Trophic leg ulcers are difficult to cure, and after healing, they often make themselves felt again. Without the use of medications, it is impossible to get rid of them, and in many cases such tissue damage leads to disability.
Trophic ulcers - what is it?
Trophic ulcers are damage to the skin, mucous membranes and subcutaneous tissues due to impaired lymph and blood circulation and an insufficient supply of nutrients and oxygen. Characterized by a long course - the affected areas may not heal for 2-3 months or longer.
There are many published scientific studies that show the positive therapeutic effect of medical manuka-manua on leg ulcers, bedsores and intractable wounds. It is important to understand that the study is based on a medical manuka for local use, and not on manuka honey jars, which are widely available in stores. Transplantation of shin cavities. . Venous ulceration of the lower leg is the result of increased venous pressure and its secondary effects on the microvascular system.
In patients with venous leg ulcers, almost half of them are indicative of past venous thrombosis, while the rest is the result of incompetence of superficial or communicating vein valves. Venous ulcer ulcer is a disease associated with age in the elderly population, especially women. This may be due to lipodermatosclerosis and eczema.
Localization of leg ulcers depends on the underlying pathology that provoked the appearance. When and they are located on the legs and ankles, with - on the feet.
The main causes of trophic ulcers:
The last two reasons are a consequence of the first two. The main diseases that can lead to trophic lesions of the lower extremities are:
Community surveys in Lothian, northwest London and Southampton show a total incidence of about 2%. The prevalence of ulcers in Europe is well documented, ranging from 18% to 1% in different countries. Leg ulcers are more common in older people, and their prevalence is likely to increase as the average age of the population increases.
This connection between deep vein damage and ulceration was noted by Gay, and later by Homans, who also noticed that venous ulcers often have few visible varicose veins. The concept of venous stagnation has shown that stagnant blood lying in winding and dilated veins near the skin can cause tissue anoxia and cell death. Recently, it has been proposed that the previous stage of venous ulcer was scleroderma-like skin, called lipodermatosclerosis. There is a growing understanding that the excessive proteolytic activity of proteases, especially matrix metalloproteinases and fibrinolytic factors of the plasminogen activation system, may be a key sign of the pathogenesis of venous leg ulceration.
Other causes and risk factors:
But in diabetic foot ulcers, increased activity of nitric oxide synthase may be a cause of impaired healing. In addition, lower concentrations of transforming growth factor β1 in diabetic ulcers may explain elevated concentrations of nitric oxide in this state.
Luts and colleagues demonstrated important differences in cellular infiltrates and the extracellular matrix of chronic diabetic and venous ulcers compared with acute wounds. It was found that the enhancement of endothelial adhesion molecules and skin infiltration by T-lymphocytes and macrophages in patients with chronic venous insufficiency is limited to the area of \u200b\u200bthe ulcer or at least to areas of skin with severe microangiopathy and is part of the secondary elimination of necrotic tissue. In patients with venous disease, there is a discrepancy between the valves in the perforating veins connecting the superficial and deep venous systems in the leg.
Trophic ulcers are skin and subcutaneous tissue damage that does not heal within 1.5 months.
Symptoms of trophic ulcers on the legs, manifestation
In normal subjects, venous pressure decreases during exercise. In patients with venous incompetence, pressure remains high during exercise. High venous pressure is associated with proliferation of capillaries and increased permeability of large molecules into the skin. It is not clear how venous hypertension is transmitted to skin ulcers, but it is obvious that venous ulcers are a disease of the skin microcirculation, as there is a rarefaction and expansion of the skin capillaries along with changes in micromiphase.
They suggested that the stretched local capillary layer expanded the endothelial pores, allowing the fibrinogen molecules to exit into the extracellular fluid, where they form fibrin complexes around the capillaries. Pericapillary fibrin has been shown to inhibit oxygen diffusion in patients with venous disease.
Symptoms of trophic ulcers develop gradually, but not suddenly. The appearance of an ulcer is preceded by severe dryness of the skin on the leg or both limbs, not falling down swelling, pigmentation and cramps. The formation of a trophic wound proceeds in 4 stages:
Consider the symptoms of trophic ulcers on the legs by stages of development.
Various theories have been put forward - for example, venous congestion, fibrin cuff, white cell trapping and growth trap theory. In the theory of "venous stagnation," blood stagnates inside the veins, which leads to local ischemia and ulceration. The “fibrin cuff” theory claims that increased venous pressure causes leakage of macromolecules from the plasma into the perivascular space when fibrinogen turns into fibrin, and this acts as a barrier to the diffusion of oxygen and nutrients. It is now recognized that the fibrin cuff is considered an effect, but not the cause of the disease, since these lesions are observed in many other cases of chronic wounds.
The initial stage of trophic ulcers on the legs
Against the background of the main disease, the permeability of the vascular walls increases, and red blood cells go beyond its limits. Hemoglobin is converted to hemosiderin and, accumulating in the skin, provokes pigmentation.
Pericapillary fibrin cuffs remain an important feature, regardless of whether they act as a barrier, a marker of damage to endothelial cells or as part of the overall mechanism of macromolecular leakage and trapping. A recent hypothesis has suggested that when venous ulceration occurs, trapped leukocytes block the capillaries, leading to skin ischemia. White cells are usually trapped inside the skin microcirculation when the legs are dependent. In venous hypertension, these white cells are activated, leading to damage and destruction of the capillaries.
This is the first stage in the development of trophic ulcers on the leg. The initial stage is also manifested by thinning of the skin, which becomes shiny, as if lacquered. Progression is supplemented by inflammation of the subcutaneous fatty tissue and hyperemia of the skin of the limb.
Due to edema, it is impossible to grasp the skin with your fingers, and the accumulated liquid appears on the surface, forming drops of moisture on it. Light spots that appear are areas of necrotic tissue.
Phalanx and Eglänstein suggested that macromolecules flow into the growth factors of the "trap" and the matrix material, leading to inadequate tissue repair, which ultimately causes ulceration. In many cases, it is the inability of damaged skin to recover normally, which leads to ulceration.
Like the fibrin cuff theory, growth factors and cytokines are contained in a fibrin cuff that prevents the maintenance of a normal homeostatic environment. Danielsen et al. There are many predisposing factors that can prevent the healing of foot ulcers shown in the table.
Without treatment, at this stage, a scab forms into the skin, and then the red wound site is actually trophic ulcer. The initial stage of a trophic ulcer, depending on the severity of the development of varicose disease or other pathologies, lasts from 3-4 hours to 4 weeks.
A trophic ulcer has rounded edges, and its appearance at the second stage depends on the presence of wound infection and the timeliness and effectiveness of treatment. The affected area secretes mucus with pus, often mixed with blood and fibrin filaments.
Factors that can prevent the healing of foot ulcers. Arterial or arterial occlusion for any reason can lead to ischemia of the skin and subcutaneous tissues, which can lead to ulceration. Three mechanisms are involved in the pathophysiology of ischemic leg ulcers.
Germinal asphyxiation Thickening thickening or accretion Internal limitation of blood flow. Prolonged suffocation usually occurs due to scar tissue and radiodermatitis, causing fibrous strips around the arterioles, which can cause a small but persistent ischemic ulceration. Thickening or accretion of intimate plaques, such as in atherosclerosis, can occur with impaired blood flow until atherothrombosis, embolism, or a superimposed infection can accelerate full occlusion, leading to ulceration.
In the presence of infection, the ulcer exudes an unpleasant, putrid smell and itches.
Additional signs of trophic ulcers (stage 1-2):
Third and fourth stages
Defeat enters the third stage only in the case of treatment carried out at stage 2. The edges begin to heal, and scarring of the ulcer occurs in the direction from the periphery to the center - pink patches appear.
There is usually a small vascular disease that interferes with the peripheral circulation leading to tissue hypoxia, which can lead to ulceration after a minor or serious injury. Peripheral gangrene can occur as a large single ulcer, characteristically located on the side or behind the ankle due to atherosclerosis. Peripheral neuropathy can coexist, with cold, swollen and dry legs. Trivial injury or blister for any reason can lead to ulceration.
If trophicity (nutrition) of tissues is not fully restored, then the risk of a reverse transition to the initial stage is high. The final scarring occurs in the fourth stage — it may take up to several months. The ulcer is completely granulated and heals.
Intensive, non-healing ulcers are a feature of sickle cell disease, thalassemia, and other hemolytic anaemia. This is usually due to microcirculation blockage. Infections can lead to ulceration, which often slows during healing due to associated edema, cellulitis, thrombophlebitis, or underlying vascular disease or diabetes. Bacterial synergistic gangrene spreads quickly and usually has a reddish, bluish and hemmed edge. Tubercular skin ulcer can occur in the area of \u200b\u200berythema or Bazin’s disease, which is usually located on the back of the calves.
Treatment of trophic ulcers of the lower extremities, drugs
In case of trophic ulcers of the lower extremities, treatment with drugs is carried out separately or as an addition to the surgical cleaning of the affected area. With an open, not yet scarring wound, use the following means:
In hypertension, the density of capillary layers in the middle and deep dermis of the skin, in particular its lateral aspect, is significantly reduced, which may predispose to ischemic necrosis, when rare arterioles undergo severe hypertension. Hypertension causes superficial ulceration, when peripheral impulses are always present, which distinguishes the condition from peripheral vascular diseases.
A leg ulcer usually develops in the lower leg or ankle after an injury, is associated with vasculitis and is often difficult to heal. Delayed healing is also associated with impaired mobility, which contributes to a poor muscular pump. Edema is often difficult to control. Ulceration of rheumatoid nodules is not common, except for pressure points.
In case of a trophic ulcer from drugs, antiseptic and antimicrobial ointments are prescribed. They are applied with a thin layer on a bandage or gauze and tightly fixed on the leg.
These ulcers can occur as a result of pressure or friction in areas that have become anesthetized due to peripheral neuropathy. Sometimes they can be associated with major vascular anomalies, for example, diabetes, which causes small vessel disease. Ulceration secondary to an artifact can be difficult to diagnose. Clinical suspicion may be caused by the following: an unusual appearance, an unusual site, after injury when dealing with possible compensation problems, the angular shape or the patient's apparent indifference to their ulcer and its consequences for their life.
Examples of remedies - Levosin, Levomekol. Salt compresses at the rate of 1 tsp are also used to combat bacterial infection. salt to 200 ml of water.
For the treatment of trophic leg ulcers at the stage of granulation and scarring, the following medications are shown:
In venous etiology, ulcers always use compression stockings, tights or elastic bandages, which are worn constantly and changed every day. In addition to the treatment of skin lesions, the main pathology that caused the development of a trophic ulcer is necessarily treated.
If the ulcer has a tendency to come and go, a skin biopsy may be required to reveal "external" damage, that is, disproportionate damage to the epidermis compared to the dermis. This may be due to chronic conditions such as inflammatory bowel disease, inflammatory arthropathy, or myeloproliferative disorders.
A skin biopsy may be helpful, but the histological features of pyoderma gangrenosum are not diagnostic. Assessment of a patient with leg ulcers is as follows. Comprehensive clinical history and physical examination to determine the etiology of ulcers. The initial dressing depends on the condition of the ulcer. Plain non-adhesive gauze should be used for small, non-exudative ulcers. Absorbent foam or alginate dressings should be used to exude ulcers, and hydrocolloids are intended for visually impaired, smelly ulcers.
Treatment of trophic ulcers of the lower extremities at home folk remedies considered as an adjunct to primary therapy. Effectively washing the wound with freshly squeezed potato or cabbage juice, which can also be used to apply compresses.
For these purposes, oak broth and willow bark powder are also used. From natural pharmacy tools in the treatment of trophic ulcers, ointments with comfrey, geranium and arnica are effective.
From unconventional methods Your doctor may prescribe:
Surgical treatment is indicated for the ineffectiveness of the conservative. The ulcer is excised during surgery, necrotic skin and subcutaneous tissues are removed. Vacuuming and curettage are used to eliminate mucopurulent contents.
Amputation of the limb is used in advanced cases when there is no other way to save a person’s life.
Trophic ulcer on the leg, treatment at home, photo, initial stage, ointment, reviews. Causes, symptoms, stages, treatment of folk remedies.
Trophic ulcer on the leg is a section of the epithelium and underlying tissues, non-healing for a long time after its damage (more than 1 month).
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"Trophy" means food. And since the skin performs the function of a protective barrier against the effects of aggressive environmental factors on the body, the malnutrition of the epithelium and surrounding tissues leads to the gradual extinction of this function.
Trophic ulcers can form in any places on the human body where, due to various reasons, the nutrition of the tissues is disturbed. However, lower limbs are more likely to suffer. The reasons are as follows:
Causes
The occurrence of a trophic ulcer can be compared with a dam in the river. As soon as a place appears that is unable to hold pressure from outside, there is a gap. If in a healthy body, if its protective cover (skin) is damaged, the recovery mechanisms are instantly activated, then in the case when the tissue supply is disturbed, the opposite happens. Any damage to the epithelium can cause a problem:
Among causes of trophic ulcers can highlight the following:
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TO “Risk factors”, contributing to the emergence and development of trophic ulcers, include:
Stages, symptoms and photos
As a rule, trophic ulcers on the leg do not appear immediately. The negative side of this is that the disease can sneak up on a person unnoticed. But there is a positive side. Showing attentiveness, a person has the opportunity, noticing disturbing symptoms, to have time to react to them.
Symptoms preceding the appearance of trophic ulcers on the body may be as follows:
It should also be alerted if the wound does not heal for a long time (more than 1 month). This is an alarming symptom. And if the process is delayed for more than 2 months - this is a trophic ulcer on the leg or on other limbs.
Depending on the causes of their appearance, trophic leg ulcer refers to the following main types of:
The foot is usually affected in patients with pathologies of the arterial vessels. Symptoms in such cases are particularly painful, since the affected areas are constantly injured when walking. Painlessness is typical for ulcerative complications. diabetes, as tissue necrosis is preceded by the death of nerve fibers. The disease begins most often on the finger, then going to the entire foot.
Ulcers caused by varicose veins often appear on the inside of the lower leg with a further transition to the external. The defeat of the foot in the heel area is characteristic of neutrophic ulcers caused by damage to the spine or head injuries.
Ulcerative complications on the background of hypertension are rarely observed. They have a red-blue color and appear, as a rule, on both legs at the same time. Forerunners of infectious trophic ulcers may be furunculosis, purulent eczema, and respiratory infectious diseasescaused by a decrease in the overall level of immunity.
Such ulcers are characterized by localization in the region of the leg and a relatively small depth of tissue damage. Also, the status of an infectious disease can be assigned to an ulcer of any origin in the event of infection.
Stage of development of ulcers
In total, there are 4 stages:
Despite the fact that a trophic ulcer on the leg is a very unpleasant disease in itself, their possible complications are even more dangerous. These include:
Treatment should begin with a struggle against the causes by which it is caused. Therefore, in the case of varicose veins, it is necessary to take measures to normalize blood circulation in them. This problem is solved through pathogenetic therapy, which includes:
Pathogenetic therapy can be carried out both in a hospital and at home. It should be borne in mind that despite the typical development of the main forms of trophic ulcers with varicose veins, the clinical picture of the disease in each particular case may have significant differences. Therefore, the whole complex of the above measures should be carried out in consultation with your doctor, and especially medication.
Of the number of hardware methods, laser and ultraviolet irradiation treatments are currently most in demand. Cauterization of wounds with their help is aimed at stimulating the processes of scarring of the damaged tissue.
Sustained success in treating trophic ulcers can only be achieved if the causes of the disease are completely or partially eliminated.
With varicose veins, this cause is dilated veins. Despite the large number of different means of drug treatment, the only effective way the solution to the problem at the present time is surgery. It should be remembered that only timely measures lead to the achievement of the best result.
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Trophic leg ulcer: home treatment with folk remedies without surgery
Traditional medicine is also known a large number of ways to combat trophic ulcers.
In the treatment of trophic ulcers, the value is the cleansing and healing properties of this plant.
Before use, cut the sheet in half and immerse in a weak solution of potassium permanganate for about an hour. Then treat the wound with an antiseptic and place aloe on it with a cut down. Cover with plastic and bandage. The procedure is repeated for at least 5 days. The scabs will start to fall off.
Options ointment set. Especially popular are those that do not require special costs and are easy to prepare. Here is one of these options:
Heat a half cup of vegetable oil and dissolve a tablespoon of beeswax in it. Add half the egg yolk, let stand for an hour and strain through caprone. Ointment is ready. Store in the refrigerator, and before use for applying to the wound healing bandage, warm to room temperature each time.
The choice of solutions is large. It is important to choose the most effective. In addition, it is convenient to use medicinal substances in solutions as an adjunct to the main active elements. So, having inflicted any medicinal substance on the wound, from above you can cover it with gauze dipped in a solution of another substance. It is only important to ensure their compatibility.
Salt Treatment - Saline
People use wonderful properties of salt for a long time. Effective its ottyagivayuschie ability here.
Prepare a solution: 2 tsp. salt to a glass of water. Moisten a bandage folded in several layers in the solution and apply to the wound overnight. Even greater efficiency can be achieved by alternating the effects of salt at night and bee propolis in the daytime.
Gel dressings are similar to ointment. It all depends on the substances in their composition. But the difference is that the gel, as a rule, has a slightly softer effect on the skin, so the time of applying the bandage with it may be longer.
Birch tar
Treatment with tar, like salt, has a pulling effect, but it should be used with caution, watching the reaction of the skin. Apply to the wound swabs of tar, changing them at least 1 time in 2 days.
If this tool is suitable - the effect will appear in a couple of days. If not, do not waste time and try other options.
The remedy is strong. Especially effective when used in the early stages of peptic ulcers. However, it works in advanced cases. It is important to be patient, and bandage regularly.
Hirudotherapy in the treatment of trophic ulcers has proven itself quite effectively. However, leeches should be used only in consultation with the doctor. Self-medication is dangerous.
Soda and laundry soap
The impact of soap and soda on the wound is favorable. It is also important that it is combined with the use of virtually any other means. It is better to wash the wound with soapy water using dark soap.
Healing Tissues
Healing wipes are especially necessary in cases of weeping wounds, when the materials used must have the greatest absorbency.
Due to their adhesive ability, adhesives are well suited in cases when a rigid fixation of the material applied to the wound is required, but the use of a conventional dressing is difficult for any reason.
How to treat trophic ulcers on the legs: photo, initial stage
The main thing from which to start treatment is to determine the causes of the disease. And the result of treatment of the trophic ulcer itself will depend on how successful the tactic chosen by the doctor will be to combat these causes. However, regardless of the cause of the disease, the following steps are necessary at the initial stage:
Where to buy ointment at the pharmacy. Preparations
Selection of drugs should be carried out taking into account the etiology and stage of the disease:
Diabetes Treatment
First stage treatment aims to stop the development of the disease. It includes:
Further treatment provides for an integrated approach with two main objectives:
How to treat trophic ulcers of the lower extremities: treatment with propolis
The combination of propolis and honey gives the greatest effect in the treatment of trophic ulcers. One of the recipes is as follows: a tablespoon of honey, a tablespoon of 20% alcohol solution propolis, a tablespoon of sunflower oil. Mix it up. Apply in the form of a compress. Healing can be expected soon. However, for a sustainable effect, a course should be conducted within a month.
Success in preventing the occurrence of trophic ulcers directly depends on the effectiveness of treatment of the disease that causes them. Common preventive measures include the following:
Treatment: Activetex wipes for trophic ulcers
It is a convenient dressing at an affordable price, which also has antioxidant properties. The composition includes: chlorhexidine, vitamins E and C.
Effective treatment: Sponge Meturakol
The active drug is made on the basis of collagen. It has anti-inflammatory and hemostatic properties, stimulates the growth and formation of granulation tissue.
The sponge is tight to the surface of the wound, actively absorbing its secretion.
Medicine: Stellanin ointment
Innovative tool. Especially effective in difficult cases. Complexly solves the following problems:
Modern means of accelerating the healing of wounds. Made on the basis of natural cellulose. It has disinfecting properties, including trypsin and mexidol. Able to remove inflammation in a short time and clear the wound from pus.
Made on the basis of the famous Peruvian balsam. It has hypoallergenic properties. It is a set of air permeable sterile dressings, impregnated with the drug.
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