Trophy ulcer on the leg. Trophic ulcers: types, symptoms, diagnosis, treatment, prevention

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Trophic ulcers on the legs are difficult to cure, and after healing they often make themselves known again. It is impossible to get rid of them without the use of medications, and in many cases such tissue damage leads to disability.

Trophic ulcers - what are they?

Trophic ulcers are damage to the skin, mucous membranes and subcutaneous tissues due to impaired lymph and blood circulation and insufficient supply of nutrients and oxygen. It is characterized by a long course - the affected areas may not heal for 2-3 months or longer.

The localization of leg ulcers depends on the underlying pathology that provoked the appearance. With varicose veins and thrombophlebitis, they are located on the lower legs and ankles, with diabetes mellitus- on the feet.

The main causes of trophic ulcers:

• violation of lymph outflow;
• venous stagnation;
• swelling due to fluid retention;
• poor nutrition of leg tissues.

The last two reasons are a consequence of the first two. The main diseases that can lead to trophic damage to the lower extremities are:

1. Varicose veins and thrombophlebitis - disrupt the circulation of venous blood in the legs, worsening the trophism of tissues and destroying them. Ulcers often form in the lower part of the leg.
2. Diabetes mellitus is a cause of inflammation vascular walls, which leads to a failure of normal metabolism in tissues and their disintegration. Ulcerative lesions are localized in the area of ​​the feet - on the heels and toes.
3. Atherosclerosis - when the lumen of blood vessels narrows due to cholesterol deposits on their walls, the supply of nutrients and oxygen is also disrupted. As a result, tissue necrosis develops - trophic ulcers are located symmetrically on the anterior and posterior surfaces of the lower leg.

Other causes and risk factors:

• hypertension;
• postthrombophlebitis;
• thromboangiitis;
• impaired innervation;
• injuries, frostbite, burns;
• allergic reactions;
• constantly wearing tight and uncomfortable shoes.

A trophic ulcer is considered to be a lesion of the skin and subcutaneous tissues that does not heal within 1.5 months.

Symptoms of trophic ulcers on the legs, manifestation

Symptoms of a trophic ulcer develop gradually and not suddenly. The appearance of an ulcer is preceded by severe dryness areas of skin on the leg or both limbs, persistent swelling, pigmentation and cramps. The formation of a trophic wound occurs in 4 stages:

1. First manifestation and beginning of progression.
2. Purification stage.
3. Granulation of the center and scarring of the edges.
4. Complete granulation and scarring.

Let's consider the symptoms of trophic ulcers on the legs by stages of development.

The initial stage of trophic ulcers on the legs

Initial stage of trophic ulcer (photo) and treatment (healing)

Against the background of the underlying 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.

This is the first stage in the development of a trophic ulcer on the leg. The initial stage is also manifested by thinning of the skin, which becomes shiny, as if varnished. The progression is complemented by inflammation of the subcutaneous fatty tissue and hyperemia of the skin of the limb.

Due to swelling, it is impossible to grasp the skin with your fingers, and the accumulated liquid appears on the surface, forming drops of moisture on it. The light spots that appear are areas of necrotic tissue.

Without treatment, at this stage a scab forms, deepening into the skin, and then a red wound area - the actual trophic ulcer. The initial stage of a trophic ulcer, depending on the severity of the development of varicose veins or other pathology, lasts from 3-4 hours to 4 weeks.

Cleansing ulcers

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 produces mucus and pus, often mixed with blood and fibrin strands.

If there is an infection, the ulcer emits an unpleasant, putrid smell and itches.

Additional signs of trophic ulcers (stages 1-2):

• heaviness in the legs;
• burning and soreness of the skin;
• chills;
• appearance of bluish blood vessels under the skin;
• increase in temperature in the affected area;
• epidermal detachment.

Third and fourth stages

The lesion progresses to 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 areas appear.

• The duration of stage 3 depends on both the effectiveness of therapy and the size of the ulcer.

If the trophism (nutrition) of tissues is not fully restored, then there is a high risk of a return to the initial stage. Final scarring occurs in the fourth stage and may take up to several months. The ulcer completely granulates and heals.

Treatment of trophic ulcers of the lower extremities, drugs

For trophic ulcers of the lower extremities, treatment with medications is carried out separately or as an addition to surgical cleaning of the affected area. For an open, non-scarring wound, the following remedies are used:

• Antibiotics - capsules, tablets, and in case of severe disease - intramuscular injections;
• NSAIDs to relieve inflammation and soreness;
• Drugs that reduce blood viscosity - antiplatelet agents - to prevent the formation of blood clots;
• Antihistamines - Suprastin, Xizal, Tavegil - to eliminate an allergic reaction;
• Antiseptic solutions or medicinal herbs for daily washing of the ulcer.

For trophic ulcers, antiseptic and antimicrobial ointments are prescribed from drugs. They are applied in a thin layer to a bandage or gauze and tightly fixed to the leg.

Examples of products are Levosin, Levomekol. To combat bacterial infection, salt compresses are also used at the rate of 1 tsp. salt per 200 ml of water.

For the treatment of trophic leg ulcers at the stage of granulation and scarring, the following medications are indicated:

• Local healing agents - gels, creams or ointments - Solcoseryl, Actovegin;
• Antioxidants – accelerate the removal of toxic substances from tissues;
• Antiseptics.

For venous etiology of ulcers, compression stockings, tights or elastic bandages are always used, which are worn constantly and changed every day. In addition to treating skin lesions, therapy for the underlying pathology that caused the development of a trophic ulcer is mandatory.

Treatment of trophic ulcers of the lower extremities at home with folk remedies is considered as an addition to the main therapy. It is effective to wash the wound with freshly squeezed potato or cabbage juice, which can also be used to apply compresses.

Oak decoction and willow bark powder are also used for these purposes. Among natural pharmaceutical products, ointments with comfrey, geranium and arnica are effective in the treatment of trophic ulcers.

From unconventional methods The attending physician may prescribe:

• mud therapy;
• laser therapy;
• ultrasonic cavitation;
• balneotherapy – treatment with mineral waters;
• hirudotherapy - the use of leeches to eliminate blood stagnation and dissolve blood clots;
• ultraviolet radiation;
• ozone therapy.

Surgical treatment is indicated when conservative treatment is ineffective. During the operation, the ulcer is excised, necrotic areas of skin and subcutaneous tissue are removed. Vacuuming and curettage are used to remove mucopurulent contents.

Limb amputation is used in advanced cases when there is no other way to save a person’s life.

Forecast

The danger of trophic ulcers lies in their complications, such as:

• ossifying periostitis, in which the lesion reaches the bone tissue;
• degeneration of the ulcer into malignant tumor;
• arthrosis of nearby joints;
• erysipelas;
• lymphadenitis, lymphangitis;
• sepsis;
• gas gangrene;
• thrombophlebitis.

Without proper and timely treatment, a trophic ulcer on the leg has an unfavorable prognosis - the result is the loss of a limb, and without seeking medical help - death due to the development of dangerous complications.

Trophic ulcer is a disease caused by the rejection of dying tissue, resulting in an open wound of the skin. Such an ulcer develops in parallel with other diseases, such as varicose veins, eczema, and venous insufficiency. This disease usually affects the lower extremities. You can see what trophic ulcers on the legs look like in the photo; the initial stage has pronounced symptoms.

Symptoms of the disease

Such signs appear initial stage trophic ulcer on the leg:

• painful sensations of the skin and its burning;
• the appearance of swelling in the legs;
• venous expansion;
• heaviness in the lower extremities when walking;
• sudden convulsions.

What does the disease look like in the initial stage (see photo)? The appearance of seizures begins to be accompanied by visual changes. The skin on your legs begins to change color, turning blue or purple. Increased moisture appears in the legs as a result of the passage of lymphatic fluid through the skin. Over time, the resulting wound begins to fester.

It is important to know! If a regular wound on the leg does not disappear within 1 month, it is a trophic ulcer! You need to immediately contact a specialist who will find out the cause of the disease and prescribe the correct treatment.

Photo of a trophic ulcer

Causes of the disease

The following factors can serve as prerequisites for the disease:

• disorders in arterial and venous circulation;
• diabetes;
• mechanical effects on the skin, trophic ulcers of the lower extremities can cause burns or frostbite;
• poisoning with highly toxic substances;
• dermatitis, eczema;
• deterioration of local blood circulation as a result of prolonged immobility.

Important! When establishing a diagnosis, the disease that caused the ulcers plays a very important role! This way, the specialist will be able to prescribe the correct treatment.

Types of trophic ulcers on the legs

Depending on the cause of the disease, there are the following types:

Arterial

This type of lesion occurs due to atherosclerosis, which disrupts the functioning of the main arteries. The cause of development is usually severe hypothermia, up to frostbite. The location of the ulcer is most often the area of ​​the foot, thumb legs, heel. A person is constantly cold, quickly overtired, and the affected leg begins to hurt at night. If this type of disease is not treated at the initial stage, the resulting wounds begin to spread throughout the foot and fester.

Venous

Usually appear on the inside of the lower leg. The occurrence is associated with a complication of varicose veins. What does a trophic ulcer look like in the initial stage? The initial stage is accompanied by swelling of the calf, the appearance of cramps at night, a venous network is formed, and the color of the skin changes. If treatment is not started, the disease will progress and affect not only the skin, but also tendons and muscles. Pus with a pungent odor begins to ooze out. Incorrectly chosen treatment can lead to more severe illnesses.

Read! Learn more about treating trophic ulcers on the leg quickly and effectively.

Diabetic

Diabetes mellitus causes many concomitant diseases, including diabetic ulcers. The initial stage is characterized by the death of nerve cells, as a result of which the sensitivity of the legs is lost. Mostly the big toes are affected. The danger of this type of disease lies in susceptibility to various types of infections, as a result of which gangrene can develop, followed by amputation.

Neurotrophic

The appearance is caused by severe injuries to the head or spine. The lateral surface of the foot is most often affected. The size of the formation is small in appearance, but very deep. The wound begins to fester rapidly.

Hypertensive ulcers

The most rare type of disease. It is a consequence of constantly elevated blood pressure. Mostly women over 40 years of age suffer. The initial stage of a trophic ulcer on the leg of this type is characterized by a change in the color of the skin and mild swelling. If the disease is not treated for a long time, then small wounds appear, the number of which increases rapidly. Accompanied by severe unbearable pain.

Pyogenic ulcers

Prerequisites for the appearance may be skin diseases and decline immune system. Most often, this type of disease affects people who do not follow hygiene rules.

Important to remember! Regardless of the cause and type, treatment of the disease should begin in the early stages! After all, going to the doctor in case of a severe form of the disease can lead to fatal consequences.

Treatment of the disease

How to treat the resulting wounds? The fight against the disease is divided into 3 stages:

1. Conservative treatment. Treatment of an initial stage trophic ulcer consists of eliminating the symptoms of the disease. For this, the following drugs are used: Actovegil, Tocopherol, Solcoseryl and their analogues.
2. Local treatment. First, you should act on the disease that was the cause of the damage to the lower extremities. Treatment should then be directed towards eliminating the infection, getting rid of dead tissue and addressing the wound. For such activities, antibacterial drugs (Furacilin, Chlorhexidine), antibiotics are used wide range, anti-allergenic medications (Suprastin, Tavegil), compresses with medicinal ointments (Levomikol, Dioksikol).
3. Surgical intervention. The indication for this type of treatment is the widespread spread of ulcers along the lower extremities with a high degree of severity. The operation involves the elimination of the ulcer and surrounding necrotic tissue. The second stage involves surgery on the veins.

Important to remember! Surgery can be avoided thanks to a quick response at the initial stage of the disease!

Complications when legs are affected

A late visit to the doctor can have serious, even fatal, consequences:

• loss of ability to work, disability;
• appearance infectious diseases;
• deterioration of the skin condition.

Therefore, such wounds should be disposed of as quickly as possible and their occurrence should not be ignored.

Important! How to treat trophic ulcers of the lower extremities with drugs can be found here.

Preventive actions

Home preventive measure is the timely treatment of diseases that cause the appearance of trophic ulcers. You should also adhere to the following rules:

• abstinence from heavy physical work, this is especially true for women;
• lead an active lifestyle;
• wear an elastic bandage during exacerbation of varicose veins;
• proper nutrition;
• giving up cigarettes and drinking alcohol;
• avoid injury;
• choose only comfortable shoes for everyday wear.

It should also be remembered that after complete recovery from the disease, reappearance is not uncommon. Therefore, it is important to follow your doctor's recommendations during the recovery period. Be sure to do therapeutic exercises to maintain blood vessels in a state of elasticity. And also treat the affected areas with moisturizers and bactericidal agents.

The history of religion knows the phenomenon of stigmatization, when bleeding wounds and ulcers appeared on the legs and arms, in places corresponding to the nails driven into the body of Christ. Let's leave aside the religious and mystical justification for this phenomenon, and let's talk about more “mundane” reasons that result in trophic ulcers on the legs.

We must immediately warn you that such deep trophic disorders as ulcers never occur suddenly in ordinary people, but are a complication of severe and long-term diseases. Neglect of one's health, presence bad habits, especially smoking, lack of control of blood glucose levels most often leads to these disorders.

Trophic ulcer - what is it?

Trophic ulcers on the legs photo

Despite the fact that this name is extremely widespread among doctors of all specialties, and they, without saying a word, understand what they mean, it is quite difficult to define a trophic ulcer.

Firstly, for the reason that such a diagnosis is not in the classification of diseases, and secondly, because this concept is collective in nature. Hemodynamic disorders, innervation disorders, lymphostasis and injuries lead to the appearance of tissue defects.

Therefore, speaking in simple language, trophic ulcers are deep defects that arise as a result of disturbances in innervation, hemodynamics, and lymphatic drainage, which reach a level below the basement membrane of the skin, are complications of many chronic diseases, and heal with the appearance of scar tissue.

This definition contains the most important facts, for example, the fact that if an ulcer has already appeared, then even if it heals, the appearance of a scar cannot be avoided. And for what reasons can such severe tissue nutritional disorders occur?

Causes of trophic ulcers

varicose veins, atherosclerosis and other causes

The main reason for their appearance is not trauma or injury, but long-term illnesses leading to chronic insufficiency of arterial and venous blood flow, and a disorder of autonomic innervation. The following are the most important reasons:

1. "Varicose ulcer." It occurs in 2/3 of all cases. Chronic venous stagnation develops, which leads to trophic disorders;
2. Arterial ulcers.

They occur much less frequently, as a result of severe ischemia of arterial thrombosis (occlusion). Most often they appear in the foot area, where the blood flow is weaker, and less often on the lower leg.

Almost all arterial lesions arise due to atherosclerosis, which occurs with obliteration of blood vessels, as well as due to thromboangiitis (Buerger's disease). Here the mechanism triggers a sharp decrease in pressure, leading to chronic hypoxia. At the same time, part of the blood flow is still preserved, since with complete thrombosis it is not an ulcer that occurs, but gangrene.

How arterial ulcers appear: they are preceded by chilliness and fatigue, cold limbs, the presence of intermittent claudication, then night pain appears. It all starts with a cut, bruise, or rubbing of the leg.

• Damages in diabetes mellitus.

Diabetic ulcers occur in 5% of all cases, but represent a very difficult problem to treat given the reduced innervation of tissue in the periphery as a consequence of diabetic polyneuropathy. In diabetic ulcers, the arterial pulse is usually preserved and there is no intermittent claudication.

See also Diabetic Foot Syndrome

trophic ulcer on the leg with diabetes photo

The presence of polyneuropathy leads to the absence of pain even with deep and wide defects. This fact “puts one’s vigilance to sleep” and often leads to very late requests see a doctor when urgent amputation is needed.

• Trophic ulcers that occur after thrombophlebitis of the legs. Their share in the total number is 6-7%, and very often they are adjacent to varicose veins, if phlebitis occurs in any long-term section of the vessel;
• Post-traumatic lesions. They arise as a result of injuries and wounds, and are often combined with the original trophic disorder. For example, if an injury occurs against the background of diabetes mellitus, which leads to a violation of trophism, then it can be very difficult to understand what caused the defect;
• Neurotrophic ulcers. They are of purely neurogenic origin and are recorded in no more than 1% of all cases. Occurs as long-term consequences of spinal injury, sciatic nerve. This is “to blame” for the damage or simply interruption of the vegetative fibers that regulate the vasomotor regulation of tissue nutrition;
• Finally, ulcerative-trophic lesions of mixed origin arise, which can be immediately classified into several categories.

There are also special forms, for example, hypertensive ulcer, or Martorell's lesion. As a rule, its occurrence is characterized by a combination of the following factors:

• Affects females, in adulthood – from 40 to 60 years;
• Patients have persistent and severe arterial hypertension, with a crisis course, which is also called “malignant”;
• Symmetrical lesions often occur;
• The peculiarity of this type of trophic disorder is severe pain in the legs, spread and progression, and a tendency to infection, that is, unfavorable factors.

Looking ahead, we’ll say right away that in this case the entire success of treatment and preservation of the limb depends on the success of treatment of the underlying disease, in in this case – arterial hypertension.

hypertensive ulcer in a woman

Doctors - surgeons and infectious disease specialists, radiology specialists also know even more rare causes of the development of lesions, for example, those that occur after frostbite and burns. Congenital and acquired arteriovenous shunts and fistulas, ulcers of syphilitic etiology, or those resulting from the action of ionizing radiation are extremely rare. How does an ulcer form?

Stages of trophic ulcers, symptoms and photos

Of course, it never happens that a person falls asleep healthy in the evening, and the next morning finds himself with a festering ulcer into which you can put your fist. An ulcer - like many other pathological formations - has a clear stage of development. But before it occurs, there is a “pre-ulcer” stage with its own symptoms.

Signs of “pre-ulcer” - initial stage

initial stage of trophic ulcer photo development

The symptoms of the initial stage of a trophic ulcer are as follows. At first, when there is no ulcer yet, you can detect induration, or thickening of the skin in the calves and legs, burning and itching, and swelling. In some cases, dilatation of small subcutaneous (subcutaneous) veins occurs.

The patient may experience leg cramps. With an arterial nature, chilliness appears and the color of the limb below the level of chronic occlusion changes to white and pale. The initial stage of a trophic ulcer on the leg may be accompanied by symptoms of the appearance of bluish or purple spots, which can merge into a single whole.

initial stage photo 2

Finally, the ulcer itself appears. There is no depression in the center yet, although everything is ready for its appearance, the tissues in the depths have already died or are dying, and it is a red (or brownish) wet scab of a certain area, with a “restless”, often painful periphery.

Stages of “life” - development of trophic ulcers

Now the defect begins to expand and deepen. In its development, it usually goes through three stages of life, which in uncomplicated cases take about 2-3 months. What happens during this time? These stages are called exudation, granulation and epithelialization:

• Exudation stage. It lasts up to 2 weeks.

Inflammation and perifocal edema occur along the perimeter. Tissue necrosis occurs in the center, that is, an ulcerative defect itself is formed. It is at this stage that a copious discharge appears from the wound, which has an unpleasant odor.

When conducting a bacteriological examination of the discharge, a significant appearance of colonies is revealed, which indicates strong microbial contamination of both the edges and the bottom of the defect.

In some cases, the process is not limited to one local zone. If lymphatic vessels - collectors and veins - passed through the ulcer, then lymphangitis and thrombosis of the veins (thrombophlebitis) occur. The appearance of secondary erysipelas, streptoderma, and erysipelas is common.

If the “rampant” local infection is not stopped, then gradual obliteration may occur lymphatic vessels with the development of persistent swelling, especially in the feet, called lymphedema. Ultimately, this can lead to elephantiasis and permanent disability.

• Stage of repair, or granulation.

Continues for the next 2-3 weeks. All this time, the bottom and walls of the formation are covered with fresh granulations, and the wound is cleared of necrosis.

It is at this stage that wound cleansing with fly larvae can be used, which carefully eat only dead tissue without causing any harm to the living (no matter how shocking this may be to many).

Suppuration gradually decreases, the severity of swelling of surrounding tissues also decreases. Scanty, serous discharge continues to appear.

• Stage of epithelization of the ulcer.

This is a late stage of ulcer development, which is observed a month or later from the beginning of the development of the process of tissue destruction, which is accompanied by the formation of epithelium, where this is possible, and where not, a scar appears.

How to treat trophic ulcers? They need to be treated strictly following the principles to avoid complications. What does this mean?

Principles of treatment of trophic ulcers on the legs, drugs

The most important thing is to determine the cause and begin intensive treatment of the underlying disease. Treatment of a trophic ulcer on the leg while it continues venous thrombosis in other areas, or blood sugar is “exorbitantly” elevated - this is useless, since even if the defect is eliminated, several new ones will immediately appear in other places.

One should not hesitate to make a decision in favor of hospitalization, even to a surgical hospital, if treatment of trophic ulcers of the lower extremities at home was delayed and was ineffective. Currently, there are many options for operations that effectively eliminate the cause of the ulcer and preserve the limb, so there is no need to be afraid of surgeons.

The main stages are:

• Consultation with a phlebologist and a vascular surgeon to decide on a priority operation. (In the case of arterial ulcers, blood flow is always restored first with surgery);
• In the case of a conservative approach, the stay in the hospital is sharply limited. vertical position(and in the diabetic form, putting pressure on the leg is completely prohibited);
• In case of varicose ulcers, compression garments are prescribed. Treatment of trophic ulcers of the lower extremities should be accompanied by improved outflow. According to indications it is prescribed compression hosiery high compression classes;
• In the first stage of ulcer formation, infection control is required, taking into account the sensitivity of the pathogen to antibiotics;
• At subsequent stages, the fight against infection gives way to reparative and restorative therapy;
• Throughout treatment, the most careful care of the ulcer is needed, and urgent hospitalization if the condition worsens.

Treatment of trophic ulcers of the lower extremities at home

At home, you can successfully use medications for trophic ulcers, but only after consultation with a vascular surgeon and a specialized specialist, for example, a diabetologist. The purpose of this is not to “miss” the operation, which in some cases should precede treatment.

In some cases, treatment in a hospital is preferable, since hyperbaric oxygen therapy sessions, rational antibacterial therapy, and correction of heart failure and blood glucose levels can be prescribed there. If all this is not required, then only then can trophic ulcers of the lower extremities be treated at home, but under the supervision of a doctor. The main groups of drugs include:

• Reparants (applied upon completion of the first stage). These include “Solcoseryl”, “Actovegin”, “Methyluraciol ointment”, “Bepanten”. Promote regeneration;
• Phlebotonics for varicose veins - “Detralex”, “Eskuzan”, “Troxerutin”, “Phlebodia”, “Venoruton”. Diosmin can be used in micronized form;
• Drugs to improve microcirculation (“Hepatrombin”);
• Local use of antibacterial drugs - antibiotics, Levomekol, Vishnevsky ointment;
• Rinsing the ulcer and removing the discharge (hydrogen peroxide, chlorhexidine solution, furatsillin) with 2-3 times changing the dressing. You can use gelatin - zinc ointment Unna;
• General antiplatelet agents are used that improve blood flow and reduce thrombus formation (Trental, Pentoxifylline, acetyl salicylic acid;
• For symptomatic purposes, NSAIDs (ketoprofen, ketorolac) are used to relieve pain and reduce inflammation;
• For severe swelling and itching, antihistamines are used, both topically (Fenistil gel) and orally;
• At the stage of wound healing, vitamin preparations are used, as well as special wound coverings, for example, Algipor. This is an absorbable dressing made from seaweed with antiseptic properties.

In any case, treatment of ulcers at home, and especially the use of antibiotics, should be under the supervision of a doctor.

Treatment prognosis

With any long-term trophic ulcer, there is a threat of its malignancy, or transformation into a malignant tumor. This occurs in 3-4% of all cases, and is often an example of the abuse of ultraviolet radiation and irritating ointments.

The next danger is purulent-septic complications, which can result in dry or wet gangrene, and sepsis, which often leads to death, especially in conditions of multiple organ failure.

In conclusion, it must be said that the most effective way to treat ulcers is to prevent them. Our body gives us many signals about an approaching disaster. And, even in the case of diabetes, when the patient simply has no pain, blood sugar levels are a threatening symptom.

The emphasis in the fight against ulcers should shift from the effect to the cause - only then the patient can not be afraid of relapses and threatening complications.

For various diseases not only of the lower extremities, but also systemic damage body, trophic ulcers may develop on the legs. The main problem is identifying them in the initial stage, since the initial prognosis of the disease depends on how early treatment is started. Progressing over time, trophic ulcers on the legs lead to serious impairments in the patient’s quality of life.

Visualization

In the initial stage, an ulcer on the skin of the leg is a small rounded skin defect with limited damage to the subcutaneous layer to a depth of no more than 2 mm. But at the same time, all the signs of a trophic ulcer can be traced: impaired local circulation, clear boundaries of the defect, dryness of the underlying tissues, weak granulations in the wound area.

Even in the initial stage, ulceration is serious problem, since due to trophic disorders, scarring occurs at an extremely slow pace, and treatment of the disease is delayed. First of all, eliminate the causes:

• Varicose veins.
• Impaired lymphatic drainage from the leg.
• Thrombophlebitis.
• Atherosclerotic damage to the arteries of the legs.
• Skin diseases - eczema, dermatitis.
• Diabetes.
• Mechanical or thermal effects at the initial stage - injury, burn.
• Systemic diseases connective tissue, provoking trophic disorders - lupus, dermatomyositis.

The main mechanism for the formation of the initial stage of a trophic ulcer is local microtrauma with damage to the skin, and then subsequent disruption of blood circulation in this area. The lack of a sufficient amount of active anti-inflammatory factors due to poor blood flow causes the formation of an ulcer.

How does the disease manifest itself?

Depending on the cause of the skin damage, a trophic leg ulcer looks different. With venous insufficiency, defects form on the legs. The photo clearly shows that the predominant localization is the anterior outer surface. Before ulcerations appear on the skin, they develop pathological processes:

• Local cyanosis forms.
• The integrity of the skin is compromised.
• Just before the onset of ulceration, whitish, rough scales form above the affected area.
• After the whitish growths fall off, a round wound is exposed on the skin - this is how the initial stage of a trophic ulcer develops due to venous insufficiency.

At the initial stage of a trophic ulcer, a wound appears on the skin.

The patient subjectively feels: dryness in the affected area, aching pain in the lower extremities, slight hemorrhagic discharge, weakness in the leg.

After the ulcer forms, it looks like a round defect with moderately bluish edges. The lack of blood flow is clearly visible in the photo. The patient does not feel pain in the leg at the site of an already formed trophic ulcer, but the function of the lower limb suffers. Even initial ulceration indicates advanced venous disorders in the leg.

For problems with the arteries, the manifestations in the lower extremities are somewhat different. Even an external comparison of photos of two pathologies has significant differences. Arteries are affected by atherosclerosis, diabetes mellitus and other diseases, but not only the vessels are affected, but also the nerve fibers located in the affected area. Venous outflow is completely preserved.

The typical development of a trophic ulcer in the initial stage is as follows:

• An area of ​​local hyperemia appears.
• The skin over it cracks and a small hemorrhagic discharge appears.
• The adjacent skin is dry.
• A zone of necrosis with a black center quickly forms at the site of the wound defect.
• The necrotic crust falls off until an ulcerative defect of the lower extremities appears within 2 days.
• The edges in the initial stage are very pale, which contrasts with the sharp hyperemia around the ulcer.

The location of the affected areas on the legs is also characteristic. They can be schematically represented in the photo: the area of ​​the sole, especially the heel area and big toe, the skin of the outer area of ​​the phalanges of the fingers, the area of ​​the ankle from the outside.

The patient does not feel any subjective sensations of pain, but they appear when trying to put weight on the leg. Treating ulcerations caused by artery problems is extremely difficult. In diabetes mellitus, especially when combined with a neurological defect, the initial manifestations rapidly progress.

Painful sensations from a trophic ulcer occur when putting stress on the legs.

How to get rid of the problem

Local treatment of trophic ulcers on the lower extremities, even in the initial stage, is unthinkable without adequate control of the underlying cause of the skin defect. Therapy depends on the type of disease, since different systemic medications are used for arterial and venous lesions.

The principles of therapeutic intervention for trophic disorders are as follows:

• Improving blood circulation in the damaged area.
• Fight against microbial insemination.
• Restoration of reparative processes at the local level.
• Ensuring stable function of nerve fibers located in the legs.

In order for the treatment to be complete, it is advisable to combine systemic therapy aimed at improving blood flow and nerve trophism with medications that act directly in the ulcer area. For the treatment of trophic leg ulcers, the following groups of drugs are used: vasodilators, angioprotectors, antiseptics, agents that improve reparative function, vitamins and metabolic stimulants.

For systemic treatment, the drugs listed below are used.

Diosmin - tones the venous system of the lower extremities. It is used for trophic ulcers in the initial stage on the legs associated with damage to the veins. The average dose for an adult is 600 mg per day in one dose. Treatment is carried out for 2 months.

Pentoxifylline – improves arterial blood flow in the area of ​​the trophic ulcerative defect. Used internally and parenterally. It is used for trophic changes in the initial stage associated with damage to the arteries. The average dose is 600 mg per day in two doses.

Thiamine is a metabolic stimulant and corrector of nervous system function. It is used parenterally, treatment is carried out in courses of 10 days. Improves nerve trophism in the leg. In the initial stage, it is useful to prevent rapid progression. The average dose is 50 mg per day.

The drug is used for systemic treatment diseases.

Local treatment is carried out with agents that restore damaged skin. Below are drugs that can be used for initial ulcerative defects.

Depantol – contains the reparant dexpanthenol and the antiseptic chlorhexidine. Effectively fights the proliferation of microbes and restores trophic changes in tissue. Use the cream twice a day under a bandage.

Olazol – contains an anesthetic, a reparant and two antiseptics. The composition contains sea buckthorn oil as a healing component. Release form: aerosol. Apply under a bandage 4 times a day.

Polivinox – has an antiseptic and regenerating effect. Available in balm form. Apply twice a day under a bandage on the leg.

Thus, it is important to quickly identify trophic ulcers in the initial stage and begin treatment immediately. This will allow you to maintain full function of the lower extremities for a long time. Therapy should be comprehensive, combining external treatment and systemic drugs. At the first sign of an ulcer, you should immediately contact a specialist.

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 low tendency to heal and a tendency to recur.

As a rule, they develop against the background of various diseases, are characterized by a 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 occurrence 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 begin 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 area of ​​the skin becomes necrotic and becomes sensitive to any traumatic agents and infection.

The following risk factors can provoke the occurrence of a trophic ulcer on the leg:

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

When making a diagnosis, the disease that caused the formation is very important, since the treatment tactics for a trophic ulcer on the leg and the prognosis largely depend on the nature of the underlying venous pathology.

Symptoms of trophic ulcers

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

Patients note increased swelling and heaviness in the calves, increased frequency of cramps in the calf muscles, especially at night, the appearance of a burning sensation, “heat,” and sometimes itching of the skin of the lower leg. During this period, a network of soft bluish veins of small diameter increases in the lower third of the leg. Violet or purple spots appear on the skin dark 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. Subsequently, the ulcer expands and deepens.

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

Complications

Trophic ulcers are very dangerous due to their complications, which are very serious and have poor prospects. If you do not pay attention to trophic ulcers of the extremities in time and do not begin the treatment process, the following unpleasant processes may subsequently develop:

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

IN mandatory Treatment of trophic ulcers on the legs should be carried out under the supervision of the attending physician without any amateur activity, only in this case can the consequences be minimized.

Prevention

The main preventative measure to prevent the occurrence of a trophic ulcer is immediate treatment primary diseases(circulation and lymph outflow disorders).

It is necessary not only to use medications internally, but also to apply them externally. Local impact will help stop pathological processes, treat existing ulcers and prevent subsequent tissue destruction.

How dangerous is the disease?

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

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

Treatment of trophic ulcers on the leg

If there is a trophic ulcer 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 doctors 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 cause of a trophic ulcer, it is also necessary not to forget about daily care behind the affected area.

How to treat a trophic ulcer of the lower extremities? Several options are used, depending on the severity of the pathological process.

1. Conservative therapy, when the patient is prescribed drugs such as phlebotonics, antibiotics, antiplatelet agents. They will help cure most of the symptoms of the disease. Patients are often prescribed the following medications: Tocopherol, Solcoseryl, Actovegil. Such drug treatment can only be prescribed by a doctor.
2. Local therapy that can help treat tissue and skin damage. For diabetes, ointments containing antiseptics and enzymes are used. These remedies heal wounds and provide local anesthesia. Ointments that increase blood circulation are prohibited from being applied to the open surface of a trophic ulcer. Ointments such as Dioxikol, Levomekol, Kuriosin, Levosin have a wound-healing effect. The ointment is applied to the compress or special bandages are made.
3. A surgical intervention that is performed after the ulcers have healed. During it, blood flow in the veins in the affected area is restored. This operation includes bypass surgery and phlebectomy.

The following drugs are used to treat wounds: Chlorhexidine, Dioxidine, Eplan. At home, you can use a solution of furatsilin or potassium permanganate.

Surgery

Surgical treatment of trophic ulcers of the lower extremities is indicated for extensive and severe skin lesions.

The operation consists of removing the ulcer with surrounding non-viable tissues, and further closing the ulcerative defect; at the second stage, surgery is performed on the veins.

There are several different surgical techniques:

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 interfere with the development of bacteria.
2. Catheterization – 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 the separation of venous-arterial fistulas.
4. Virtual amputation. The metatarsal bone and metatarsophalangeal joint are cut off, but the anatomical integrity of the foot is not violated - but foci of bone infection are removed, which makes it possible to effectively combat neurotrophic ulcers.

If the size of the ulcer is less than 10 cm², the wound is closed with its own tissues, tightening the skin by 2-3 mm per day, gradually bringing the edges together and completely closing it in 35–40 days. A scar remains at the site of the wound, which must be protected from any possible injury. If the affected area is more than 10 cm², skin grafting is used using the patient’s healthy skin.

Drug therapy

A course of drug treatment necessarily accompanies any operation. Treatment with medications is divided into several stages, depending on the stage of the pathological process.

At the first stage (wetting ulcer stage), the course of drug therapy includes the following drugs:

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

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

1. Washing the wound with antiseptic solutions: potassium permanganate, furatsilin, chlorhexidine, decoctions of celandine, string or chamomile;
2. The use of dressings with medicinal ointments (dioxicol, levomikol, streptolaven, etc.) and carbonet (a special dressing 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 - solcoseryl, actevigin, ebermin, etc., as well as antioxidant drugs, for example, tolcoferon, are used in treatment.

Also at this stage, specially developed wound coverings, Swiderm, Geshispon, Algimaf, Algipor, Allevin, etc., are used. Treatment of the ulcerated surface is carried out with curiosin. At the final stages, drug treatment is aimed at eliminating the underlying disease that provoked the appearance of a trophic ulcer.

How to treat a trophic ulcer on the leg at home

When starting to treat a trophic ulcer using traditional recipes, you must always consult with your doctor.

At home you can use:

1. Hydrogen peroxide. You need to drop peroxide onto the ulcer itself, then sprinkle streptocide on this place. On top you need to put a napkin previously moistened in fifty milliliters of boiled water. Add two teaspoons of peroxide to this water. Then cover the compress with a bag and tie it with a scarf. Change the compress several times a day. Add streptocide when the wound becomes moist.
2. Healing balm in the treatment of trophic ulcers in diabetes mellitus. It contains: 100 g of juniper tar, two egg yolks, 1 tablespoon of rose oil, 1 teaspoon of purified turpentine. All this needs to be mixed. Pour the turpentine 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. Wash the wound with a solution of rivanol. Sprinkle with prepared powder. Apply a bandage. The next morning, sprinkle the powder again, but do not wash the wound before. Soon the ulcer will begin to heal.
4. Trophic ulcers can be treated with antiseptics: rinse the wounds with warm water and laundry soap, apply antiseptic and bandage. These dressings are alternated with applications of a solution of sea or table salt (1 tablespoon per 1 liter of water). Fold gauze into 4 layers, soak in saline solution, squeeze lightly and apply to the wound, compress paper on top, hold for 3 hours. Repeat the procedure twice a day. There is a break of 3-4 hours between applications, during which time the ulcers should be kept open. Soon they will begin to decrease in size, the edges will turn pink - this means that the healing process is underway.
5. Garlic poultices or compresses are used for open ulcers. Take multi-layer gauze or a terry towel, soak it in hot garlic broth, squeeze out excess liquid and immediately apply to the sore spot. Place a dry flannel bandage and a heating pad or hot water bottle over the poultice or compress to retain heat longer.
6. You need to mix the egg white with honey so that these ingredients are in the same ratio. Whisk everything together and apply to the ulcers, including the veins that hurt. Then cover with the back of the burdock leaves. There should be three layers. Wrap in cellophane film and bandage with 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 correct therapy, complications such as: microbial eczema, erysipelas, periostitis, pyoderma, arthrosis ankle joint etc. Therefore, use only folk remedies, while neglecting traditional treatment not worth it.

Ointments for treatment

For treatment of this disease You can also use various ointments, both natural and purchased at the pharmacy. Arnica, comfrey, and indoor geranium ointments effectively heal wounds and have an anti-inflammatory effect.

Vishnevsky ointment is also often used. Of the ointments that can be bought at the pharmacy, dioxykol, levomekol, as well as streptolaven and a number of analogues are especially distinguished.

Content

Pathological processes that lead to the formation of ulcerative defects have many causes. Doctors who promise a quick cure are more likely to cure the symptom, but do not remove the source of the problem. Trophic ulcers are localized in most diagnostic episodes on the lower extremities (in some cases on the arms) and are skin lesions that do not heal for more than 6 weeks.

What is a trophic ulcer

At its core, it is a trophic ulcerative lesion, which is accompanied by a violation of the upper layer of skin and tissue with damage to the vessels located underneath it (it is not contagious, except for infectious diseases). Such manifestations are often localized on the legs, since they bear the maximum load in everyday life. In addition, ulcers are located on any part of the body where tissue microcirculation is impaired. They look like an ulcerated spot surrounded by skin defects, from which pus, lymph and blood are secreted.

Symptoms

It is difficult to notice the formation of an ulcer, because at the beginning of its development it is no different from a banal bruise. Patients often turn to specialists when a full-fledged surgical intervention is already required to eliminate damaged areas of tissue. If the patient knows that his disease can lead to the formation of such ulcers, then he should carefully monitor the condition of his skin. Signs of ulcerative manifestations and their initial stages of development (using the legs as an example, but all points apply to any part of the body):

• regular severe swelling lower extremities;
• severe periodic cramps in the calves (usually at night);
• burning and itching in certain areas;
• feeling of heat in the legs;
• increased sensitivity skin to contact;
• thickening of the skin;
• discharge on the surface, similar to sweat.

Causes

A trophic ulcer is a symptom of a dangerous disease, and not an independent problem. If you treat only a skin problem, then after a while it will appear again (or the treatment will be unsuccessful). When a vascular surgeon makes a diagnosis, he will definitely refer the patient for a full examination to identify the cause of the ulcerative lesion. What can cause trophic ulcers on the legs:

• wounds of any type that were not properly treated;
• burns;
• frostbite;
• bedsores;
• complication of varicose veins;
• chronic diseases vessels;
• chemical contact exposure;
• radiation or radiation exposure;
• constantly wearing inappropriate shoes;
• complications of diabetes;
• purulent infections
• insufficient blood flow in the veins and arteries;
• autoimmune diseases;
• weakened immunity, including AIDS;
• chronic arterial hypertension;
• sharp set body weight (found in bodybuilders who actively build muscle);
• syphilis;
• tuberculosis;
• head injuries and spinal cord.

Kinds

Trophic peptic ulcer disease, depending on the location and cause, can have a different etiology, so accurate diagnosis of the original disease is important. Ulcers begin to form at different levels of tissue, and their types are classified according to the reason for their formation and structure. There are six main types of ulcers:

1. Arterial (atherosclerotic). They are formed as a result of shear ischemia of the soft tissues of the lower leg (arterial circulation disorder). The initial appearance is provoked by constant or severe one-time hypothermia, uncomfortable shoes, and skin breakdown. Localized in most episodes in the foot area. It looks like small semicircular painful wounds filled with pus, with dense edges and pale yellow skin around. Formed more often in elderly patients with destruction of the arteries of the extremities, formations from the heel to the lower leg increase in diameter and depth.
2. Venous ulcers on the legs. The initial trigger is a violation of normal venous circulation in the veins, localized within the lower leg. They begin to develop from purple spots. Incorrect treatment can lead to the growth of the ulcer inward to the Achilles and muscles, and death due to blood poisoning is possible.
3. Diabetic ulcers. They develop in patients with diabetes if treatment and prevention are not followed; ulcers often form on the lower extremities. Home treatment actually does not produce results, surgical intervention and serious drug therapy. Appearance: large diameter sores with deep defects in the tissue, severe bleeding and pus with a strong unpleasant odor (diabetic foot).
4. Neurotrophic ulcers. Appear after injuries to the head or spine due to disruption of the innervation of the limbs and damage to the nervous structure. Externally they look like small craters that secrete unpleasant-smelling pus. The depth of ulceration can reach tendons and bones.
5. Hypertensive ulcers (Martorella). The occurrence occurs against the background of malignant arterial hypertension, which leads to the destruction of the walls of small vessels. Outwardly they look like symmetrical small spots of a red-bluish tint with mild pain on palpation. It often develops in women after 40 years of age, the pathology is accompanied by severe pain at any time of the day, and is most prone to bacterial infection.
6. Pyogenic. Hygienic ulcers that are typical for street dwellers. They appear against the background of furunculosis, purulent eczema when the rules of personal hygiene are ignored. The shape is oval, the depth of ulceration is small.

Complications

Ignoring any disease, regardless of its symptoms, will gradually lead to complications. Trophic ulcers of the lower extremities in this sense are among the most dangerous: purulent processes of small localization are a favorable environment for the development of infections with the gradual destruction of surrounding tissues (a typical example is homeless people with serious pyogenic lesions). What can be the consequences of ignoring trophic ulceration:

• eczema of various types around ulcers;
• development of fungal diseases;
• streptococcal skin lesions;
• deformation and destruction of joints, tendons;
• vein thrombosis;
• cancerous formations in rare cases, when the problem is completely neglected;
• removal of affected muscle tissue;
• amputation of totally affected limbs.

Diagnostics

The initial indicators for identifying the presence of such an ulcer are varicose veins and previous phlebothrombosis. Diagnosis occurs after comprehensive examination the patient for the presence of diseases that provoke the problem. Primary diagnosis The disease occurs by palpation of the area of ​​possible localization. If trophic manifestations are suspected (subcutaneous depressions on the legs or calves, hardening of the skin, discoloration), additional ultrasound examination of the leg veins, rheovasography and duplex ultrasound examination are performed.

Treatment of trophic ulcers

How to treat trophic ulcers on the legs if they appear? Long-term therapy for such diseases is a comprehensive approach, which is aimed in parallel at minimizing the impact of the underlying disease and eliminating the non-healing ulcers themselves. Conservative therapy begins with the use of antibiotics to limit the development of purulent lesions and secondary local infections. Separately, drugs are selected to normalize the functioning of blood vessels and circulatory system, effective treatment of ulcerations.

The ulcers are cleaned using special enzymes. After partial healing and normalization of tissue condition, vessels and veins are surgically restored, and total skin damage is removed. Ulcerated areas should be observed even after the underlying disease has been cured in order to prevent their reappearance due to weakened immunity. There is no strict treatment regimen, because the causes of ulcers and their forms are very different.

Surgery

It is important that primary treatment and surgical intervention are carried out properly, otherwise there is a high probability of secondary progression of trophic tissue damage. The main foci of inflammation, affected areas, and purulent discharge are surgically removed (vascular restoration is a separate category of operations that is performed after the elimination of the ulcerative defect). Treatment of non-healing leg wounds:

• vacuum: pumping out pus, reduces swelling, stimulates blood flow and regenerative processes, reduces the risk of relapse, blocks access to bacteria and viruses;
• catheterization: used for deep ulcers that are difficult to heal;
• suturing venous-arterial fistulas to divide the wound area into smaller wounds for a more targeted effect.

Drug therapy

Invasive therapy is aimed at maintaining immunity, fighting infection and the underlying disease. Treatment of the ulcer itself is often limited to the use of medicinal ointments and creams that will reduce the bacteriological component will provoke tissue to heal. It is impossible to deliver the active substance to the affected area in any other way. Lotions from the compositions are used only after thorough cleaning of the wound.

Drug name	Properties	Mode of application	Notes
Solcoseryl	The ointment is used to stimulate regeneration processes and cleanse the wound. The active ingredients of the ointment normalize blood flow in the vessels, which provokes tissue restoration, even over large areas.	The frequency of use directly depends on the degree of damage to the lesion and the intensity of purulent discharge (on average 2-3 per day).	Solcoseryl actually has no contraindications (except for individual intolerance).
Stellanin	A relatively new drug, the action of which is aimed at restoring the body's immune defense. Stimulates the restoration of blood circulation and stops the appearance of purulent discharge.	You can use the ointment only after consultation with your doctor, because there is a large list of contraindications.	Cannot be used by people with thyroid problems.
Argosulfan	Antibacterial action. Relieves pain, burning sensation in the affected area, protects wounds from infections.	The ointment is applied in a thick thick layer to the wound as clean as possible 2-3 times a day to heal the damaged area.	Problems may arise with individual intolerance to sulfathiazole, congenital deficiency of glucose-6-phosphate dehydrogenase. During pregnancy, the ointment can be used if the area of ​​damage does not exceed 20% and possible benefit prevails over the theoretical risk to the fetus.

Compression therapy

Fixation with compression bandages is mandatory in the treatment of trophic ulcerative manifestations and varicose veins at all stages of the disease. This effect helps to reduce the diameter of the veins and reduce swelling. Modern technologies suggest using not classic elastic bandages, but specialized compression garments that can be selected according to size and for a specific area of ​​the limb.

Physiotherapeutic procedures

Physiotherapy helps improve microcirculation of the vessels of the lower extremities, reduce inflammatory processes in tissues, promotes healing of ulcerative lesions. Such manipulations are permitted if the therapeutic effect does not worsen the condition of the limbs and brings real benefit. Methods differ in the direction of influence:

• reduction of inflammation: microwave and UHF therapy;
• bactericidal effect: electrophoresis with an antibacterial component (cleanses ulcer localization from necrotic components), aeroionotherapy, darsonvalization (exposure to high-frequency currents);
• vasodilating effects: galvanization, infrared irradiation, ultratonotherapy, electrophoresis;
• for wound healing, formation of healthy tissues: paraffin therapy, oxygen barotherapy, magnetic therapy;
• ozone and air baths.

Traditional methods

It is important to remember that a trophic non-healing defect is not a cold or a callus. A complete cure will occur only after comprehensive treatment of the provoking disease and the ulcer itself. The use of folk remedies must be agreed with the treating specialist in order to avoid worsening the condition or neutralizing the therapeutic effects of traditional therapy. Popular home remedies for treating ulcers:

1. Burnet tincture. Stimulates the healing of the disease focus and the regeneration of skin areas. The root of the plant must be ground to a powder and pour 100 ml of chilled boiled water. Leave for 10 hours and take 1 tbsp before meals. l. three times a day.
2. Compress made from birch ash. Pour 100 grams of powder into 1 liter of boiling water, close the container and wrap tightly in a blanket or blanket. After 2 hours, moisten the gauze in the resulting liquid and apply it to the cleaned lesion for 3-4 hours. The procedure should be carried out over 2-3 weeks.
3. Wraps using golden mustache leaves. Finely chop the leaves and pound in a mortar until the juice appears. Treat the lesion with a sterile solution (hydrogen peroxide or chlorhexidine), place the mixture on the lesion and cover with a sterile bandage (burning may occur in the first minutes). Treat the ulcerated area until complete healing.

Prevention

It is important to remember that ulcerative lesions appear in diseases of the arteries and damage to the venous structure. For varicose veins, when the patient refuses surgical intervention, it is recommended to wear compression garments, which is selected individually. It is strongly recommended for patients to reduce the load on their legs, monitor their weight, and, if possible, avoid working on hazardous industries(hot shops), adhere to a strict diet and avoid injury to tissues that are susceptible to ulceration.

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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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A trophic ulcer on the legs is an open wound located on the skin, formed against the background of tissue rejection. Trophic ulcers tend to persist for a long time and do not heal for 6 weeks or more. The pathological process involves not only the skin epithelium, but also the tissues located underneath it. After healing of trophic ulcers, scars remain on the skin. Even despite the development of modern medicine, the treatment of trophic ulcers is one of the most difficult.

The most common are trophic ulcers of the legs and feet. According to statistics, up to 2 million people suffer from this pathology in the world. Up to 70% of cases of ulcers are associated with certain disorders in the functioning of the venous system. vascular bed. Ulcers never occur spontaneously; they are preceded by a rather long process of various disorders in the body. Phlebology is a branch of medicine that identifies and treats trophic ulcers.

The causes of trophic ulcers are diverse, among them the following can be noted:

The formation of trophic ulcers is primarily caused by a disease such as varicose veins. Varicose veins contribute to the deterioration of blood outflow, leading to its stagnation. As a result, fresh blood, rich in nutrients, is not able to deliver them to the tissues of the lower extremities. The result of such starvation is the gradual destruction of cells. First formed superficial wound, which gradually transforms into an ulcer.

Vein thrombosis is another common cause of trophic ulcers. They appear by the same mechanisms as with varicose veins, only the result of blood stagnation is a blood clot that blocks the lumen of the artery.

Atherosclerosis of the lower extremities is characterized by the formation of fatty plaques on the arterial walls, which, as they grow, can completely block the artery. As a result of malnutrition, pathological processes begin to develop in tissues, which lead to the formation of ulcers.

Martorell syndrome, which develops against the background of an existing hypertension, can lead to the formation of shunts inside veins and arteries. This also causes circulatory problems and becomes a trigger in the formation of trophic ulcers.

Diabetes mellitus can lead to the formation of deep non-healing wounds in the form of trophic ulcers.

Systemic diseases, such as vasculitis, collagenosis, blood diseases, and metabolic disorders, can become a trigger for this pathology.

If personal hygiene rules are not followed, pyoderma occurs, which can lead to the formation of ulcers.

The etiological factor is Lyell's toxic epidermal necrolysis.

Any diseases of cardio-vascular system can provoke the development of trophic ulcers. They arise as a result of severe swelling of the lower extremities due to circulatory failure.

Infectious diseases can lead to the formation of trophic ulcers - these are tuberculosis, syphilis, infectious tropical disease, Naga ulcer, onchocerciasis, leishmaniasis, etc.

Trophic ulcers can be a consequence of malignancy of various skin formations and can occur with radiation injuries.

Provoking factors are burns and frostbite of the lower extremities.

According to available data, in 52% of cases, trophic ulcers have a varicose etiology, in 14% of cases, their occurrence is associated with disturbances in the functioning of the arteries, in 13%, trophic ulcers arise as a result of the influence of several factors.

Ulcers resulting from venous thrombosis account for 7% of cases. Due to trauma, ulcers appear in 6% of cases. Diabetic ulcers account for 5% of the total number of ulcers.

In general, any disease of the veins of the lower extremities (both deep and superficial) with venous insufficiency can lead to the formation of ulcers. Moreover, even minor scratches and wounds can cause a long-term non-healing wound.

Trophic ulcer in diabetes mellitus

A trophic ulcer in diabetes mellitus or a diabetic ulcer occurs as a complication of the underlying disease. It is known that in diabetes mellitus there is a disturbance in the absorption of glucose. The walls of the blood vessels become rigid, and diabetic neuropathy and diabetic angiopathy are formed. In the affected areas, blood circulation is hampered, and lack of tissue nutrition leads to the formation of ulcers.

The danger of a diabetic ulcer is that it can transform into gangrene, which will lead to the need for amputation of the limb.

Symptoms of trophic ulcers depend on what caused their formation:

Symptoms of venous trophic ulcers. The formation of a trophic ulcer of venous origin is always preceded by the occurrence of specific symptoms indicating the progression of damage to the venous system.

• At the very beginning of the disease, people notice that their legs become more swollen. There is a feeling of heaviness in the area of ​​the calves and legs.

  At night, cramps may appear and tend to become more frequent. At the same time, burning and itching occurs in the lower extremities.

  Pigment accumulates in the skin, making it darker. As the disease progresses, the hyperpigmented area increases in size.

  Hemosiderin accumulates in the dermis, provoking the development of eczema and dermatitis. The skin itself thickens, acquires a varnish shine, and feels painful when touched.

  Lymphostasis increases; it can lead to lymph seeping out through the skin and appearing on its surface in the form of dew drops.

  As the disease progresses, a pre-ulcerative condition develops, when an area of ​​epidermal atrophy appears in the center of the affected area white. In this case, a person may not notice such minimal damage to the skin until an ulcerative defect appears in the atrophied area. At first it is small in size, and the ulcer itself is located on the surface.

  Over time, the ulcer begins to deepen and becomes larger in diameter. If several ulcers occur, they can merge, forming large affected areas.

  The pathological process tends to expand not only to the sides, but to grow deeper. The deeper the ulcer penetrates, the more intense the pain becomes.

  The calf muscles, Achilles tendon, and the frontal surface of the tibia may be involved in the process. If the process has spread to bone tissue, this can trigger the development of osteomyelitis.

  Various contents are released from the ulcer. At first it is hemorrhagic, then becomes cloudy and may contain fibrin threads or pus. An unpleasant odor emanates from the wound. Microbial eczema often forms around a trophic ulcer.

  There is a risk of secondary infection, which can be provoked by opportunistic bacteria against the background of a decrease in local and general immunity. In older people, trophic ulcers are often complicated by mycotic infection. This significantly worsens the prognosis.

Trophic ulcers are accompanied by severe pain and cause suffering to a person.

Symptoms of a diabetic ulcer. A diabetic ulcer develops against the background of diabetes mellitus and is expressed in the following symptoms:

• At the initial stage of development of a diabetic ulcer, loss of sensation in the lower extremities occurs. This is caused by the death of nerve endings.

  At night, a person begins to experience pain.

  The location of a diabetic ulcer is the big toes or the tips of the phalanges of the toes. On the sole it can form in the place where the corns are located - this is the surface of the foot or the heel.

  As the disease progresses, a small but deep wound appears. Then it increases in size.

More often than other ulcers, a diabetic trophic ulcer is complicated by gangrene and leads to amputation of a limb.

Symptoms of atherosclerotic trophic ulcers. Atherosclerotic trophic ulcers are formed against the background of vascular atherosclerosis and have the following clinical picture:

• The initial stage of development of atherosclerotic trophic ulcers is characterized by intermittent claudication. The sensitivity of the affected limb is impaired, it gets tired faster, and often freezes.

  The location of the ulcers is the outer side of the foot, the phalanx of the big toe, the heel area.

  The ulcers are small in size and semicircular in shape.

  The edges of the ulcer are denser and torn. The dermis surrounding the edges of the ulcer has a yellowish tint.

  The contents of the ulcer are purulent. As the disease progresses, ulcers fill the entire surface of the foot.

Symptoms of trophic ulcers of Martorella. This type of trophic ulcers is formed against the background of increased blood pressure. Most often, women aged 40 years and older suffer from such ulcers.

A characteristic feature of ulcers in Martorell syndrome is the formation of a papule on the lower limb, which responds with mild pain. As the disease progresses, the papule transforms into an ulcer.

Another one distinguishing feature hypertensive ulcers - this is the symmetry of their occurrence. That is, they occur on both limbs, most often in the central part of the lower leg.

Ulcerations progress slowly and are particularly painful. There is an increased risk of joining bacterial infection.

During the development of the disease, there are four main stages of trophic ulcers, including:

Stage of exudation (beginning of inflammation, appearance of necrotic lesions).

Reparation stage (cleaning the surface of the ulcer from necrotic contents, forming granules, reducing inflammation).

Stage of epithelization (appearance of fresh epithelium, healing of the wound).

Stage of tissue scarring (the final stage, when scar tissue forms at the site of the existing ulcer).

The stages of trophic ulcers may differ slightly, depending on what caused them. These differences are characteristic of the initial stage of inflammation; all ulcers go through the stage of repair, epithelization and scarring, with an uncomplicated course of the disease.

Initial stage of trophic ulcer

The initial stage of a trophic ulcer with varicose veins is characterized by the appearance of hyperpigmented areas on the skin. As venous insufficiency progresses, the skin becomes thinner, becomes hyperemic, and then a whitish spot appears on the skin. If treatment is not carried out, a scab forms on the dermis, which penetrates deep into the tissue.

The initial stage of a diabetic ulcer is characterized by the fact that the limb loses its former sensitivity, this is caused by the destruction of nerve endings (diabetic polyneuropathy).

Against the background of hypertension, the initial stage of a trophic ulcer is characterized by the appearance of intermittent claudication.

In general, the manifestation of the disease is characterized by damage to the skin with perifocal inflammation, necrotic areas, and copious discharge with an unpleasant putrid odor. If treatment is not carried out at the initial stage of ulcer development, this risks the development of complications.

Complications and consequences of trophic ulcers

The long-term existence of a defect can cause conditions unfavorable to human health, which can lead to hospitalization.

Complications and consequences of trophic ulcers may be as follows:

Pyoderma.

Microbial eczema.

Allergic dermatitis.

Fungal infection.

Lymphagitis, erysipelas, inguinal lymphadenitis.

Varicothrombophlebitis.

Phlegmon.

Gangrene.

Tetanus.

Arthritis, arthrosis, periostitis, tendinitis, osteomyelitis.

Wound malignancy (from 1.6 to 3.5% of cases).

Wound myiasis, that is, the colonization of an ulcer by insect larvae.

Development of bleeding.

• Secondary lymphedema.

Answers to popular questions

Is a trophic ulcer on the leg contagious? No, a trophic ulcer on the leg is not contagious.

Is it possible to wet a trophic ulcer on the leg? It is not recommended to wet a trophic ulcer on the leg, as this can lead to the development of complications, the addition of a bacterial infection, etc. The ulcer must be treated with the help of special antibacterial, antiseptic and drying agents.

Which doctor treats trophic ulcers? Trophic ulcers are treated by a phlebologist.

A phlebologist will tell the patient how and how to treat a trophic ulcer. The specialist and the patient are faced with a whole range of tasks. Firstly, it is necessary to minimize the manifestations of the underlying disease that led to the formation of the ulcer. That is, varicose veins should be treated, blood pressure should be lowered, and diabetes should be treated. Secondly, it is necessary to take measures aimed at healing the trophic ulcer itself.

General conservative therapy boils down to using the following tools:

Treatment of the underlying disease using phlebotonics, antiplatelet agents, disaggregants. These may be drugs such as: Pentoxifylline, Heparin, Acetylsalicylic acid, Prostaglandins. They allow you to correct blood clotting processes, help normalize blood circulation, and prevent venous stagnation. Oral administration and administration of drugs in the form of injections is possible.

Antibacterial therapy is selected taking into account the sensitivity of the microorganism to the bacterial flora. Wound treatment with Levometicin, Hexicon, Fuzidin, Miramistin is effective. It is possible to use drugs in the form of ointments or sprays for local wound treatment. If necessary, antimycotics are prescribed: Fluconazole, Caspofungin, Voriconazole, etc.

To speed up regeneration processes, drugs are prescribed that affect metabolic processes in tissues. This could be Actovegin, Ebermin, Sulfargin.

Painkillers are prescribed to relieve pain.

Toileting a trophic ulcer should be regular. To begin with, the wound is washed with sterile saline solution, dead tissue and exudate are removed from it. After sanitation, an antibacterial agent is applied and the ulcer is covered with a bandage. If it is at the healing stage, the dressing should ensure normal hydration and breathing of the wound surface. If there is an infection, you should choose a dressing that can absorb secretions and provide an antiseptic effect. Special napkins are used for this.

It is possible to undergo physical procedures that help speed up the healing of the ulcer. The following techniques are effective: ultrasound cavitation of the wound, UV irradiation, hyperbaric oxygenation, laser therapy, magnetic therapy.

When the ulcer heals and the patient feels satisfactorily, surgical intervention is possible. It will be aimed at normalizing venous and arterial outflow, at removing veins that have undergone varicose veins.

Pain reliever for trophic ulcers

Pain from trophic ulcers varies in intensity. Therefore, in case of severe pain, painkillers are prescribed.

They can be used in the form of ointments, sprays, or prescribed in tablet form:

Parmidine. Available in the form of tablets and ointments. Helps relieve swelling and reduce pain.

Acetylsalicylic acid and drugs based on it: Aspirin, Cefekon.

Drugs from the NSAID group: Ibuprofen, Ambene, Ketorolac, Naproxen.

It is possible to use Emla and Dimexide ointments.

Vinilin and Romazulan balm have a weak analgesic effect.

Wipes for the treatment of trophic ulcers

Sterile wipes for the treatment of trophic ulcers are used when they do not heal for a long time and fester. They contain antibacterial agents, as well as components that accelerate tissue regeneration.

The following napkins can be used:

Activetex. They are made from knitwear and impregnated with medications. Thus, Aktivtex F has furagin as its main active ingredient, Aktivtex X has chlorhexidine, Aktivtex HF combines chlorhexidine and furagin.

There are also wipes for the treatment of trophic ulcers from the companies Hartman, Koletex, Multiferm, Proteox-TM. All of them have antibacterial and antiseptic effects.

It is possible to use absorbent dressings, which are applied when there is copious discharge from ulcers. These can be dressings: Voskopran, Tsetuvit E, Biaten, Branolind N.

Treatment of trophic ulcers must be comprehensive and timely; an indispensable condition is getting rid of the underlying disease. This is the only way to avoid serious complications and prevent relapse of the disease.

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 low tendency to heal and a tendency to recur.

As a rule, they develop against the background of various diseases, are characterized by a 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 occurrence 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 begin 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 area of ​​the skin becomes necrotic and becomes sensitive to any traumatic agents and infection.

Provoke the occurrence The following risk factors can cause a trophic ulcer on the leg:

1. Problems of venous circulation:, and so on (both diseases contribute to 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. Deterioration of arterial circulation (in particular, with,);
3. Some systemic diseases ();
4. Any types of mechanical damage to the skin. This can be not only an ordinary household injury, but also a burn or frostbite. This area also includes ulcers that form in drug addicts after injections, as well as the consequences of radiation;
5. Poisoning with toxic substances (chromium, arsenic);
6. Skin diseases, for example, chronic;
7. Impairment of local blood circulation during prolonged immobility due to injury or illness (bedsores form).

When making a diagnosis, the disease that caused the formation is very important, since the treatment tactics for a trophic ulcer on the leg and the prognosis largely depend on the nature of the underlying venous pathology.

Symptoms of trophic ulcers

The formation of an ulcer on the leg, as a rule, is preceded by a whole complex of objective and subjective symptoms indicating a progressive disorder of venous circulation in the extremities.

Patients note increased swelling and heaviness in the calves, increased frequency, especially at night, the appearance of a burning sensation, “heat,” and sometimes itching of the skin of the lower leg. During this period, a network of soft bluish veins of small diameter increases in the lower third of the leg. Violet or purple pigment spots appear on the skin, which, merging, form a large area of ​​hyperpigmentation.

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

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

Complications

Trophic ulcers are very dangerous due to their complications, which are very serious and have poor prospects. If you do not pay attention to trophic ulcers of the extremities in time and do not begin the treatment process, the following unpleasant processes may subsequently develop:

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

It is imperative that the treatment of trophic ulcers on the legs should be carried out under the supervision of the attending physician without any amateur activity, only in this case can the consequences be minimized.

Prevention

The main preventive measure to prevent the occurrence of a trophic ulcer is the immediate treatment of primary diseases (circulatory disorders and lymph outflow).

It is necessary not only to use medications internally, but also to apply them externally. Local exposure will help stop pathological processes, treat existing ulcers and prevent subsequent tissue destruction.

How dangerous is the disease?

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

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

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Treatment of trophic ulcers on the leg

If there is a trophic ulcer 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 doctors 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 cause of a trophic ulcer, it is also necessary not to forget about daily care of the affected area.

How to treat a trophic ulcer of the lower extremities? Several options are used, depending on the severity of the pathological process.

1. Conservative therapy when the patient is prescribed drugs such as phlebotonics, antibiotics, antiplatelet agents. They will help cure most of the symptoms of the disease. Patients are often prescribed the following medications: , Tocopherol, . Such drug treatment can only be prescribed by a doctor.
2. Local therapy, with which you can cure tissue and skin damage. For diabetes, ointments containing antiseptics and enzymes are used. These agents heal wounds and provide local anesthesia. Ointments that increase blood circulation are prohibited from being applied to the open surface of a trophic ulcer. Ointments such as have a wound healing effect. The ointment is applied to the compress or special bandages are made.
3. Surgical intervention, which is produced after the ulcers have healed. During it, blood flow in the veins in the affected area is restored. This operation includes bypass surgery and phlebectomy.

The following drugs are used to treat wounds: Eplan. At home, you can use a solution of furatsilin or potassium permanganate.

Surgery

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

There are a few various 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 interfere with the development of bacteria.
2. Catheterization – 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 the separation of venous-arterial fistulas.
4. Virtual amputation. The metatarsal bone and metatarsophalangeal joint are cut off, but the anatomical integrity of the foot is not violated - but foci of bone infection are removed, which makes it possible to effectively combat neurotrophic ulcers.

If the size of the ulcer is less than 10 cm², the wound is closed with its own tissues, tightening the skin by 2-3 mm per day, gradually bringing the edges together and completely closing it in 35–40 days. A scar remains at the site of the wound, which must be protected from any possible injury. If the affected area is more than 10 cm², skin grafting is used using the patient’s healthy skin.

Drug therapy

A course of drug treatment necessarily accompanies any operation. Treatment with medications is divided into several stages, depending on the stage of the pathological process.

At the first stage (wetting ulcer stage), the course of drug therapy includes the following drugs:

1. Broad-spectrum antibiotics;
2. , which include , etc.;
3. Antiplatelet agents for intravenous injection: and;
4. : , etc.

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

1. Washing the wound with antiseptic solutions: potassium permanganate, furatsilin, chlorhexidine, decoctions of celandine, string or chamomile;
2. The use of dressings with medicinal ointments (dioxicol, levomikol, streptolaven, etc.) and carbonet (a special dressing 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 - solcoseryl, actevigin, ebermin, etc., as well as antioxidant drugs, for example, tolcoferon, are used in treatment.

Also at this stage, specially developed wound coverings, Swiderm, Geshispon, Algimaf, Algipor, Allevin, etc., are used. Treatment of the ulcerated surface is carried out with curiosin. At the final stages, drug treatment is aimed at eliminating the underlying disease that provoked the appearance of a trophic ulcer.

How to treat a trophic ulcer on the leg at home

When starting to treat a trophic ulcer using traditional recipes, you must always consult with your doctor.

At home you can use:

1. Hydrogen peroxide. You need to drop peroxide onto the ulcer itself, then sprinkle streptocide on this place. On top you need to put a napkin previously moistened in fifty milliliters of boiled water. Add two teaspoons of peroxide to this water. Then cover the compress with a bag and tie it with a scarf. Change the compress several times a day. Add streptocide when the wound becomes moist.
2. Healing balm in the treatment of trophic ulcers in diabetes mellitus. It contains: 100 g of juniper tar, two egg yolks, 1 tablespoon of rose oil, 1 teaspoon of purified turpentine. All this needs to be mixed. Pour the turpentine 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 Tatar leaves. Wash the wound with a solution of rivanol. Sprinkle with prepared powder. Apply a bandage. The next morning, sprinkle the powder again, but do not wash the wound before. Soon the ulcer will begin to heal.
4. Trophic ulcers can be treated with antiseptics: wash the wounds with warm water and laundry soap, apply an antiseptic and bandage. These dressings are alternated with applications of a solution of sea or table salt (1 tablespoon per 1 liter of water). Fold gauze into 4 layers, soak in saline solution, squeeze lightly and apply to the wound, compress paper on top, hold for 3 hours. Repeat the procedure twice a day. There is a break of 3-4 hours between applications, during which time the ulcers should be kept open. Soon they will begin to decrease in size, the edges will turn pink - this means that the healing process is underway.
5. Garlic poultices or compresses used for open ulcers. Take multi-layer gauze or a terry towel, soak it in hot garlic broth, squeeze out excess liquid and immediately apply to the sore spot. Place a dry flannel bandage and a heating pad or hot water bottle over the poultice or compress to retain heat longer.
6. Need to mix egg whites with honey so that these ingredients are in the same ratio. Whisk everything together and apply to the ulcers, including the veins that hurt. Then cover with the back of the burdock leaves. There should be three layers. Wrap in cellophane film and bandage with 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 correct therapy, complications such as microbial eczema, erysipelas, periostitis, pyoderma, arthrosis of the ankle joint, etc. may develop. Therefore, you should not use only folk remedies, while neglecting traditional treatment.

Ointments for treatment

To treat this disease, you can also use various ointments, both natural and purchased at the pharmacy. Arnica, comfrey, and indoor geranium ointments effectively heal wounds and have an anti-inflammatory effect.

Vishnevsky ointment is also often used. Of the ointments that can be bought at the pharmacy, dioxykol, levomekol, as well as streptolaven and a number of analogues are especially distinguished.

Section description

Trophic ulcers are deep purulent-necrotic skin lesions of the extremities that do not heal for more than 1.5 months. The feet and legs are most often affected. The size of the ulcer varies widely: from 1 cm in diameter to a wound surface that occupies the entire surface of the calf.

This pathology is not an independent nosological form. It develops as a complication of certain diseases, has a persistent course and is often curable only by surgery.

Causes

Ulcers form against the background of tissue hypoxia, caused by disorders of microcirculation, metabolism and tissue innervation. The skin becomes very vulnerable, and even superficial microdamages lead to the formation of a poorly healing deep defect.

Secondary infection and blood stagnation contribute to the accumulation of toxins in the affected area, which accelerates the development of necrosis and the progression of pathology.

What causes trophic ulcers on the legs? These disorders can develop due to the adverse effects of various causes.

There are external factors that can provoke the formation of an ulcer. These include the following skin damage:

• wound (scratches, cuts, bruises);
• frostbite;
• thermal or chemical burns;
• chronic inflammatory and allergic skin diseases (furunculosis, eczema, dermatitis);
• radioactive skin damage;
• bedsores with prolonged immobility of the patient.

The causes of a trophic ulcer on the leg can be complications of the following diseases:

• chronic vascular insufficiency - thrombophlebitis, arterial circulation disorders due to stenotic processes;
• endocrinological pathology - diabetes mellitus, obesity;
• arterial hypertension;
• any etiology;
• autoimmune diseases;
• immunodeficiency conditions, including HIV infection;
• CNS lesions - brain or spinal cord injuries, strokes, degenerative diseases of the nervous system;
• infectious pathology (tuberculosis, syphilis);
• blood diseases;
• poisoning with arsenic, chromium and heavy metals.

Experts often state a combination of external and internal factors that led to the formation of a trophic ulcer.

Symptoms

How does a trophic ulcer begin? A person complains of rapid fatigue when walking, a feeling of heaviness in the legs with minor loads, which persists at rest. There is itching of the skin, a burning sensation, crawling in the area of ​​the foot or lower leg, cramps in the calf muscles, especially at night.

Upon examination, the doctor discovers the following: initial signs trophic ulcer:

• pastosity of the soft tissues of the lower extremities;
• thickening, roughening of the skin of the affected area;
• change in the color of the skin in the affected area - a growing spot of grayish or blue-violet color, reminiscent of a hematoma with a glossy tint;
• increased sensitivity at the site of ulcer formation, sharp pain when you lightly touch it;
• There may be serous-mucous discharge on the skin in the area of ​​the spot.

With minor trauma, overload, or nervous fatigue, the disease progresses quickly. In the center of the spot, an area of ​​atrophy of the epidermis of a whitish color forms, and a bloody discharge appears.

Symptoms of a trophic ulcer at the height of the disease are as follows:

• severe swelling of the leg or foot;
• the presence of an ulcerative lesion, which, if left untreated, tends to quickly increase and deepen;
• bloody purulent discharge with an unpleasant odor;
• excruciating pain in the legs, worsening with exercise and at night, limiting physical activity;
• general condition disorders (fever, chills, fatigue, poor appetite).

Kinds

Ulcers are classified depending on the cause of their formation.

Venous trophic ulcer occurs in 8 out of 10 patients. The cause is stagnation due to impaired venous circulation. A trophic ulcer of the leg most often forms in the lower third on the inner surface of the leg.

Arterial

The background for the development of pathology in 20% of patients is obliterating diseases of the arteries of the lower extremities. Arterial stenosis leads to ischemia and necrosis of the soft tissues of the legs. Provoking moments are most often injuries or hypothermia of the extremities, the use of uncomfortable shoes.

Features of this type of trophic ulcers: most often occurs in old age, a person experiences difficulty walking up stairs and a feeling of coldness in the leg.

On examination, the leg is cold. Most often, small ulcers with symptoms of suppuration are found in the heel, big toe and on the outer surface of the foot. They have an oval shape, dense edges, and the skin around them acquires a yellow tint.

Diabetic

Trophic foot ulcer is a common complication of diabetes mellitus. Typical localization is the big toe or injured corns in the sole area. Develops in diabetic angiopathy against the background of sharp fluctuations in blood glucose levels.

Characteristic signs: decreased sensitivity in the legs, extinction of tendon reflexes, rapid increase in size of the defect, tendency to develop necrosis, resistance to therapy.

Neurotrophic

When the central nervous system is affected, the ulcers are located in the heels and soles.

Features of neurotrophic ulcers: small size and significant depth of wounds (down to the bone), abundant purulent discharge with an unpleasant odor in the absence of pain.

Hypertensive

They are rare, usually in elderly women against the background of long-term arterial hypertension.

They are characterized by slow formation, and on both legs at once, severe pain syndrome, and a high frequency of purulent complications.

Infectious

They form on the legs with advanced skin diseases against the background of unsanitary conditions and the accumulation of secondary purulent infection. Peculiarities: semicircular shape, small size and depth.

Which doctor treats trophic ulcers?

Trophic ulcers with varicose veins are treated by phlebologists and vascular surgeons. Patients with ulcerative skin defects of any etiology are subject to mandatory hospitalization, since effective treatment of trophic ulcers is possible only in an inpatient setting. Complex therapy and dynamic observation are required.

It is permissible to treat a trophic ulcer at home only at the earliest stage.

Diagnostics

Trophic ulcer on the leg is accompanied by specific complaints and has characteristic appearance upon inspection. The main task of specialists is to find out the cause of the disease. Only by establishing the etiology of the ulcerative lesion can adequate therapy be prescribed.

The following diagnostic measures are carried out:

1. A thorough history taking and examination by a therapist, phlebologist, angiosurgeon.
2. Laboratory methods: general blood and urine tests, including determination of glucose levels, biochemical blood test, immunogram, bacteriological analysis of ulcer discharge and biopsy of biomaterials taken.
3. Instrumental methods: rheovasography, angiography with the introduction of contrast agents, ultrasound of the vessels of the lower extremities (Dopplerography, duplex study).

Treatment

The main directions of therapy are the impact on the underlying disease, the fight against secondary infection, and the stimulation of healing of the ulcerative surface.

Treatment of trophic ulcers depends on the following factors:

• the cause of the appearance and duration of existence of the skin lesion;
• patient’s age and presence of concomitant diseases;
• size and depth of the skin defect, growth rate;
• condition of the skin around the ulcer.

How to cure a trophic ulcer? Therapy is extremely complex, complex and lengthy. It is more often regarded as preparation for surgery, since conservative methods are not very effective.

If surgery is contraindicated for a patient for some reason, the goal of therapy is to prevent the skin defect from enlarging and deepening.

In a hospital, a patient with a trophic ulcer is provided with bed rest; the affected limb should be in an elevated position to improve blood and lymph circulation.

Conservative

A universal cure for trophic ulcers, equally effective for all types of disease, has not been developed. Treatment of trophic ulcers on the leg includes taking drugs of various pharmacological groups.

How to treat trophic ulcers with varicose veins? Specialists prescribe complex therapy, the purpose of which is to stop inflammation and tissue necrosis and stimulate healing processes.

Medicines from the following groups are used:

1. Vasoactive drugs , including phlebotonics (Troxevasin, Detralex) and antiplatelet agents (Thrombo-ass). Helps dilate blood vessels, improve microcirculation, strengthen vein walls and reduce venous stagnation.
2. Infusion therapy - solutions of hemodez, rheopolyglucin for symptoms of intoxication.
3. Decongestants . Used according to strict indications, periodically, under the supervision of a physician. When taking them, the content of electrolytes in the blood is monitored.
4. Antibiotics - with an infectious etiology of the ulcer or the accumulation of a secondary infection. Prescribed after isolating a pathogenic agent from ulcer secretions and determining its sensitivity to antibiotics of various groups.
5. Anti-inflammatory drugs - in the presence of purulent discharge, inflammatory reaction surrounding tissues and severe pain.
6. Hyposensitizing drugs reduce secretion of the ulcer surface.

The same drugs in different combinations are used in the treatment of trophic ulcers of any etiology.

During the regeneration period, antioxidant, metabolic and immunostimulating therapy is prescribed - injections of Mexidol, Actovegin, ascorbic acid, B vitamins.

Physiotherapy is used to heal trophic ulcers. UHF is used to enhance the anti-inflammatory effects of drugs, electrophoresis with solutions of wound-healing, anti-inflammatory and vascular drugs. Laser treatment is used to reduce pain and inflammation.

During the regeneration period and postoperative period Ultraviolet irradiation, ozone therapy, mud therapy, hyperbaric oxygenation, and plasmapheresis are recommended.

Treatment of trophic ulcers of the lower extremities complements proper nutrition. To avoid increasing swelling in the legs, a person should eat more vegetables and fruits, control the amount of fluid consumed, and exclude salty, spicy, pickled foods. With diabetes, patients eat in accordance with the recommendations of the endocrinologist and regularly monitor blood glucose levels.

Local therapy

To cleanse the wound of pus and dead tissue, it is treated with disinfectants.

The following antiseptics are used:

• aqueous solution of chlorhexidine;
• 3% boric acid solution;
• potassium permanganate solution of a certain concentration;
• Rivanol;
• enzymes.

How to treat trophic ulcers on the legs after cleansing them of pus? For healing and accelerated scarring of skin defects, medicinal ointments are used: Solcoseryl, Ebermin, Actovegin. It is effective to use special dressings and sponges with antibacterial, antisecretory and wound-healing effects (Allevin, Algipor, Geshispon).

It is mandatory to use an elastic bandage, which is replaced as necessary several times a day. It not only protects the affected area from secondary infection and injury, but also helps reduce swelling.

Surgical intervention

A trophic ulcer on the leg can be completely cured through surgery. In order for the operation to be successful, it is necessary to competently prepare the patient for the upcoming intervention, achieve improved well-being, stabilize the general condition and begin healing of the wound surface.

The following methods have been developed in angiosurgery:

• bypass surgery for vascular diseases;
• removal of a section of vein with varicose nodes ().

If there is a large and deep ulcer, a skin flap is transplanted.

Traditional methods

The question of the possibility of outpatient treatment of trophic ulcers is decided only by the treating specialist. With a short duration of the disease, small single ulcers that are at the stage of regeneration, the patient can use folk recipes as a supplement to the main therapy.

How to treat a trophic ulcer at home? Clean the wound surface from any remaining pus, as it slows down healing. For this purpose, decoctions of chamomile, celandine, string, and calendula are used.

After washing the ulcer, with the permission of the doctor, apply pharmaceutical ointments that help relieve inflammation and healing, including Vishnevsky ointment and ichthyol ointment.

You can treat the ulcerative defect with golden mustache juice, make a bandage with an ointment prepared on the basis of propolis, comfrey, and arnica. Apply compresses with powdered leaves of tartar, golden mustache, willow or oak bark, which can be left overnight.

You cannot rely only on traditional medicine; refusal of comprehensive hospital treatment can lead to life-threatening consequences.

Complications

In advanced cases and in the absence of active treatment, a number of dangerous complications appear:

• layering of secondary infection, possibly erysipelas;
• skin diseases (eczema);
• damage to the osteoarticular system (arthritis, periostitis, contractures);
• vascular disorders ();
• skin neoplasms (in extremely advanced cases).

How dangerous is the disease?

Ulcers are dangerous due to rapid progression in severe cases of the underlying disease. At the same time, they not only increase in size, but also become numerous and can merge into a large wound surface.

This pathology is also distinguished by the following features:

• tendency to relapsing course;
• resistance to all methods of therapy, except surgical treatment, which may have contraindications;
• the possibility of developing sepsis - with ulcers of venous origin, gangrene - with diabetic ulcers, osteomyelitis.

Prevention

The main rule is to consult a doctor in a timely manner if health problems arise. After surgery, to avoid relapses, it is important to adhere to the following recommendations:

• annual Spa treatment in sanatoriums of the corresponding profile;
• healthy lifestyle, balanced diet and body weight control;
• exclusion of prolonged static loads, hypothermia of the legs;
• regular use of an elastic bandage, especially when walking;
• constant monitoring of blood glucose levels in diabetes mellitus;
• using comfortable shoes, crutches and walking sticks to reduce the load on the feet;
• a course of taking vitamin and mineral complexes recommended by a doctor to strengthen the immune system, antithrombotic agents.

Ulcers form as severe complications of advanced diseases. They progress steadily, are resistant to therapy and often recur. Only some varieties in the initial stages of development can be treated with therapeutic methods. It is impossible to cure at home without resorting to medical help.

The prognosis depends on timely treatment, careful implementation of medical recommendations and treatment of the underlying disease against which the ulcer appeared.

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