Purulent trophic ulcers on the legs treatment. Modern methods of symptomatology, prevention and treatment of trophic ulcers on the legs. Treatment of the legs after the treatment of a trophic ulcer

A trophic ulcer on the legs is an open type wound, located on the skin, formed against the background of tissue rejection. Trophic ulcers are prone to long-term existence, do not heal for 6 weeks or more. The pathological process involves not only the skin epithelium, but also the tissues located under 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 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 vascular bed. Ulcers never occur spontaneously, they are preceded by a rather long process of various disorders in the body. The identification and treatment of trophic ulcers is carried out by such a branch of medicine as phlebology.

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

The formation of trophic ulcers in the first place leads to a disease such as varicose veins. Varicose veins contribute to the deterioration of the outflow of blood, leading to its stagnation. As a result, fresh blood, rich in nutrients, is unable to carry them to the tissues of the lower extremities. The result of such starvation is the gradual destruction of cells. Initially, a superficial wound is formed, which gradually transforms into an ulcer.

Venous thrombosis is another common cause of trophic ulcers. They appear according to the same mechanisms as in varicose veins, only the result of stagnation of blood 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, are able to completely block the artery. As a result of malnutrition, pathological processes begin to develop in the tissues, which lead to the formation of ulcers.

Martorella syndrome, which develops against the background of already existing hypertension, can lead to the formation of shunts inside the veins and arteries. It also causes circulatory disorders 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, collagenoses, blood diseases, metabolic disorders, can become a trigger for this pathology.

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

The etiological factor is Lyell's toxic epidermal necrolysis.

Any diseases of the cardiovascular system can provoke the development of trophic ulcers. They occur as a result of pronounced edema of the lower extremities against the background of 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 may be the result of malignancy of various skin formations, may occur with radiation injuries.

The provoking factors are burns and frostbite of the lower extremities.

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

The share of ulcers resulting from vein thrombosis accounts 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. At the same time, 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 violation of the absorption of glucose. The walls of the vessels become rigid, diabetic neuropathy and diabetic angiopathy are formed. In the affected areas, blood circulation becomes difficult, and the 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 they have increased swelling of the legs. There is a feeling of heaviness in the area of calves and shins.

At night, convulsions may appear, which tend to become more frequent. In parallel, there is a burning sensation and itching 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 lacquer sheen, and when touched, it responds with painful sensations.

Lymphostasis is growing, it can lead to the fact that lymph seeps through the skin to the outside and appears on its surface in the form of dew drops.

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

Over time, the ulcer begins to deepen, becoming larger in diameter. If several ulcers occur, they can merge, forming extensive lesions.

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

It is possible to involve the calf muscles, the Achilles tendon, the frontal surface of the tibia in the process. If the process has spread to the bone tissue, this can provoke the development of osteomyelitis.

The contents of a different nature are released from the ulcer. Initially, it is hemorrhagic, then becomes cloudy, may contain fibrin threads or pus. An unpleasant odor emanates from the wound. Often, microbial eczema forms around a trophic ulcer.

There is a risk of secondary infection, which can be triggered by opportunistic bacteria against the background of a decrease in local and general immunity. In the elderly, trophic ulcers are often complicated by mycotic infection. This greatly 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, there is a loss of sensation in the lower extremities. This is due to the death of nerve endings.

At night, a person begins to experience pain.

The place of localization of a diabetic ulcer is the big toes of the foot, or the tops of the phalanges of the fingers. On the sole, it can form in the place where the corns are located - this is the surface of the foot or 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 limb amputation.

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

For the initial stage of development of an atherosclerotic trophic ulcer, intermittent claudication is characteristic. The sensitivity of the diseased limb is disturbed, it gets tired faster, often freezes.

The place of localization of ulcers is the outer side of the foot, the phalanx of the big toe, the heel zone.

Ulcers are small, semicircular in shape.

The edges of the ulcer are denser, torn. The dermis surrounding the edges of the ulcer has a yellowish tinge.

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

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

A characteristic feature of ulcers in Martorell's 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 distinguishing feature of hypertensive ulcers is the symmetry of their occurrence. That is, they occur on both limbs, most often in the central part of the lower leg.

Ulceration progresses slowly and is particularly painful. There is an increased risk of bacterial infection.

In the process of the development of the disease, four main stages of a trophic ulcer are distinguished, among which:

The stage of exudation (the beginning of inflammation, the appearance of necrotic foci).

Stage of repair (cleansing the surface of the ulcer from necrotic contents, the formation of granules, reducing inflammation).

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

The 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 typical for the initial stage of inflammation, the stage of repair, epithelialization and scarring are all ulcers, with an uncomplicated course of the disease.

The initial stage of a trophic ulcer

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

The initial stage of a diabetic ulcer is characterized by the fact that the limb loses its former sensitivity, this is due to 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, abundant discharge with an unpleasant putrefactive odor. If treatment at the initial stage of ulcer development is not carried out, then this threatens the development of complications.

Complications and consequences of trophic ulcers

The prolonged existence of a defect can cause conditions that are unfavorable to human health, which can lead to hospitalization.

Complications and consequences of trophic ulcers can 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 the 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. It is necessary to treat the ulcer with the help of special antibacterial, antiseptic and drying agents.

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

A phlebologist will tell the patient how and how to treat a trophic ulcer. The specialist and the patient face a whole range of tasks. First, it is necessary to minimize the manifestations of the underlying disease, which led to the formation of an ulcer. That is, it is necessary to carry out therapy for varicose veins, lower blood pressure, treat diabetes. Secondly, it is necessary to carry out measures aimed at healing the trophic ulcer itself.

General conservative therapy is reduced to the use of the following means:

Treatment of the underlying disease with the use of phlebotonics, antiplatelet agents, antiplatelet agents. These can be drugs such as: Pentoxifylline, Heparin, Acetylsalicylic acid, Prostaglandins. They allow you to adjust the processes of blood clotting, contribute to the normalization of blood circulation, and prevent venous stasis. 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. Effective wound treatment with Levomethicin, Hexicon, Fuzidin, Miramistin. It is possible to use preparations in the form of ointments or sprays for local treatment of the wound. If necessary, antimycotics are prescribed: Fluconazole, Caspofungin, Voriconazole, etc.

To speed up the regeneration processes, drugs are prescribed that affect metabolic processes in tissues. It can be Actovegin, Ebermin, Sulfargin.

Painkillers are prescribed to relieve pain.

The toilet of a trophic ulcer should be regular. To begin with, the wound is washed with sterile saline, dead tissue and exudate are removed from it. After the sanitation, an antibacterial agent is applied and the ulcer is covered with a bandage. If it is at the healing stage, then the dressing should provide normal hydration and breathing of the wound surface. In the case where there is infection, a dressing should be chosen that can absorb secretions and provide an antiseptic effect. For this, special napkins are used.

It is possible to undergo physiotherapy procedures that help accelerate the healing of the ulcer. The following methods are effective: ultrasonic cavitation of the wound, UV irradiation, hyperbaric oxygen therapy, laser therapy, magnetotherapy.

When the ulcer heals and the patient feels well, surgery may be performed. It will be aimed at normalizing venous and arterial outflow, at removing veins that have undergone varicose expansion.

Pain reliever for trophic ulcers

Pain in trophic ulcers have different intensity. Therefore, with severe pain, painkillers are prescribed.

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

Parmidin. Available in the form of tablets and ointments. Promotes the removal of edema, reduces pain.

Acetylsalicylic acid and preparations based on it: Aspirin, Cefecon.

Preparations from the group of NSAIDs: Ibuprofen, Ambene, Ketorolac, Naproxen.

It is possible to use ointments Emla, Dimexide.

Balm Vinilin and Romazulan have a weak analgesic effect.

Napkins for the treatment of trophic ulcers

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

You can use the following wipes:

Activetex. They are made of knitwear, impregnated with medicines. So, Activtex F has furagin as the main active ingredient, Activtex X has chlorhexidine, Activtex HF combines chlorhexidine and furagin.

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

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

Treatment of trophic ulcers should 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 the recurrence of the disease.

Sores on the legs can be the result of a congenital or acquired disease. This is a very unpleasant phenomenon, which is quite difficult to deal with. For example, according to official statistics, at least 2 million people suffer from trophic ulcers. The cause can be either a weakened immune system or a complication caused by diabetes mellitus.

About common symptoms of trophic ulcer

Sores on the legs, which are a trophic ulcer, are quite difficult to recognize at an early stage. For example, if a person spends all day on his feet, then he takes the fatigue of the lower extremities and pulling pain as the norm. Noticed redness, a small area of white skin or swelling - for an insect bite or an allergy. At the same time, the main part of the population begins to think: how to smear the sores on the legs in order to eliminate the aesthetic defect? Zelenka, alcohol, ointment and much more are used, which only aggravates the disease.

As soon as the process of development of a trophic ulcer began, an urgent need to go to an appointment with a phlebologist. These are the following symptoms:

heaviness and buzzing in the legs;
weakness, growing in the evening;
unpleasant itching, causing a slightly noticeable inflammation of the skin;
swelling that appears after prolonged sitting, drinking plenty of fluids or long walks;
convulsions of the calf muscle that occur at a time when complete relaxation occurs (deep night or morning).

Sores on the legs with diabetes

Patients with diabetes eventually begin to notice sores on their legs - the skin is rough and flakes noticeably. The hair becomes dull, the palms and soles become covered with cracks and calluses, and the skin becomes yellowish. Nails can also become deformed and thickened.

Many types of sores on the legs, as well as dermatological disorders, indicate the presence of diabetes even before the doctor makes a diagnosis.

Skin lesions can be avoided through strict adherence to the rules of hygienic care. The use of conventional cosmetics should be kept to a minimum, as, for example, exposure to toilet soap can lead to a decrease in the acidity of the skin and its ability to resist microbes. For washing hands and feet, as well as for washing, it is necessary to use a pH-neutral soap. To cleanse the face, you can use cosmetic milk or water lotion.

Types of ulcers

Many people suffer from leg ulcers. This disease looks like a deep defect in the skin or basement membrane and inevitably causes inflammation. The cause of an ulcer is a malnutrition of the cells, which, in turn, impairs the ability to recover.

Ulcers are:

arterial;
venous;
pyogenic;
diabetic;
neurotrophic.

An open sore on the leg for a long period of time (2 months or more).

The main causes of leg ulcers

Ulcers can be caused by arterial insufficiency, diabetes, and other factors.

As for diseases, the appearance of ulcers can be caused by varicose veins, thrombosis, incompetence of perforating veins. These diseases lead to stagnation of blood in the veins, malnutrition of tissues and their destruction.

Arterial insufficiency can lead to the appearance of ulcers due to Menckeberg's arteriosclerosis. In addition, the cause of the development of trophic ulcers may be hidden:

1. In various infections:

fungal (coccidioidomycosis, sporotrichosis, etc.);
bacterial (ecthyma, boils, etc.);
protozoan (leishmaniasis).

2. In metabolic disorders:

Gaucher disease;
skin calcification;
gout;
diabetes mellitus;
bullous pemphigoid, etc.

Leukemia, sarcoma, melanoma, metastases and any other malignant neoplasm can provoke the appearance of an ulcer.

Sores on the legs can also be the result of common calluses, burns, insect bites, frostbite, radiation dermatitis and other factors.

How to recognize an ulcer on the leg?

The process of the occurrence of an ulcer is difficult not to notice, since the symptoms are quite obvious. It all starts with the appearance of burning, itching and redness, as well as a slight coarsening to the touch.

Got spots on your legs? There is no need to wait for skin peeling and the appearance of long-term non-healing wounds, it is better to immediately consult a doctor, because if you leave the disease unattended and run, it can “hook” the muscles and even the periosteum.

Prevention of the appearance of a trophic ulcer

A person suffering from varicose veins or another condition that increases the likelihood of leg ulcers should adhere to the following guidelines:

wearing compression stockings and elastic bandage;
minimizing prolonged stress and physical inactivity;
avoid overheating and hypothermia.

Venous ulcers on the legs

The following symptoms indicate that the leg was struck by a venous ulcer:

puffiness;
dryness, itching, thickening, and sometimes a brownish color (if there is severe swelling, the skin looks stretched and shiny);
with the development of varicose eczema, scalyness and small cracks are observed;
the inflammatory process of the ulcer may be accompanied by an unpleasant odor and the release of a pale yellowish-greenish liquid.

The location of a venous ulcer is usually on the inside of the leg just above the ankle.

Factors provoking venous ulcer

A venous ulcer can be aggravated or provoked by the following:

a healed ulcer that damaged the venous system;
fracture or any other injury;
thrombus in a deep vein;
surgical intervention;
working conditions in which a person sits or stands for a long period of time;
inflammation of deep veins;
pregnancy;
overweight.

How to cure leg ulcers?

How to treat sores on the legs? It all depends on the factors that caused the ulcer or prevented its healing. Once each of these is brought under control, such as blood sugar levels, the skin lesion will go away on its own.

Treatment usually includes cleaning the wound, using anti-inflammatory drugs, and using dressings. If you have healthy arteries, you can also use pressure bandages.

A positive effect can be achieved through vascular surgery. The implantation of a new leg artery, or balloon angioplasty, is a procedure that expands a narrowed artery and eliminates its blockage.

Sometimes, in order to hide the ulcer, they resort to plastic surgery - they transplant the skin from some inconspicuous area to the surface of the wound.

home treatment

The main rules for the treatment of trophic ulcers include:

Special diet: carbohydrates should be reduced, vegetables and fruits should be significantly increased, and spices and spicy foods should be completely eliminated.
Bed rest. Of course, it’s not worth lying in bed all the time, but rest should be daily.
Special exercises of a regular nature aimed at eliminating blood stasis and improving metabolism: flexion and extension of the legs in the prone position, rotation of the feet, crossing the legs extended upwards, etc.
Wearing special orthopedic shoes that reduce the risk of injury.

Several recipes for the treatment of trophic ulcers:

The Tatar has proven himself quite well. Dry leaves must be ground to a state of dust, and then sifted, put in a jar and placed in a dark place. After treating the wound with some kind of pharmaceutical agent (for example, "Rivanol"), you need to blow the powder on it and fix it with a bandage. The result - the ulcer dries up, and the resulting crust disappears over time.
Means on the basis of curd whey. From homemade milk, you must first make curdled milk, then pour the resulting product into gauze and hang it up. Serum is recommended to be used to lubricate the sore, and cottage cheese - to apply to the affected area.
Streptomycin. A few crushed tablets can not only relieve pain, but also quickly heal the wound.

What is swelling of the lower extremities?

Edema in the legs is a pathological process that causes the accumulation of various volumes of fluid in the intercellular space. Outwardly, this phenomenon looks like swelling.

At the same time, a person begins to feel heaviness in the legs or even pain. As a result of pressure, a fossa is usually observed. The occurrence of puffiness is usually accompanied by the following points:

increased permeability of the walls of blood vessels;
violation of the lymphatic and venous outflow of fluid, which leads to increased pressure in these vessels;
the chemical composition of blood plasma and tissue fluid does not correspond to the norm.

Causes of edema

Edema in the legs may appear due to hemodynamic disturbances in the zone of osmotic regulation. The location of these zones is the atrium, therefore, the result of their reaction to such a failure is a significant decrease in blood flow in the extremities. Further, a reaction of the sympathetic nervous system is observed, leading to an increase in the level of catecholamines in the blood, which reduces the excretion of fluid from the body and leads to a narrowing of the peripheral vessels.

The role of the endocrine system in the process of regulating the amount of fluid in the body cannot be ignored. If the hypothalamus begins to produce, then this inevitably leads to an increase in the total volume of blood circulating through the vessels. Such a change can lead to an increase in pressure, including hydrostatic pressure, which greatly complicates the evacuation of excess fluid from the tissues. In addition, the presence of a large volume of blood stretches the vascular walls, which leads to an increase in permeability and the entry of protein molecules from the blood must into the tissues. The result is venous stasis, which causes spasm of the vessels of the lymphatic system, which further complicates the outflow of fluid from the tissues.

Causes of skin rashes

The spot on the leg itches - what to do? First you need to find out the reason for its appearance: to determine what kind of disease caused it. The primary action is to contact a qualified specialist who will find out exactly why the skin has changed color and select the necessary treatment.

A hormonal failure, a disease of an internal organ, or a manifestation of an allergy are the main causes of a skin rash. Every person periodically encounters the appearance of red spots, but if they are present on the body from birth, then you should immediately seek help from a vascular surgeon and phlebologist.

You can get rid of it by reviewing your own diet. The exclusion of spicy, smoked and fried foods can significantly refresh the skin color and improve its condition. A dry sore on the leg will pass much faster if you do not comb it.

A bright pink rash can be triggered by a lack of vitamins. In this situation, it is recommended: drinking plenty of water, proper nutrition (more fresh fruits and vegetables) and bed rest.

Anything can be the cause of discomfort, from an allergic reaction to the use of a depilatory cream or cosmetic product to uncomfortable shoes.

Sores on the legs do not go away? An injured part of the body will heal much faster if it is carefully treated immediately after the injury has been received. Particularly severe cases require qualified assistance from medical professionals who will suture if necessary and help the victim with valuable advice and useful recommendations.

If there is no qualified specialist nearby, then it is recommended to use any antiseptics that are at hand to treat the damaged area of the body: brilliant green, iodine, hydrogen peroxide, etc. After treatment, the wound should be covered with a temporary sterile bandage. It is necessary to bandage the damaged areas at least 2 times a day and remember that different means must be used to treat wet and dry wounds.

In the world, more than two million people suffer from the appearance of trophic ulcers on the legs (shins and feet). This is a disease characterized by a deep defect in the skin epithelium or basement membrane, accompanied by an inflammatory process. It leads to tissue loss, and scars remain on the skin after the ulcer has healed. Treatment of trophic ulcers on the legs, despite the development of medicine, remains one of the most difficult. This is due to a violation of the nutritional process of cells - trophism (hence the name of the disease). At the same time, the protective functions of the body are reduced, and the regenerative ability is partially lost.

Types of trophic ulcers and their specificity

All types of trophic ulcers are the result of diseases associated with impaired blood flow in the legs, leading to malnutrition of epithelial cells and their gradual death. From what served as the root cause of this disease, there are several types of expressions:

Venous ulcers;
Arterial ulcers (atherosclerotic);
Diabetic ulcers (against the background);
Neurotrophic associated with traumatic brain injury or spinal injury;
Martorella ulcers or hypertensive;
Pyogenic (infectious).

Arterial (atherosclerotic) ulcers

Ulcerations of this type occur with the progression of ischemia of the soft tissues of the lower leg, which is a consequence of which affects the main arteries. The appearance of this type of ulcer is most often provoked by hypothermia of the legs; using tight shoes; as well as damage to the integrity of the skin. A trophic ulcer of this type is localized on the sole and outer side of the foot, the big toe (its final phalanx), in the heel area. These are wounds of small size, semicircular, with torn, compacted edges, filled with purulent contents. The area of skin around them is pale yellow. Atherosclerotic ulcers most often affect the elderly. Their appearance is preceded by a small one, in which it is difficult for the patient to climb the stairs. He is constantly cold and tired quickly. The leg almost always remains cold and hurts at night. If treatment is not started at this stage, ulcers appear, gradually growing over the entire surface of the foot.

Venous ulcers

This type of trophic ulcers is formed mainly on the lower leg, in the lower part of its inner surface. On the back and outer sides are extremely rare. They occur when the venous blood flow of the lower extremities is disturbed, including as a complication. Ulcers are preceded by the following symptoms:

The calf swells, a feeling of heaviness appears;
At night, convulsions are noted;
The skin of the lower leg begins, a mesh appears on it with markedly enlarged veins;
Gradually, the veins merge into spots of a purple hue, turning into a purple color, spreading over larger areas;
As the disease progresses, the skin thickens, acquires a specific luster and smoothness.

At the end of the initial stage, whitish clamps appear, resembling paraffin flakes. If at this stage the treatment was not started, then after a few days a small ulcer will form, the development of which will progress. At first, it affects only the skin, then the Achilles tendon, the gastrocnemius muscle (in the back), the periosteum of the tibia. At the same time, pus is released from the ulcer, which has an unpleasant odor.
If the treatment of a trophic ulcer of the lower leg of venous origin is chosen incorrectly or started late, serious diseases may develop, such as inguinal, purulent. Often it leads to an irreversible increase in the lymphatic vessels and elephantiasis of the lower leg. There have been cases where late treatment has been the cause of death.

diabetic ulcer

Diabetes mellitus is a disease that gives many different complications, one of them is a diabetic trophic ulcer. Its development begins with a loss of sensation in the lower extremities associated with the death of individual nerve endings. This is felt when running a hand over the leg (it remains cold to the touch). There are night pains. The symptoms are similar to an ulcer of arterial origin. But there is a significant difference - there is no intermittent claudication syndrome. The location of the ulcer is most often on the thumbs. Often, the causes of its appearance are injury to the corns on the sole. Another difference from an arterial ulcer is a deeper, larger wound. A diabetic ulcer is very dangerous because it is more likely than other forms to undergo various infections, leading to amputation of the leg. One of the common causes of diabetic ulcers is neglected.

Ulcers, neurotrophic

The causes of this type of trophic ulcer are head or spine injuries. The area affected by them is the lateral surface of the heel or part of the sole from the side of the calcaneal tubercle. Ulcers - in the form of a deep crater, the bottom of which is a bone, tendon or muscle. At the same time, their external dimensions are insignificant. Pus accumulates in them. An unpleasant odor emanates from the wound. The tissue in the area of the ulcer hole loses sensitivity.

Hypertensive ulcers (Martorella)

This type of ulcer is considered rare. It is formed against the background of a constant, which causes hyalinosis of the walls of small vessels and persists for a long time. More often occurs in the female part of the population of the older age group (after 40 years). The onset of the disease is characterized by the appearance of a papule or an area of red-bluish color, with slight soreness. With the development of the disease, they turn into manifestations. A distinctive feature of the hypertonic form is the symmetry of the lesion. Ulcers occur immediately on both legs, localized in the middle part of the outer surface. Unlike all other forms, they develop very slowly. At the same time, they are accompanied by excruciating pains that do not subside day or night. They have a high chance of bacterial contamination.

Pyogenic ulcers

The cause of pyogenic ulcers is a decrease in immunity caused by furunculosis, folliculitis, purulent eczema, etc. This disease is typical for people with low social culture. Most often, their appearance is associated with non-compliance with hygiene rules. Pyogenic ulcers are located singly or in groups on the lower leg, over its entire surface. Usually they have an oval shape, small depth.

Video: questions to the phlebologist about trophic ulcers

Treatment of ulcers

Treatment of trophic ulcers of the lower extremities is strictly individual for each individual patient. This is due to the variety of reasons that cause their appearance. Therefore, it is important to correctly diagnose the type of ulcer. For this, cytological, histological, bacteriological and other types of research are carried out. Methods of instrumental diagnostics are also used. After an accurate diagnosis has been established, treatment begins. A trophic ulcer can be treated with both surgical and medical methods. The complex of therapeutic measures also includes local treatment aimed at cleansing the wound from purulent contents and necrotic tissues, treating with antiseptic solutions and applying ointments that contribute to scarring of wounds and restoration of the epithelium. Physiotherapeutic procedures and traditional medicine are of great importance in recovery.

Surgical methods

Surgical methods are surgical intervention, during which the excision of dead tissues and the removal of the focus of inflammation are performed. These include:

Curettage and evacuation;
VAC therapy (vacuum therapy) – treatment with low negative pressure (-125 mm Hg) using polyurethane sponge dressings. This method allows you to quickly and effectively remove purulent exudate from the wound and helps to reduce swelling around the ulcer, its depth and external dimensions; enhances blood microcirculation in the soft tissues of the lower extremities and activates the formation of new granulation. This reduces the likelihood of complications. Vacuum therapy creates a moist environment inside the wound, which is an insurmountable barrier to bacteria and viral infection.
Catherization method for the treatment of long-term non-healing venous, hypertensive and other trophic ulcers.
In the treatment of neurotrophic ulcers, the technique of "virtual amputation" is widely used. Its essence lies in the resection of the metatarsophalangeal joint and metatarsal bone, without violating the anatomical integrity of the foot. At the same time, problems with excessive pressure and foci of bone infection are eliminated.
In the treatment of Martorell's syndrome (hypertensive ulcer), the technique of percutaneous stitching of veno-arterial fistulas is used to separate them. The operation is performed along the edges of the ulcer.

Medical therapy

A course of drug treatment necessarily accompanies any surgical operation. It can also be carried out as an independent therapy for some forms of trophic ulcers, moderate and mild development. Treatment with medicines is divided into several stages, depending on the stage of the course of the disease. At the first stage (the stage of a weeping ulcer), the course of drug therapy includes the following drugs:

Antibiotics with a wide range of applications;
Anti-inflammatory drugs (non-steroidal), which include ketoprofen, diclofenac, etc.;
for intravenous injections: pentoxifylline and reopoglyukin;
Antiallergic drugs: tavegil, suprastin, etc.

Local treatment at this stage is aimed at cleansing the ulcer from dead epithelium and pathogenic bacteria. It includes:

Washing the wound with solutions of antiseptics: potassium permanganate, furacilin, chlorhexidine, decoctions of celandine, string or chamomile;
The imposition of bandages with therapeutic ointments (dioksikol, levomikol, streptolaven, etc.) and carbonet (a special bandage for sorption).

Also, according to the situation, blood purification (hemosorption) can be carried out. At the second stage, which is characterized by the initial phase of healing and scar formation, healing ointments for trophic ulcers are used in the treatment - Solcoseryl, Actevigin, Ebermin, etc., as well as antioxidant drugs, for example, tolkoferon. The nature of local treatment is also changing. At this stage, special wound dressings are used: sviderm, geshispon, algimaf, algipore, allevin, etc. Treatment of the ulcerated surface is carried out with curiosin. At subsequent stages, drug treatment is aimed at eliminating the underlying disease, which is the cause of the trophic ulcer.

Compression bandages in the treatment of trophic ulcers

At all stages of treatment, elastic compression must be performed. Most often, this is a bandage of several layers of elastic bandages of limited extensibility, which must be changed daily. This type of compression is used for open ulcers of venous origin. Compression significantly reduces swelling and vein diameter, improves blood circulation in the lower extremities and the functioning of the lymphatic drainage system. One of the progressive compression systems for the treatment of venous trophic ulcers is Saphena Med UCV. It uses a pair of elastic stockings instead of bandages. For the treatment of ulcers in varicose veins, permanent elastic compression is recommended using Sigvaris or Medi, compression class II or III. For intermittent compression in pyogenic, congestive and other types, you can use special compression bandages called "Unna boot" on a zinc-gelatin basis or "Air Cast boot".

Physiotherapy procedures

To increase the effectiveness of medical procedures, one of the physiotherapeutic (hardware) procedures is prescribed at the healing stage.

Treatment with local negative pressure in the Kravchenko pressure chamber. Recommended for atherosclerotic (arterial) ulcers.
Low frequency ultrasonic cavitation. Helps to enhance the effect of antiseptics and antibiotics on viral microorganisms that live inside the ulcer.
laser therapy. It is used to relieve excruciating pain, eliminate the inflammatory process, simulate the regeneration of epidermal cells at the biological level.
magnetic therapy. It is recommended as a sedative, decongestant, analgesic and vasodilator.
Ultraviolet irradiation is prescribed to increase the body's resistance to various infections.
Therapy with ozone and nitrogen (NO-therapy) - helps to increase the absorption of oxygen by the cells of the skin and activates the growth of connective tissue.
For a complete recovery, balneotherapy and mud therapy are recommended.

Treatment of complex forms of trophic ulcers

Sometimes the ulcer is localized on too large areas and therapeutic therapy does not give positive results. The wound remains open, causing constant pain to the patient. Most often this occurs with venous insufficiency in a pronounced form. In these cases, skin grafting is recommended for trophic ulcers. It is taken from the buttocks or thighs. The transplanted areas of the skin, taking root, become a kind of stimulator for the restoration of the skin epithelium around the wound.

Traditional medicine in the treatment of trophic ulcers

Treatment of trophic ulcers is very difficult. They are very difficult to clean from purulent contents, which prevents wound healing and the start of the recovery process. Significantly increases the effectiveness of drug therapy for trophic ulcers (especially at the stage of healing), treatment with folk remedies. It includes washing the ulcerated hole with infusions and decoctions of medicinal plants, followed by their treatment with prepared homemade ointments. The most effective antiseptic properties are infusions of herbs of celandine, chamomile, calendula and string. They not only eliminate the inflammatory process, but also contribute to the formation of a young epithelium. After washing, you can use one of the following recipes:

Burn a clean wound with alcohol tincture of propolis or ordinary vodka. And then apply Vishnevsky's ointment, which includes birch tar. You can use ichthyol ointment, which has similar properties.
For long-term non-healing ulcers, use cotton pads soaked in tar. They are applied to the wound for 2-3 days, then changed to fresh ones. And so on until complete recovery.

prickly tartar

Of particular difficulty is the treatment of trophic ulcers in diabetes. The following recipes will help with this:

Powder from the dried leaves of the tartar. Rinse the wound with a solution of rivanol. Sprinkle with prepared powder. Put on a bandage. In the morning of the next day, again sprinkle with powder, but do not wash the wound before that. Soon the ulcer will begin to heal.
Similarly, you can use bath discs soaked in Golden Mustache juice. or lay crushed leaves in the wound.
Freshly made cottage cheese. Cottage cheese prepared at home in any way is used. First, the ulcer is washed with whey obtained by squeezing the curd mass. Then a piece of cottage cheese is laid in it (it should be soft). Above - compress paper or parchment, and a bandage bandage.
Propolis ointment based on goose fat. Take 100 g of goose fat and 30 g of crushed propolis. Boil in a water bath for 15 minutes. Lay the ointment in the expressed hole. Cover with compress paper and bandage. Such an ointment can be prepared in butter or interior pork fat.
Fractions of ASD. This drug must be taken orally according to a certain scheme and at the same time used externally to treat the ulcer.
1. For oral administration: dilute 0.5 ml of ASD-2 in half a glass (100 mg) of tea or water. Take 5 days. Then take a three-day break.
2. Outwardly: ASD-3 fraction diluted in vegetable oil (1:20) is used. Treat the wound with hydrogen peroxide before applying. After the appearance of a whitish film on the surface of the wound, stop washing with peroxide.

There are people who believe in the power of magic words. They can use a plot from trophic ulcers. To do this, it is important to perform a certain ritual, which is as follows:

Dial exactly 77 seeds from a bag of poppy seeds. They need to be poured into the palm of your hand and go to any intersection of two roads. Scatter poppy seeds, standing in the wind. At the same time, the following words should be pronounced: “77 evil spirits! You fly everywhere, Collecting tribute from sinful people! And take the ulcers from me, take them away! Throw them into the field empty, in the expanse of that rotten. Let the ulcers remain there, and they will not return to me again. My word is true, sticky to poppy seeds. All that has been said will come true, the dashing disease will be forgotten! AMEN!"

Video: treatment of trophic ulcers with folk remedies

Prevention of trophic ulcer

Even after a complete cure of a trophic ulcer, its relapses are possible. Therefore, it is important to follow all the recommendations of the attending physician. Be sure to carry out preventive treatment twice a year. Monitor the condition of blood vessels. Places with healed ulcers should from time to time be lubricated with oil infused with St. John's wort, calendula or chamomile. They have the ability to regenerate tissues. It is necessary to avoid stress on the legs. It is recommended to wear special underwear that creates long-term compression. If possible, use treatment at balneological resorts. Contact the office of physiotherapy exercises so that a set of physical exercises is selected for you, aimed at increasing the elasticity of blood vessels and reducing the risk of new ulcers.

Video: trophic ulcers in the program “About the most important thing”

- this is an open wound on the skin or mucous membrane that has arisen after the rejection of dead tissue and does not heal for 6 or more weeks. The reason for the development of a trophic ulcer is a local violation of blood circulation or tissue innervation. Trophic ulcers develop against the background of various diseases, are characterized by a persistent long course and are difficult to treat. Diagnosis is carried out by ultrasonic methods (UZDG, ultrasound of veins). Recovery directly depends on the course of the underlying disease and the possibility of compensating for the disorders that led to the appearance of the ulcer.

General information

A trophic ulcer is a long-term non-healing defect of the skin and tissues located under it. Varicose trophic ulcers often occur in the lower third of the leg against the background of varicose veins. A cyanotic painful spot appears on the edematous limb, then small sores, which gradually merge into one defect. Bloody or purulent discharge oozes from the ulcer, often with a smell. The course is recurrent, progressive, complete cure of varicose trophic ulcers is possible only when the altered veins are removed.

The development of a trophic ulcer can be caused by chronic venous insufficiency (with varicose veins, post-thrombophlebitic disease), deterioration of arterial circulation (with hypertension, diabetes mellitus, atherosclerosis), impaired lymph outflow (lymphedema), trauma (frostbite, burns), chronic skin diseases (eczema, etc.). A trophic ulcer can develop with chromium or arsenic poisoning, some infectious diseases, systemic diseases (vasculitis), impaired local circulation during prolonged immobility as a result of illness or injury (bedsores). More than 70% of all trophic ulcers of the lower extremities are caused by venous diseases. Clinical phlebology is engaged in the diagnosis and elimination of the causes of the appearance of a trophic ulcer in such cases.

The reasons

Violation of venous blood flow caused by diseases of the venous system leads to the deposition of blood in the lower extremities. Blood stagnates, it accumulates waste products of cells. Tissue nutrition deteriorates. The skin is thickened, soldered to the subcutaneous tissue. Dermatitis develops, weeping or dry eczema.

Due to ischemia, the healing process of wounds and scratches worsens. As a result, the smallest damage to the skin in chronic venous insufficiency can cause the development of a long-term, difficult-to-treat trophic ulcer. Accession of infection aggravates the course of the disease and leads to the development of various complications.

The occurrence of trophic ulcers may be due to any disease of the superficial or deep veins, accompanied by chronic venous insufficiency. When making a diagnosis, the disease that caused the formation of an ulcer is very important, since the tactics of treatment and prognosis largely depend on the nature of the underlying venous pathology.

Symptoms of a trophic ulcer

The development of a trophic ulcer of venous etiology is preceded by the appearance of characteristic signs of a progressive lesion of the venous system. Initially, patients note an increase in edema and a feeling of heaviness in the calf area. Nighttime muscle cramps become more frequent. There is itching, a feeling of heat or burning. Hyperpigmentation intensifies, its zone expands. Accumulating hemosiderin in the skin causes eczema and dermatitis. The skin in the affected area acquires a varnish appearance, thickens, becomes motionless, tense and painful. Lymphostasis develops, leading to lymph extravasation and the formation of small droplets on the skin, resembling dew in appearance.

After some time, a whitish focus of epidermal atrophy appears in the center of the affected area (pre-ulcerative condition - white atrophy). With minimal damage to the skin, which can go unnoticed for the patient, a small ulcerative defect is formed in the area of atrophy. In the initial stage, the trophic ulcer is located superficially, has a moist dark red surface covered with a scab. In the future, 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 around the entire circumference of the lower leg.

The process extends not only in breadth, but also in depth. Penetration of the ulcer into the deep layers of tissues is accompanied by a sharp increase in pain. Ulcerative lesions can capture the calf muscles, Achilles tendon and periosteum of the anterior surface of the tibia. Periostitis, complicated by a secondary infection, can turn into osteomyelitis. When soft tissues are damaged in the ankle joint, arthritis occurs with the subsequent development of contracture.

The nature of the discharge depends on the presence of a secondary infection and the type of infectious agent. In the initial stages, the discharge is hemorrhagic, then cloudy with fibrin threads or purulent with an unpleasant odor. Maceration of the skin around a trophic ulcer often leads to the development of microbial eczema.

Complications

When an ulcer becomes infected, the risk of complications increases. As a rule, secondary infection is caused by opportunistic pathogenic bacteria. In elderly debilitated patients, the addition of a fungal infection is possible, which aggravates the course of the disease, causes rapid progression of trophic disorders and worsens the prognosis.

Often trophic ulcers are accompanied by pyoderma, allergic dermatitis. Lymphangitis, purulent varicothrombophlebitis, erysipelas, inguinal lymphadenitis may develop. In some cases, a trophic ulcer is complicated by phlegmon and even sepsis. Recurrent infection causes damage to the lymphatic vessels and leads to the development of secondary lymphedema.

Diagnostics

Confirmation of the venous etiology of a trophic ulcer is concomitant varicose veins and phlebothrombosis. The presence of a history of diseases of the blood system, the use of hormonal drugs, catheterizations and punctures of the veins of the lower extremities, episodes of prolonged immobility due to injuries, chronic diseases and surgical interventions indicates a high probability of past deep vein thrombosis.

A typical localization of a venous trophic ulcer is the inner surface of the lower third of the leg. The skin around the ulcer is thickened and pigmented. Often there is eczema or dermatitis. On palpation in the zone of trophic disorders, crater-like dips (places where altered communicating veins exit through the fascia of the lower leg) can be determined. Visually, varicose veins are detected, most often located along the medial and posterior surface of the lower leg and the posterior surface of the thigh.

To assess the state of the venous system, functional tests, ultrasound of the veins of the lower extremities, ultrasound duplex examination are carried out. For the study of microcirculation, rheovasography of the lower extremities is indicated. Trophic ulcers of venous etiology often develop in elderly patients with a whole "bouquet" of concomitant diseases, so treatment tactics should be determined only after a comprehensive examination of the patient.

Treatment of a trophic ulcer

In the process of treating a trophic ulcer, a phlebologist must solve a whole range of problems. It is necessary to eliminate or, if possible, minimize the manifestations of the underlying disease that caused the formation of an ulcer. It is necessary to fight the secondary infection and treat the trophic ulcer itself.

General conservative therapy is carried out. The patient is prescribed drugs for the treatment of the underlying disease (phlebotonics, antiplatelet agents, etc.), antibiotics (taking into account the sensitivity of the microflora). Locally, enzymes are used to cleanse a trophic ulcer, local antiseptics are used to combat a secondary infection, and after inflammation is eliminated, wound healing ointment dressings are used.

Surgical treatment is carried out after preparation (healing of the ulcer, normalization of the general condition of the patient). Perform operations aimed at restoring venous blood flow in the affected area: shunting, removal of varicose veins (miniphlebectomy, phlebectomy).

Prevention

Preventive measures include early detection and timely treatment of varicose veins. Patients suffering from varicose veins and post-thrombophlebitic disease should use elastic compression (medical knitwear, elastic bandages). You should follow the recommendations of the doctor, avoid prolonged static loads. Patients with chronic venous insufficiency are contraindicated in work in hot shops, prolonged hypothermia, work in a stationary state. Moderate physical activity is required to stimulate the muscle pump of the legs.

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Trophic ulcers on the legs are difficult to heal, and after healing they often make themselves felt again. Without the use of medicines, it is impossible to get rid of them, and in many cases such tissue damage leads to disability.

Trophic ulcers - what is it?

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

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

The main causes of trophic ulcers:

violation of the outflow of lymph;
venous congestion;
swelling due to fluid retention;
poor nutrition of the tissues of the legs.

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

Varicose veins and thrombophlebitis - disrupt the circulation of venous blood in the legs, worsening the trophism of tissues and destroying them. Ulcers are more often formed in the lower part of the lower leg.
Diabetes mellitus is the cause of inflammation of the vascular walls, which leads to a failure of normal metabolism in tissues and their decay. Ulcerative lesions are localized in the area of the feet - on the heels and fingers.
Atherosclerosis - when the lumen of the vessels narrows due to the sediment of cholesterol 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;
disturbed innervation;
injury, frostbite, burns;
allergic reactions;
constant wearing of tight and uncomfortable shoes.

A trophic ulcer is 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, not suddenly. The appearance of an ulcer is preceded by severe dryness of the skin on the leg or both limbs, swelling that does not subside, pigmentation and convulsions. The formation of a trophic wound proceeds in 4 stages:

The first manifestation and the beginning of progression.
Cleansing stage.
Granulation of the center and scarring of the edges.
Complete granulation and scarring.

Consider the symptoms of a trophic ulcer on the legs according to the stages of development.

The initial stage of a trophic ulcer on the legs

The initial stage of a trophic ulcer (photo) and treatment (healing)

Against the background of the underlying disease, the permeability of the vascular walls increases, and the erythrocytes go beyond it. 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. Progression is complemented by inflammation of the subcutaneous adipose tissue and hyperemia of the skin of the limb.

Due to edema, it is impossible to grab the skin with your fingers, and the accumulated liquid appears on the surface, forming drops of moisture on it. Appearing light spots are areas of necrotic tissue.

Without treatment, at this stage, a scab is formed, 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.

Ulcer cleansing

A trophic ulcer has rounded edges, and its appearance at the second stage depends on the presence of wound infection and the timeliness and effectiveness of treatment. The affected area secretes mucus with pus, often mixed with blood and fibrin filaments.

In the presence of an infection, the ulcer exudes an unpleasant, putrid odor and itches.

Additional signs of a trophic ulcer (1-2 stages):

heaviness in the legs;
burning and soreness of the skin;
chills;
protrusion of cyanotic vessels under the skin;
an increase in temperature in the affected area;
exfoliation of the epidermis.

Third and fourth stages

The lesion passes into 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 - areas of pink color appear.

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

If the trophism (nutrition) of the tissues is not fully restored, then the risk of a reverse transition to the initial stage is high. The final scarring occurs in the fourth stage - this can take up to several months. The ulcer completely granulates and heals.

Treatment of trophic ulcers of the lower extremities, preparations

With trophic ulcers of the lower extremities, drug treatment is carried out separately or as an addition to the surgical cleaning of the affected area. With an open, not yet scarring wound, the following means are used:

Antibiotics - capsules, tablets, and in severe cases of the disease - injections intramuscularly;
NSAIDs to relieve inflammation and soreness;
Drugs that reduce blood viscosity - antiplatelet agents - to prevent the formation of blood clots;
Antihistamines - Suprastin, Ksizal, Tavegil - to eliminate an allergic reaction;
Solutions of antiseptics or medicinal herbs for daily washing of the ulcer.

With a trophic ulcer, antiseptic and antimicrobial ointments are prescribed from the preparations. They are applied in a thin layer on a bandage or gauze and tightly fixed on the leg.

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

For the treatment of trophic ulcers on the legs at the stage of granulation and scarring, the following medicines are indicated:

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

For venous ulcers, compression stockings, pantyhose, or elastic bandages are always used and are worn constantly and changed every day. In addition to the treatment of skin lesions, the therapy of 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. Effectively washing the wound with freshly squeezed potato or cabbage juice, which can also be used to apply compresses.

For these purposes, a decoction of oak and willow bark powder are also used. From natural pharmaceutical products in the treatment of trophic ulcers, ointments with comfrey, geranium and arnica are effective.

From unconventional methods your doctor may prescribe:

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

Surgical treatment is indicated when conservative treatment fails. The ulcer is excised during the operation, necrotic areas of the skin and subcutaneous tissues are removed. Vacuum treatment and curettage are used to eliminate mucopurulent contents.

Amputation of a limb 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 an ulcer into a malignant tumor;
arthrosis of nearby joints;
erysipelas;
lymphadenitis, lymphangitis;
sepsis;
gas gangrene;
thrombophlebitis.

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

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

Symptoms of the disease

There are such signs of the initial stage of a trophic ulcer on the leg:

pain sensations of the skin and its burning;
the appearance of swelling on 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 the legs begins to change color, turning blue or purple. There is increased moisture in the legs as a result of the passage of lymphatic fluid through the skin. After a while, the resulting wound begins to fester.

It's important to know! If an ordinary wound on the leg does not disappear within 1 month - this is a trophic ulcer! It is required to immediately contact a specialist who will find out the cause of the onset 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:

disturbances in arterial and venous circulation;
diabetes;
mechanical effect 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! Thus, 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 such types of it:

Arterial

The defeat of this type occurs due to atherosclerosis, in which the work of the main arteries is disrupted. The cause of development is usually severe hypothermia, up to frostbite. The location of the ulcer is most often the area of the foot, big toe, heel. A person constantly freezes, quickly overworks, the affected leg begins to hurt at night. If this type of disease is not treated at the initial stage, then the formed wounds begin to spread throughout the foot and fester.

Venous

Usually appear on the inside of the 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 convulsions at night, a venous network is formed, the skin color changes. If you do not start treatment, then the development of the disease will progress - to affect not only the skin, but also tendons and muscles. Pus with a pungent odor begins to stand out. Incorrectly chosen treatment can lead to more serious diseases.

Read! Details about the treatment of trophic ulcers on the leg quickly and effectively.

diabetic

With diabetes, there are many comorbidities, 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. The big toes are mostly affected. The danger of this type of disease lies in the susceptibility to various kinds of infections, as a result of which gangrene may 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 commonly affected. The size of the formation is insignificant in appearance, but very deep. The wound begins to fester rapidly.

Hypertensive ulcers

The most rare form of the disease. It is the result of persistently high blood pressure. Mostly women over 40 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 slight swelling. If the disease is not treated for a long time, then small wounds appear, the number of which increases intensively. Accompanied by severe unbearable pain.

Pyogenic ulcers

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

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

Treatment of the disease

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

Conservative treatment. Treatment of a trophic ulcer of the initial stage is to eliminate the symptoms of the disease. For this, the following drugs are used: Actovegil, Tocopherol, Solcoseryl and their analogues.
local treatment. To begin with, you should act on the disease that was the cause of the lesion of the lower extremities. Then the treatment should be aimed at eliminating the infection, getting rid of dead tissue and affecting the wound. For such activities, antibacterial drugs (Furacilin, Chlorhexidine), broad-spectrum antibiotics, anti-allergenic medicines (Suprastin, Tavegil), compresses with therapeutic ointments (Levomikol, Dioksikol) are used.
Surgical intervention. The indication for this type of treatment is the extensive spread of ulcers in the lower extremities with a high degree of severity. The operation is the elimination of the ulcer and surrounding necrotic tissues. The second stage is the operation on the veins.

Important to remember! Surgical intervention can be avoided due to the rapid response at the initial stage of the disease!

Complications in the defeat of the legs

Seeing a doctor late can have serious, even fatal, consequences:

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

Therefore, such wounds should be disposed of as soon as possible, not to ignore their appearance.

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

Preventive actions

The main preventive measure is the timely treatment of diseases that cause the appearance of a trophic ulcer. You should also follow these rules:

refraining from heavy physical work, especially for women;
lead a mobile lifestyle;
wear an elastic bandage during an exacerbation of varicose veins;
proper nutrition;
avoiding cigarettes and drinking alcohol;
avoid injury;
choose only comfortable shoes for everyday wear.

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

It should be warned right away 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, the presence of bad habits, especially smoking, lack of control over blood glucose levels most often lead 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 rather difficult to define a trophic ulcer.

Firstly, for the reason that there is no such diagnosis in the classification of diseases, and secondly, because this concept is of a collective nature. Hemodynamic disturbances, innervation disorders, lymphostasis and trauma also lead to the appearance of tissue defects.

Therefore, in simple terms, trophic ulcers are deep defects that occur as a result of impaired innervation, hemodynamics, 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, then the appearance of a scar cannot be avoided. And for what reasons can such severe tissue malnutrition appear?

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:

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

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

Almost all arterial lesions occur as a result of atherosclerosis occurring 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, not an ulcer occurs, but gangrene.

How arterial ulcers appear: they are preceded by chilliness and fatigue, coldness of the limb, the presence of intermittent claudication, then night pains appear. It all starts with a cut, bruise, rubbing of the leg.

Lesions in diabetes mellitus.

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

Stages of a trophic ulcer, symptoms and photos

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

Signs of "preulcer" - the initial stage

the initial stage of a 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, one can detect induration, or thickening of the skin in the area of the calves and shins, the occurrence of burning and itching, the appearance of edema. In some cases, there is an expansion of small subcutaneous (subcutaneous) veins.

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

initial stage photo 2

Finally, the ulcer itself appears. There is no recess 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" - the development of a trophic ulcer

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:

stage of exudation. It lasts up to 2 weeks.

Along the perimeter there is inflammation, perifocal edema. In the center, tissue necrosis occurs, that is, the ulcer itself is formed. It is at this stage that there is an abundant discharge from the wound that has appeared, which has an unpleasant odor.

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

In some cases, the process is not limited to one local area. In the event that lymphatic vessels passed through the ulcer - collectors and veins, then lymphangitis occurs, thrombosis of the veins (thrombophlebitis). Often the appearance of secondary erysipelas, streptoderma, erysipelas.

In the event that the “rampant” of a local infection is not stopped, then a gradual obliteration of the lymphatic vessels may occur with the development of persistent edema, especially on the feet, which is called lymphedema. In the end, this can lead to elephantiasis and permanent disability.

The 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 the cleansing of the wound with fly larvae can be applied, which carefully eat away only dead tissue without causing any harm to the living (as shocking as it may be).

Suppuration gradually decreases, the severity of edema of surrounding tissues also subsides. Continues to appear meager discharge, serous nature.

The stage of ulcer epithelialization.

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

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

Principles of treatment of trophic ulcers on the legs, preparations

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 venous thrombosis continues in other areas, or “outrageously” high blood sugar is useless, because even with the elimination of the defect, several new ones will immediately appear in other places.

It is necessary not to hesitate to make a decision in favor of hospitalization, even to a surgical hospital, if the 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 formation of an ulcer and save the limb, so you should not be afraid of surgeons.

The main steps are:

Consultation of a phlebologist and a vascular surgeon with a decision on the priority operation. (In the case of arterial ulcers, blood flow is always restored first by surgery);
In the case of a conservative approach, they sharply limit their stay in a vertical position (and in the diabetic form, they completely prohibit the load on the leg);
In the case of varicose ulcers, compression underwear is prescribed. Treatment of trophic ulcers of the lower extremities should be accompanied by an improvement in outflow. According to the indications, compression knitwear of high compression classes is prescribed;
In the first stage of ulcer formation, infection control is required, taking into account the sensitivity of the pathogen to antibiotics;
In the subsequent stages, the fight against infection gives way to reparative and restorative therapy;
Throughout the treatment, the most thorough care for 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 drugs for trophic ulcers, but only after consulting 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 must precede the treatment.

In some cases, hospital treatment is preferable, since sessions of hyperbaric oxygenation, rational antibiotic therapy, 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 (used upon completion of the first stage). These include Solcoseryl, Actovegin, Methyluraciol Ointment, Bepanten. Promote regeneration;
Phlebotonics for varicose veins - Detralex, Aescusan, Troxerutin, Phlebodia, Venoruton. You can apply diosmin in micronized form;
Preparations for improving microcirculation ("Hepatrombin");
Local application of antibacterial drugs - antibiotics, Levomekol, Vishnevsky ointment;
Washing the ulcer and removing the discharge (hydrogen peroxide, a solution of chlorhexidine, furacillin) with a 2-3-fold dressing change. You can use Unna gelatin-zinc ointment;
Apply general antiplatelet agents that improve blood flow and reduce thrombosis (Trental, Pentoxifylline, acetylsalicylic acid;
For symptomatic purposes, NSAIDs (ketoprofen, ketorolac) are used to relieve pain and reduce inflammation;
With 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 dressings, for example, Algipor. It is an absorbable bandage made from seaweed with antiseptic properties.

In any case, the 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 that 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 an ulcer is to prevent it. Our body gives us many signals of an impending disaster. And, even in the case of diabetes, when the patient simply does not have pain, blood sugar levels are a threatening symptom.

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

With various diseases, not only of the lower extremities, but also of a systemic lesion of the body, trophic ulcers can develop on the legs. The main problem is their identification 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 impairment of the quality of life of the patient.

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 are traced: a violation of local blood circulation, clear boundaries of the defect, dryness of the underlying tissues, weak granulations in the wound zone.

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

Varicose disease.
Violation of lymphatic drainage from the leg.
Thrombophlebitis.
Atherosclerotic damage to the arteries of the legs.
Skin diseases - eczema, dermatitis.
Diabetes.
Mechanical or thermal impact at the initial stage - injury, burn.
Systemic connective tissue diseases that provoke trophic disorders - lupus, dermatomyositis.

The main mechanism for the formation of the initial stage of a trophic ulcer is a local microtrauma with damage to the skin, and then a subsequent violation 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 the disease manifests itself

Depending on the cause of the skin damage, the trophic leg ulcer looks different. With venous insufficiency, defects are formed on the legs. The photo clearly shows that the predominant localization is the anterior outer surface. Before the appearance of ulceration on the skin, pathological processes develop:

A local bluishness is formed.
The integrity of the skin is broken.
Just before the onset of ulcer formation, whitish coarse scales form over the affected area.
After the whitish growths fall off, a rounded 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.

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

After the formation of an ulcer, it looks like a rounded defect with moderately cyanotic 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 the initial ulceration indicates far-reaching venous disorders in the leg.

With 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 vessels are affected, but also nerve fibers located in the affected area. The 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, 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 locations of the affected areas on the legs are also characteristic. They can be schematically represented in the photo: the sole area, especially the heel area and thumb, the skin of the outer region of the phalanges of the fingers, the ankle area from the outside.

The patient does not subjectively feel pain, but they appear when trying to load the leg. Treatment of ulcers caused by problems with the arteries is extremely difficult. In diabetes mellitus, especially when combined with a neurological defect, the initial manifestations progress rapidly.

Pain in a trophic ulcer occurs with a load on the legs.

How to get rid of the problem

Local treatment of a trophic ulcer on the lower extremities, even at 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 drugs are used for arterial and venous lesions.

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

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

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

For the purpose of 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 within 2 months.

Pentoxifylline - improves arterial blood flow in the area of a trophic ulcer. It is used orally 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 divided doses.

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

The drug is used for systemic treatment of the disease.

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

Depanthol - contains the reparant dexpanthenol and the antiseptic chlorhexidine. Effectively fights the reproduction of microbes and restores trophic tissue changes. The cream is used twice a day under a bandage.

Olazol - contains an anesthetic, a reparant and two antiseptics. As a healing component, sea buckthorn oil is present in the composition. Release form - aerosol. It is applied under a bandage 4 times a day.

Polyvinox - has an antiseptic and regenerating effect. Available in the form of a balm. It is applied twice a day under a bandage on the leg.

Thus, it is important to quickly identify trophic ulcers in the initial stage and immediately begin treatment. This will preserve the full function of the lower extremities for a long time. Therapy should be complex, combine 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 course and are difficult to treat. Recovery directly depends on the course of the underlying disease and the possibility of compensating for the disorders that led to the onset of the 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 be started when the first signs are detected at the initial stage.

Causes

Violation of the blood supply to the skin area leads to the development of microcirculation disorders, lack of oxygen and nutrients, and gross metabolic disorders in the tissues. The affected area of the skin becomes necrotic, becomes sensitive to any traumatic agents and infection.

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

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 lower leg;
Deterioration of arterial circulation (in particular, with atherosclerosis, diabetes mellitus);
Some systemic diseases (vasculitis);
Any kind of mechanical damage to the skin. It can be not only an ordinary, domestic injury, but also a burn, frostbite. The same area includes ulcers that form in drug addicts after injections, as well as the effects of radiation exposure;
Poisoning with toxic substances (chromium, arsenic);
Skin diseases, for example, chronic dermatitis, eczema;
Violation of local blood circulation with prolonged immobility due to injury or illness (bedsores are formed).

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

Symptoms of a trophic ulcer

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 impairment of venous circulation in the extremities.

Patients note increased swelling and heaviness in the calves, increased spasms of 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 cyanotic veins of small diameter increases in the lower third of the leg. Violet or purple pigment spots appear on the skin, which, merging, form an extensive area of hyperpigmentation.

In the initial stage, the trophic ulcer is located superficially, has a moist dark red surface covered with a scab. In the future, 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 around the entire circumference of the lower leg. The process extends not only in breadth, but also in depth.

Complications

A trophic ulcer is very dangerous for its complications, which are very serious and have poor prospects. If you do not pay attention to trophic ulcers of the limbs in time and do not start the treatment process, the following unpleasant processes may subsequently develop:

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

Without fail, the treatment of trophic ulcers on the legs should be carried out under the supervision of the attending physician without any initiative, only in this case the consequences can be minimized.

Prevention

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

It is necessary not only to apply medicines inside, but also to apply them externally. Local exposure will help stop pathological processes, treat an existing ulcer and prevent subsequent tissue destruction.

Why is the disease dangerous?

A progressive trophic ulcer can eventually occupy significant areas of the skin, increase the depth of the necrotic effect. A pyogenic infection that has got 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 the reason for urgent surgical intervention. Long-term non-healing wounds exposed to aggressive substances - salicylic acid, tar, can develop into malignant transformations - skin cancer.

Treatment of a trophic ulcer on the leg

In the presence of 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 the daily care of the affected area.

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

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 medication can only be prescribed by a doctor.
Local therapy that can heal tissue and skin damage. In diabetes, ointments containing antiseptics and enzymes are used. These agents heal wounds and provide local anesthesia. Ointments that enhance blood circulation are not allowed to be applied to the open surface of a trophic ulcer. Ointments such as Dioksikol, Levomekol, Curiosin, Levosin have a wound healing effect. The ointment is applied to a compress and whether special dressings are made.
Surgical intervention, which is performed after the healing of ulcers. During it, the blood flow in the veins in the affected area is restored. This operation includes shunting and phlebectomy.

For the treatment of wounds, the following drugs are used: Chlorhexidine, Dioxidine, Eplan. At home, you can use a solution of furacilin or potassium permanganate.

Surgery

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

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

There are several different surgical methods:

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 hinder the development of bacteria.
Catherization - suitable for ulcers that do not heal for a very long time.
Percutaneous stitching - suitable for the treatment of hypertensive ulcers. Its essence is the separation of venous-arterial fistulas.
virtual amputation. The metatarsal bone and the metatarsophalangeal joint are cut off, but the anatomical integrity of the foot is not violated - on the other hand, foci of bone infection are removed, which makes it possible to effectively deal with a neurotrophic ulcer.

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

Medical therapy

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

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

Broad spectrum antibiotics;
NSAIDs, which include ketoprofen, diclofenac, etc.;
Antiplatelet agents for intravenous injections: pentoxifylline and reopoglyukin;
Antiallergic drugs: tavegil, suprastin, etc.

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

Washing the wound with solutions of antiseptics: potassium permanganate, furacilin, chlorhexidine, decoctions of celandine, string or chamomile;
The use of bandages with therapeutic ointments (dioksikol, levomikol, streptolaven, etc.) and carbonet (a special bandage 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 are used in the treatment - Solcoseryl, Actevigin, Ebermin, etc., as well as antioxidant drugs, for example, tolcoferon.

Also at this stage, wound dressings specially designed for this are used: sviderm, geshispon, algimaf, algipore, allevin, etc. Treatment of the ulcerated surface is carried out with curiosin. At the final stages, drug treatment is aimed at eliminating the underlying disease, which provoked the appearance of a trophic ulcer.

How to treat a trophic ulcer on the leg at home

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

At home, you can use:

Hydrogen peroxide. It is necessary to drop peroxide on the ulcer itself, then sprinkle streptocide on this place. On top you need to put a napkin, previously moistened with 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. And add streptocide when the wound becomes moist.
Healing balm in the treatment of trophic ulcers in diabetes mellitus. It consists of: 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 a trophic ulcer, then covered with a bandage. This folk remedy is a good antiseptic.
Powder from the dried leaves of the tartar. Rinse the wound with a solution of rivanol. Sprinkle with prepared powder. Put on a bandage. In the morning of the next day, again sprinkle with powder, but do not wash the wound before that. Soon the ulcer will begin to heal.
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 from a solution of sea or table salt (1 tablespoon per 1 liter of water). Fold gauze in 4 layers, moisten in saline solution, squeeze lightly and apply to the wound, compress paper on top, hold for 3 hours. Repeat the procedure twice a day. Between applications, a break of 3-4 hours, during which time the ulcers should be kept open. Soon they will begin to decrease in size, the edges will turn pink - which means that the healing process is underway.
Garlic poultices or compresses are used for open sores. Take a multi-layered gauze or terry towel, soak in a hot decoction of garlic, squeeze out excess liquid and immediately apply to the sore spot. Place a dry flannel dressing and a heating pad or hot water bottle over the poultice or compress to keep warm longer.
You need to mix the egg white with honey so that these ingredients are in the same ratio. Whisk everything and apply on ulcers, including veins that hurt. Then cover with the reverse side of the burdock leaves. There should be three layers. Wrap with cellophane film and bandage with a linen cloth. Leave the compress 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. can develop. Therefore, you should not use only folk remedies, while neglecting traditional treatment.

Ointments for treatment

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

Often also apply Vishnevsky's ointment. Of the ointments that can be bought at the pharmacy, dioxycol, levomekol, as well as streptolaven and a number of analogues are especially distinguished.