Trophic ulcers of lower extremities

click fraud protection

Trophic ulcer is a disease characterized by the formation of skin or mucosal defects that occurs after the rejection of necrotic tissue and is characterized by a sluggish course, a small tendency to healing and a tendency to recur.

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

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

Causes of

Infringement of the 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 area of ​​the skin is necrotic, becomes sensitive to any traumatic agents and infection.

The occurrence of on the trophic ulcer on the leg is capable of such risk factors:

1. The problems of venous circulation: thrombophlebitis, varicose veins of the lower limbs and the like( both diseases contribute to the stagnation of blood in the veins, disrupting nutrition of the tissue and causing necrosis) - ulcers appear on the lower third of the shin;
2. Deterioration of the arterial blood circulation( in particular, with atherosclerosis, diabetes mellitus);
3. Some systemic diseases( vasculitis);
4. Any kind of mechanical damage to the skin. It can be not only an ordinary, domestic trauma, but also a burn, frostbite. The same area includes ulcers that are formed in addicted people after injections, as well as the effects of irradiation;
5. Poisoning with toxic substances( chromium, arsenic);
6. Skin diseases, for example, chronic dermatitis, eczema;
7. Violation of the local circulation at prolonged immobility due to trauma or illness( bedsores are formed).

When diagnosed, the disease that caused the formation is very important, since the tactics of treating the trophic ulcer on the leg and the prognosis depend to a large extent on the nature of the underlying venous pathology.

Symptoms of trophic ulcer

The formation of an ulcer on the leg is usually preceded by a whole complex of objective and subjective symptoms, indicative of a progressive violation of venous circulation in the extremities.

Patients report an increase in edema and heaviness in calves, an increase in gastrocnemius muscle cramps, especially at night, the appearance of burning sensation, "heat," and sometimes itching of the shin. During this period, in the lower third of the shin, a network of soft cyanotic veins of small diameter increases. Violet or purple pigment spots appear on the skin, which, merging, form a vast zone of hyperpigmentation.

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

Individual sores can merge with each other, forming extensive defects. Multiple launched trophic ulcers in individual cases can form a single wound surface along the whole circumference of the shin. The process extends not only in breadth, but also in depth.

Complications of

Trophic ulcer is very dangerous due to its complications, which are very serious and have poor prospects. If you do not pay attention to trophic ulcers of the extremities in time and start the treatment process, the following unpleasant processes can develop later:

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

The treatment of trophic ulcers on the legs must be performed under the supervision of the attending physician without any independent activity, only in this case it is possible to minimize the consequences.

Prevention

The main preventive measure for preventing the occurrence of trophic ulcers is the immediate treatment of primary diseases( disorders of blood circulation and lymph drainage).

It is necessary not only to apply the drugs inside, but also to apply them externally. The local effect will help to stop the pathological processes, treat the existing ulcer and prevent the subsequent destruction of tissues.

What is the danger of the disease?

Progressive trophic ulcer may eventually occupy large areas of the skin, increase the depth of necrotic effect. Gnoyrodnaya infection, got inside, can provoke the appearance of erysipelas, lymphadenitis, lymphangitis, septic complications.

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

Treatment of trophic ulcers on the foot

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 with such doctors as phlebologist, dermatologist, endocrinologist, cardiologist, vascular surgeon or general practitioner.

Late stages of the disease are treated usually in surgical hospitals. However, in addition to identifying and eliminating the cause of trophic ulcers, one must also not forget about daily care for the affected area.

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

1. Conservative therapy , when the patient is prescribed drugs such as phlebotonics, antibiotics, antiaggregants. They will help cure most of the symptoms of the disease. Patients often prescribe the following drugs: Tocopherol, Solcoseryl, Actovegil. This medication can be prescribed only by a doctor.
2. Local therapy , with which you can cure tissue and skin damage. With diabetes, ointments containing antiseptics and enzymes are used. These remedies heal wounds and provide local anesthesia. Ointments that increase blood circulation are forbidden to apply to the open surface of a trophic ulcer. Such ointments as Dioxysol, Levomecol, Curiosine, Levosin exert a wound-healing effect. Ointment is applied to the compress and whether special bandages are made.
3. Surgical intervention of , which is performed after healing of ulcers. In the course of it, the blood flow in the veins in the affected area is restored. This operation involves shunting and phlebectomy.

For treatment of wounds use such drugs: Chlorhexidine, Dioxydin, Eplan. At home, you can use a solution of furacilin or potassium permanganate.

Surgical 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 ulcerative defect, in the second stage, the operation is performed on the veins.

There are several different surgical methods :

1. Vacuum therapy that allows you to quickly remove pus and reduce edema, and create a moist environment in the wound that will greatly prevent bacteria from developing.
2. Cataract - suitable for ulcers that do not heal for a very long time.
3. Percutaneous stitching - suitable for the treatment of hypertensive ulcers. Its essence is in disconnection 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 disturbed - but the foci of bone infection are removed, which allows effectively to fight the neurotrophic ulcer.

When the size of the ulcer is less than 10 cm², the wound is closed with its own tissues, tightening the skin daily for 2-3 mm, gradually bringing the edges together and completely closing it for 35-40 days. On the wound site remains a scar, which must be protected against any possible injuries. If the area of ​​the lesion is more than 10 cm², apply skin plastic, using the patient's healthy skin.

Drug therapy

The course of treatment with drugs necessarily accompanies any operation. Treatment with medicines is divided into several stages, depending on the stage of the pathological process.

In the first stage( the stage of a wetting ulcer), the course of drug therapy includes such drugs:

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

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

1. Wash the wound with solutions of antiseptics: potassium permanganate, furacilin, chlorhexidine, decoctions of celandine, string or chamomile;
2. Use of dressings with medicinal ointments( dioxycol, levomikol, streptolaven, etc.) and carbonate( special bandage for sorption).

In the next stage, which is characterized by the initial phase of healing and the formation of scars, healing waxes are used for trophic ulcers - solcoseryl, actevigin, ebermin, etc., as well as antioxidant preparations, for example, tolkoferon.

Also at this stage are used specially developed for this wound coverings of the swederm, geschispon, algimaf, algipore, allein, etc. The treatment of the expressed surface is carried out by kuriosine. At the final stages, drug treatment is aimed at eliminating the underlying ailment, which provoked the appearance of trophic ulcers.

How to treat a trophic ulcer on the foot at home

When starting treatment for trophic ulcers according to folk recipes, it is necessary to consult with your doctor.

At home, you can use:

1. Hydrogen Peroxide .It is necessary to drip onto the ulcer peroxide, then sprinkle streptocicide on this place. On top you need to put a napkin, previously soaked in fifty milliliters of boiled water. In this water, add two teaspoons of peroxide. Then cover with a pack and bandage with a handkerchief. Change the compress several times a day. And sprinkle the streptocide, when the wound becomes moist.
2. Healing balm in the treatment of trophic ulcers in diabetes mellitus. It includes: 100 g of juniper tar, two egg yolks, 1 tablespoon of rose oil, 1 teaspoon of purified turpentine. All this must be mixed. Turpentine pour slowly, otherwise the egg will curdle. This balm is applied to the trophic ulcer, then covered with a bandage. This folk remedy is a good antiseptic.
3. Powder from dried Tartar leaves .Rinse with rivalol solution. Powder with cooked powder. Apply a bandage. In the morning of the next day, sprinkle powder again, but do not wash the wound before this. Soon the ulcer will begin to heal.
4. Trophic ulcers can be treated with antiseptics : Wipe off wounds with warm water and 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).Gauze is folded in 4 layers, moistened with saline solution, lightly squeezed and applied to the wound, on top of the compress paper, hold for 3 hours. The procedure should be repeated twice a day. Between applications, the break is 3-4 hours, at this time the ulcers should be kept open. Soon they will begin to diminish in size, the edges become dense, which means that the healing process is going on.
5. Garlic poultices or compresses are used for open ulcers. Take multi-layer gauze or a terry towel, soak in hot broth of garlic, squeeze out excess liquid and immediately attach to a sore spot. On a poultice or a compress put a dry flannel bandage and a hot water bottle or a bottle of hot water to keep the heat longer.
6. It is necessary to mix egg protein with honey so that these ingredients are in the same ratio. Whip everything and apply to ulcers, including the veins that are hurting. Then cover the back side of the burdock leaves. There should be three layers. Wrap the cellophane film and bandage it with a linen cloth. Leave the compress on overnight. You need to do this treatment five to eight times.

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

Ointments for the treatment of

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

Vishnevsky Ointment is also often used. Of the ointments that can be bought in the pharmacy, they particularly distinguish dioxycol, levomecol, as well as streptolaven and a number of analogues.