Treatment of Trophic Ulcers on the Legs
Trophic changes can be caused by various diseases associated with cardiovascular dysfunction. Ulcers are most often observed on the lower extremities, but other parts of the body are not immune to these pathologies.
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Causes of Trophic Ulcers
In approximately one in six clinical cases, a combination of several risk factors is observed, contributing to the development of deep defects in the skin and subcutaneous structures. The most common combination is the simultaneous presence of venous and arterial pathologies, as well as a specific complication of diabetes known as angiopathy. This multi-component nature of the lesion significantly complicates diagnosis and treatment, since each component can exacerbate the manifestations of another.
Main Causes
The formation of purulent skin lesions is caused by a number of serious pathological conditions:
- Chronic venous outflow disorder associated with the formation of blood clots or inflammatory processes in the vein walls (varicose veins)
- Dysfunction of blood circulation in the arteries caused by the accumulation of cholesterol plaques or a persistent increase in pressure in the vessels
- Destabilization of blood glucose levels in severe diabetes
- Disruption of nerve fiber function, leading to the formation of neurogenic skin defects
- Adventure of a secondary bacterial infection
- Mechanical effects on the skin - bruises, cuts, burns of various types Nature
- Allergic skin diseases (dermatitis), inflammatory changes in the epidermis (erysipelas, eczema)
- Growth of malignant tumors with surface ulceration
- Lymphatic system pathologies accompanied by congestion in the skin and soft tissues
When identifying and eliminating the causes of trophic changes, it is important to use a comprehensive approach.
Why trophic ulcers most often appear on the legs
Statistics are relentless: the lower extremities are the primary location for the majority of trophic ulcers. This is explained by the anatomy of the human body.
Firstly, our legs experience enormous pressure from our body weight every day. They are constantly subjected to stress when walking, standing, and playing sports. This creates conditions for prolonged compression of superficial and deep blood vessels, impairing circulation and causing a deficiency of oxygen and nutrients in cells.
Secondly, the structure of the venous system in the legs deserves special attention. It is designed in such a way that blood is forced to overcome gravity, rising upward. A third important factor is that the skin and soft tissues of the legs are thinner and less dense than those of the torso and arms. This makes the legs particularly vulnerable to mechanical injury, irritation, and infection.
Symptoms of trophic ulcers
The development of the pathology begins with a subtle sign—the appearance of a small patch of grayish-blue skin. Soon, the person begins to experience discomfort in the affected area: a feeling of fullness, an unpleasant tingling sensation, discomfort, and irritation, gradually developing into pain.
Then the skin noticeably thickens, loses elasticity and smoothness, and becomes denser than usual. The next stage is marked by the formation of a moist, erosive surface that rapidly expands in diameter. Upon detecting the first alarming symptoms, it is extremely important to immediately consult a phlebologist or a surgeon specializing in vascular diseases.
Stages of development of trophic ulcers
The progression of a trophic ulcer proceeds sequentially through four key phases:
- The appearance of a precursor to pathology—a change in the color of individual areas of the skin, which may differ from surrounding areas by a higher temperature.
- The appearance of small, open, bright pink damaged areas, affecting only the upper layer of the epithelium.
- The development of deepening destruction, accompanied by the involvement of the deeper layers of the skin, down to the fatty layer, sometimes reaching the bone structure. The appearance of a yellowish tint, indicating the onset of tissue necrosis.
- The development of significant damage, often complicated by the appearance of foci of suppuration, including deep abscesses and even the destruction of bone elements.
- The onset of a critical condition—gangrene develops, in which the affected area takes on an almost black hue due to the complete cessation of local blood circulation, threatening the viability of the entire limb.
The lack of timely medical intervention dramatically increases the risk of the disease progressing to severe forms.
Methods of treatment of trophic ulcers
Conservative Treatment Methods
Many people try to combat the condition by using disinfectant solutions such as brilliant green, antibacterial ointments, and drying compounds, but this negatively impacts the healing process of trophic ulcers. Prolonged treatment with such agents can significantly slow tissue repair, provoke allergic reactions, and develop drug resistance in infectious agents.
If dangerous bacterial strains such as Staphylococcus aureus or Pseudomonas aeruginosa are present, broad-spectrum antibiotics are advisable, although they should only be used when other methods have proven ineffective.
The most effective method of conservative treatment for venous trophic ulcers is the use of specialized elastic bandages or special medical stockings. In addition, medications are prescribed to improve vein tone and strengthen the capillary system.
Surgical Treatment Methods
Primary surgical debridement—a radical operation to remove nonviable tissue—is recognized as the optimal method for cleaning ulcerative lesions. The procedure is performed using modern technologies: laser surgery, ultrasound equipment, or hydrosurgical devices under local anesthesia.
Once the surgery is completed, measures are taken to stimulate the formation of new, healthy cells. If complete wound closure does not occur after effective cleansing and active growth of new tissue, the next step is skin flap transplantation.
Laser Treatment
The main goal of treating trophic leg ulcers with varicose veins is to stop the abnormal backflow of blood into the superficial veins. This is achieved using modern technologies, such as laser coagulation. A key feature of this method is its minimal trauma: the procedure is performed on an outpatient basis, under local anesthesia, without incisions. The laser beam heats the inner lining of the vein, causing its walls to adhere together and form a fibrous band. This stops the abnormal blood flow characteristic of varicose veins, improving the patient's overall well-being.
Sclerotherapy
Foam sclerotherapy is an alternative to surgical treatment for venous trophic ulcers. A series of sessions stops localized blood flow and restores normal circulation in the leg, regardless of the stage of trophic changes. This method is especially recommended for elderly patients with severe skin damage due to advanced varicose veins.
Vacuum Therapy
Another innovative approach to treating trophic ulcers is vacuum therapy, which creates negative pressure directly within the wound cavity. A special device gently draws out fluid and bacteria, improves blood flow, and stimulates new tissue formation. The technique involves placing a sterile dressing with a soft drain over the wound, connected to a pump that creates a vacuum.
General information
Diagnosis of trophic ulcers
Detection of the pathology is based on a clear definition of its etiology, the degree of activity of the inflammatory-destructive process, the depth of tissue damage, and the presence of pathogenic microflora. Only a comprehensive assessment of these key aspects allows for the selection of an adequate treatment strategy.
A consultation with a phlebologist plays an important role in the examination process. The doctor conducts a thorough assessment of the venous system, identifying signs indicating blood stasis, as well as factors that can lead to the development of trophic ulcers.
Ultrasound duplex scanning
Ultrasound is considered the main tool for diagnosing blood circulation in the affected limb and identifying the origins of a trophic ulcer. It helps accurately determine the direction of blood flow back through superficial or deep veins and detect the presence of bypasses through small connecting veins near the ulcer itself.
This diagnostic test is especially valuable in elderly patients, as the detection of short perforating veins offers the chance to effectively eliminate the problem by simply injecting a special agent directly into the pathologically altered vessels.
Contrast X-ray phlebography
This diagnostic tool allows for visualization of the venous system using X-rays. The method involves intravenous administration of a special contrast agent, which illuminates the vessels, allowing for observation of their structure and function.
X-ray phlebography provides comprehensive information about the condition of large veins, identifies possible obstructions to blood flow, and detects anomalies and deviations from the norm.
Why are trophic ulcers best treated at K+31?
The K+31 Clinic specializes in the diagnosis and comprehensive treatment of trophic ulcers, offering patients effective solutions and a high standard of medical care.
Our advantages:
- Highly qualified doctors with many years of successful experience
- Modern equipment and innovative treatment methods allow us to select the optimal treatment protocol for each individual case
- A comprehensive approach, including physiotherapy, exercise therapy, and consultations with related specialists
- Conveniently located clinic
- A comfortable, stress-free atmosphere allows you to focus on restoring your health
We believe that a sound treatment strategy for trophic ulcers should include an accurate diagnosis, comprehensive patient preparation, and ongoing monitoring of the effectiveness of the chosen methods. This is precisely the approach we employ in our clinics.
Frequently Asked Questions
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Definition and classification of trophic ulcers
A trophic ulcer is a chronic injury to the skin and underlying tissues that is difficult to heal. The primary cause of chronic, non-healing wounds is impaired blood supply and neurotrophic regulation of the affected areas.
Such pathologies typically arise as a result of chronic diseases such as varicose veins, diabetic vascular disease, and arterial disorders. Among the most common patient complaints are pain, hyperemia, and swelling in the affected area. The severity of clinical manifestations varies significantly depending on the stage of the pathological process.
Regeneration in such cases is complicated by profound metabolic disorders in the body, which impede normal tissue repair. Complex therapy is aimed at eliminating the underlying cause of ulcer formation, activating tissue repair processes, and preventing possible complications.
According to the cause of their occurrence, trophic ulcers are divided into several types:
Each form of pathology requires individual approach to therapy, for example, in the treatment of venous trophic ulcers, the basis is the elimination of blood stagnation.