Thesis (doctoral)--Ludwig Maximilians-Universität zu München, 1979.

Orientadores: Fabio Husemann Menezes, João Poterio Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T07:32:33Z (GMT). No. of bitstreams: 1 Viarengo_LuizMarceloAiello_D.pdf: 5372848 bytes, checksum: 053f8a2b3ec69d775d15f4e631b7f2c9 (MD5) Previous issue date: 2007 / Resumo: Este estudo foi desenvolvido para avaliar, prospectivamente, os resultados do tratamento de varizes com úlcera em atividade com laser endovenoso (EVL), comparando com um grupo sob tratamento clínico, durante um ano. Foram estudados 52 pacientes consecutivos portadores de varizes com úlcera em atividade há mais de um ano, divididos em dois grupos aleatórios. O Grupo I, tratamento clínico, formado por 25 indivíduos; o Grupo II, tratamento com EVL, constituído por 27 indivíduos. Todos os pacientes foram estudados com ultra-som no início e término do estudo. Os pacientes do Grupo II foram seguidos com ultra-som com 7 dias, 30 dias e a cada 3 meses. As áreas das feridas foram avaliadas a cada 3 meses. O laser utilizado para o tratamento endovenoso das varizes tronculares foi um laser de diodo, com comprimento de onda de 980 nanômetros, com potência nominal de 15W com fibra óptica condutora de laser de 600 microns, introduzida endovenosamente por punção percutânea dirigida por ultra-som e com emprego de anestesia local por infiltração intumescente associado a sedação leve por via oral com 15mg de Midazolam®. As medidas de temperaturas intra e perivenosa foram realizadas com um termômetro digital acoplado ao computador. Em 12 meses, 81,5% das feridas dos pacientes do Grupo II estavam cicatrizadas enquanto no Grupo I apenas 24% estavam cicatrizadas. A recorrência de úlcera foi de 44,4% no Grupo I, sem nenhuma recorrência no Grupo II. A área média das feridas no Grupo I reduziu de 18,04cm² para 13,16cm² ao final de um ano, enquanto no Grupo II reduziu de 22,7cm² para 3,64cm² (p<0,05). A temperatura média registrada foi de 79,3ºC no intravenoso e de 43,0ºC nos tecidos perivenosos. Não houve efeito adverso importante. O tratamento de varizes com laser endovenoso em pacientes com úlcera venosa em atividade mostrou-se seguro, com taxa de cicatrização das feridas superior à dos pacientes com tratamento clínico no prazo de um ano, e não houve recorrência / Abstract: Conventional saphenous vein stripping is difficult to be indicated for the treatment of varicose veins in patients classified as CEAP C4, C5 or C6. This study was developed to consecutively evaluate treatment results for varicose veins with active ulcers using endovenous laser (EVL), compared to a groupundergoing clinical treatment, during a year. Fifty-two consecutive patients presenting with varicose veins with active ulcers for more than a year were divided for treatment into two randomized groups: Group I, clinical treatment, composed of 25 subjects, were submitted to elastic or inelastic compression therapy according to individual medical recommendation; Group II, EVL treatment, composed of 27 subjects, were submitted to great and or small saphenous vein ablation with a 980 nm diode endovenous laser, plus the clinical treatment. Intravenous and perivenous temperatures were measured continuously with a digital thermometer connected to a computer during the EVL treatment. All patients were followed for 12 months and studied with ultrasound at the beginning and end of the study. The ulcers¿areas were evaluated initially and at every 3 months. In 12 months, 81.5% of the wounds in patients in Group II and only 24% in patients in Group I had healed. Ulcer recurrence rate was 44.4% in Group I. The average wound area in Group I decreased from 18.04cm² to 13.16cm² at the end of the year. In Group II, the wound area decreased from 22.7cm² to 3,64cm² (p<0,05). Mean intravenous and perivenous temperatures of 79.3ºC and 43.0ºC were recorded. In conclusion, the treatment for varicose veins with endovenous laser (EVL) as described is safe in patients with active ulcers. Wounds healed faster than in patients undergoing clinical treatment alone during a one-year period. There was no ulcer recurrence in patients treated with EVL / Doutorado / Cirurgia / Doutor em Cirurgia

Introdução: apesar de todo o avanço científico e tecnológico voltado para o cuidado de pessoas com úlcera venosa crônica, muitas apresentam dificuldades para aderir ao cuidado necessário à cicatrização dessa lesão, o que traz impactos negativos às suas vidas. Objetivo: compreender a ação das pessoas com úlcera venosa crônica em relação à adesão ao cuidado orientado pelos profissionais de saúde. Método: pesquisa de abordagem fenomenológica, realizada em uma cidade do interior de Minas Gerais. Participaram cinco homens e sete mulheres com úlcera venosa crônica, com idade média de 61 anos e tempo médio da lesão de 13 anos. Para obtenção dos dados, utilizou-se a entrevista aberta com as seguintes questões norteadoras: fale-me sobre as orientações que você recebeu do profissional de saúde sobre o cuidado com a ferida. Como está sendo para você seguir estas orientações? O que você tem em vista quando procura o profissional de saúde para cuidar da sua ferida? A organização e análise foram realizadas seguindo os passos preconizados por estudiosos da fenomenologia social de Alfred Schütz. O projeto foi aprovado pelo Comitê de Ética em Pesquisa com seres humanos da Escola de Enfermagem da Universidade de São Paulo, sob o Parecer nº 1.235.302, de 18 de setembro de 2015. Resultados: o típico da ação vivida por pessoas com úlcera venosa crônica frente à adesão ao cuidado orientado pelos profissionais de saúde caracteriza-se como aquele que age em busca da adesão aos cuidados com vistas à cicatrização da úlcera venosa crônica e à manutenção da integridade da pele dos membros inferiores o maior tempo possível, vislumbrando a retomada das atividades do cotidiano. Além disso, inclui a expectativa do estabelecimento de uma boa relação interpessoal com o profissional no serviço de saúde. Embora intencionalidade se volte para a adesão ao cuidado orientado pelos profissionais de saúde, as atividades cotidianas impedem a concretização dessa intencionalidade, dificultando a realização do repouso, prática de exercícios físicos, dieta e uso da terapia compressiva. Também a falta de infraestrutura dos serviços de saúde interfere na adesão ao cuidado, o que pode dificultar a cicatrização da úlcera venosa crônica. Conclusões: a fenomenologia social de Alfred Schütz permitiu desvelar o típico da ação de pessoas com úlcera venosa crônica frente à adesão ao cuidado orientado pelos profissionais de saúde, trazendo elementos importantes para a reflexão acerca da dificuldade para a adesão a esse cuidado. A perspectiva das pessoas com úlcera venosa crônica aponta questões alocadas no universo intersubjetivo e cultural dos participantes, além daquelas relacionadas à operacionalização dos cuidados nos serviços de saúde, que precisam ser refletidas no âmbito da assistência, gestão, ensino e pesquisa na área de saúde e enfermagem. / Introduction: despite all the scientific and technological advances meant for the care of people with chronic venous ulcers, many people with this wound have difficulty adhering to the care necessary for the healing of this wound, which brings negative impacts to their lives. Objective: To understand the action of people with chronic venous ulcer in relation to adherence to care guided by health professionals. Method: phenomenological research, carried out in a city in Minas Gerais. The study included five men and seven women with chronic venous ulcers, with mean age of 61 years and mean duration of 13 years injury. To obtain the data we used the open interview with the following guiding questions: Tell me about the prescriptions you received from health professionals about the care of the wound. How it is for you to follow these recommendations? What you have in mind when looking for health professional to take care of your wound? The organization and analysis were carried out following the steps recommended by researchers of social phenomenology of Alfred Schütz. The project was approved by the Ethics Committee in Research with human beings of the University of São Paulo School of Nursing, Protocol number1,235,302, September 18, 2015. Results: the typical action experienced by people with venous ulcers front adherence to care guided by health professionals is characterized as one who acts in pursuit of adherence to care with a view to healing of chronic venous ulcers and skin integrity maintenance of the lower limbs as long as possible, seeing the resumption of daily activities. It also includes the expectation of establishing good interpersonal relationship with the professional in the health service. Although intentionality will return to adherence to care guided by health professionals, everyday activities do not allow the realization of this intention, hindering the realization of rest, physical exercise, diet and use of compression therapy. The lack of infrastructure of health services interferes with adherence to care which can hinder the healing of chronic venous ulcers. Conclusions: social phenomenology of Alfred Schütz allowed reveal the typical action of people with chronic venous ulcers front adherence to care guided by health professionals, bringing important elements for reflection on the difficulty adhering to this care. The perspective of people with chronic venous ulcers point issues allocated in the intersubjective and cultural universe of participants, as well as those related to operationalization of care in health services, which need to be reflected in assistance, management, teaching and research in health and nursing.

O cuidado com feridas crônicas faz parte do cotidiano do enfermeiro, o que torna relevante o conhecimento de sua experiência e expectativas em relação ao tratamento de pessoas com úlcera venosa crônica (UVC). Este estudo, com abordagem da Fenomenologia Social de Alfred Schutz, teve como objetivo compreender a experiência e as expectativas do enfermeiro em relação ao cuidado à mulher com úlcera venosa crônica na Atenção Primária à Saúde. Foi realizado com sete enfermeiras que atuam em Unidades de Atenção Primária à Saúde de Juiz de Fora, Minas Gerais. A obtenção dos depoimentos ocorreu em janeiro de 2012, e foi utilizada a entrevista fenomenológica, com as seguintes questões norteadoras: como é para você cuidar de mulheres com UVC? Fale-me das suas expectativas quando cuida de uma mulher com UVC. A análise compreensiva permitiu tipificar a enfermeira como aquela profissional que identifica as dificuldades da mulher para realizar seu autocuidado, considerando as questões inerentes a seu cotidiano, a baixa autoestima e a falta de suporte da família para o prosseguimento do tratamento. Ela percebe limitações na terapêutica, que é prejudicada por valores e crenças relacionadas à ferida, desmotivação da mulher e a própria frustração, principalmente em face da recidiva da lesão. Refere-se também à falta de insumos e tecnologia, de trabalho interdisciplinar e capacitação da equipe de enfermagem como fatores limitantes para o tratamento. Tem como expectativa a adesão da mulher ao tratamento da UVC e realça a necessidade do cuidado contínuo, as orientações para o autocuidado e a padronização de condutas no tratamento de feridas para evitar as recidivas da lesão, propiciando-se à mulher obter maior qualidade de vida. Evidenciou-se que os limites e as possibilidades que permeiam o cuidado se relacionam a diversos sujeitos, instituições e políticas de saúde nele envolvidos. Espera-se que esta pesquisa possibilite reflexões e ações no âmbito assistencial, do ensino e da pesquisa no que tange ao cuidado à mulher com UVC. Estas devem fundamentar a aplicação do conhecimento deste estudo nos referidos âmbitos, valorizando os diversos aspectos objetivos e subjetivos entremeados no cuidado a essa mulher. / The care of chronic wounds is part of daily nursing, being relevant to know your experience and expectations regarding the treatment of people with chronic venous ulcers (CVU). A study used the approach of Social Phenomenology by Alfred Schutz to understand the experiences and expectations of nurses who cared for women with Chronic Venous Leg Ulcers (CVLU) in primary health care. This study was conducted with seven nurses who were working in Primary Health Care units, Juiz de Fora, Minas Gerais. The taking of statements took place in January 2012, utilizing the phenomenological interview approach, asking the following questions: How do you take care of women with CVLU? What are your expectations when caring for a woman with CVLU? The comprehensive analysis resulted in classifying the professional nurse as one who identifies the difficulties of women to perform self-care, considering the issues inherent in their daily life, low self-esteem and lack of family support for the continuation of treatment. Perceived limitations in therapy are affected by values and beliefs related to the condition and the woman\'s and nurses frustration, mainly due to reoccurrence of the wounds. The study also refers to the lack of inputs and technology, interdisciplinary work and training of nursing staff as limiting factors for treatment. The expectation is that the treatment of CVLU, underlining the necessity of continuous care, self care guidelines and standardization of ducts to treat wounds and preventing recurrences of the injury, thereby allows women to achieve a better quality of life. It was evident that the limits and possibilities that permeate the care of this disease are due to various situations, including institutions and health policies related to it. It is hoped that this research allows will result in reflections and actions in health care, education and research regarding the care of women with CVLU. This research should support the application of knowledge in these areas of study, highlighting the various objective and subjective aspects woven into the care of woman.

A total of 180 patients participated in the study, with 30 withdrawn due to various reasons. At 12 weeks, 76% patients treated with SSB, 78% patients treated with 4LB, and 31% patients treated with usual care alone had completed ulcer healing. The hazard ratios for healing for 4LB and SSB relative to the control group were 3.14 (95% CI = 1.74-5.67) and 2.72 (95% CI = 1.53-4.86), respectively. The key findings indicated the significant effects of compression bandaging resulted in a higher proportion of complete ulcer healing; reduction in ulcer size, pain severity, and pain interference; and improvement in quality of life and lifestyle activity. Across the 12-week study period, the present study also highlighted the significant improvement of the psychosocial composite outcome among the three study groups. Furthermore, the reduction in pain severity and pain interference accounted for the major contribution to the total effect of the psychosocial composite outcome. Therefore, effective pain control and minimizing the effect of pain on daily life is essential in promoting ulcer healing. It is evident that the application of compression bandaging with either 4LB or SSB is feasible and more effective than the current usual care with no compression. This study add new knowledge to the psychosocial benefit of compression bandaging for venous ulcer patients living in the community; and support incorporating compression bandaging in the routine venous ulcer care. Further studies are therefore suggested to focus on the assessment of the cost-effectiveness of and the satisfaction and experience of both patients and nurses with compression bandaging using different high compression bandage systems. / The study was a randomized controlled trial. Those patients who participated in the experimental groups received compression bandaging with either the 4LB or SSB along with a local usual care. In contrast, the control group participants received usual care. A 12-week study intervention was given individually to the study participants. The research outcome of this study was the proportion of complete ulcer healing, ulcer size, pain severity, pain interference, disease-specific and generic health-related quality of life measures, and lifestyle activity. The instruments used include VeV MD stereophotogrammetry, Brief pain Inventory, The SF-12 Health Survey, Charing Cross Venous Ulcer Questionnaire, and the Frenchay Activity Index. Data analysis involved the use of descriptive statistics and inferential statistics such as survival analysis, one way analysis of variance (ANOVA), multivariate analysis variance (MANOVA), doubly multivariate analysis of variance (Doubly MANOVA), and Roy-Bargman stepdown analysis were used. / Venous ulcer is the most serious clinical consequence of chronic venous insufficiency. It is a chronic health problem that afflicts older people as well as health care professions. Its chronicity, together with its high recurrent rate, creates not only a big challenge to nurses' workload and health cost, but it also has a direct impact on patients' physiological and psychosocial well-being. Compression bandaging has been identified as the mainstream form of treatment for venous ulcer in previous literature, although this is not very well known by the nurses in Hong Kong. Previous studies have confirmed that the proportion of complete ulcer healing is improved with high compression as compared to no compression. However, a definite conclusion on the effectiveness of different high compression systems, such as the four-layer compression system (4LB) and short-stretch compression system (SSB), was not found. Most importantly the treatment impacts on proportion of complete ulcer healing, ulcer size, pain severity and pain interference, health-related quality of life, and lifestyle activities are essential influences on patients' participation in venous ulcer care and treatment choice. These limited data leave a gap in today's knowledge on venous ulcer management in relation to both patients and health care providers. Therefore, the aim of this study is to examine the effect of two compression bandage systems, the 4LB and SSB, in promoting ulcer healing in terms of the proportion of complete ulcer healing and ulcer size, as well as the psychosocial well-being including pain, heath-related quality of life, and lifestyle activity for older people in the community. / Wong, Kit Yee Irene. / "December 2007." / Adviser: Diana T. F. Lee. / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4672. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 248-268). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

<p>Treatment for varicose veins (VV) is insufficiently evidence based and recurrence rates are high. The aim of this thesis was to study the long-term results after VV surgery, risk factors for recurrences and the effect of preoperative duplex scanning on recurrence rate, quality of life (QoL) and costs.</p><p>In a follow-up study 89 patients with 100 legs operated on for VV 6–10 years earlier were re-examined with duplex, in 13 cases also with varicography. 57% had incompetent vessels in the groin visible with duplex, equally well defined by varicography. Residual branches could not be differentiated from new vessel formation. The recurrence rate did not correlate to the surgeon’s level of experience or perioperative difficulties at primary surgery. </p><p>In a prospective randomized study 293 patients (343 legs) were operated on for primary VV with or without preoperative duplex. Duplex was done postoperatively, at 2 months and 2 years. QoL was measured with SF-36 preoperatively, at 1 month, 1 year and 2 years. </p><p>After 2 years the number of reoperations were 2 in the group with preoperative duplex and 14 in the group without (p=0.002). Incompetent veins were seen in the saphenofemoral or saphenopopliteal junction in 19 and 53 legs respectively (p<0.001).</p><p>Preoperative QoL was worse in the VV patients compared to a reference population, and was normalised 2 years postoperatively. The improved surgical result in the duplex group was not reflected in a significantly higher QoL. </p><p>The lower costs for redo surgery in the duplex group did not offset the costs for duplex, partly due to more extensive primary surgery. </p><p>A significant proportion of recurrences after 2 years was new vessel formation and progression of disease. Preoperative perforating vein incompetence did not influence recurrence rate, and was abolished without specific interruption in 60% at 2 years postoperatively.</p>

Treatment for varicose veins (VV) is insufficiently evidence based and recurrence rates are high. The aim of this thesis was to study the long-term results after VV surgery, risk factors for recurrences and the effect of preoperative duplex scanning on recurrence rate, quality of life (QoL) and costs. In a follow-up study 89 patients with 100 legs operated on for VV 6–10 years earlier were re-examined with duplex, in 13 cases also with varicography. 57% had incompetent vessels in the groin visible with duplex, equally well defined by varicography. Residual branches could not be differentiated from new vessel formation. The recurrence rate did not correlate to the surgeon’s level of experience or perioperative difficulties at primary surgery. In a prospective randomized study 293 patients (343 legs) were operated on for primary VV with or without preoperative duplex. Duplex was done postoperatively, at 2 months and 2 years. QoL was measured with SF-36 preoperatively, at 1 month, 1 year and 2 years. After 2 years the number of reoperations were 2 in the group with preoperative duplex and 14 in the group without (p=0.002). Incompetent veins were seen in the saphenofemoral or saphenopopliteal junction in 19 and 53 legs respectively (p&lt;0.001). Preoperative QoL was worse in the VV patients compared to a reference population, and was normalised 2 years postoperatively. The improved surgical result in the duplex group was not reflected in a significantly higher QoL. The lower costs for redo surgery in the duplex group did not offset the costs for duplex, partly due to more extensive primary surgery. A significant proportion of recurrences after 2 years was new vessel formation and progression of disease. Preoperative perforating vein incompetence did not influence recurrence rate, and was abolished without specific interruption in 60% at 2 years postoperatively.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

O cuidado com feridas crônicas faz parte do cotidiano do enfermeiro, o que torna relevante o conhecimento de sua experiência e expectativas em relação ao tratamento de pessoas com úlcera venosa crônica (UVC). Este estudo, com abordagem da Fenomenologia Social de Alfred Schutz, teve como objetivo compreender a experiência e as expectativas do enfermeiro em relação ao cuidado à mulher com úlcera venosa crônica na Atenção Primária à Saúde. Foi realizado com sete enfermeiras que atuam em Unidades de Atenção Primária à Saúde de Juiz de Fora, Minas Gerais. A obtenção dos depoimentos ocorreu em janeiro de 2012, e foi utilizada a entrevista fenomenológica, com as seguintes questões norteadoras: como é para você cuidar de mulheres com UVC? Fale-me das suas expectativas quando cuida de uma mulher com UVC. A análise compreensiva permitiu tipificar a enfermeira como aquela profissional que identifica as dificuldades da mulher para realizar seu autocuidado, considerando as questões inerentes a seu cotidiano, a baixa autoestima e a falta de suporte da família para o prosseguimento do tratamento. Ela percebe limitações na terapêutica, que é prejudicada por valores e crenças relacionadas à ferida, desmotivação da mulher e a própria frustração, principalmente em face da recidiva da lesão. Refere-se também à falta de insumos e tecnologia, de trabalho interdisciplinar e capacitação da equipe de enfermagem como fatores limitantes para o tratamento. Tem como expectativa a adesão da mulher ao tratamento da UVC e realça a necessidade do cuidado contínuo, as orientações para o autocuidado e a padronização de condutas no tratamento de feridas para evitar as recidivas da lesão, propiciando-se à mulher obter maior qualidade de vida. Evidenciou-se que os limites e as possibilidades que permeiam o cuidado se relacionam a diversos sujeitos, instituições e políticas de saúde nele envolvidos. Espera-se que esta pesquisa possibilite reflexões e ações no âmbito assistencial, do ensino e da pesquisa no que tange ao cuidado à mulher com UVC. Estas devem fundamentar a aplicação do conhecimento deste estudo nos referidos âmbitos, valorizando os diversos aspectos objetivos e subjetivos entremeados no cuidado a essa mulher. / The care of chronic wounds is part of daily nursing, being relevant to know your experience and expectations regarding the treatment of people with chronic venous ulcers (CVU). A study used the approach of Social Phenomenology by Alfred Schutz to understand the experiences and expectations of nurses who cared for women with Chronic Venous Leg Ulcers (CVLU) in primary health care. This study was conducted with seven nurses who were working in Primary Health Care units, Juiz de Fora, Minas Gerais. The taking of statements took place in January 2012, utilizing the phenomenological interview approach, asking the following questions: How do you take care of women with CVLU? What are your expectations when caring for a woman with CVLU? The comprehensive analysis resulted in classifying the professional nurse as one who identifies the difficulties of women to perform self-care, considering the issues inherent in their daily life, low self-esteem and lack of family support for the continuation of treatment. Perceived limitations in therapy are affected by values and beliefs related to the condition and the woman\'s and nurses frustration, mainly due to reoccurrence of the wounds. The study also refers to the lack of inputs and technology, interdisciplinary work and training of nursing staff as limiting factors for treatment. The expectation is that the treatment of CVLU, underlining the necessity of continuous care, self care guidelines and standardization of ducts to treat wounds and preventing recurrences of the injury, thereby allows women to achieve a better quality of life. It was evident that the limits and possibilities that permeate the care of this disease are due to various situations, including institutions and health policies related to it. It is hoped that this research allows will result in reflections and actions in health care, education and research regarding the care of women with CVLU. This research should support the application of knowledge in these areas of study, highlighting the various objective and subjective aspects woven into the care of woman.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2018-03-21T15:14:50Z No. of bitstreams: 1 Fabiana Lopes Joaquim.pdf: 4740814 bytes, checksum: 38c60c466d468d249ad3baf04b8e97d3 (MD5) / Made available in DSpace on 2018-03-21T15:14:50Z (GMT). No. of bitstreams: 1 Fabiana Lopes Joaquim.pdf: 4740814 bytes, checksum: 38c60c466d468d249ad3baf04b8e97d3 (MD5) Previous issue date: 2017 / Doutorado Acadêmico em Ciências do Cuidado em Saúde / As úlceras venosas crônicas acometem os membros inferiores e provocam nas pessoas dificuldades relacionadas à necessidade de adaptação à condição clínica, levando estes a repensar valores, entender a enfermidade, seguir procedimentos e enfrentar o olhar da sociedade repleta de mitos e estigmas. Frente ao exposto, esta pesquisa teve como objeto a percepção existencial das pessoas que vivem com úlceras venosas crônicas e a tese defendida e comprovada resultante do construto teórico é que através da compreensão da percepção existencial das pessoas que vivem com úlceras venosas crônicas, pautada em uma perspectiva merleaupontiana, que prioriza as experiências vividas, é possível identificar a presença das “úlceras metafísicas”, o que auxilia a produzir em coexistência o cuidado a partir do contexto sociocultural, contribuindo para o fortalecimento das Ciências do Cuidado em Saúde. O objetivo geral foi compreender como as pessoas adultas e idosas percebem sua existência frente às úlceras venosas; e os objetivos específicos foram descrever como as pessoas com úlceras venosas crônicas percebem a própria existência e analisar esta percepção à luz da fenomenologia de Merleau-Ponty. É um estudo fenomenológico, descritivo, com abordagem qualitativa. O campo de pesquisa foi o Ambulatório de Reparo de Feridas do Hospital Universitário Antônio Pedro (HUAP), localizado em Niterói/RJ. Participaram 36 pacientes que vivem com úlceras venosas crônicas e que aceitaram participar da pesquisa. A coleta de dados ocorreu por meio do instrumento de protocolo de pesquisa; da entrevista fenomenológica, operacionalizada pela pergunta: Como é para o (a) senhor (a) viver com a(s) lesão/lesões da úlcera venosa? ; do instrumento de registro das expressões relacionadas à narratividade do corpo; e pela observação não estruturada. O parecer de aprovação ocorreu junto ao Comitê de Ética e Pesquisa do HUAP sob o número 1.581.358 e CAAE: 51981915.6.0000.5243. Os dados inerentes às entrevistas e aos instrumentos de registro das expressões relacionadas à narratividade do corpo se complementaram e se reafirmaram entre si, resultando em três categorias: 1) Vivendo com a doença: sinais e sintomas como marcas de uma vida - os resultados apontam que o desvelar existencial dos participantes têm repercussões inerentes ao estado patológico, levando à invisibilidade social e à indissociação das feridas; 2) O ser além da lesão e a afetividade - como consequência desta percepção, as pessoas com as referidas lesões passam a sentir necessidade da afetividade perdida por consequência do corpo lesionado. Frente a esta realidade, família e amigos são amparo no “mundo da vida”, auxiliando nas potencialidades; 3) A volta ao passado e o atual isolamento social - recordar a existência antes da lesão traz à tona a questão do isolamento social. Ante a este isolamento e às percepções do “mundo da vida”, evidencia-se a importância da espiritualidade como sustentáculo. Conclui-se que a existência das pessoas que apresentam as úlceras venosas vai além da lesão física, fazendo com que estas necessitem se reencontrar corporalmente, dando um novo sentido ao “mundo percebido”, minimizando, e por que não dizer cicatrizando? as “úlceras metafísicas” originadas da incompreensão do mundo ao ser que se encontra com a lesão. / Chronic venous ulcers affect the lower limbs and cause difficulties related to the need to adapt to the clinical condition in people, leading them to rethink values, understand the disease, follow procedures and face the eyes of society full of myths and stigmas. In view of the above, this research had as its object the existential perception of people living with chronic venous ulcers and the thesis defended and proven, resulting from the theoretical construct, that it is possible to identify the presence of “metaphysical ulcers” by understanding the existential perception of people living with chronic venous ulcers, based on a Merleau-Pontian perspective that prioritizes lived experiences. This helps to produce, in coexistence, care from the sociocultural context, contributing to the strengthening of Health Care Sciences. The general objective was to understand how adults and elderly people perceive their existence in the face of venous ulcers; and the specific objectives were to describe how people with chronic venous ulcers perceive their own existence and analyze this perception in the light of Merleau-Ponty‟s phenomenology. It is a phenomenological, descriptive study, using a qualitative approach. The research area was the Wound Repair Ambulatory of the Antônio Pedro University Hospital (HUAP), located in Niterói/RJ. Participants were 36 patients living with chronic venous ulcers who accepted to participate in the study. Data collection took place through: a research protocol instrument; the phenomenological interview, operationalized by the question: How do you live with the venous ulcer lesion(s)? ; the instrument of registration of expressions related to the narrativity of the body; and unstructured observation. The approval opinion was presented to the Ethics and Research Committee of HUAP under number 1.581.358 and CAAE: 51981915.6.0000.5243. The data inherent to the interviews and the recording instruments of the expressions related to the narrativity of the body were complemented and reaffirmed among themselves, resulting in three categories: 1) living with disease: signs and symptoms as marks of a life - the results indicate that the existential disclosure of the participants have inherent repercussions to the pathological state, leading to social invisibility and the indissociation of the wounds; 2) the individual beyond injury and affectivity - as a consequence of this perception, people with those injuries begin to feel the need for the affection lost as a consequence of the injured body. Faced with this reality, family and friends are supported in the “life world”, helping in the potentialities; 3) the return to the past and the current social isolation - remembering the existence before the injury brings up the question of social isolation. Faced with this isolation and perceptions of the “life world”, the importance of spirituality as a support is evident. It is concluded that the existence of people with venous ulcers goes beyond physical injury, causing them to find themselves again in their bodies, giving a new meaning to the “perceived world”, minimizing, and why not saying, healing “metaphysical ulcers” originated from the incomprehension of the world by the individual who is injured.