Trophic ulcer

A trophic ulcer is a collective name for skin and mucosal defects that occur after tissue rejection and are difficult to heal. In other words, these are ulcers that practically do not heal without special treatment, but only grow and capture all new tissues.

Most often, such pathologies occur in older people with venous insufficiency. At the same time, the movement of blood through the vessels is disturbed due to various diseases. With age, the risk of formation of trophic ulcers increases. After 65 years, in the presence of venous insufficiency, ulcers appear three times more often.

Trophic ulcers most often affect the legs, especially the legs. This is due to the slowing of blood flow in the lower extremities as they are further away from the heart. In addition, gravity contributes to the stagnation of blood.

Trophic ulcers differ depending on the affected vessels. They are:

• venous – against the background of venous insufficiency;
• arterial – against the background of atherosclerosis.

Trophic ulcers are also common in diabetics.

Malnutrition of tissues, stagnation of lymph leads to necrosis of the skin area and the appearance of ulcers. They quickly become infected and begin to fester. At the same time, the healing of such injuries is very poor. For a month of treatment, trophic ulcers are reduced by only 30 – 50%. Complete healing takes up to 4 months. According to statistics, up to 10% of trophic ulcers do not heal even in 5 years.

What is a trophic ulcer

A trophic ulcer is a long-term non-healing wound on the skin that occurs due to a violation of the local blood supply. This disease is of a protracted nature, occurs gradually, and even after healing, periods of exacerbation are possible.

A trophic ulcer differs from a normal wound by a long course, constant recurrences and the inability of tissues to heal completely. Part of the tissue is lost, and a deep scar is formed at the site of the trophic ulcer.

Causes of trophic ulcers

The main reason for the formation of trophic ulcers is varicose veins, or simply varicose veins. This cause accounts for more than 70% of all cases.

Atherosclerosis often impairs blood supply – the formation of cholesterol plaques on the walls of arteries, as well as diabetes. Among the rarer causes of trophic ulcers: burns, severe skin diseases, radiation, bedsores from prolonged immobility.

Due to the constant stagnation of blood, oxygen starvation of tissues develops. Leukocytes are activated – inflammatory cells, red blood cells stick together into “columns” and form microthromboses, fibrin protein enters the surrounding space. This further aggravates the situation and increases the stagnation of blood and lymph.

Gradually, the tissues begin to die, become inflamed. Damaged layers of the skin quickly become infected, which can even lead to sepsis – the spread of bacteria throughout the body.

Symptoms of trophic ulcers

Trophic ulcer develops gradually. At the first stages, a person is concerned about swelling, burning and itching in the affected area. The skin becomes thinner, bluish or dark.

Chills, cramps in the muscles of the legs are possible. Stagnation of lymph leads to the appearance of drops of fluid on the surface of the affected skin. Without treatment, an ulcer gradually opens, which has torn edges and causes severe pain. Almost immediately, an infection penetrates into it, and the ulcer begins to fester.

Trophic ulcer treatment

Trophic ulcers are treated by a phlebologist surgeon. This doctor specializes in diseases of the vessels of the legs.

It is at the initial stage, when the ulcer has not yet festered, that all measures must be taken to stop the process. In the later stages, treatment is much more difficult and less effective.

All treatment will be aimed at preventing infection, improving blood circulation, and eliminating the root cause. The patient is prescribed bed rest, local and systemic antibacterial and anti-inflammatory drugs are prescribed. Also, drugs are required to increase the outflow of blood, lymph, and increase vascular tone.

Often used drugs with heparin, which thins the blood, relieves pain and inflammation. It is also important for the patient to wear special compression underwear – stockings or stockings – to avoid the accumulation of blood and lymph in the extremities.

Diagnostics

The doctor examines the patient and interrogates him. Additional tests are prescribed: a general blood test, blood for sugar separated from the wound, if the ulcer has already opened.

Be sure to examine the veins to find out the root cause of the appearance of a trophic ulcer and the condition of the valves. For this, ultrasound duplex scanning of veins, phlebotonography, radiopaque and radioisotope phlebography and other methods are used. The choice depends on the history and condition of the patient, as well as on which veins you want to examine – superficial or deep.

Modern treatments

Treatment of a trophic ulcer is a long process, and you need to be prepared for this. Since an ulcer is not an independent disease, you first need to eliminate the main cause, or at least reduce its effect on the vessels.

Of the modern methods, special wound dressings are widely used. These are special dressings that perform different tasks depending on the phase of the disease. For example, during an inflammatory process, such a bandage stimulates the rejection of dead tissues, and absorbs toxins and fluid. During the healing phase, the dressing protects the skin from damage and stimulates regeneration.

Apply ultrasonic cavitation of wounds, magnetic and laser therapy, ultraviolet irradiation and ozone therapy. They are prescribed only by a doctor, depending on the stage and extent of the lesion. These methods are aimed at expanding blood vessels and increasing blood flow, relieve swelling and have a bactericidal effect.

If all types of treatment have not helped and the trophic ulcer does not close, they resort to surgical intervention – sclerotherapy.

Prevention of trophic ulcers at home

The best prevention is to prevent blood stasis in the extremities. Methods and loads differ, since much is prohibited in the acute phase. You need to clarify all the preventive measures that are right for you with your doctor.

Gentle sports are needed – hiking, swimming, aqua aerobics. At the same time, the calf muscles contract and help pump the blood of their limbs higher. The patient should not stand or sit for a long time, lift weights, go to the bath and sauna, as this provokes blood stasis. Excess weight complicates the course of the disease, so it must be controlled.

Many are recommended elastic compression underwear, which does not allow the veins to expand even more. You need to wear such underwear while lying down, with the legs elevated.

The doctor prescribes medications to thin the blood and improve its circulation. In diabetes, blood sugar control becomes especially important.

Popular questions and answers

Trophic ulcers are insidious in that they can develop for quite some time. And even after healing, there is a risk of opening the ulcer again, so this problem must be taken very seriously. Answered popular questions from patients phlebologist surgeon Tatyana Abrosimova.