Trophic ulcers of the lower extremities

A trophic ulcer is a disease characterized by the formation of defects in the skin or mucous membrane, which occurs after the rejection of necrotic tissue and is characterized by a sluggish course, a small tendency to healing and a tendency to recurrence.

As a rule, they develop on the background of various diseases, are distinguished by a persistent long course and are difficult to treat. Recovery directly depends on the course of the underlying disease and the possibility of compensating for disorders that led to the onset of pathology.

Such ulcers do not heal for a long time - more than 3 months. Most often, a trophic ulcer affects the lower extremities, so treatment should be started when the first signs are detected at the initial stage.

Causes

Impaired blood supply to the skin area leads to the development of microcirculation disorders, lack of oxygen and nutrients, and gross metabolic disorders in the tissues. The affected skin area is necrotic, becomes sensitive to any traumatic agents and the accession of the infection.

To provoke the occurrence of trophic ulcers on the leg are capable of such risk factors:

  1. Problems of the venous circulation: thrombophlebitis, varicose veins of the lower extremities, etc. (both diseases contribute to the stagnation of blood in the veins, disrupting the nutrition of the tissue and causing necrosis) - ulcers appear on the lower third of the leg;
  2. Worsening of the arterial blood circulation (in particular, in atherosclerosis, diabetes mellitus);
  3. Some systemic diseases (vasculitis);
  4. Any kind of mechanical damage to the skin. It can be not only a usual, household injury, but also a burn, frostbite. The same area includes ulcers that form in drug addicts after injections, as well as the effects of radiation;
  5. Poisoning with toxic substances (chromium, arsenic);
  6. Skin diseases, such as chronic dermatitis, eczema;
  7. Violation of local blood circulation during prolonged immobility due to injury or illness (bedsores are formed).

When making a diagnosis, the disease is very important, which caused education, since the tactics of treating trophic leg ulcers and the prognosis largely depends on the nature of the underlying venous pathology.

Symptoms of trophic ulcers

The formation of leg ulcers, as a rule, is preceded by a whole complex of objective and subjective symptoms indicating a progressive violation of the venous circulation in the limbs.

Patients report increased swelling and heaviness in the calf, increased cramps in the calf muscles, especially at night, a burning sensation, "heat", and sometimes itchy skin of the lower leg. During this period, the network of soft bluish veins of small diameter increases in the lower third of the leg. On the skin appear purple or purple pigment spots, which, merging, form an extensive zone of hyperpigmentation.

In the initial stage, the trophic ulcer is located superficially, has a moist dark red surface covered with a scab. In the future, the ulcer expands and deepens.

Separate ulcers can merge with each other, forming extensive defects. Multiple running trophic ulcers in some cases can form a single wound surface around the entire circumference of the leg. The process extends not only in breadth, but also in depth.

Complications

A trophic ulcer is very dangerous for its complications, which are very serious and have bad prospects. If we do not pay attention to trophic ulcers of the extremities in time and do not begin the process of treatment, the following unpleasant processes may subsequently develop:

  • erysipelas;
  • lymphadenitis, lymphangitis;
  • sepsis;
  • gas gangrene;
  • skin cancer.

Mandatory treatment of trophic ulcers on the legs should be conducted under the supervision of the attending physician without any initiative, only in this case, you can minimize the consequences.

Prevention

The main prophylactic to prevent the occurrence of trophic ulcers is the immediate treatment of primary diseases (circulatory disorders and lymph outflow).

It is necessary not only to apply the medicine inside, but also to apply them externally. Local exposure will help to stop pathological processes, treat an existing ulcer and prevent the subsequent destruction of tissues.

What is dangerous disease?

A progressive trophic ulcer may, over time, occupy large areas of skin, increasing the depth of the necrotic effect. A pyogenic infection that gets inside can provoke erysipelas, lymphadenitis, lymphangitis, and septic complications.

In the future, the advanced stages of trophic ulcers can develop into gas gangrene, and this becomes an occasion for urgent surgical intervention. Long-term non-healing wounds exposed to aggressive substances - salicylic acid, tar, can develop into malignant transformations - skin cancer.

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Treatment of trophic ulcers on the leg

In the presence of trophic ulcers on the leg, one of the main stages of treatment is to identify the cause of the disease. For this purpose, it is necessary to consult a physician such as a phlebologist, dermatologist, endocrinologist, cardiologist, vascular surgeon, or general practitioner.

Late stages of the disease are usually treated in surgical hospitals. However, in addition to identifying and eliminating the causes of trophic ulcers, it is also necessary not to forget about the daily care of the affected area.

How to treat trophic ulcer of the lower extremities? Use several options, depending on the neglect of the pathological process.

  1. Conservative therapy, when patients are prescribed such drugs as phlebotonics, antibiotics, antiplatelet agents. They will help cure most of the symptoms of the disease. The following drugs are often prescribed to patients: Detralex, Tocopherol, Solcoseryl, Actovegin. Only a doctor can prescribe such drug treatment.
  2. Local therapy, which can be used to cure tissue and skin damage. In diabetes use ointments containing antiseptics and enzymes. These remedies heal wounds and provide local anesthesia. Ointments that enhance blood circulation is prohibited to apply to the open surface of a trophic ulcer. Such ointments as Dioxycol, Levomekol, Kuriosin, Levosin have a wound healing effect. Ointment is applied to the compress and whether they make special dressings.
  3. Surgical intervention that is performed after the healing of ulcers. During it, the blood flow in the veins in the affected area is restored. Such an operation includes shunting and phlebectomy.

For the treatment of wounds using these drugs: Chlorhexidine, Dioxidin, Eplan. At home, you can use a solution of furatsilina or potassium permanganate.

Operative intervention

Surgical treatment of trophic ulcers of the lower extremities is indicated for extensive and severe skin lesions. The operation consists in removing the ulcer with the surrounding non-viable tissues, and further closing the ulcer, in the second stage the operation on the veins is performed.

There are several different surgical methods:

  1. Vacuum therapy, which allows you to quickly remove pus and reduce swelling, as well as create a moist environment in the wound, which will greatly hinder the bacteria from developing.
  2. Catheterization - suitable for ulcers that do not heal for a very long time.
  3. Percutaneous flashing is suitable for the treatment of hypertensive ulcers. Its essence is in dissociation of venous arterial fistulas.
  4. Virtual amputation. The metatarsal bone and metatarsophalangeal joint is cut off, but the anatomical integrity of the foot is not impaired - but the foci of bone infection are removed, which makes it possible to effectively combat a neurotrophic ulcer.

With an ulcer size of less than 10 cm², the wound is covered with its own tissues, tightening the skin a day by 2-3 mm, gradually bringing the edges together and closing it in 35-40 days. In place of the wound remains a scar, which must be protected from any possible injury. If the lesion area is more than 10 cm², skin plastics are applied using the healthy skin of the patient.

Drug therapy

The course of drug treatment necessarily accompanies any operation. Drug treatment is divided into several stages, depending on the stage of the pathological process.

At the first stage (stage of weeping ulcer) the following drugs are included in the course of drug therapy:

  1. Broad-spectrum antibiotics;
  2. NSAIDs, which include ketoprofen, diclofenac, etc .;
  3. Antiplatelet agents for intravenous injection: pentoxifylline and reopolyglukine;
  4. Antiallergic drugs: tavegil, suprastin, etc.

Local treatment at this stage is aimed at cleansing the ulcer from dead epithelium and pathogens. It includes the following procedures:

  1. Washing the wound with antiseptic solutions: potassium permanganate, furatsilina, chlorhexidine, decoction of the celandine, succession or chamomile;
  2. The use of dressings with medicinal ointments (dioxycol, levomikol, streptolaven, etc.) and carbonette (special dressings for sorption).

At the next stage, which is characterized by the initial phase of healing and the formation of scars, healing ointments for trophic ulcers are used in the treatment - solcoseryl, actevigin, ebermine, etc., as well as antioxidant preparations, such as tolcoferon.

Also at this stage, specially designed for this wound coverings sviderm, geshispon, algimaf, algipor, allevin, etc. are used. Treatment of the expressed surface is carried out by curiosin. In the final stages, medical treatment is aimed at eliminating the main disease that provoked the emergence of trophic ulcers.

How to treat trophic leg ulcers at home

Starting treatment of trophic ulcers according to popular recipes, it is necessary to consult with your doctor.

At home you can use:

  1. Hydrogen peroxide. It is necessary to drop peroxide on the ulcer itself, then sprinkle streptocide on this place. On top of you need to put a napkin, pre-moistened with fifty milliliters of boiled water. In this water, add two teaspoons of peroxide. Then cover the compress with a packet and tie it with a handkerchief. Change the compress several times a day. And streptotsid poured, when the wound will be moistened.
  2. Healing balm in the treatment of trophic ulcers in diabetes mellitus. It consists of: 100 g of juniper tar, two egg yolks, 1 tablespoon of rose oil, 1 teaspoon of purified turpentine. All this needs to be mixed. Turpentine pour on the sly, otherwise the egg will fold. This balm is applied to a trophic ulcer, then covered with a bandage. This folk remedy is a good antiseptic.
  3. Powder from dried leaves Wash the wound with a solution of rivanol. Sprinkle with the prepared powder. Apply a bandage. Next morning, powder the powder again, but do not rinse the wound. Soon the ulcer will begin to scar.
  4. Trophic ulcers can be treated with antiseptics: wash the wounds with warm water and laundry soap, apply antiseptic and bandage. These dressings alternate with applications from a solution of sea salt or table salt (1 tablespoon per 1 liter of water). The gauze should be folded in 4 layers, moistened in saline, slightly pressed and put on the wound, on top of the compress paper, hold for 3 hours. The procedure is repeated twice a day. Between applications a break of 3-4 hours, at this time keep the ulcers open. Soon they will begin to decrease in size, the edges will become gray, which means that the healing process is underway.
  5. Garlic poultices or compresses are used for open ulcers. Take a multi-layer gauze or terry towel, soak garlic in a hot broth, squeeze out excess liquid and immediately apply to the sore spot. Put a dry flannel dressing and a heating pad or a bottle of hot water on a poultice or compress to keep it warm longer.
  6. You need to mix egg white with honey so that these ingredients are in the same ratio. Beat everything and apply to the ulcers, including the veins that hurt. Then cover the back of the leaves of burdock. There should be three layers. Wrap cellophane film and perebintyuyu linen fabric. Leave a compress for the night. You need to do this treatment five to eight times.

Remember that in the absence of timely and correct therapy, complications such as microbial eczema, erysipelas, periostitis, pyoderma, arthrosis of the ankle joint, etc. may develop. Therefore, it is not necessary to use only folk remedies, while neglecting traditional treatment.

Ointment for treatment

For the treatment of this disease, you can also use a variety of ointments, both natural and purchased in a pharmacy. Effectively heal wounds and have anti-inflammatory effect of ointment of arnica, comfrey, and room geranium.

Often also used Vishnevsky ointment. Of the ointments that can be bought at the pharmacy, especially highlight dioxole, levomekol, as well as streptoveno and a number of analogues.

Watch the video: Characteristics of Venous Ulcers (January 2020).

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