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Patients visit various specialists, have had many treatment attempts, sometimes surgical operations, and transplants. And when it seems that they have won the fight against the disease, it returns. There is pain again and the wound oozes oozing with an unpleasant smell. And with that, the loss of hope for recovery. We are talking about leg ulcers, a disease that affects nearly 2 percent of people. adult population.
The disease most often develops against the background of hypertension in the venous system, post-thrombotic syndrome and microcirculation disorders that have existed for many years. The problem is more common in older women. But not only. Many people with high blood pressure, arterial disease, obesity, rheumatoid arthritis, diabetes and cancer struggle with leg ulcers. Sometimes the direct cause of the formation may be trauma, burns, frostbite, post-antigenic damage to the skin, bacterial infections or lesions of the nature of allergic contact eczema. Hormonal disorders and smoking are also among the risk factors.
In the first stage of the vein disease, slight telangiectasias and reticular veins appear; then varicose veins and swelling of the lower limbs, which first appear around the ankles, especially in the evening. The next stage is the appearance of itching, skin changes and discoloration as well as eczema of the lower leg with the presence of fibrosis of the skin and subcutaneous tissue, usually on 1/3 of the lower leg. Over time, the limb acquires a bottle-shaped shape, which indicates permanent, advanced tissue damage as a result of hypoxia caused by stagnation. In many people, the disease begins with quite unusual symptoms, in the form of pain, a feeling of heaviness and rapid fatigue of the limbs, as well as tension and tenderness of the lower limbs. Often there are paraesthesia, night cramps and discomfort when standing or sitting for a long time. The first symptom may also be the so-called restless leg syndrome.
Leg ulcers – symptoms
Leg ulcers, i.e. defects in the dermis and subcutaneous tissue, are the final and most severe symptom of trophic disorders resulting from chronic venous insufficiency. The most common location is around 1/3 of the lower part of the shin on the medial side, less often on the lateral or posterior side. As a consequence of deep vein thrombosis, sometimes full-shin ulcers can develop and come in many shapes and sizes. It happens that they cover the entire circumference of the limb. Within the ulcer, necrotic tissue develops, seeping serous or purulent discharge. Pus and necrotic tissue often result from bacterial or fungal infection of the ulcer, which causes burning and stinging. Small ulcers are most painful, especially if they are persistent. It causes limitation of movements in the ankle joint, deformation of the foot, and even permanent disability.
Diagnosis and treatment of venous ulcers
A doctor can make a diagnosis based on the appearance of the limb. The advancement of the changes is assessed on the basis of Doppler ultrasound. If a blood clot is suspected, your doctor may order phlebography. Venous ulcers heal difficult (only about 50% of ulcers heal within four months) and require long-term, sometimes even years of treatment.
In most cases, conservative treatment is used to cleanse the ulcers, that is, remove superficial necrosis, control inflammation and prevent local infection. The mainstay of conservative treatment of venous leg ulcers is also the use of compression therapy (in the form of special compression stockings or bandages), which reduces the pressure of blood remaining in the veins. Compression therapy accelerates the healing of ulcers, and the continuation of compression therapy after healing prevents relapse. Additionally, active dressings of various compositions and indications are used, contributing to the healing of ulcers. Traditional gauze dressings are not recommended as they hinder the healing process and, additionally, they easily soak and adhere to the wound. In addition, changing them is painful, it causes the scab to break off. In the first phase of treatment, dressings are used, which, thanks to their structure and saturation, allow the removal of necrotic tissue and cleaning the wound. An interesting fact is the external larvaseptic used for this purpose in a few centers (with the use of larvae feeding on necrotic tissue). This method is quick, effective and painless. The next stage of healing is the formation of granulation tissue, which fills the tissue defects and acts as a barrier against bacteria. In this case, it is recommended to use a pressure or active dressing, which accelerates the healing process. Modern active dressings accelerate the angiogenesis process, enable gas exchange, provide the right temperature and humidity, absorb exudate and odor, and some of them additionally contain antibiotics or disinfectants. The use of these dressings is possible only after the ulcer has been cleaned and the venous hypertension has been compensated.
When there is inflammation of the subcutaneous tissue around the ulcer and the ulcer is very sore, in addition to antiseptics, the doctor may decide to treat with general antibiotics, medications to improve circulation and painkillers. An important element of the therapy is also the compensation of chronic diseases, including circulatory failure and metabolic diseases. Supportive measures can be used: high-voltage electrostimulation, ultrasounds, laser biostimulation, ozone therapy and magnetic field.
In a situation where these methods do not bring the expected results, especially in the case of large ulcer areas in patients with little mobility, with muscle pump failure (the principle of its operation is to pump blood from the lower parts of the body to the higher parts thanks to the work of the muscles), surgical treatment is considered. excision of the ulcer and covering the wound with an autograft. However, this requires a long period of preparation for the procedure, and is associated with a high risk of infection and recurrence of ulcers.
At the same time, general pharmacological treatment is used. To date, there is no effective agent for reducing venous hypertension, and therefore it is not possible to effectively treat leg ulcers by administering only vascular drugs without the use of other medications and compression. Most of the preparations used improve venous microcirculation and, together with anticoagulants, may constitute an important supplement to compression treatment. The most commonly used drugs in this group include preparations of rutosides, escin, extracts of rusczyk and horse chestnut. Together with pentoxifylline, they are one of the most effective methods of pharmacological treatment.
Prevention of venous insufficiency and ulceration
Ulcer relapse prevention should begin with treatment. It is designed to reduce the risk of developing leg ulcers and to avoid recurrences, the annual frequency of which is 6-15%. To do this, follow a few tips.
- Take care of the correct body weight
- Please wear comfortable shoes
- Stay physically active
- When lying down, both during the day and at night, try to keep your legs 10-20 cm above the level of the heart
- Wear stockings or elastic knee-highs with graded compression force
If you suffer from venous insufficiency, use elastic bandages recommended by your doctor. Cohesive bandages give little pressure while resting, while significantly supporting the action of the muscle pump when walking. These bandages are intended for people who have had the first phlebitis or thrombosis, without limb swelling, and who lead an active lifestyle. Adhesive bandages are recommended for people with edema, overweight, sedentary lifestyle. It is possible to combine two types of bandages on the same patient depending on the season and the state of health.