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Varicose leg ulcers

17 Aug 18

Treatment methods for trophic ulcers with varicose veins

Varicose veins are a dangerous chronic disease with a progressive course and serious consequences. One of these consequences is trophic ulcers.

Trophic ulcers are skin defects associated with impaired microcirculation, which are difficult to treat. Today, treatment of trophic ulcers with varicose veins is successful in most cases; modern technologies and means give excellent results, especially in the early and middle stages.

Causes and clinic of pathology

The disease does not develop on its own; it is always a complication of the underlying disease. Since the development of trophic ulcers directly depends on the underlying pathology, the etiology of the disease is closely related to it. There are the following reasons:

  • genetic predisposition;
  • excessive physical stress on the legs;
  • hypothermia;
  • obesity.
  • Also, risk factors play a significant role in the development of pathologies:

  • metabolic disorders;
  • weakened immune system;
  • dermatological diseases;
  • wearing uncomfortable shoes.
  • Wounds can appear on any part of the body, but with varicose veins, most often the lower limbs in the shin area are affected. The development mechanism is associated with a violation of trophism, as a result of which the leg tissues do not receive sufficient nutrition. Chronic starvation leads to cell death. Along with them, local skin protective factors die. This leads to the addition of bacterial microflora with the further formation of an abscess. As the disease progresses, muscles, tendons and even bones are affected.

    The development of the disease can be recognized by the following symptoms:

  • lack of hair;
  • the appearance of shine on the lower leg;
  • thinning and roughening of the skin;
  • change in skin color in the form of blue and purple spots;
  • "blue mesh";
  • swelling of the legs in the late afternoon;
  • nonspecific pain in the legs;
  • burning sensation;
  • the presence of surface defects (erosions) that heal poorly.
  • If you have these symptoms, you should consult a specialist.

    Types of trophic ulcers

    A common feature for all types of ulcers is that they always accompany some other diseases and do not develop independently. There are these types of them:

  • Venous. They arise as a result of damage to the veins, which leads to disruption of the microvasculature.
  • Arterial. They develop against the background of arterial diseases (atherosclerosis, endarteritis). The vascular endothelium changes due to the accumulation of pathological substances, narrowing their lumen. This impedes blood flow.
  • Diabetic. The pathology is based on micro- and macroangiopathy, that is, the tissues of the skin and subcutaneous layers do not receive sufficient nutrition as a result of damage to large and small vessels.
  • Neurotrophic. Associated with severe neurological diseases and injuries of the brain and spinal cord, in which there is no innervation to the limbs.
  • Hypertensive. High blood pressure is characterized by constant vasospasm. This leads to destruction of the endothelium and the formation of hyalinosis. Such ulcers are very difficult to treat.
  • Pyogenic. Develops in people with weakened immune systems. Contributes to the development of this type of personal hygiene violation.
  • The disease takes a long time to develop. Their appearance is facilitated by the lack of treatment of the underlying pathology or its ineffectiveness. There are several stages of disease progression. Localization is distinguished:

    Stage 1. Only the skin is affected.

    Stage 2. The process spreads to the subcutaneous tissue.

    Stage 3. An ulcer forms with a bottom in the deep layers of the soft tissues of the limb.

    Stage 4. Lesions of tendons and bones.

    Phase of appearance and progression of trophic ulcers

    With varicose veins, the skin becomes thin, stretched and dry. The hair falls out completely and the hair follicles atrophy. The subcutaneous tissue becomes inflamed and swollen. The so-called “varnish” skin appears. Excess fluid tries to seep through the epithelial cover. Some areas cannot cope with it and white spots appear in this place. At this stage it is already worth starting treatment.

    If the process is not stopped, a scab will form, which will turn into erosion, and then into a real acute trophic ulcer of a dark cherry color. Over time, the ulcers spread throughout the lower leg, merging together. An infection almost always occurs, which is accompanied by pain and disruption of the patient’s general condition.

    Trophic ulcer cleansing phase

    This phase requires special and intensive treatment. The ulcer is usually round with clear edges and admixtures of mucus, pus, blood and fibrin. This is accompanied by a terrible unpleasant odor. During the healing process, the wounds are cleared of pathological formations, which is accompanied by an improvement in the patient's condition and itching of the lower leg.

    Granulation phase in the center of the trophic ulcer and scarring at the edges

    This is a very important stage, because at this time a relapse may occur. At this stage, all pathological microorganisms and dead cells must be removed from the affected area. At this time, the body separates the lesion with granulation tissue along the edges of the ulcer. Violation of these processes leads to a repetition of the episode of illness.

    Phase of granulation and scarring of a trophic ulcer

    Granulation tissue appears at the site of the lesion. This tissue itself is a collection of small vessels. They carry nutrients, oxygen, as well as cells that promote healing and healing of the wound (mainly fibroblasts), which form connective tissue at the site of the ulcer. This process may take several months. As a result, an epithelial cover appears.

    There is also a hydration phase (wet wound), where the most important thing is to dry the wound, followed by a dehydration phase (dry wound), in which ointments are used to heal the wound. The duration of therapy depends on the state of immunity, the effectiveness of treatment and the severity of the process.

    What treatment methods to use

    As already mentioned, trophic ulcers occur against the background of the underlying disease. In this case, it is necessary to treat varicose veins. As for the ulcers themselves, there is general and local treatment.

    The general idea is to use drugs to improve blood supply, relieve inflammation, swelling and better nutrition of tissues. As for the local one, ointments or gels are prescribed depending on the stage of the process. Among them, antiseptic, anti-inflammatory, and wound-healing substances are used.

    There are also conservative treatment, surgical treatment and folk remedy therapy. You need to understand that the treatment of trophic ulcers in varicose pathology should be comprehensive using different approaches to treatment.

    Treatment can be carried out both in the hospital and at home, depending on the indications.

    Therapy with solutions and ointments

    Ointments must be applied in the correct sequence.

    At the beginning of the disease , in the presence of infiltration, ointments with an antiseptic are used. Before the appearance of granulation tissue, it is necessary to use anti-inflammatory drugs, as well as drugs that improve blood supply, help nourish the skin and stimulate regeneration.

    At the stage of formation of granulation tissue, it is necessary to prevent relapse of the disease and remove the terrible itching that accompanies the process.

    At the scarring stage , restorative drugs are used that will accelerate the development of the epithelium.

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    It is worth combining the use of ointments with solutions in the form of compresses.

    Firstly, you need to wash the wounds with antiseptic solutions (potassium permanganate, furacillin) at all stages of the process. They also make a compress at night with wound healing solutions (Eplan).

    Tablet forms and herbal medicine

    The course, dose, and frequency of taking tablets are prescribed by the attending doctor individually for each patient. Among the pharmaceutical products recommended to use:

  • Broad-spectrum antibiotics in tablet forms. If the condition is very severe, it is administered by injection.
  • Non-steroidal anti-inflammatory drugs (Nimmesil).
  • Antihistamines (Loratadine).
  • Diuretics (Lasix).
  • Drugs that improve blood circulation (Actovegin).
  • Vitamin therapy.
  • As symptomatic therapy, antipyretics and painkillers are prescribed, if necessary.

    For less stress on the body, herbs are an alternative to medications. You can make solutions from them and apply them topically, but oral use will have the best effect. The most effective remedies are considered to be plantain, celandine, chamomile, and horsetail. They help restore trophism of damaged tissues. They are combined with anti-inflammatory herbal remedies, as well as with herbs that improve immunity and remove intoxication.

    Pathogenetic therapy

    It is almost impossible to treat trophic ulcers etiologically, because the problem lies in the affected vessels. Therefore, the most effective treatment is pathogenetic. It consists of combating the consequences that arose during the development of these wounds. In other words, the therapy removes inflammation, swelling, itching, changes in skin color and other symptoms. The most important thing is to restore blood flow as much as possible.

    Pathogenetic therapy, in this case, is intended to combat venous insufficiency. For this we recommend:

  • The bed should have a raised foot edge.
  • To prevent swelling, wear special knitted underwear or bandage your feet.
  • Take prescribed medication in a timely manner.
  • Try to do minimal physical exercise without stress;
  • Stick to your diet and nutrition regimen.
  • Surgical treatment of varicose ulcers

    If conservative therapy does not stop the process within six weeks, the treatment is considered ineffective. In such cases, surgery is required. The task of surgery:

    • cleansing the wound from infiltrate, pus, dead cells;
    • removal of ulcers;
    • removal of the superficial venous system;
    • separation of superficial and deep venous systems;
    • skin plastic.

    The classic method of removal is using a scalpel. But such an intervention is used only in advanced conditions, because it is very traumatic, difficult for patients to tolerate, and requires anesthesia and a long recovery period. More modern methods have much fewer negative properties. These methods include:

  • curettage or curettage;
  • laser removal is a very effective method, without the use of anesthesia and with a complete lack of rehabilitation;
  • radiofrequency obliteration - in combination with laser coagulation shows good results.
  • After removing a huge lesion, plastic surgery is required to restore the skin. A flap of skin tissue is taken from the buttocks.

    Folk remedies for varicose ulcers

    The advantage of this therapy is that it does not have the same side effects on the body as medications. Disadvantage - cannot be used in complex cases, in severe conditions and when the process is neglected. These are rather additional methods that are best used during the period of remission, since they require more time than pharmacological drugs. Such methods will have not only therapeutic properties, but also preventive ones.

    Therapy consists of baths, compresses, lotions and decoctions for rinsing and other methods. There are several proven home recipes.

    1. Antiseptic ointment. In this case, you will need oil (sunflower or olive) 1 spoon. It needs to be boiled in a water bath for 10 minutes. A tablespoon of fish oil is added to it and heated for the same amount of time. At this time, streptocide tablets are crushed into powder. When the oil solution has cooled, the powder must be added and mixed. Soak gauze in the resulting solution, apply to the wound, covering it with a plastic bag, and wrap it with a bandage.
    2. Bath with a drying effect. To do this you will need potassium permanganate and warm water. Dilute to a bright purple color. The feet are immersed in the bath and kept for about thirty minutes. After this, the calendula solution, at the rate of 1 bottle per 1 liter of warm water, is poured into a container and the feet continue to be held for another 30 minutes. The most important thing is to wrap your feet with sterile wipes and then apply a bandage.
    3. Delay treatment. Ordinary kitchen salt will help with this, because it perfectly pulls the exudate and infiltrate of the wound. Dilute 2 teaspoons in a glass of water and moisten a gauze cloth in it. Bandaged for the night. A compress of bee propolis is made daily to prevent the ulcer from completely drying out. Tar has a similar effect, but it must be handled very carefully, because it can cause harm. Before the procedure, on a small area of ​​healthy skin, you need to apply a small amount of the product to check for allergies. Tar can achieve the desired effect within 2 days, but if this does not happen, you need to stop using it.
    4. Ointment based on chicken yolks. Separate the white and yolk. In a 1:1 ratio, the yolks are mixed with a 5% iodine solution. It should be applied to the wounds in a thin layer. Then rewind with a sterile bandage. You can wear it for a day, then reapply the ointment. Store in a cool place (refrigerator) at temperatures up to 12 C.

    Possible complications

    If you do not pay attention to the development of the disease, it will certainly progress. But even with proper treatment, there is always a risk of complications. These include:

  • loss of sensation;
  • restriction of movement;
  • gangrene of the limb;
  • eczema;
  • dermatitis;
  • arthrosis of the lower leg joints;
  • sepsis;
  • thrombophlebitis after surgery;
  • relapse or recurrence of the disease;
  • malignancy (skin cancer).
  • To avoid complications, it is recommended to seek medical help in a timely manner, as well as treat the underlying pathology.

    Trophic ulcers are a clear symptom of neglected varicose veins. They will not go away on their own; such wounds require severe and lengthy therapy. Despite the huge number of modern treatment methods, as well as various folk methods, there remains a high risk of recurrence of the problem. At the first symptoms, you should definitely consult a doctor.

    Do you still think that getting rid of varicose veins quickly is difficult?

    An advanced stage of the disease can cause irreversible consequences, such as gangrene, blood poisoning. Often the life of a person with an advanced stage can only be saved by amputation of a limb.

    Under no circumstances should the disease be started!

    We recommend reading the article by the head of the Institute of Phlebology of the Ministry of Health of the Russian Federation, Doctor of Medical Sciences of Russia Viktor Mikhailovich Semenov.

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