How to treat the disease trophic ulcer. Why does a trophic ulcer appear: photos, methods of treatment and prevention. Trophic ulcers on the background of neoplasms

Trophic ulcer is a superficial defect of the integumentary tissues, which eventually spreads to deeper tissues and does not tend to heal. In most cases, trophic ulcers are formed as a result of malnutrition of a certain area of the skin or mucous membrane, lack of blood supply, or due to disorders of the innervation of this area.

Trophic ulcers do not occur spontaneously. At the initial stages of the development of the pathological process, a bluish spot appears on the integumentary tissues of the affected area, which is accompanied by itching, burning and swelling, and eventually turns into a superficial wound, which tends to grow in depth and width instead of healing. A trophic ulcer is usually called any defect in the integumentary tissues that does not heal for more than eight weeks. Such ulcers are dangerous for their complications, as they can lead to sepsis or even limb amputation. They should be treated in a timely manner and under the close supervision of the attending physician.

The most common are trophic ulcers of the feet and legs. Approximately 70% of such ulcers are caused by various pathologies of the venous circulation, such as varicose veins. The second most common cause of trophic ulcers is atherosclerosis obliterans (approximately 8% of cases). Another important factor is the presence of diabetes mellitus in a patient, which leads to the occurrence of various defects in integumentary tissues in about 3% of cases. Other causes may be thrombosis, trauma, impaired innervation, etc. Trophic ulcers are accompanied by severe complications in approximately 3.5% of cases.

The structure of the skin, its blood supply and innervation

The skin is a multifunctional organ that covers the human body and many animals. It takes part in the thermoregulation of the body, performs a protective and barrier function, has the ability to breathe, absorb and release various substances. Also, the skin is an important component in contacting the body with environment because it contains many receptors various kinds sensitivity, such as pain or touch. The skin is a vital organ, damage to which can lead to serious consequences.

In the structure of the skin, three main layers are distinguished, which in turn are divided into thinner layers:
1) The epidermis or outer layer of the skin is the thickest and most multi-layered part of the skin. The epidermis, in turn, consists of five thinner layers, arranged in a strict order, starting from the deepest and ending with the most superficial:

Basal layer
layer of spiny cells
Granular layer
glitter layer
stratum corneum

These layers include a huge variety of cells and extracellular structures that change as they move from the deepest (basal) to the most superficial (stratum corneum) layer. Thus, the skin is renewed and restored from various damages. The full cycle of skin renewal is approximately two months. When the skin cells reach the stratum corneum, they take the form of scales, tightly adjacent to each other. It is the stratum corneum that is the thickest part of the epidermis and plays an important role in the barrier and protective functions.

2) The second layer in the structure of the skin is the dermis or the skin itself. It also consists of several types of cells, and in addition it includes many elastic fibers and an interstitial substance. In different areas human body the thickness of the dermis varies. Thus, it can be from 0.5 mm to 5 mm in thickness. The dermis is divided into two main layers: papillary and reticular. The papillary layer is more superficial and is so named because it has the appearance of peculiar papillae protruding into the epidermis. This layer is softer and more delicate than the mesh one. It consists of collagen and elastic fibers, as well as an amorphous structureless substance. The mesh layer is more compact and coarse-fibered. It is he who is the main layer of the dermis, as it provides the skin with strength and elasticity. In addition to cells of various origins, the dermis is also rich in blood vessels and nerve endings.

3) The last and deepest layer of the skin is the hypodermis. It is also called subcutaneous fat. It consists of numerous bundles of connective tissue, between which are located closely adjacent to each other fat cells. The thickness of this layer varies greatly depending on age, gender, constitution, type of diet, and many other factors. This layer is a kind of energy reserve of the body and its thickness can vary significantly throughout life. The hypodermis also includes blood vessels of various sizes, nerve endings and nerves proper, sweat glands and hair follicles. Also, around the vascular plexuses and near the hair follicles, you can find skin muscles that “raise” the hair under the action of various stimuli, such as stress, cold, strong emotions, etc.

Skin blood supply It is carried out thanks to a huge multi-loop network of arteries located under the hypodermis. Many smaller vessels depart from it, penetrating the skin and forming the so-called “superficial” choroid plexus between the papillary and reticular layers of the dermis. Skin capillaries form a complex and very dense network of blood vessels that nourish all skin cells. The density of capillaries varies between 15 and 70 capillaries per 1 mm2 of skin.

Skin innervation is a rather complex system of receptors and nerve endings that perceive many different types of stimuli. The skin is a huge receptor field involved in the formation of a sense of touch, heat or cold, pain, itching, burning, pressure and vibration, body position in space, etc. in the deep parts of the hypodermis, all these nerve endings form plexuses, from which larger nerves extend, leading to the central nervous system.

Reasons for the formation of a trophic ulcer

The formation of a trophic ulcer is a chronic slow process. The word "trophy" means nutrition, i.e. the very name of the disease indicates its origin. Regardless of the mechanism of development, the main link in the occurrence of a trophic ulcer is a local violation of cellular and tissue nutrition. It can be caused by various vascular, metabolic, blood or neurological disorders.

Cause	Mechanism of skin damage
Phlebeurysm	Varicose veins rank first among the pathologies leading to the formation of a trophic ulcer. With the expansion of the veins, the outflow of venous blood is significantly disturbed, which leads to its stagnation at the site of expansion. This blood interferes with the supply of fresh arterial blood, rich in nutrients needed by the skin. Venous blood is not able to nourish cells and tissues, therefore, when it stagnates, the skin does not receive the elements it needs and, being in “starvation” conditions for a long time, it begins to gradually break down, forming first superficial wounds, gradually turning into ulcers.
vein thrombosis	Venous thrombosis is another common cause of the formation of trophic ulcers. Its mechanism is similar to that of varicose veins. With the formation of blood clots, the lumen of the vessels narrows significantly, which interferes with the normal outflow of blood. Blood stasis, in turn, prevents the flow of nutrients to nearby tissues. Prolonged lack of nutrition leads to the formation of a trophic ulcer in these areas of the skin.
Arteriosclerosis	Atherosclerosis is the formation of fatty plaques on the walls of arteries. Growing for a long time, these plaques can completely close the lumen of the blood vessel. This seriously impairs the flow of arterial blood to all tissues that receive blood from a blocked vessel. Various pathological processes, such as ischemia and hypoxia, begin to develop in these tissues. Over time, the skin in these areas becomes dry, thin, and gradually becomes covered with trophic ulcers.
Diabetic neuroangiopathy	Diabetes mellitus is an endocrine disease associated with impaired glucose metabolism in the body. It is dangerous with many complications, one of which is a violation of the innervation and structure of blood vessels. With this disease, the walls of the vessels become rigid, their structure changes, which leads to impaired blood circulation in the affected areas of the bloodstream. With a lack of arterial blood flow, trophic ulcers appear on the skin. Also, diabetes mellitus is dangerous because the patient often does not feel pain in the area of ulcer formation and does not notice it, which leads to a significant increase in the size and depth of the ulcer.
Infectious skin lesions	Various skin infections, combined with a local decrease in immunity and malnutrition of the skin, can lead to the formation of a trophic ulcer. This is due to the fact that some bacteria are able to destroy skin cells and disrupt its structure. And the recovery processes cannot compensate for this process due to circulatory disorders and lack of nutrients.

Symptoms of a trophic ulcer

The formation of a trophic ulcer develops in stages. Its symptoms can be divided into two large groups: early signs and late signs. Early signs include thinning and pallor of the skin, itching, burning, swelling, muscle cramps. Later signs are a bluish spot, dermatitis, a superficial wound, purulent discharge, or an unpleasant odor from the wound. However, the main symptom is the long-term absence of recovery processes and the inability of the wound to heal.

Group	Symptom	Manifestation	Origin mechanism
early signs	Thinning and pallor of the skin		The thinning of the skin is associated with a lack of " building material”, brought by arterial blood, necessary for normal skin renewal. And pallor is a sure sign of the absence or lack of blood in the capillaries.
	Itching		Itching is caused by irritation of nerve endings by various stimuli. Itching does not always indicate a pathological process, however, if it is constant in the absence of any visible irritants (insect bite, contact with a plant or tissue, contact with the skin of any substance), this may indicate a local circulatory disorder.
	Burning		Burning is another signaling mechanism of the nervous system. Like itching, it can accompany the influence of various irritants on the skin, as well as indicate pathological processes occurring in this area of the skin.
	Puffiness		The occurrence of edema is closely related to blood circulation, namely, venous outflow. In case of violation of the outflow of blood and congestion in the venous bed, the fluid goes beyond the vessels and accumulates in the tissues, leading to edema.
	Local muscle cramps		With prolonged tissue hypoxia or a violation of the structure of the nerve endings that innervate the muscles in the ischemic zone, spontaneous muscle contractions, called convulsions, may occur. Usually they are short and painless, but this symptom should not be neglected.
late signs	bluish spot		Prolonged oxygen starvation of tissues leads to their destruction, which manifests itself in the form of a spot on the skin of a changed color - cyanotic or purple.
	Dermatitis		Dermatitis is an inflammatory process that occurs in the skin and is caused by various factors. Most often, dermatitis indicates a local decrease in skin immunity that occurs with poor blood circulation. At the same time, bacteria living on the skin can start a chain of inflammatory reactions leading to tissue destruction.
	superficial wound		The appearance of superficial skin lesions in the absence of obvious causes is a serious sign of malnutrition and regeneration processes of the skin area. With trophic ulcers main characteristic of such wounds is their inability to heal.
	Purulent discharge and an unpleasant smell of the wound		A putrid smell and purulent discharge from the ulcer indicate that it is infected and serious pathological changes occur in it, dangerous with many complications.

Diagnosis of the causes of trophic ulcers

Diagnosis of the trophic ulcer itself is usually not difficult, since this is a superficial skin lesion that can be detected with a simple examination. It is much more important to establish the cause of the occurrence of a trophic ulcer, since its elimination is an important step in the treatment.

Group	Study	Methodology	results
Laboratory methods	Blood test		A complete blood count may show a significant increase in the number of red blood cells, which increases the viscosity of the blood and can cause circulatory disorders. Increased leukocytosis will indicate the presence of an infection. A biochemical blood test is performed to identify risk factors such as increased cholesterol or glucose levels.
	Bacteriological research		A bacteriological examination of a smear from an ulcer will help determine the presence and type of bacteria in order to select a suitable antibacterial treatment.
	Histological examination		Histological examination in the initial stages may indicate the degree of tissue hypoxia or damage to the microvasculature. In the later stages, this study is not informative.
	Rheumatic tests		Rheumoprobes indicate the presence of an autoimmune process that affects the connective tissue. Often, autoimmune diseases affect the bloodstream. The presence of indicators such as cryoglobulins, ANCA antibodies indicates a serious systemic disease that affects the walls of blood vessels.
Instrumental Methods	Doppler ultrasound		Ultrasound dopplerography is the most common research method in the presence of trophic ulcers. With the help of ultrasonic waves, blood flow is observed in the vessels located in the affected parts of the body. The method is very accessible, cheap, simple, non-invasive and quite informative.
	MSCT angiography		MSCT angiography is a special method of computed tomography aimed at a detailed study of the bloodstream. It helps to study the state of blood vessels in some detail and to identify any structural changes in the walls of arteries and veins that lead to circulatory disorders.
	MRI		Magnetic resonance imaging, as well as computed tomography, is an expensive, but very informative and useful research method for diagnosis. This method is based on the physical phenomenon of magnetic resonance and helps to investigate the state and functions of various organs and tissues in the body.
	X-ray contrast angiography		With this method, a contrast agent is introduced into the studied vessels, and its progress through the vessels is observed using x-rays. If the vessel has expansions, aneurysms, or, conversely, is narrowed or clogged, this method will certainly reveal such pathological changes.
	Laser flowmetry		Laser flowmetry is similar to Doppler ultrasound, but instead of ultrasound, a laser is used here. This method is characterized by high accuracy, sensitivity and objectivity of the results. It is used in the study of the microcirculatory bed in order to identify the slightest circulatory disorders.

Treatment of a trophic ulcer

In the presence of a trophic ulcer, 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.

Drug group	Representatives	Mechanism of action	Mode of application
Angioprotectors and antiplatelet agents	Acetylsalicylic acid; Pentoxifylline; Heparin; Prostaglandins	Angioprotectors and antiplatelet agents are aimed at correcting disorders of the coagulation system, systemic improvement of blood circulation and prevention of blood stasis in the vessels. Antiplatelet drugs are drugs that affect blood clotting and reduce the risk of blood clots. Angioprotectors are aimed at restoring and protecting the structure of the vascular wall, and may also have an antispasmodic effect.	They are used in the form of tablets or intramuscular and intravenous injections. They have a systemic effect, affecting blood circulation throughout the body.
Antibacterial drugs	Levomycetin; Hexicon; Fusidin; Miramistin	These drugs include an antibiotic or antiseptic that promotes the destruction of bacterial cells in the wound.	These drugs are available in the form of an ointment or solution for topical use. They treat the ulcer directly, after which a special bandage is applied to reduce the risk of subsequent infection. The use of concentrated forms of antiseptics should be avoided.
Drugs that accelerate tissue regeneration	Sulfargin; Ebermin; Actovegin	These drugs affect metabolic processes in tissues, accelerating their recovery and improving their nutrition.	Preparations of this group should be applied topically in the form of an ointment or cream. Such drugs are applied directly to the ulcers.

Trophic ulcer treatment: The correct toilet of a trophic ulcer begins with its cleansing and washing. For this purpose, a sterile saline solution is used. In the later stages, dead tissue, secretions and damaged tissue at the edges and at the base of the ulcer are surgically removed from the wound. After sanitation of the trophic ulcer, an antibacterial drug or ointment is applied that accelerates tissue regeneration, and the ulcer itself is closed with a special bandage.

The choice of dressing agent depends on the degree of infection of the wound and on the stage of its formation. If the wound is sterile and is at the healing stage, dressings are used to provide adequate hydration and breathing of tissues, protect it from pathogenic bacteria or mechanical damage, and also accelerate the recovery processes in the wound. In case of an infected ulcer, the dressing material should provide constant absorption of secretions from the wound, have an antibacterial effect, and stimulate the rejection of microorganisms and dead tissues from the ulcer.

In order to accelerate the healing of trophic ulcers, additional physiotherapy procedures are often resorted to, such as hyperbaric oxygen therapy, ultrasonic cavitation of wounds, ultraviolet radiation, magnetotherapy, laser therapy, etc.

Name of physiotherapy	Conduct method	Effect
Hyperbaric oxygen therapy	In this procedure, high pressure oxygen is applied to the affected area of the skin. For this, there are special chambers in which the pressure and oxygen concentration are artificially regulated.	Hyperbaric oxygenation significantly reduces the resistance of microorganisms to antibiotic therapy, disrupts their vital activity, and also enriches tissues with oxygen.
Ultrasound cavitation of wounds	The wound is affected by ultrasonic radiation generated by a special apparatus.	Ultrasonic cavitation of wounds leads to the destruction of microorganisms in the ulcer, significantly improves microcirculation, tissue regenerative abilities and has an anti-inflammatory effect.
UV irradiation	The affected area of the skin is placed under a special lamp that emits ultraviolet rays.	UV exposure is known for its antibacterial properties. In addition, it is able to dilate blood vessels, improving blood circulation, increase the body's resistance to various infections, and also activate the work of phagocytes - important participants in the inflammatory process.
Magnetotherapy	This method of therapy is based on the use of static magnetic field affecting areas of the skin with trophic ulcers.	As a result of this procedure, the vessels expand, blood circulation improves, and the swelling of the affected tissues disappears. Magnetic therapy also has an analgesic effect.
Laser therapy	The area of the skin where the trophic ulcer has formed is exposed to laser radiation, regulated by a special apparatus.	This type therapy has analgesic, antispasmodic and anti-inflammatory effects. However, laser therapy should be performed under the close supervision of a competent doctor, as it can both cure and worsen the condition of tissues.

Trophic ulcers rank first in prevalence along with purulent infections. This disease is long and painful. Trophic ulcers can form on any part of the skin, but most often they form on the legs - from the foot to the knee. What you need to know about this pathology and how to treat it?

Causes of the disease

Trophic ulcers are assigned 183 ICD code 10. These are inflammatory wounds that do not heal for a long time. As a rule, they are a consequence of some pathologies. Trophic ulcers in medicine are not considered an independent disease. The causes of the disease are divided into two groups. The first group includes external irritants: frostbite, burns, radiation exposure, exposure to chemicals, bedsores.

Trophic ulcers of the lower extremities can create quite a lot of trouble, not only physical, but also psychological.

The second group includes diseases such as:

diabetes;
tuberculosis;
AIDS;
syphilis;
violation of the lymph flow;
disturbed metabolism;
spinal and brain injuries;
autoimmune diseases.

All causative factors have a common feature, namely, an insufficient supply of oxygen and nutrients. Trophic ulcers 183 ICD code 10 can be triggered by a combination of several causes from both groups. In 70% of cases, the disease is caused by pathologies associated with impaired venous blood flow. One of these pathologies is varicose veins. With varicose veins, venous blood flow is disturbed, which leads to stagnation of blood. The venous blood does not contain nutrients, so the skin does not receive useful substances for it. Under such conditions, it "starves" and gradually collapses, which leads to the appearance of wounds.

Most often, this pathology develops in the absence of adequate treatment of venous insufficiency, other diseases of the blood vessels.

The second most common cause is venous thrombosis. The lumen of the vessel narrows and because of this, the blood stagnates. At the site of thrombus formation, small superficial wounds first appear, which later turn into weeping ulcers.

Stages and types of pathology

ICD 10 trophic ulcers of the lower leg L97 occur gradually. An insufficient flow of oxygen and nutrients is observed with venous congestion. Against this background, the tissues begin to inflame. First, the inflamed skin becomes thinner and then thickens. The subcutaneous tissue becomes thicker. The skin becomes dark shade. In violation of tissue trophism, the protective properties of the skin are reduced. As a result - the appearance of weeping wounds on the lower extremities. Ulcers do not heal well and are prone to recurrence.

Doctors classify several degrees of trophic ulcers

Phlebologists distinguish several types of lesions:

venous;
arterial;
diabetic;
neurotrophic;
hypertonic;
pyogenic.

The venous type of ulceration is considered the most common. Often, wounds develop on the lower leg. At the initial stage of the disease, heaviness in the legs, swelling, cramps and itching appear. An enlarged vein becomes visible on the lower leg. With the progression of the disease, the veins merge into spots and acquire a purple hue. The skin becomes dry and smooth. If timely treatment is not started, then the superficial wound deepens and begins to fester. In this case, sepsis may begin.

Arterial ulcerations develop against the background of obliterating atherosclerosis. Hypothermia of the feet or wearing tight shoes can provoke the development of ulcers. Localized arterial wounds on the foot. This type of defect is round shape, with torn and dense edges. Arterial ulcers are painful and cause a lot of inconvenience to a person. Without treatment, the ulcers spread throughout the foot.

They are very painful. As a rule, they are often exposed to infections leading to the development of gangrene or limb amputation.

Trophic ulcer: Symptoms, features, causes

The neurotrophic type of ulceration also develops on the feet. The cause of their appearance is a trauma to the head or spine. These are deep and painful wounds. Hypertensive ulcers are formed against the background of increased heart pressure. This type is characterized by the symmetry of the lesion. Wounds develop immediately on both legs. With their appearance, a person experiences excruciating pain day and night. Pyogenic ulcers develop against a background of weakened immunity. These are oval and shallow wounds that can be located singly or in groups.

Clinical symptoms

Trophic ulcers of the lower extremities develop in stages, so the signs of pathology can be divided into two main groups:

early (pallor of the skin, itching, burning, cramps and swelling);
late (dermatitis, purulent, mucous discharge, fetid odor).

Fourth stage of varicose veins

At the initial stage of the development of the disease, the skin becomes thinner. This is due to the lack of nutrients and nutrients that are needed for its regeneration. Paleness appears due to insufficient blood volume in the capillaries.

For availability pathological changes also indicate symptoms such as burning and itching. These symptoms cannot be ignored. Without treatment, swelling is added to the symptoms. With stagnation of blood, the fluid goes beyond the bloodstream and accumulates in the tissues. Puffiness is usually observed in the evening. With a lack of oxygen in the tissues and nerve fibers, a person develops convulsions. They are of short duration. Hypoxia also leads to the destruction and death of tissues. The skin takes on a purple or crimson hue.

As the disease progresses, dermatitis and a superficial wound develop. This is dangerous because pathogens are able to start a chain inflammatory processes. Wounds don't heal well. Without treatment, a purulent discharge and an unpleasant fetid odor appear.

Features of treatment

Trophic ulcers of the lower extremities are treated depending on the type of ulceration and the cause that provoked them. Treatment is prescribed on the basis of histological, bacteriological and cytological examination. A trophic leg ulcer can be treated in two ways:

Medical.
Surgical.

Conservative treatment includes taking angioprotectors (acetylsalicylic acid, Heparin), antibiotics (Levomycetin, Fuzidin), as well as medications that stimulate tissue regeneration (Actovegin, Sulfargin). The wound surface is cleaned of pathogenic microorganisms with a solution of "potassium permanganate", "Chlorhexidine". Alternative medicine is also effective: a decoction of chamomile flowers, celandine, coltsfoot, strings.

Section description

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

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

Causes

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

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

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

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

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

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

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

Often, experts state a combination of external and internal factors that led to the formation of a trophic ulcer.

Symptoms

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

On examination, the doctor discovers the following initial signs of a trophic ulcer:

pastosity of soft tissues of the lower extremities;
thickening, coarsening of the skin of the affected area;
discoloration of the skin in the affected area - a growing spot of grayish or blue-violet color, resembling a hematoma with a glossy tint;
increased sensitivity at the site of ulcer formation, acute pain with a light touch to it;
there may be serous-mucous discharge on the skin in the area of the spot.

With a minor injury, overload, nervous fatigue, the disease progresses rapidly. In the center of the spot, an area of atrophy of the epidermis of a whitish color is formed, a bloody discharge appears.

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

severe swelling of the lower leg or foot;
the presence of an ulcerative lesion, which, if left untreated, is prone to rapidly increase and deepen;
bloody-purulent discharge with an unpleasant odor;
excruciating pain in the legs, aggravated by exertion and at night, limiting motor activity;
violations of the general condition (fever, chills, fatigue, poor appetite).

Kinds

Ulcers are classified according to the cause that caused their formation.

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

Arterial

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

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

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

diabetic

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

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

neurotrophic

With damage to the central nervous system, ulcers are located in the heels, on the soles.

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

Hypertensive

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

They are distinguished by delayed formation, and on two legs at once, a pronounced pain syndrome, and a high frequency of purulent complications.

infectious

Formed on the shins with advanced skin diseases against the background of unsanitary conditions and layering of a secondary purulent infection. Features: semicircular shape, small size and depth.

Which doctor treats trophic ulcers?

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

It is permissible to treat a trophic ulcer at home only at a very early stage.

Diagnostics

A trophic ulcer on the leg is accompanied by specific complaints and has a characteristic appearance on examination. The main task of specialists is to find out the cause of the disease. Only by establishing the etiology of ulcerative lesions, it is possible to prescribe adequate therapy.

The following diagnostic measures are carried out:

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

Treatment

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

Treatment of a trophic ulcer depends on the following factors:

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

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

If the operation is contraindicated for the patient for some reason, the goal of therapy is to prevent the increase and deepening of the skin defect.

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

conservative

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

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

Medicines from the following groups are used:

Vasoactive drugs , including phlebotonics (Troxevasin, Detralex) and antiplatelet agents (Trombo-ass). Contribute to the expansion of blood vessels, improve microcirculation, strengthen the walls of the veins and reduce venous congestion.
Infusion therapy - solutions of hemodez, rheopolyglucin in cases of intoxication.
Decongestants . They are used according to strict indications, periodically, under the supervision of a physician. When they are taken, the content of electrolytes in the blood is monitored.
Antibiotics - with an infectious etiology of an ulcer or a layering of a secondary infection. It is prescribed after the isolation of the pathogenic agent from the ulcerative secretion and the determination of its sensitivity to antibiotics of various groups.
Anti-inflammatory drugs - in the presence of purulent discharge, inflammatory reaction of surrounding tissues and severe pain syndrome.
Hyposensitizing drugs reduce the secretion of the ulcer surface.

These same medicines in various combinations are used in the treatment of trophic ulcers of any etiology.

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

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

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

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

Local therapy

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

The following antiseptics are used:

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

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

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

Surgical intervention

You can finally cure a trophic ulcer on the leg with the help of surgery. In order for the operation to be successful, it is necessary to competently prepare the patient for the upcoming intervention, to achieve an improvement in well-being, stabilization of the general condition and the beginning of healing of the wound surface.

The following methods have been developed in angiosurgery:

shunting in vascular diseases;
removal of a section of a vein with varicose nodes ().

In the presence of a large and deep ulcer, a skin flap is transplanted.

Folk methods

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

How to treat a trophic ulcer at home? They clean the wound surface from the remnants of pus, as it slows down healing. For this, decoctions of chamomile, celandine, succession, calendula are used.

After washing the ulcer, with the permission of the doctor, pharmacy ointments are applied to help relieve inflammation and heal, including Vishnevsky's ointment, ichthyol ointment.

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

Hope only for folk medicine impossible, rejection of the complex inpatient treatment can lead to life-threatening consequences.

Complications

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

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

Why is the disease dangerous?

Ulcers are dangerous by rapid progression in severe cases of the underlying disease. At the same time, they not only increase in size, but also become numerous, can merge into an extensive wound surface.

Also, this pathology is distinguished by the following features:

tendency to relapse;
resistant to all therapies except surgical treatment, which may have contraindications;
the possibility of developing sepsis - with ulcers of venous origin, gangrene - with diabetic ulcers, osteomyelitis.

Prevention

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

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

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

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

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The appearance of trophic ulcers can complicate the course of a fairly large list of diseases - from diseases of the circulatory system to metabolic disorders, and the development of an ulcer is accompanied by both a violation of normal blood circulation and a change in innervation. That is why the recovery process may require the use of a complex effect and a sufficiently long treatment.

Who treats, which doctor to contact?

Those specialists who promise patients a quick result, to put it mildly, try to wishful thinking - trophic ulcers on the legs occur under the influence of several factors, so the impact should be on all parts of the pathological process.

The ulcer itself is a defect in the mucous membrane or skin, which is formed due to the destruction of surface tissues. The cause of tissue destruction is a change in blood flow in the microvasculature and a violation of innervation at the site of the appearance of an ulcer. The entry of a pyogenic infection and ongoing pathological processes in the vascular bed aggravate the manifestations of the disease, and these processes cause frequent relapses and create enormous difficulties in treatment.

Reasons for the development of trophic ulcers

In the formation of a trophic ulcer, two processes are of equal importance - the formation of pathological phenomena that affect the blood supply and innervation of a certain area of the skin and subcutaneous tissue (most often on the lower extremities) and an injury that provokes primary damage at the site of the future ulcer.

Most common causes occurrence of trophic ulcers:

Obliterating atherosclerosis of arteries of various calibers in the lower extremities;
Chronic diseases of the veins of the lower extremities - varicose veins, thrombophlebitis and its consequences;
Anatomical and inflammatory diseases of the lymphatic vessels - acute and chronic lymphostasis;
Thermal injury - frostbite or burns;
Diabetes mellitus and its complications;
Chronic dermatitis, including allergic;
Autoimmune diseases of the connective tissue, accompanied by a systemic violation of blood flow in the arterial, microcirculatory and venous bed, including antiphospholipid syndrome;
Injuries of the nerve trunks with subsequent violation of the integrity.

According to statistics, the symptoms of a trophic ulcer most often occur with a complicated course of varicose veins or thrombophlebitis. In this case, the cause of the disease is a violation of the outflow of venous blood from the underlying parts of the lower extremities - blood stagnation gradually develops in small-caliber veins, the regulation of the tone of the capillaries of the microcirculatory bed is disrupted, and the arterial link of the vascular system is affected last. With atherosclerosis of the arteries, blood flow worsens and, accordingly, the supply of oxygen and nutrients to the tissues below the location of the atherosclerotic plaque.

The most difficult case of trophic ulcers is the damage that occurs in the complicated course of diabetes mellitus. In this case, at the same time, there is a violation of blood flow to the tissues, the supply of oxygen directly to the cells decreases, and the accumulation of underoxidized metabolic products that occurs during hypoxia damages the nerve fibers. Even a slight accidental damage to the skin "triggers" an avalanche-like pathological process - reparative processes do not develop in the wound under conditions of impaired blood supply and altered innervation. On the contrary, the area and depth of the ulcer gradually increase, and the addition of a secondary purulent infection provokes an increase in the phenomena of general intoxication of the body.

Symptoms of the disease

Symptoms of a trophic ulcer rarely occur suddenly, in the midst of complete well-being. In the vast majority of cases, the appearance of a defect is preceded by the appearance of pain, swelling, a constant feeling of heaviness in the legs (most pronounced in the legs). Then these symptoms are accompanied by burning in the skin, constant itching and a feeling of heat, and convulsions may occur at night. At the same time, visible changes in the skin appear - it becomes “glossy”, acquires an uneven purple or violet hue, small spots of pigmentation become prone to merging, the skin becomes rougher to the touch and sharply painful when accidentally touched.

Such symptoms most often appear on the inner surface of the lower third of the lower leg - they are characteristic of ulcers that occur when the venous vessels of the lower leg are affected. The trophic ulcer itself, located on the site of darkened skin, in this case most often has a relatively small size, oval or round shape, jagged edges, an attempt at the slightest impact brings severe pain to the patient.

In diseases of the arteries of the limb of any origin, fingers become a favorite place for the localization of ulcers or ulcerative defects appear in the form of a necklace of several small ulcers that occur against the background of whitened skin. Neurotrophic ulcers, which in appearance are very similar to bedsores, are formed in places of increased pressure - on the sole, heel, such ulcers are round in shape and are characterized by minimal inflammation around the ulcer and the absence of pain even when a pronounced defect is formed. Ulcers in autoimmune diseases of the connective tissue usually occur symmetrically on both limbs, more often on the shins, while trophic ulcers that complicate the course of diabetes mellitus affect the heel region and the first toe.

Diagnosis of ulcerative lesions

Usually, the diagnosis of a trophic ulcer can only be made based on the results of a conversation and examination of the patient by a doctor - the presence of a long-term non-healing ulcer and the characteristic appearance of the damage make the diagnosis reliable.

Diagnostic measures are much more important for establishing the cause of the disease, determining the nature of the damage and choosing a treatment program - this largely determines the prognosis of recovery, and in some cases the patient's life.

From laboratory tests prescribe clinical blood and urine tests, biochemical and immunological studies, bacteriological examination of discharge from a wound defect for the selection of antibiotic therapy.

Additional instrumental research methods help to clarify the nature of the lesion and outline a program of surgical treatment - this is most relevant for vascular diseases of the lower extremities. Patients are prescribed angiography of the vessels of the arterial and venous bed with the introduction of appropriate contrast agents. If microcirculatory disorders are detected, rheovasography of the vessels of the lower extremities is indicated.

Complications during a trophic ulcer

The progression of a trophic ulcer invariably causes an increase in the area and depth of the necrotic defect, and the ingestion of a pyogenic infection can provoke the development of erysipelas of the skin, lymphangitis, lymphadenitis, and septic complications. Progressive tissue necrosis and penetration into the lesion of anaerobic flora causes gas gangrene, the occurrence of which requires immediate surgical treatment. Very rarely, especially with the long-term existence of a non-healing trophic ulcer, in the treatment of which aggressive substances were used (birch tar, salicylic acid and its derivatives), there is a threat of cell malignancy and the development of skin cancer.

Treatment of trophic ulcers

Treatment of a trophic ulcer of the lower extremities should always be comprehensive and directed not only to the elimination of local manifestations of the pathological process, but also to the elimination of the disease, the progression of which led to the development of a necrotic defect. Systemic exposure improves the conditions of regional blood supply, reduces hypoxia and tissue metabolism disorders. The question of the selection of treatment in each case should be decided by a qualified surgeon, who also determines the need for systemic use of antibiotics. With the development of a pronounced microbial infection, detoxification therapy is carried out - its timely appointment allows you to remove the decay products of microbial cells and significantly improve the patient's condition.

In case of diseases of the veins of the lower extremities, it is necessary to normalize the regime of work and rest, wearing compression underwear recommended by the doctor. Of the general effects, the appointment of venotonics (troxevasin, phlebodia or detralex inside a long course), agents that improve microcirculation (deaggregants) - special forms of aspirin, pentoxifylline, nicotinic acid and its salts are shown.

In the pathology of the arteries, the appointment of a diet that corrects the underlying disease (salt-free for hypertension, hypocholesterol for widespread atherosclerosis) is indicated, a complete exclusion of bad habits that worsen circulatory conditions is recommended. Patients are advised to prevent hypothermia of the feet and select soft and comfortable shoes made from natural materials - this reduces the risk of developing tissue ischemia.

In diabetes mellitus, it is necessary to simultaneously prescribe effective hypoglycemic therapy, correct the blood lipid spectrum, prevent even accidental damage and prescribe the maximum effective drugs to treat existing injuries. Treatment of a trophic ulcer in diabetes mellitus must necessarily begin in a hospital setting - patients need regular dressings, the maximum restriction motor activity, the use of drugs that improve regional blood circulation (peripheral vasodilators, antiplatelet agents, metabolic therapy, including vitamins).

Patients with trophic ulcers are shown the use of non-drug therapy methods - hyperbaric oxygenation in a special pressure chamber, plasmapheresis and blood ultrafiltration, intravascular ultraviolet blood irradiation. When an ulcer is located on the plantar surface of the foot and toes, the use of special splints is shown to improve wound oxygenation and reduce the risk of anaerobic infection; when walking, patients should use a stick or crutches to reduce the load on the wound.

In the local treatment of the wound, it is necessary to conduct a surgical toilet of the wound (dressing), during which the maximum removal of non-viable tissues is carried out, the wound is treated with antiseptic solutions, the use of antibiotics in the form of special powders, creams and ointments. Ointments that improve blood circulation should not be applied directly to the surface of the ulcer.

Traditional medicine

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 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 nutrient and gross metabolic disorders in tissues. The affected area of the skin becomes necrotic, becomes sensitive to any traumatic agents and infection.

provoke the occurrence trophic ulcers on the leg are capable of such risk factors:

Problems of venous circulation:, and so on (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,);
Some systemic diseases ();
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,;
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 frequency, especially at night, the appearance of a burning sensation, "heat", and sometimes itching of the skin of the lower leg. During this period, a network of soft cyanotic veins of small diameter increases in the lower third of the leg. Violet or purple appear on the skin dark spots, which, merging, form an extensive zone of hyperpigmentation.

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

lymphadenitis, lymphangitis;
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.

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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,. Such drug treatment can only be prescribed by a doctor.
Local therapy, with which tissue and skin damage can be cured. 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 have a wound healing effect. The ointment is applied to a compress and whether special dressings are made.
Surgical intervention, which is produced 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 preparations are used:, 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 various 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;
, which include , etc.;
Antiplatelet agents for intravenous injection: and;
: , 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, algipor, 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 dried tartar leaves. 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 used for open ulcers. 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.
Need mix 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 proper therapy, complications such as microbial eczema, erysipelas, periostitis, pyoderma, arthrosis of the ankle joint, etc. can develop. Therefore, use only folk remedies, while neglecting the traditional treatment is not worth it.

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.