How to treat trophic ulcers on the legs: causes, preparations, treatment methods

An open wound, i.e. an erosive skin defect (usually on the shin or foot) that does not heal for a month or more, is called a trophic ulcer. The skin, as you know, is a protective barrier to the body, and when its nutrition (trophic) is disturbed, this function is leveled. Therefore, the ulcer got its name. Trophy can be violated for a variety of reasons. Determining the development mechanism is extremely important, since treatment depends on it.

Differences from other ulcers

Distinctive features of trophic ulcers:

1. The duration of the lesion and recurrent nature.
2. The defeat occurs not only in breadth, but also in depth, down to the bones.
3. The absence or a sharp decrease in the regeneration processes in ulcer tissues.
4. Cicatricial healing with timely treatment. But this does not mean final recovery. There is no guarantee that the ulcer will not reappear in the future.
5. Spontaneous healing of such ulcers is ruled out.

As early as the beginning of the 20th century, the famous Russian surgeon S. Spasokukotsky said that “leg ulcers are a cross of doctors, it requires diligence and time.” And although more than 100 years have passed after such a conclusion, despite all the new technologies, the treatment of trophic ulcers remains an equally difficult task.

Etiology of trophic ulcers

As a percentage of pathologies:

• consequence of varicose veins - 52% (according to other sources, up to 90%);
• arterial circulation pathology - 14%;
• problems with veins and arteries - 13%;
• consequences of thrombophlebitis - 7%;
• lower limb injuries - 6%;
• complications of diabetes - 5%;
• injuries to the head or spine - 1%;
• unknown reasons - 2%.

Provocateurs:

• burns, frostbite;
• atherosclerosis of the vessels of the legs;
• autoimmune diseases with circulatory disorders;
• traumatic injuries;
• acute and chronic lymphostasis;
• chronic dermatitis.

Localization of trophic ulcers

They are determined by the etiology of the ulcer:

1. With autoimmune diseases - on both legs.
2. Neurotrophic - on the soles and heels, in places of close contact with shoes.
3. Infectious ulcers - multiple or single injuries of the lower leg, their cause is the lack of proper hygiene.
4. Ulcers in diabetes - erosion on the finger, on the heel.
5. Damage to arteries and veins - minor damage to the fingers and foot.

Thus, it is noticeable that a trophic ulcer forms on the legs. Why? Because the legs are farthest from the heart; experience a tremendous load compared to other parts of the body. According to the laws of gravity, blood circulation in the lower extremities is difficult. Ulcers on the arms and trunk, head often appear due to injuries, pressure sores, and not vascular disorders.

Where is trophic foot ulcer treated ? In severe cases of pathology - in a hospital, in vascular surgery. In the absence of complications, most often outpatient treatment, since this process is long.

Classification

Characteristics:

1. Neurotrophic ulcers are deep, crater-like.
2. Pyogenic - oval, shallow.
3. Venous - in the form of purple or purple spots along the veins, which are complemented by swelling, cramps in the legs at night.
4. Hypertonic (Martorell's ulcers) are symmetrical seals that form rarely and slowly against a bluish skin background.
5. Diabetic - deep, large, rapid development, accompanied by a complete loss of sensitivity and intermittent claudication.
6. Atherosclerotic (arterial) - their precursor - “intermittent claudication”, legs cold to the touch, cyanotic, with increased night pain.

Stages of the development of pathology

1. The first stage - the first signs are noted: red spots on the legs, peeling and itching.
2. The second stage - the pathology progresses: dark wounds appear on the site of red spots; they secrete a donut and do not heal. General health may worsen, temperature may rise.
3. The third stage - pus is intensively secreted. The ulcer increases in breadth and in depth, takes a certain regular shape. The pain becomes severe, new lesions occur. If untreated, sepsis may develop.

Characteristic appearance

An experienced doctor in the appearance of an ulcer can distinguish their origin. Which doctor treats trophic ulcers in the legs? This is determined by the etiology of the wounds. First of all, a phlebologist is engaged in this, if necessary, an endocrinologist, a neurologist, an angiosurgeon, a dermatologist, a neurosurgeon can connect.

Varicose ulcer has the following characteristics:

• localized on the lower third of the leg, its front or side;
• big and deep;
• can reach 10 cm in diameter, round or oval;
• painful, with uneven edges and indentations;
• pus and areas of new tissue are visible at the bottom of the wound;
• the skin around the ulcer is stretched, shiny, swollen and pigmented.

Such an ulcer is often complicated by erysipelas.

Atherosclerotic, or arterial ulcer:

• localized on the fingers or lower third of the leg;
• round, the edges are even, clear;
• the bottom is black or gray, with a dry scab; surrounding skin without discoloration, but shiny, without hair;
• the foot is cold to the touch, the pulse is not felt;
• severe pain is noted.

More characteristic of the elderly.

Which doctor treats trophic ulcers in the legs in this case? Angiosurgeon, therapist.

Characteristics of a diabetic ulcer:

• localized on the feet and bone protrusions - at the places of friction of shoes;
• deep, corn edges;
• the bottom is dry, black;
• the skin is warm, but there is no sensitivity.

Signs and symptoms of trophic ulcers

The peculiarity is that the symptoms appear as if suddenly. But still there are initial signs:

• burning and itching in some parts of the legs;
• night leg cramps;
• the appearance of a painful area, and then purple spots, prone to fusion;
• the skin in these places becomes shiny, a mesh of small vessels is visible on it;
• the color of the affected area darkens to dark cherry brown;
• swelling of the legs and soreness;
• in this area, round erosion resembles a volcano crater; it increases and does not heal.

On the periphery of the formation is peeling in the form of flakes of paraffin. Such changes are located along the veins, on the inner part of the leg most often - these are varicose ulcers.

When arteries are damaged, small ulcers appear on the toes or heels, pallor of the skin is observed. The edges of the ulcers are dense, yellow, with a purulent surface, they can cover the entire foot with their growth. With prolonged walking, the patient begins to limp, the leg freezes and hurts.

Neurotrophic ulcers are similar to bedsores, round. More often they form on the heel or sole. There is no particular pain, the inflammation is lethargic.

In a diabetic ulcer, a dry wound or callus first appears on the bony protrusions or the first finger. Then it becomes infected, grows, the sensitivity of the foot is lost, and the gait changes. Gangrene develops due to non-healing of the wound.

If at least one symptom appears, treatment should begin immediately.

Complications

A trophic ulcer always has poor prospects. It may be complicated:

• lymphadenitis and lymphangitis;
• erysipelas;
• gangrene and sepsis;
• skin cancer.

In advanced cases, a fatal outcome is possible.

Treatment: general information

How to treat a trophic ulcer in the legs? It should be noted right away that it does not make sense to treat only an ulcer and not pay attention to its source. Therapy is always long in time.

Treatment should be comprehensive, general systemic and local. The best results are given by early treatment.

The initial stages can be treated conservatively. Surgical treatment is indicated in advanced cases.

Where is trophic foot ulcer treated? Therapy is usually outpatient, home treatment becomes a cruel necessity for the patient. But for most people, especially retirees, the purchase of medicines is virtually unavailable. The drugs are expensive, and the course is long. Therefore, home treatment and often traditional medicine are becoming the most acceptable. But with the correct implementation of all the doctor’s prescriptions at home, you can also achieve results.

How to treat a trophic foot ulcer at home? The circuit is something like this:

• therapy of the underlying disease is necessary;
• daily ulcers;
• wound care and treatment;
• the use of medications prescribed by a doctor;
• control and prevention of new lesions;
• limb immobilization;
• proper nutrition;
• preventative measures.

How to treat a purulent trophic ulcer

How to treat a trophic ulcer in the legs with its purulent character? In this case, usually prescribed:

1. Broad-spectrum antibiotics.
2. NSAIDs that relieve inflammation: Ketoprofen, Diclofenac, Indomethacin, etc.
3. Means against the formation of blood clots: "Pentoxifylline", "Reopoglukin."
4. Sedative and antihistamines: Suprastin, Zodak, etc.
5. Analgesics.

There is no bed rest, but limiting the load on the leg is mandatory. In addition, drug treatment should be supplemented with exercises and physiotherapy, wearing compression underwear.

Wound care

It is not enough to know how to treat trophic ulcers on the legs. The dressing plays a huge role in the healing process.

To do this, you must:

• regular washing of the wound to clean it and destroy germs;
• while air should freely enter the wound;
• ointment application;
• proper bandaging;
• preservation of a certain humidity of the wound for the formation of new tissues;
• the use of means with regenerative and reparative properties.

The dressing should be easy to remove if necessary.

How to treat a trophic ulcer in the leg? The very first rule: it must not be dried. This is harmful because it reduces the flow of oxygen into the wound and prevents the formation of new tissues. A moist microclimate in the wound will give a smaller and stronger scar when healed. But this does not mean that the ulcer can be soaked with dressing.

What is needed to dress a wound?

To do this, you need a flat surface for manipulation - a coffee table is ideal. It is covered with a clean and ironed cloth, a sterile bandage and cotton wool, sterile cotton swabs, cotton buds, a clean linen or cotton towel are laid out on it. Spread scissors, treating them with alcohol, a patch, disinfectants (peroxide, "Furacilin", "Rivanol", "Chlorhexidine"). Bandaging is done once a day.

Purulent and weeping wounds will quickly wet the dressing, so you need to change it as it gets dirty. A stray or dirty dressing also changes.

Wound treatment always has a common algorithm:

1. Carefully cut and remove the old dressing - you need to do this along the surface of the wound.
2. If the gauze does not go away, moisten it with an antiseptic or a decoction of herbs.
3. If bleeding occurs, firmly press a sterile cotton ball to the wound.
4. The skin around the ulcer, starting from its edge, is carefully cleaned with gauze napkins soaked in saline or water with baby soap. Do not wet the wound itself!
5. After cleansing, carefully examine the wound to assess changes in its condition.
6. If an ointment is prescribed, it is squeezed onto a sterile napkin and pressed to the affected area. Powder can be strewed onto the wound itself. Several layers of gauze napkins are placed on top. Wet prescribed wipes in the presence of dry scabs are placed directly on the wound, and on top - dry. Often, the doctor prescribes the application of a rubber sponge from above.
7. The bandage is fixed, preferably with a band-aid. To do this, a long adhesive plaster is applied to the gauze bandage, leaving the ends to fix the tissue.

Hair in the treatment area must be removed.

How to treat a trophic ulcer on the leg from ointments? For treatment, ointments of antiseptics, proteolytics and venotonics are used:

1. Antiseptics: Bioptin, Miramistin, Levomekol.
2. Proteolytics: Iruxol and Protex.
3. Venotonics: Lawton, Hepatrombin and Hepton.

For the treatment of trophic ulcers, heparin-based gels (topically) are also used: Lyoton, Thrombless, Thrombophob.

Compression dressings

How to treat trophic ulcers in the legs with varicose veins at home after further treatment? Varicose trophic ulcers are necessarily bandaged with a compression dressing for better healing. This is a special elastic bandage that creates compression in the morning.

The dressing begins with the toes, gradually rising. The bandage layer should ½ overlap the previous one. Bandage height - to the knee. As you rise, the dressing is less tightened. The foot is fixed at a right angle to the foot. A bandage is not applied to the knee and thigh - there is no curative effect. At night, the bandage is removed.

In the treatment of varicose ulcers, Unna's dressing is used. To do this, you need to have a gelatin-glycerin mixture with the addition of zinc and an elastic bandage.

It is also superimposed from the foot to the knee. The finished mixture is applied to the skin, then a bandage, again the mixture and so on in several layers. Topped with formalin so that the bandage does not stick.

Radical methods

How to treat a trophic ulcer on the leg with its neglect? Surgical intervention is possible. Then there will be no complications.

Under anesthesia, the surgeon removes necrotic tissue, blood clots, excised affected areas. Sutures are not immediately applied, more often the wound is left open.

The second stage is the application of a sterile aseptic dressing. With deep trophic ulcers on the toes, feet, the affected areas are amputated.

Treatment of ulcers in the elderly

How to treat trophic leg ulcers in the elderly at home? The selection of drugs depends on the stage of pathology:

1. In the initial stages, when it is necessary to remove inflammation and clean the wound, Levosin, Levomekol, Solkoseril, Actovegin, Algofin, Vulnuzan, Argosulfan, Sulfargin, Dermazinin are used. They also improve trophy.
2. At the granulation stage - antibacterial and painkillers that regenerate: Vundekhil, Thiotriazolin, Betadine, Methyluracil, Thiotriazolin.
3. At the stage of scarring to accelerate it: "Curiosin", "Mefenat", "Bepanten", etc.

Therapy for diabetes

How and how to treat a trophic ulcer in the legs with diabetes at home? With small sizes of wounds, you can use salicylic ointment, ichthyol, applying the drug to the surface of the wound and covering with a sterile dressing on top. You can pour crushed streptocide. The legs need to be bandaged (how to apply a compression bandage, shown in the photo).

"How to treat a trophic ulcer in the legs with diabetes?" - This question is often asked by people who, for one reason or another, refuse to see a doctor. Often they are recommended balm "Rescuer". Before applying the wound is treated with peroxide.

How to treat wet trophic ulcers in the legs? Well established "Solcoseryl". Ointment has an excellent regenerating effect, anesthetizes.

Ebermin ointment is good for diabetes.

As you know, from the very beginning of treatment, the goal of doctors and the patient is to stop the development of the process and prevent complications. To do this, appoint:

• vascular strengthening therapy;
• means for improving tissue trophism;
• wound cleansing to prevent secondary infection.

In addition, measures are needed to prevent relapse. Feet must be treated with oil solutions of St. John's wort or chamomile.

Physiotherapy

Physiotherapy:

1. It is considered to be very effective UFO - stimulates scarring of wounds. They also use magnetotherapy (dilates blood vessels and enhances blood flow), ultrasonic cavitation at low frequencies is a wonderful antiseptic.
2. The pressure chamber is good for arterial wounds.
3. Laser treatment - anesthetizes.
4. Ozone therapy - cleanses the wound and delivers oxygen to the tissue.
5. For complete recovery after scarring, balneotherapy and mud therapy are indicated.

Wet sores

Soaking trophic ulcers are a typical complication of varicose veins. With extensive wounds, lymphatic fluid in the initial stage is released from the ulcer as an element of the body's defensive reaction. This protects it, cleanses it and prevents it from entering the infection, which indirectly helps to avoid amputation. If untreated, lymph begins to flow continuously, making treatment and healing difficult.

Weeping Wound Treatment

What is the best way to treat weeping trophic ulcers in the legs? The phased treatment coincides with the stages of the ulcer:

1. Wound cleansing.
2. Inflammation of nearby tissues - it is accompanied by an accumulation of pus.
3. The formation of granulations - they are always sluggish and slow.

Primary treatment is no different from that of an ulcer without getting wet, but there are also differences. The task becomes a constant outflow of purulent contents. Otherwise, the accumulation of pus can spread to the surrounding tissue. Then it will be more difficult to treat.

Purulent lesions necessarily expand and drain. The process is painful and requires anesthesia - aerosols "Lidocaine spray" or "Xylocaine" will help. After that, the ulcers are washed with antiseptics - for example, "Dioxidine".

In treatment, proteolytics are widely used - these enzymes increase the rejection of necrotic masses.

Trypsin or chemotrypsin powders are dissolved in saline, blot wipes and applied to the wound. With deep ulcers, the napkin remains in the cavity and changes every 2 days. It can be treated with dry enzymes - they are poured directly onto the wound.

How to treat trophic ulcers in the elderly? Apply a complex of special medicines.

Ointment treatment

What ointment can I treat a trophic ulcer on my leg? Inside the wound, a combined ointment with the antibacterial and wound healing effect "Levosin" is administered. It will also relieve pain and inflammation. When weeping, surgeons against vaseline ointments - they interfere with healing.

Useful for wet ulcers.

In addition to the above drugs, additional treatment is useful:

1. Activtex wipes - possess not only disinfecting, but also antioxidant properties. Ingredients: chlorhexidine, vitamins E and C.
2. Sponge "Meturakol" - the basis is collagen. It fits snugly and absorbs its discharge. It has anti-inflammatory and hemostatic properties, stimulates the growth and formation of granulations.
3. Ointment "Stellanin" - an innovation. It has a complex effect - it improves blood microcirculation, accelerates healing, destroys pathogens, and relieves inflammation.
4. The Proteox-TM dressing on the lower legs is based on natural cellulose. Accelerates healing and disinfects, relieves inflammation and eliminates pus. Contains trypsin and mexidol enzymes.
5. "Branolind N" - made of Peruvian balm. This is a set of breathable sterile dressings with medicinal components.
6. Absorbent dressings - they are dense, sterile and saturated with medicines. At the edges there are clamps that prevent the bandage from sliding down during movements. The components of the fabric are selected in such a proportion that a bandage like a sponge perfectly absorbs the oozing liquid and at the same time maintains a stable moisture balance on the surface. You can recommend “Biaten”, “Cetuvit”, “PAM-T”.

Compression underwear

Wearing it removes the very essence of the problem, strengthening the walls of blood vessels. Due to compression, the stagnation of lymph and blood is stopped. Lymphostasis is normalized and discharge is sharply reduced. The wound begins to dry out.

Collagen hydrogel

How to treat non-healing trophic ulcers in the legs with this remedy? The drug is used for the most complicated forms of weeping ulcers, when other remedies did not give an effect. The hydrogel is applied evenly on the surface of the wound and after 10-15 minutes completely blocks the flow of lymph, providing both anti-inflammatory and wound healing effects. The best proved to be "Emalan" on a collagen basis.

Prevention

For prophylaxis, it is recommended to monitor the condition of the veins, lubricating the skin with ointments that improve blood circulation, and avoid a long stay in a static position.

Do not load your legs. Exercise therapy should be performed regularly - exercises within the bed. Moderate physical activity must be present. It is impossible to prevent hypothermia and overheating, injuries to the legs and feet. Nutrition must be correct. You should stop drinking alcohol and smoking. Wearing compression underwear and the right comfortable shoes is shown.