Abordagens terapêuticas e desafios no manejo de feridas complexas: uma revisão de escopo

Vollständiger Abstract

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Complex wounds constitute a significant public health problem, characterized by difficult healing, the need for multidisciplinary follow-up, and the use of advanced health technologies. This study aimed to map the available scientific evidence regarding therapeutic approaches, technologies, and care strategies employed in the management of complex wounds. This is a scoping review conducted according to the methodological recommendations of the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist. The guiding question was: what scientific evidence is available on the approaches and care strategies employed in the management of complex wounds? The search was conducted in the PubMed/MEDLINE, CINAHL, LILACS, BDENF, and Google Scholar databases, encompassing publications between 2020 and 2025, in Portuguese, English, and Spanish. Primary studies, reviews, and clinical guidelines addressing pressure injuries, diabetic ulcers, venous and arterial ulcers, as well as complicated traumatic and surgical wounds were included. The results highlighted a diversity of interventions, including topical therapies, photobiomodulation with blue light, therapies with placental matrices, negative pressure therapy with instillation, microcurrent therapy, hyaluronic acid associated with amino acids, foams with silver ions, and artificial intelligence-based technologies for wound measurement. Observational and retrospective studies predominated, in addition to clinical trials and systematic reviews. Among the main reported outcomes were reduction in wound area, acceleration of the healing process, control of bacterial load, pain reduction, and overall clinical improvement. Emerging technologies demonstrated promising results, especially in biofilm control, stimulation of re-epithelialization, and digital monitoring of lesions. It is concluded that the management of complex wounds involves a multifactorial approach and the integration of innovative technologies with evidence-based practices. Despite the identified therapeutic advances, gaps persist related to the standardization of protocols, cost-effectiveness evaluation, and strengthening of interdisciplinary action, especially in the context of nursing. The review contributes to the systematization of knowledge and supports the improvement of care practices and care policies at different levels of health care.