10&#37; de p&#233;rdidas&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Los pacientes se incluyeron por muestreo consecutivo y competitivo hasta alcanzar el tama&#241;o muestral&#46; Cuando el paciente decid&#237;a participar y firmaba el CI&#44; se introduc&#237;an sus datos en un cuaderno de recogida de datos electr&#243;nico &#40;CRDe&#41; dise&#241;ado <span class="elsevierStyleItalic">ad hoc</span>&#44; y se le asignaba al grupo experimental o control mediante asignaci&#243;n aleatoria simple&#44; utilizando un sistema automatizado incluido en el CRDe&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Intervenci&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">Grupo control&#58; pr&#225;ctica cl&#237;nica habitual seg&#250;n recomendaciones para el tratamiento de &#250;lceras cut&#225;neas cr&#243;nicas de la Comunidad de Madrid&#58; valoraci&#243;n&#44; limpieza&#44; desbridamiento y tratamiento t&#243;pico de cura&#46; Aplicaci&#243;n de terapia compresiva con venda de compresi&#243;n ligera monocapa &#40;crep&#233;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Grupo experimental&#58; la misma pr&#225;ctica habitual para el tratamiento de la herida&#46; Aplicaci&#243;n de terapia compresiva con vendaje multicapa de 2 capas&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Todos los pacientes recibieron consejos higi&#233;nico-diet&#233;ticos e informaci&#243;n de signos y s&#237;ntomas adversos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las enfermeras aplicaron los 2 tipos de vendaje&#46; Para normalizar la pr&#225;ctica habitual y la experimental&#44; se realiz&#243; un entrenamiento previo al comienzo del ensayo&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Variables</span><p id="par0085" class="elsevierStylePara elsevierViewall">La variable respuesta principal fue la cicatrizaci&#243;n completa a las 12 semanas de seguimiento&#44; definida como epitelizaci&#243;n completa y mantenida por lo menos durante 2 semanas&#46; Se midi&#243; el tiempo transcurrido entre el comienzo del estudio y la cicatrizaci&#243;n completa en d&#237;as&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Las variables de respuesta secundarias fueron&#58; grado de severidad de las lesiones medido con el cuestionario Resvech 2&#46;0<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a>&#44; calidad de vida relacionada con la salud medida con CCVUQ-e<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> y presencia de reacciones adversas&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Se recogieron variables sociodemogr&#225;ficas &#40;edad&#44; g&#233;nero&#44; nivel de estudios&#41;&#59; variables cl&#237;nicas relacionadas con la cicatrizaci&#243;n&#58; &#237;ndice de masa corporal &#40;IMC&#41;&#44; consumo de alcohol&#44; h&#225;bito tab&#225;quico&#44; movilidad del paciente&#44; tiempo con las piernas elevadas&#44; si camina y hace ejercicio&#44; si es recidivante&#44; dolor&#44; n&#250;mero de &#250;lceras&#44; tiempo de evoluci&#243;n&#59; patolog&#237;as asociadas &#40;insuficiencia cardiaca&#44; insuficiencia renal&#44; hipertensi&#243;n arterial&#44; diabetes&#44; asma o EPOC&#44; artrosis y varices&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">El grado de severidad de la &#250;lcera y la cicatrizaci&#243;n fueron valorados por una enfermera evaluadora externa&#44; en la visita previa a la intervenci&#243;n y en las siguientes visitas de seguimiento&#44; desconociendo siempre la intervenci&#243;n&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">An&#225;lisis estad&#237;stico</span><p id="par0105" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis comparativo de los 2 grupos en la visita basal&#44; utilizando los test correspondientes &#40;chi cuadrado para comparaci&#243;n de proporciones y t de Student para comparaci&#243;n de medias&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">An&#225;lisis de efectividad principal&#58; se compar&#243; la incidencia de &#250;lceras con cicatrizaci&#243;n completa a las 12 semanas de seguimiento en ambos grupos&#44; as&#237; como el tiempo hasta la cicatrizaci&#243;n completa utilizando curvas de Kaplan-Meier &#40;test de log-rank&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Para ajustar por factores pron&#243;sticos&#44; se realiz&#243; un modelo de regresi&#243;n de Cox&#44; en el que la variable dependiente fue el tiempo de cicatrizaci&#243;n completa y la variable independiente&#44; el grupo de intervenci&#243;n&#46; Se incluyeron en el modelo aquellas variables que pudieran actuar como confusoras o modificadoras del efecto&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Para comparar el grado de cicatrizaci&#243;n alcanzado medido a trav&#233;s del Resvech2&#46;0 en ambos grupos se utilizaron las medias marginales&#46; Para comparar la mejora de la calidad de vida se utiliz&#243; un anova de medidas repetidas&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Todos los an&#225;lisis se realizaron por intenci&#243;n de tratar&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Se utiliz&#243; el paquete estad&#237;stico SPSS&#46;19&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Aspectos &#233;ticos y legales</span><p id="par0135" class="elsevierStylePara elsevierViewall">El estudio fue evaluado con informe favorable por la Comisi&#243;n Central de Investigaci&#243;n de la Gerencia de AP de Madrid y por el Comit&#233; de &#201;tica e Investigaci&#243;n Cl&#237;nica del Hospital Gregorio Mara&#241;&#243;n&#46; Se respetaron los principios b&#225;sicos en investigaci&#243;n de acuerdo a los principios de la Declaraci&#243;n de Helsinki &#40;2013&#41;&#46; Todos los sujetos que participaron en el estudio fueron informados verbalmente y por escrito y firmaron el CI&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Registro del Proyecto en Clinical trials&#46;gov&#58; NCT02364921&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Esquema general del estudio</span>&#46; Ensayo cl&#237;nico controlado multic&#233;ntrico con grupos paralelos&#44; asignaci&#243;n aleatoria y evaluaci&#243;n ciega de la variable respuesta&#44; de 12 semanas de seguimiento&#46; <elsevierMultimedia ident="202205180634474401"></elsevierMultimedia></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Resultados</span><p id="par0150" class="elsevierStylePara elsevierViewall">En el periodo de estudio&#44; de febrero de 2015 a enero de 2018&#44; se invit&#243; a participar a 108 pacientes&#46; Se excluyeron 15&#44; y 93 fueron incluidos en el estudio&#59; 56 fueron aleatorizados al grupo experimental y 37 al grupo control&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describen las caracter&#237;sticas basales de los pacientes incluidos&#46; Los grupos fueron homog&#233;neos en cuanto a variables cl&#237;nicamente relevantes&#44; no encontr&#225;ndose diferencias estad&#237;sticamente significativas entre los pacientes de ambos grupos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se describen las caracter&#237;sticas basales de las &#250;lceras seg&#250;n los aspectos evaluados en la escala Resvech 2&#46;0&#46; Tampoco se encuentran diferencias estad&#237;sticamente significativas entre ambos grupos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Los pacientes con &#250;lceras con cicatrizaci&#243;n completa al finalizar el seguimiento fueron 57&#44; 61&#44;35&#37; &#40;IC al 95&#37; 50&#44;6-71&#44;2&#41;&#46; En el grupo de pacientes tratados con vendaje de crep&#233;&#44; 25&#44; 67&#44;5&#37; &#40;IC al 95&#37; 50&#44;2-81&#44;9&#41; y en el de los tratados con vendaje multicapa&#44; 32&#44; 57&#44;1&#37; &#40;IC al 95&#37; 43&#44;2-70&#44;3&#41;&#46; No encontramos diferencias estad&#237;sticamente significativas en el porcentaje de &#250;lceras con cicatrizaci&#243;n completa entre ambos grupos&#44; RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;10 &#40;IC al 95&#37; 0&#44;864-1&#44;424&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">La mediana del tiempo de cicatrizaci&#243;n completa fue de 45 d&#237;as para las &#250;lceras con vendaje multicapa y de 60 para las &#250;lceras con crep&#233;&#46; La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra el tiempo transcurrido hasta la cicatrizaci&#243;n completa en los 2 grupos&#46; No encontramos diferencias entre ambos&#46; Log-rank&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;744&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> muestra la evoluci&#243;n del grado de cicatrizaci&#243;n medido a trav&#233;s de la puntuaci&#243;n Resvech&#44; en las visitas de seguimiento&#46; No encontramos diferencias estad&#237;sticamente significativas entre los 2 grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;635&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">En relaci&#243;n con las variables asociadas al tiempo transcurrido hasta la cicatrizaci&#243;n completa de las &#250;lceras&#44; en el an&#225;lisis de regresi&#243;n de Cox&#44; solo se asoci&#243; de manera significativa el grado de severidad de las &#250;lceras al comienzo del estudio&#44; medido con la puntuaci&#243;n Resvech&#44; HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;86 &#40;IC al 95&#37; 0&#44;78-0&#44;94&#41;&#59; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra la evoluci&#243;n de la calidad de vida&#44; seg&#250;n el tipo de vendaje&#46; En el total de la muestra se observan diferencias estad&#237;sticamente significativas en la puntuaci&#243;n de la calidad de vida total antes y despu&#233;s de la intervenci&#243;n&#44; que indican mejora&#44; y al estudiarlo por dimensiones&#44; en la dimensi&#243;n cosmesis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41; y estado emocional &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41;&#46; Tambi&#233;n se observa mejor&#237;a en la dimensi&#243;n cosmesis en el grupo multicapa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Al analizar la calidad de vida seg&#250;n el vendaje utilizado&#44; no se encuentran diferencias significativas en la mejora de la calidad de vida total ni por las dimensiones estudiadas&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">No se produjeron reacciones adversas graves en ninguno de los grupos&#46; Se observa una reacci&#243;n al&#233;rgica leve en el grupo intervenci&#243;n doble capa&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discusi&#243;n</span><p id="par0195" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; el 61&#44;35&#37; de los sujetos alcanzaron la cicatrizaci&#243;n completa al finalizar el seguimiento &#40;12 semanas&#41;&#44; el 67&#44;5&#37; de los tratados con crep&#233; y el 57&#44;1&#37; de los tratados con multicapa&#46; No hemos encontrado diferencias estad&#237;sticamente significativas entre ambos grupos&#44; ni tampoco en el tiempo de cicatrizaci&#243;n&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Entre los estudios que comparan la cicatrizaci&#243;n de las &#250;lceras venosas al aplicar distintos vendajes&#44; encontramos resultados diferentes&#46; En la revisi&#243;n de O&#8217;Meara et al&#46; concluyen que los sistemas de compresi&#243;n con varios componentes son m&#225;s efectivos que los de un componente<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Torra et al&#46; realizaron un estudio comparando la efectividad y el coste entre el vendaje de 4 capas y el de crep&#233;&#46; A pesar de las limitaciones metodol&#243;gicas&#44; sus resultados orientan a que el vendaje de 4 capas es m&#225;s efectivo en el manejo del dolor y genera menor coste<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Guest et al&#46; observaron tasas m&#225;s elevadas de cicatrizaci&#243;n en los pacientes a los que se les aplic&#243; un vendaje de un componente frente a vendajes de m&#225;s componentes<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">En una reciente revisi&#243;n sistem&#225;tica que compara la efectividad de los vendajes de 4 capas frente al de corto estiramiento&#44; concluyen que ambos sistemas son semejantes en cuanto al porcentaje de &#250;lceras con cicatrizaci&#243;n completa a las 24 semanas de seguimiento<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; el 61&#44;35&#37; de los pacientes alcanzaron la cicatrizaci&#243;n completa a las 12 semanas de seguimiento&#46; Consideramos que es un buen resultado&#46; Adem&#225;s&#44; esta cifra est&#225; en el rango superior de las observadas en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">6&#8211;8&#44;18&#44;19</span></a>&#46; Las &#250;lceras de los sujetos de nuestro estudio son&#44; en general&#44; de peque&#241;o tama&#241;o&#46; Este hecho ha podido explicar en parte el alto porcentaje de &#250;lceras que han alcanzado la cicatrizaci&#243;n completa&#46; Adem&#225;s&#44; ha podido ser uno de los factores que hayan influido en no encontrar diferencias en la cicatrizaci&#243;n entre ambos grupos&#44; ya que el mayor grado de compresi&#243;n alcanzado con el vendaje multicapa marca la diferencia sobre todo en el caso de &#250;lceras de mayor tama&#241;o&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Tambi&#233;n ha podido influir una mayor tasa de abandonos debido a la intolerancia a la compresi&#243;n que se ha producido en el grupo de vendaje de multicapa &#40;16&#37;&#41; frente al de crep&#233; &#40;3&#37;&#41;&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Otro factor que ayuda a explicar la falta de diferencia en la cicatrizaci&#243;n entre los 2 grupos puede ser que&#44; a pesar de la formaci&#243;n recibida previa al estudio&#44; las enfermeras tuvieran diferente habilidad al aplicar una t&#233;cnica de vendaje u otra&#44; hecho observado en otros estudios<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a>&#46; Posiblemente&#44; las enfermeras mostraron mayor habilidad en el vendaje de crep&#233;&#44; por llevar m&#225;s tiempo utilizando esta t&#233;cnica&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">El &#250;nico factor asociado a la cicatrizaci&#243;n de las &#250;lceras ha sido el grado de severidad de las &#250;lceras&#44; medido con el Resvech&#44; que valora aspectos espec&#237;ficos de la herida&#44; dimensi&#243;n&#44; bordes&#44; exudado e infecci&#243;n&#46; La dimensi&#243;n de la &#250;lcera ha sido identificada como un factor asociado a la cicatrizaci&#243;n en los trabajos de O&#8217;Meara et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a> y de Margolis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a>&#46; Otros estudios identifican&#44; como factores asociados a la cicatrizaci&#243;n&#44; el tiempo de evoluci&#243;n de la &#250;lcera<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">8&#44;21</span></a> y el ser recurrente<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Al comparar la calidad de vida de los pacientes&#44; medida al comienzo y al final del estudio&#44; observamos una mejora significativa&#46; Analizando por dimensiones&#44; la mejora es significativa en las dimensiones cosmesis y estado emocional&#46; Esta mejor&#237;a se observa en los 2 grupos&#44; sin encontrar diferencias entre ellos&#46; En otros estudios tampoco se encuentran diferencias en la mejora de la calidad de vida entre los tipos de vendajes utilizados<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">7&#44;22</span></a>&#46; Sin embargo&#44; la utilizaci&#243;n de diferentes instrumentos de medida de la calidad de vida limita la comparaci&#243;n de estos datos&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n de nuestro estudio ha sido no haber alcanzado el tama&#241;o de muestra predeterminado&#46; Dificultades ajenas&#44; como la movilidad laboral de los profesionales durante la captaci&#243;n de pacientes&#44; han condicionado una importante reducci&#243;n del tama&#241;o muestral&#46; Adem&#225;s&#44; se han producido m&#225;s p&#233;rdidas de las esperadas&#44; un 19&#37; en el grupo de vendaje de crep&#233; y un 30&#37; en el grupo de doble capa&#44; debido principalmente a la intolerancia a la compresi&#243;n&#46; Los resultados de nuestro estudio muestran una diferencia en el porcentaje de cicatrizaci&#243;n entre los 2 grupos de un 10&#37;&#44; menor de la esperada del 20&#37;&#44; y adem&#225;s a favor del vendaje de crep&#233;&#44; en contra de nuestra hip&#243;tesis inicial&#46; Todo ello ha derivado en disminuir la potencia del estudio&#44; limitando la posibilidad de encontrar diferencias entre los grupos si realmente exist&#237;an&#46; Como fortaleza&#44; destaca la evaluaci&#243;n ciega de la variable respuesta principal&#59; la enfermera que evaluaba el grado de cicatrizaci&#243;n desconoc&#237;a el tipo de vendaje aplicado&#46; Tambi&#233;n&#44; la utilizaci&#243;n de instrumentos de medida espec&#237;ficos para &#250;lceras venosas&#58; la escala Resvech&#44; para la cicatrizaci&#243;n&#44; y la escala CCQVU-e&#44; para calidad de vida&#46; Adem&#225;s&#44; se comprob&#243; el car&#225;cter venoso de las &#250;lceras asegurando un ITB entre 0&#44;8 y 1&#44;3&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclusiones</span><p id="par0250" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; no encontramos diferencias significativas en la cicatrizaci&#243;n de las &#250;lceras entre los 2 tipos de vendaje utilizados&#44; por lo que no podemos extraer conclusiones sobre la t&#233;cnica de vendaje m&#225;s adecuada&#46; Sin embargo&#44; los datos obtenidos nos permiten concluir que ambas t&#233;cnicas empleadas son apropiadas para lograr la cicatrizaci&#243;n de las &#250;lceras&#44; y para mejorar la calidad de vida&#44; adem&#225;s de seguras para el paciente&#46; Proponemos que al elegir el tipo de vendaje se tenga en cuenta las habilidades y preferencias de los cl&#237;nicos en la t&#233;cnica&#44; el coste y la aceptabilidad de los pacientes&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Creemos que ser&#237;a adecuado llevar a cabo nuevos estudios en el marco de la AP intentando alcanzar un tama&#241;o de muestra que permita obtener conclusiones&#44; a la vez que explorar otras variables&#44; como las habilidades de los profesionales en la t&#233;cnica de vendaje&#44; que ayuden a explicar los factores que influyen en la cicatrizaci&#243;n de las &#250;lceras y a elegir la mejor opci&#243;n terap&#233;utica&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Financiaci&#243;n</span><p id="par0295" class="elsevierStylePara elsevierViewall">Financiado por el <span class="elsevierStyleGrantSponsor" id="gs1">Ministerio de Ciencia e Innovaci&#243;n&#44; a trav&#233;s del Instituto de Salud Carlos III</span>&#46; PN de I&#43;D&#43;I 2008-2011 Cofinanciado con fondos FEDER &#40;PI13&#47;01975&#41; y la Fundaci&#243;n para la Investigaci&#243;n e Innovaci&#243;n Biosanitaria de Atenci&#243;n Primaria de la Comunidad de Madrid &#40;<span class="elsevierStyleGrantSponsor" id="gs2">FIIBAP</span>&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicto de intereses</span><p id="par0300" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses relacionado con el contenido del manuscrito&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar si el vendaje de 2 capas es m&#225;s efectivo que el vendaje de crep&#233; en la cicatrizaci&#243;n de &#250;lceras venosas tras 12 semanas de seguimiento&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ensayo cl&#237;nico aleatorizado multic&#233;ntrico&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Emplazamiento</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">22 Centros de Salud de Madrid&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participantes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mayores de 18 a&#241;os&#44; con diagn&#243;stico de &#250;lceras venosas&#46; Se aleatorizaron 93 pacientes&#44; 56 en el grupo de doble capa y 37 en crep&#233;&#46; Retiradas&#58; 16 en el grupo de doble capa y 7 en el de crep&#233;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Intervenciones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Grupo control&#58; pr&#225;ctica cl&#237;nica habitual&#58; tratamiento de la herida y vendaje con crep&#233;&#46; Grupo experimental&#58; misma pr&#225;ctica habitual para tratamiento de la herida y vendaje con doble capa&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Mediciones principales</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Variable respuesta principal&#58; cicatrizaci&#243;n completa a las 12 semanas&#46; Variables secundarias&#58; severidad de las lesiones&#44; calidad de vida&#44; reacciones adversas&#46; Evaluaci&#243;n ciega de la variable respuesta&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cicatrizaci&#243;n completa&#58; 25 &#40;67&#37;&#41; en el grupo crep&#233; &#40;IC al 95&#37; 50&#44;2-81&#44;9&#41; y 32 &#40;57&#44;1&#37;&#41; en doble capa &#40;IC al 95&#37; 43&#44;2-70&#44;3&#41;&#46; Sin diferencias en ambos grupos&#44; RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;10 &#40;IC al 95&#37; 0&#44;864-1&#44;424&#41;&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La severidad de las &#250;lceras basales se asocia al tiempo de cicatrizaci&#243;n&#44; HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;86 &#40;IC al 95&#37; 0&#44;78-0&#44;94&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se objetiva mejora significativa en la calidad de vida total y en las dimensiones cosmesis y estado emocional&#46; No se encuentran diferencias seg&#250;n el vendaje utilizado&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Sin reacciones adversas graves en ninguno de los grupos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">No encontramos diferencias significativas en la cicatrizaci&#243;n entre los 2 tipos de vendaje&#46; Ambos son apropiados para la cicatrizaci&#243;n de las &#250;lceras y para mejorar la calidad de vida&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objective</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">To evaluate if the two-layer bandage is more effective than the crepe bandage in the healing of venous ulcers after 12 weeks of follow-up&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Design</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Randomized multicentre controlled clinical trial&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Location</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">22 Primary Health Centers of Madrid&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participants</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Over 18 years old&#44; with diagnosis of venous ulcers&#46; 93 patients were randomized&#44; 56 in the double layer group and 37 in the crepe group&#46; Withdrawals&#58; 16 in double layer group&#44; 7 in crepe group&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Interventions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Control group&#58; usual clinical practice&#58; treatment of the wound and bandage with crepe&#46; Experimental group&#58; same usual clinical practice for wound treatment and bandage with double layer&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Main measurements</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Primary outcome&#58; complete healing at 12 weeks&#46; Secondary outcomes&#58; severity of ulceration&#44; health-related quality of life&#44; adverse events&#46; Blind evaluation of the response variable&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Complete healing&#58; in crepe group&#44; 25&#44; 67&#46;5&#37; &#40;95&#37; CI 50&#46;2-81&#46;9&#41; and in double layer group&#44; 32&#44; 57&#46;1&#37; &#40;95&#37; CI 43&#46;2-70&#46;3&#41;&#46; No evidence of a difference in both groups&#44; RR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;10 &#40;95&#37; CI 0&#46;864-1&#46;424&#41;&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">The basal severity of the ulcers is associated with the healing time&#46; HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;86 &#40;95&#37; CI 0&#46;78-0&#46;94&#41;&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Our data showed a significant improvement in health-related quality of life&#44; total and in the of cosmesis and emotional dimensions&#46; No evidence of a difference in both groups&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">We didn&#8217;t find serious adverse events in any of the groups&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">We didn&#8217;t find significant differences in the healing between the two bandages evaluated&#46; Both are appropriate for ulcer healing and to improve the health-related quality of life&#46;</p></span>"
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;18&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bajo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31 &#40;55&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;54&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;8&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">37 &#40;66&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24 &#40;64&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Precise ayuda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16 &#40;35&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;35&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Movilidad total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">40 &#40;71&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;64&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Camina &#40;min&#47;d&#237;a&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38&#44;8 &#40;33&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52&#44;4 &#40;70&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ejercicio &#40;min&#47;d&#237;a&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#44;7 &#40;13&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;17&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Eleva piernas &#40;min&#47;d&#237;a&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">81&#44;8 &#40;104&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65&#44;6 &#40;88&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">IMC</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32 &#40;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31&#44;8 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Consumo de alcohol &#40;g&#47;semana&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;7 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;45&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Variables relacionadas con la &#250;lcera</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#218;lcera recidivante</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30 &#40;53&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">16 &#40;43&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Inicio de la &#250;lcera</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Traum&#225;tico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;35&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">20 &#40;54&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Espont&#225;neo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36 &#40;64&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;45&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dolor</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nulo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;16&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27 &#40;48&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">16 &#40;43&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Moderado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18 &#40;32&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13 &#40;35&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Extremo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;7&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;5&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;16&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>36-63<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3 &#40;5&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>64-100<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1 &#40;1&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;075&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Profundidad&#47;tejidos afectados</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dermis-epidermis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32 &#40;57&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;62&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tejido subcut&#225;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;41&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;35&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#250;sculo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;83&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Bordes</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No distinguibles&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Difusos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 &#40;30&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;29&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Delimitados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29 &#40;51&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;35&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Da&#241;ados&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;24&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Engrosados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;8&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de tejido en el lecho</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Necr&#243;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Necr&#243;tico y&#47;o esfacelos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;55&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;51&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Granulaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;37&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;35&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Epitelial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;8&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Exudado</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>H&#250;medo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27 &#40;48&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#40;62&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mojado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;17&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;21&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Con fuga de exudado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;23&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;13&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Infecci&#243;n&#47;inflamaci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dolor en aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;13&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Eritema en la perilesi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;41&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;56&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Edema en la perilesi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;30&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;13&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aumento de la temperatura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;7&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;30&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exudado en aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;7&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exudado purulento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;3&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tejido friable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#40;16&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;24&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Herida estancada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;41&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;40&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tejido compatible con biofilm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;19&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;13&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Olor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;10&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipergranulaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aumento del tama&#241;o de la herida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;16&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;18&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lesiones sat&#233;lite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;19&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;29&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;8&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Puntuaci&#243;n total&#44; media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#44;3 &#40;3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7&nbsp;\t\t\t\t\t\t\n
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                  """
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        ]
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      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
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          "leyenda" => "<p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">Los datos se presentan como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#46; En los apartados correspondientes a las diferencias&#44; la diferencia se presenta como estimaci&#243;n puntual&#44; acompa&#241;ada de su intervalo de confianza al 95&#37; entre par&#233;ntesis&#46;</p><p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">CVAD&#58; calidad de vida dimensi&#243;n actividades dom&#233;sticas&#59; CVC&#58; calidad de vida dimensi&#243;n cosmesis&#59; CVEE&#58; calidad de vida dimensi&#243;n estado emocional&#59; CVIS&#58; calidad de vida dimensi&#243;n interacci&#243;n social&#59; CVT&#58; calidad de vida total&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Calidad de vida total &#40;CVT&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Puntuaci&#243;n CVT inicial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46&#44;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Puntuaci&#243;n CVT final&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diferencia CVT inicial-final&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;101&#40;1&#44;8 a 6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&#44;25&#40;1&#44;62 a 6&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;90&#40;&#8722;0&#44;04 a 7&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8722;0&#44;35&#40;&#8722;4&#44;8 a 4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Calidad de vida dimensi&#243;n interacci&#243;n social &#40;CVIS&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CVIS inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CVIS final&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diferencia CVIS inicial-final&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;05&#40;&#8722;0&#44;20 a 6&#44;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;58&#40;&#8722;2&#44;27 a 5&#44;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;96&#40;&#8722;0&#44;85 a 10&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&#40;&#8722;3&#44;1 a 9&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Calidad de vida dimensi&#243;n actividades dom&#233;sticas &#40;CVAD&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CVAD inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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          "es" => "<p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n de la calidad de vida&#44; medida a trav&#233;s del cuestionario <span class="elsevierStyleItalic">Charing Cross Venous Ulcer Questionnaire</span> &#40;CCVUQ-e&#41;&#44; seg&#250;n el tipo de vendaje &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>93&#41;</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Lo conocido sobre el tema</span><p id="par0260" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">&#8226;</span></span><p id="par0265" class="elsevierStylePara elsevierViewall">Las &#250;lceras de etiolog&#237;a venosa son muy prevalentes en la poblaci&#243;n mayor de 65 a&#241;os y producen un importante impacto en la calidad de vida de los pacientes&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">&#8226;</span></span><p id="par0270" class="elsevierStylePara elsevierViewall">Existe evidencia acerca de que la terapia compresiva favorece el proceso de cicatrizaci&#243;n de las &#250;lceras venosas&#44; pero no existe un claro acuerdo en cuanto al tipo de vendaje a utilizar&#46;</p></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Qu&#233; aporta este estudio</span><p id="par0275" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Los 2 tipos de vendaje utilizados&#58; doble capa y crep&#233; son apropiados para lograr la cicatrizaci&#243;n de las &#250;lceras&#44; as&#237; como para mejorar la calidad de vida&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Ambos tipos de vendaje son seguros para el paciente&#44; al no observar reacciones adversas graves&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0290" class="elsevierStylePara elsevierViewall">No encontramos diferencias significativas en la cicatrizaci&#243;n de las &#250;lceras entre los 2 tipos de vendaje utilizados&#44; por lo que no podemos extraer conclusiones sobre el m&#233;todo de vendaje m&#225;s adecuado&#46;</p></li></ul></p></span></span>"
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                    0 => array:2 [
                      "titulo" => "Conferencia nacional de consenso sobre las &#250;lceras de la extremidad inferior&#46; Documento de consenso CONUEI"
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                        0 => array:2 [
                          "etal" => false
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                0 => array:2 [
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                      "titulo" => "Correlation between health-related quality of life and venous leg ulcer&#39;s severity and characteristics&#58; a cross-sectional study"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Gonz&#225;lez de la Torre"
                            1 => "M&#46;L&#46; Quintana-Lorenzo"
                            2 => "E&#46; Perdomo-P&#233;rez"
                            3 => "J&#46; Verd&#250;"
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                    0 => array:2 [
                      "doi" => "10.1111/iwj.12610"
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                        "tituloSerie" => "Int Wound J&#46;"
                        "fecha" => "2017"
                        "volumen" => "14"
                        "paginaInicial" => "360"
                        "paginaFinal" => "368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27112627"
                            "web" => "Medline"
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                            0 => "H&#46; Ma"
                            1 => "T&#46;F&#46; O&#8217;Donnell Jr&#46;"
                            2 => "N&#46;A&#46; Rosen"
                            3 => "M&#46;D&#46; Lafrati"
                          ]
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ISSN: 02126567
Idioma original: Español
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es en pt

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos