Types of sores on the legs. Leg ulcers photo causes the initial stage

Integrity disorders are called trophic ulcers. skin or mucous membranes arising from insufficient blood circulation of epithelial cells and their gradual death. They are located mainly on the legs (in the lower parts), but they are also found in other places.

The main difference between such wounds on the legs is long-term healing, which in most cases is impossible without medical intervention. Often, ulcers do not heal for more than 60 days, inflammation and swelling of the skin continually intensify and require prompt treatment. This material will tell you how to treat trophic ulcers of the lower extremities, about their types and characteristics.

What it is?

A trophic ulcer of the lower limb is a defect in the skin and mucous surface that appears after the destruction of surface tissues. Intense destruction can be triggered by impaired blood flow, infection, and other factors. After that, in the patient's vessels, the development of the disease is observed, which spreads, as a result, treatment becomes difficult.

Trophic ulcer differs from other diseases:

• long-term (up to 1 month or more) recurrent nature;
• the spread of the lesion not only along the surface of the skin, but also deep into the tissues up to the bones;
• loss of the ability to regenerate in the damaged area;
• healing occurs with the formation of a rough scar.

Timely treatment of a trophic ulcer leads to scarring. However, not a single patient is immune from the reappearance of trophic ulcerations on the legs in the future.

Causes of occurrence

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

The most common causes of trophic ulcers:

1. Thermal injuries - frostbite or burns;
2. Diabetes mellitus and its complications;
3. Chronic, including allergic;
4. arteries of various sizes on the lower extremities;
5. Chronic diseases of the veins of the lower extremities - varicose veins, thrombophlebitis and its consequences;
6. Anatomical and inflammatory diseases lymphatic vessels - acute and chronic;
7. Injuries to the nerve trunks with subsequent violation of the integrity;
8. Autoimmune diseases connective tissue accompanied by systemic impairment of blood flow in the arterial, microcirculatory and venous bed, including antiphospholipid syndrome.

Usually, two processes are of equal importance in the formation of a trophic ulcer - 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 formation of a future ulcer.

See photos

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Symptoms

The danger of the disease is that the symptoms that help diagnose a trophic ulcer appear suddenly. Still, there are signs in the form of the presence of swelling, heaviness and pain in the extremities, against the background of which symptoms arise, which determine the onset of the development of a trophic ulcer.

In the list of signs that indicate the possibility of the onset of the development of a trophic ulcer, the main ones should be highlighted:

1. Itching, heat and burning in the areas of the skin.
2. Convulsions that occur during sleep.
3. The appearance of the epidermis, which is accompanied by soreness.
4. The presence of spots of a purple hue, which can be reunited during the growth process.
5. External change in the skin: rough areas with a glossy surface appear.

The listed signs appear in the area of ​​the veins, on the inner part of the lower leg. This is due to the fact that the development of the disease begins precisely from the zones where the veins are located, where it manifests itself in the form of the formation of small ulcers. In shape, the ulcer resembles a volcano crater, with torn edges along its entire roundness, with possible suppuration at the ends, as a result of inflammatory processes. The defeat of the arteries, namely, they are primarily exposed to inflammatory processes and destruction of integrity, is determined by the following criteria:

• The appearance of small ulcers on the toes.
• Paleness of the epidermis.

Neurotrophic ulcers appearance resemble bedsores that are round in shape. The place of their location is most often the heel zone or the sole of the foot. Inflammatory processes are sluggish and do not bother with special pains. Autoimmune lesions are expressed in the symmetry of the location on both limbs; in diabetes mellitus, ulcers appear on the heel and one of the fingers.

Classification

Characteristic features of development different types trophic ulcers:

1. Neurotrophic ulcers - have the shape of a deep crater;
2. Pyogenic ulcers are shallow, oval in shape;
3. Venous ulcers - night cramps, swelling and heaviness of the legs, purple / purple spots along the veins;
4. Hypertensive ulcers (Martorella) - quite rare, symmetrical seals form slowly against a red-cyanotic background;
5. Diabetic ulcer - loss of sensitivity, night pains, there is no symptom of "intermittent claudication", very deep wounds of a large area develop rapidly;
6. Atherosclerotic ulcers - preceded by "intermittent claudication" (difficulty climbing stairs), constant coldness of the legs, increased pain at night.

Stages of ulcer development

Trophic ulcers are formed in several stages:

1. The first stage of the formation of pathology. The patient has an initial symptomatology - red spots on the lower extremities, which are intensely peeling. Gradually, the spots begin to provoke itching and discomfort.
2. The second stage of the progression of pathology. Instead of red spots, the patient develops wounds that have a dark tint. On the surface of the wounds, an ichor is visible, which slows down healing. The patient begins to complain of a deterioration in health, elevated temperature body and fever. Intoxication can also be diagnosed.
3. The third stage of the defeat. From the wounds, pus begins to vigorously secrete. The lesion increases in size and becomes of the correct shape. Ulcers also progress to the depths of the leg, causing severe pain. The patient develops new lesions.

If you do not start treatment, then this situation can provoke sepsis.

What does a trophic ulcer look like: photo

The photo below shows how the disease manifests itself in the initial and advanced stages.

Click to view

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How to treat a trophic ulcer?

The earlier a full-fledged (both local and systemic) treatment is started, the better the result will be achieved, and the body will be exposed to less risk. Shallow ulcerative skin defects in the initial stage are treated conservatively, surgical intervention in this case it is not advisable.

How to treat trophic ulcers, and what drugs to use - only a phlebologist decides. Self-administered local treatment can result in the healing of a single ulcer, but does not exclude the appearance of new wounds. Only prescribed by a doctor local impact and systemic therapy of the underlying disease will prevent the deepening of the ulcerative process and minimize the chances of relapse.

With an open, not yet scarring wound, the following means are used:

• NSAIDs to relieve inflammation and soreness;
• Antibiotics - capsules, tablets, and in case of severe disease - intramuscular injections;
• Antihistamines - Suprastin, Ksizal, Tavegil - to eliminate allergic reaction;
• Drugs that reduce blood viscosity - antiplatelet agents - for the prevention of blood clots;
• Antiseptic solutions or medicinal herbs for daily washing of the ulcer.

Unna's dressing is often used to treat ulcers. This requires a gelatin-glycerin mixture with the addition of zinc and an elastic bandage.

• The bandage should be applied to the lower leg from the foot to the knee.
• A ready-made mixture is applied to the skin, then wrapped with 1 layer of bandage, and re-covered with the mixture already on top of the bandage. Do the same with other layers.
• After 10 minutes, the dressing should be lubricated with formalin to get rid of the stickiness.
• You can walk after 3 hours. After 1.5 months, the ulcers heal.

Of the ointments for treatment, it is necessary to use antiseptics, proteolytics and venotonics.

• The first includes: Bioptin, Miramistin, Levomekol.
• To the second group: Iruksol and Protex - TM.
• The group of venotonics includes: Lawton, Hepatrombin and Hepton.

For the treatment of trophic ulcers, heparin-based topical gels are used. The enzymes that make up the gels are insignificant, so they do not cause allergies and side effects... The more heparin is in the gel, the better effect... These gels include:

• Lyoton;
• Trombless;
• Thrombophobe.

To start treatment with a patch, you need to prepare it:

• 20 g of combustible sulfur;
• two medium onion heads;
• 80 g wax;
• 20g of spruce resin;
• 60 g butter.

Mix everything thoroughly to get one thick mass. Apply the mixture to a linen cloth and apply to a sore spot, fix with a bandage. Withdraw after 2 days.

In addition to this, physiotherapy procedures will significantly increase the rate of healing of ulcers:

1. Exposure to magnets dilates blood vessels and increases blood flow;
2. Sunbathing (ultraviolet lamp);
3. The method of influencing the ulcer by ultrasonic cavitation, operating at low frequencies, has an antiseptic effect;
4. Procedures in a pressure chamber give an excellent effect in the treatment of arterial wounds;
5. Laser treatment of ulcers is relative new method, which allows you to significantly reduce pain;
6. Ozone therapy cleans the wound from bacteria and dead cells, saturates living tissues with oxygen, and is well tolerated by all patients.
7. For complete recovery, balneotherapy and mud therapy are recommended.

Compression bandages in the treatment of trophic ulcers

At all stages of treatment, elastic compression must be performed. Most often it is a bandage of several layers of elastic bandages of limited elongation, which must be changed daily. This type of compression is used for open ulcers of venous origin. Compression significantly reduces swelling and diameter of veins, improves blood circulation in the lower extremities and the functioning of the lymphatic drainage system.

One of the progressive compression systems for the treatment of venous trophic ulcers is Saphena Med UCV. It uses a pair of elastic stockings instead of bandages. For the treatment of ulcers with varicose veins, it is recommended to use permanent elastic compression using medical jersey "Sigvaris" or "Medi", compression class II or III. For intermittent compression in pyogenic, stagnant and other types, you can use special compression dressings called "Unna boot" on a zinc-gelatin base or "Air Cast boot".

Bandaging and applying a compression bandage

Folk remedies

A list of some popular recipes, they can additionally help in the treatment of ulcers at home:

1. This happened even before the revolution. A 6-year-old girl has all the legs covered with ulcers and abscesses. She lay and cried day and night. Once a passer-by entered the hut, examined the wounds and said what to do. It is necessary to take 3 handfuls of dope and nettle and steam them in 5 liters of boiling water. Then dilute in a barrel with water so that the water level reaches the girl's groin. Keep the child in a warm broth for 30-40 minutes. The parents did so, at first the girl screamed as if she had been dipped in boiling water. After the procedure, she fell asleep and slept peacefully for 24 hours. Three procedures were enough for a complete cure. (HLS 2004, No. 23, p. 30).
2. Take 4 toasted hazel kernels, grind into powder on a coffee grinder. Boil 2 eggs hard, take out the yolks, dry them and grind them into powder in a hot frying pan (clean without fat). Mix and grind the yolks and kernels, add 1 coffee spoon of yellow iodoform powder. Clean the trophic ulcer from necrotic layers with hydrogen peroxide, then apply a thin layer of the mixture, do not bandage for 1.5 hours. Then cover with a sterile napkin and bandage for two days. (HLS 2003, No. 6, p. 15, from a conversation with Klara Doronina).
3. Cauterize a clean wound with alcohol tincture of propolis or ordinary vodka. And then apply Vishnevsky ointment, which includes birch tar. Ichthyol ointment can be used, which has similar properties.
4. The woman in the background diabetes mellitus trophic ulcers on the legs opened. For 4 months she almost did not sleep, experiencing either terrible pains or impossible itching. She went around many medical institutions, was treated with various means that doctors prescribed to her, but the ulcers on the legs did not heal. A friend advised her to read the "Healthy Lifestyle Bulletin", write folk recipes and pay special attention to treatment with the ASD fraction. I decided to treat the ulcers with this remedy, as a result, the pains stopped almost immediately, and after two weeks the ulcers began to heal. (2010, No. 13, pp. 22-23).
5. Propolis based ointment goose fat... Take 100 g of goose fat and 30 g of chopped propolis. Cook in a water bath for 15 minutes. Put the ointment in the pronounced hole. Cover with compress paper and bandage. This ointment can be prepared for butter or interior pork fat.
6. Once a patient was brought to the hospital from the department of medical and social assistance on a stretcher, he had three trophic ulcers of the lower leg, he lived alone and suffered from alcoholism, looked like a homeless person, he was washed, began to heal, his condition improved, but the wounds were not in the legs. The doctor who treated the patient found in the literature a method of treatment with solidol. The man was treated with hydrogen peroxide ulcers and bandaged with solidol for two days. Gradually, the wounds cleared and began to heal. The patient began to walk. (2008, No. 8, p. 19).
7. Powder from dried tartar leaves. Rinse the wound with rivanol solution. Sprinkle with prepared powder. Apply a bandage. In the morning of the next day, sprinkle with powder again, but do not rinse the wound before that. Soon, the ulcer will begin to heal.

Treatment of diseases of the lower extremities folk remedies Is a long and laborious process. Recovery occurs only with regular treatment of the affected skin areas, adherence to the diet, correct image life. The folk remedies used must also be prescribed by the attending physician. Self-medication can lead to complications.

Surgery

If the condition is neglected or it is not possible to slow down the development of the ulcer, surgical interventions are effective. In each case, an individual operation plan is drawn up. But the general meaning of the intervention is as follows:

• Remove dead tissue;
• Provide the fastest possible removal of the discharge;
• Activate and create conditions for natural healing.
• With deep trophic ulcers on the toes and feet, they are amputated to prevent the development of gangrene and blood poisoning.

A separate group of interventions is the elimination of cosmetic defects left after trophic ulcers. Transplantation of healthy skin (for example, from the patient's buttocks), scar resurfacing can be performed.

Complications of a trophic ulcer

As already mentioned, the ulcer is not terrible in itself. Its complications are much worse. Among which:

1. Gangrene.
2. Sepsis (blood poisoning).
3. Osteomyelitis (purulent lesion of the periosteum and bone).
4. Death.

To prevent this from happening, trophic ulcers should be treated in time.

Prophylaxis

Any disease is easier to prevent than to cure; this is especially true for a trophic ulcer. For prevention, it is recommended to closely monitor the condition of the veins, periodically apply gels and ointments that improve blood circulation, and avoid prolonged standing or sitting.

If circulatory problems are detected, it is necessary to regularly perform exercise therapy and do not neglect medical examinations. It's also important to remember that self-medication can be fatal.

A trophic ulcer on the legs appears as a result of diseases associated with metabolic disorders in the body. Pathology often occurs with varicose veins of the lower extremities, diabetic disease. The disease creates a lot of inconvenience to patients, appears in the form of non-healing ulcers of the lower extremities on the feet and heel. Leg ulcers do not heal for a long time, blood stagnates in the affected areas. The affected areas of the lower extremities become a place of concentration of bacteria.

The disease is more common in older people, among young people it also happens. Foot and heel ulcers do not appear by accident. A common cause of the occurrence is associated with a high load on the lower extremities. As a result, the blood flow of the foot is disturbed, and the blood vessels in the leg are blocked.

Trophic ulcers are more often provoked by the listed reasons:

• varicose veins;
• arthritis;
• eczema;
• dermatitis;
• past foot injuries;
• burns;
• atherosclerosis;
• diabetic disease;
• with thrombophlebitis.

Symptoms can come on suddenly. The formation of non-healing leg ulcers is preceded by suppuration, cramps, severe swelling of the legs, internal burning sensation in the area of ​​the foot, blue skin, bloody or purulent discharge from the lower extremities and ulcers caused by diabetic disease, or with thrombophlebitis.

To eliminate the disease, medication is often used, or they wield a laser, the ASD fraction - a drug that accelerates the processes of skin regeneration. Sometimes surgery is required to correct the disease on the leg.

It is possible to cure the disease at home, if it is present - the initial stage of the disease. The indicated stage is treated with the help of ointments, folk remedies, for example, propolis. It is acceptable to use medications, compresses, lotions, sterile napkins and dressings: activetex, waxopran or proteox, stellanin ointment. Any doctor will tell you that leg ulcers need to be treated with medication. Situations when drugs lead to complications are described. An example of this is people suffering from diabetic disease, when it is difficult to determine the course of treatment.

A sufficient number of methods are known by which the disease can be cured at home. How the trophic ulcer of the lower extremities is treated at home is described in the article.

Treatment with honey

Mix equal amounts of honey and egg white... Instead of honey, it is permissible to use propolis. Beat the mixture well, apply on the feet or on sore veins.

Then the leg needs to be wrapped reverse side burdock leaf, cover the ankle and foot with cellophane film on top, bandage tightly with an elastic bandage. It is better to leave the compress overnight, after sleep, wash your leg with water at room temperature, or clean the damaged surface with a Proteox cleaning cloth, Activetex dressings or waxed. Any sterile dressing will do. At the end of the procedure, it is advisable to lubricate the legs with stellanin ointment.

Compress on the legs should be done for a week. The treatment of the lower extremities can be completed if the ulcers become crusted and heal later.

Treatment with peroxide and streptocide

In places where non-healing leg ulcers form, it is permissible to apply a solution of hydrogen peroxide. After application, the wounds should dry out. Then the feet are sprinkled with streptocide. Over the wound, apply a clean cloth soaked in chilled boiled water. Instead of a cloth, it is possible to use sterile wipes or a bandage. Then the place of the ulcer on the leg is covered with polyethylene. Wrap the leg with a woolen cloth. At the end of the procedure, the feet are processed using the mentioned means - activetex, waxed. A sterile Proteox napkin is used for the same purpose. It is required to apply stellanin to the site of the ulcer, but on a clean surface of the leg.

Advice: the described compress on the legs is allowed to be done up to twice a day.

Elimination of ulcer pathology with vegetable oil and yolk

To make an ointment, you need a boiled egg. The yolk must be separated from the protein, mixed with vegetable unrefined oil.

Place the resulting mixture in a frying pan, lightly fry. Then squeeze moisture out of the mass using a napkin or cotton cloth. After squeezing, a healing ointment is formed, which must be applied to the area of ​​the foot or ankle affected by the ulcer. At the end of the procedure, stellanin is used.

Then a Kalanchoe leaf is placed on the leg. Previously, the sheet is shown to be poured with boiling water, then freed from the film. The product should be smeared on the surface of the leg at least twice a day. The first procedure is recommended in the morning, the second one - before bedtime.

Tip: the feet should be treated with a peroxide solution. Additional cleaning agents are Activetex, waxed. Excess ointment is removed with a proteox napkin.

Treatment with a golden mustache

Rinse the leaves of the plant in warm boiled water, cut into small pieces.

Place the chopped leaves in an enamel saucepan and knead with a wooden spoon. Knead until juice forms. The resulting mixture is applied with a napkin to the wounds on the legs, then a sterile bandage is tied around the leg.

The procedure is done before bedtime. If the compress is done systematically, a positive result will come quickly. Before applying the mixture, the feet are treated with a napkin.

Treatment of pathology with apple cider vinegar

It is possible to cure the disease of the lower extremities using the vinegar method. Pour apple cider vinegar over four heads of garlic. To enhance the effect, it is permissible to use propolis. Close the product with a stopper, hold for fourteen days. After preparing the infusion, the liquid is used to heal weeping ulcers on the legs, the agent has a drying effect.

Take a sterile tissue, wet it with the resulting solution. Now we wrap the leg with a sterile bandage, leave the compress overnight.

The listed methods of treating such defects on the leg contribute to the drying out and further disappearance of the defects.

Remember, it takes an extremely long time to heal. This is especially true for patients with diabetic disease. The procedures prescribed by the doctor must be carried out systematically. To achieve a positive result of the lotion, it is undesirable to skip or ignore the compresses. After the procedures, the feet are freed from ointments and other remedies... Activetex, waxed, proteox napkin, hydrogen peroxide are agents that should not be neglected. Stellanin helps to eliminate ulcers.

Why do leg ulcers appear

A trophic ulcer on the leg is not able to appear independently. Usually, the defeat is a consequence of the disease. In order to find out the causes of the underlying disease, it is important that the doctor makes an accurate diagnosis. If the disease is started, you need to be treated in a hospital.

Sometimes radical methods of treatment are required. For example, the mentioned surgery on the leg, laser treatment. In mild forms, the doctor has the right to prescribe stellanin. The ASD faction is used to fight infections. If the patient cannot walk, they call a phlebologist at home. After the conclusion of the doctor, they begin to treat the disease at home.

Elimination of pathology with sterile wipes

In the treatment of pathology, sterility must be observed. Special sterile wipes have been created, which are widely used to remove ointments. Known new generation products used for this purpose are activetex, waxopran, proteox. Numerous positive reviews and effectiveness give reason to consider drugs in an efficient way elimination of the disease.

Activetex is a relatively new dressing agent. It is used for the purpose of sterilizing the affected areas in case of injury to the skin, with other damage.

Usually, treatment is carried out in two stages. Activex HF will help remove the tumor, relieve redness, it is prescribed at first. At the second stage, Activetex is used, where there is an inscription on the package - CHVIT. Wipes are used until the wounds are completely healed.

Voskopran is a dressing widely used in the treatment of trophic ulcers. Voskopran is an antibacterial agent. It is used to protect the damaged area from secondary infection.

Proteox is a napkin designed specifically for the treatment of ulcers, including trophic. Cleans wounds from pus, creates conditions for healing. Proteox wipes need to be changed no more than once a day.

Where to start treatment

Front self-treatment the disease will need to take into account the appointments prescribed by the doctor. Home treatment regimen:

1. Wounds on the leg should be treated daily, cleaned of dead fragments with a napkin dipped in hydrogen peroxide. Then panthenol or other drugs that promote rapid healing are applied to the affected area. Activetex, waxed, sterile proteox dressing is used for the specified purpose. To alleviate the suffering of the patient, it is possible to use stellanin ointment.
2. Keep a moist environment around the affected area to prevent hardening.
3. To reduce puffiness, use a variety of lotions, compresses, stellanin ointment. It is permissible to use folk methods: sage, chamomile, calendula and other herbs with antiseptic properties.
4. To increase blood flow, drugs are used that enhance blood microcirculation, for example, stellanin. Prescribed exclusively by a doctor.
5. For patients with atrophic ulcers, bed rest is indicated.
6. Regular compresses are made, Activetex or wax is applied, a sterile proteox dressing, stellanin ointment. To eliminate congestion, an elastic bandage is used.

Treatment of pathology in diabetes mellitus

Trophic ulcers are extremely difficult to cure. If the lesions are caused by a diabetic disease, they can disappear and appear at times in unexpected ways. With diabetes mellitus, it is especially difficult to eliminate the symptoms of the disease. The explanation is logical - in patients with diabetic disease, the natural process of blood clotting is disrupted.

It is difficult for diabetics to find drugs that help tissue regeneration. In severe cases of diabetic disease, the ulcer can reach the bone. provides clear instructions issued by the doctor, impeccable implementation by the patient.

A trophic ulcer resulting from suppuration provoked by a diabetic disease is much more difficult to prevent. People with the disease need to avoid stagnation and wear comfortable shoes. The seriously ill should avoid any kind of injury. If not everyone succeeds in getting rid of congestion in diabetes, a person attentive to health will be able to avoid stupid injuries.

Do I need to follow a diet for trophic ulcer

The diet consists in the use of foods that restore the protective functions of the body. Vitamins E, C, A accelerate tissue regeneration. It is useful to use carrots, nuts, vegetable oil, dairy products and preparations containing these substances.

It is advisable to include dishes from pumpkin, yolks, tomatoes, fish caviar in the diet. The listed products contain substances that increase immunity. It is recommended to eat seafood, seeds, white lean meat.

Diet for pathology involves the use of foods in small quantities. Split meals are encouraged to help stabilize blood sugar levels. The diet becomes especially useful for people suffering from diabetic disease. It is important that breakfasts, lunches and dinners start at the set times.

Patients should clearly understand - to stabilize the immune system, to avoid clogging of the veins will work only if correct reception food. With the onset of the disease, nutrition changes, but as a result of adherence to the diet, positive dynamics are felt soon.

To provide the body with the necessary elements, it is possible to use herbal preparations that contribute to the elimination of pathology. Argosulfan and stellanin are distinguished among medicinal creams. Instructions for the use of argosulfan, which require mandatory familiarization before using the drug, shows the cons and advantages of the medication. The downside is the presence of multiple contraindications associated with kidney disease and other pathologies. The recognition of the substance as an antibacterial agent is recognized as a positive factor, which causes fast healing ulcers.

Often a trophic ulcer is treated with folk methods treatments that become for many the main hope for a successful recovery. Especially when lost last hope get rid of sores with medicinal ointments, gels. In any case, before using traditional methods, you need to consult a doctor.

Tips from traditional healers:

1. Cakes made from rye flour help relieve inflammation and swelling of the legs. A spoonful of honey is mixed with yolk, aloe juice and flour. Add as much as needed to knead the dough. The resulting layer is placed not on the affected area, but around. Then the place is covered with cellophane and left overnight.
2. An onion-based gauze dressing helps relieve inflammation. An onion is taken, chopped in a blender. The mixture should be mixed with powdered willow bark and calendula flowers. The mass is poured hot water to a mushy consistency. Then you need to add a little honey to the mixture, dip the gauze bandage. The gauze cloth will be replaced with sterile wipes. The bandage is applied to the affected surfaces for an hour.

Prevention methods

Preventive methods are primarily aimed at eliminating chronic diseases. For example, with a diabetic disease, you must first carry out therapeutic methods of treatment associated with the disease that provoked the appearance of the ulcer. It is considered a big mistake of patients to ignore the disease. A lot of people perceive ulcers as cosmetic defect... They decide to start seriously after the appearance of complications. Long time people are not able to think that a slight blue discoloration of the skin indicates the progression of the disease.

If the treatment is successful, you need to monitor the state of the vessels. Places of scars from trophic ulcers are periodically wiped with oil based on calendula and chamomile. The oil is distinguished by its regenerating properties, chamomile with calendula plays the role of antiseptics. Stellanin is acceptable. You need to use the drugs prescribed by your doctor.

With varicose veins, heavy physical labor is strictly contraindicated. Patients should not lift weights, sit still for a long time.

Promote increased blood flow special means: compression tights, leggings, knee pads, elastic bandages.

To prevent trophic ulcers of the lower extremities on the leg, you need to take care of your health, do not overcool, do not smoke, do not drink alcohol. Patients should refuse food containing cholesterol, follow the doctor's recommendations.

Excessive stress on the legs must be avoided. Physiotherapy exercises are useful for people with pathology. To this end, it is important to select exercises that improve the elasticity of blood vessels, strengthen the feet and protect patients from new relapses.

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

General symptoms of a trophic ulcer

Sores on the legs, which are a trophic ulcer, are quite difficult to recognize at an early stage. For example, if a person spends all day on his feet, then he takes fatigue of the lower extremities and pulling pain as normal. Redness, a small patch of white skin, or swelling is noticed - due to an insect bite or allergy. At the same time, the bulk of the population begins to think: how to smear sores on the legs in order to eliminate the aesthetic defect? Brilliant green, alcohol, ointment and much more are used, which only leads to an aggravation of the disease.

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

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

Sores on the legs with diabetes

Patients with diabetes mellitus over time begin to notice sores on the legs - the skin is rough and noticeably flaky. Hair becomes dull, palms and soles become covered with cracks and calluses, and the skin becomes yellowish. Nails can also become deformed and thickened.

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

Skin lesions can be avoided through strict adherence to the rules. hygiene care... The use of conventional cosmetics should be minimized, as, for example, exposure to toilet soaps can reduce the acidity of the skin and its ability to resist microbes. Use a pH neutral soap to wash your hands, feet and wash your face. You can use cosmetic milk or water lotion to cleanse your face.

Types of ulcers

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

Ulcers are:

• arterial;
• venous;
• pyogenic;
• diabetic;
• neurotrophic.

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

The main causes of leg ulcers

The causes of ulcers can be arterial insufficiency, diabetes and other factors.

With regard to diseases, the appearance of ulcers can be caused by varicose veins, thrombosis, failure of perforating veins. These diseases lead to stagnation of blood in the veins, tissue malnutrition and destruction.

Arterial insufficiency can lead to ulcers due to Mönckeberg's arteriosclerosis. In addition, the cause of the development of trophic ulcers may lurk:

1. In various infections:

• fungal (coccidioidosis, sporotrichosis, etc.);
• bacterial (ecthyma, boils, etc.);
• protozoal (leishmaniasis).

2. In metabolic disorders:

• Gaucher disease;
• calcification of the skin;
• gout;
• diabetes mellitus;
• bullous pemphiogoid, etc.

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

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

How to recognize a leg ulcer?

The process of ulceration is difficult to miss, since the symptoms are quite obvious. It all starts with the appearance of burning, itching and redness, as well as a slight roughness to the touch.

Have spots on your feet? There is no need to wait for peeling of the skin and the appearance of wounds that do not heal for a long time, it is better to immediately consult a doctor, since if you leave the ailment unattended and start it, it can "hook" the muscles and even the periosteum.

Prevention of the appearance of a trophic ulcer

A person suffering from varicose veins or another condition that increases the likelihood of leg ulcers should follow these guidelines:

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

Venous leg ulcers

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

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

The site of the venous ulcer is usually inner side feet just above the ankle.

Factors provoking venous ulcer

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

• a healed ulcer that has damaged the venous system;
• fracture or any other injury;
• a blood clot in a deep vein;
• surgical intervention;
• working conditions under which a person sits or stands for an extended period of time;
• deep vein inflammation;
• pregnancy;
• overweight.

How to cure leg ulcers?

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

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

The beneficial effect can be achieved through vascular surgery. New leg artery implantation, or balloon angioplasty, is a procedure that widens a narrowed artery and removes a blockage in it.

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

Home treatment

The basic rules for the treatment of trophic ulcers include:

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

Several recipes for the treatment of trophic ulcers:

• The Tatar has proved to be quite good. Dry leaves must be ground to a state of dust, and then sieved, put in a jar and placed in a dark place. After treating the wound with some pharmacy remedy(for example, "Rivanol") you need to blow powder on it and fix it with a bandage. The result is that the ulcer dries up, and the resulting crust disappears over time.
• Means based on curd whey. You must first make curdled milk from homemade milk, then pour the resulting product into cheesecloth and hang. It is recommended to use serum to lubricate the ulcer, and curd to apply it to the affected area.
• Streptomycin. A few crushed tablets can not only relieve pain, but also quickly heal the wound.

What is lower limb edema?

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

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

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

Causes of edema

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

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

Causes of skin rashes

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

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

You can get rid of it by revising your own diet. Avoiding spicy, smoked and fried foods can significantly refresh skin color and improve skin condition. A dry sore on your leg will go away much faster if you do not scratch it.

A bright pink rash can be triggered by a vitamin deficiency. In this situation, it is recommended to drink plenty of fluids, proper nutrition (plenty of fresh fruits and vegetables) and bed rest.

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

Do the sores on your legs go away? The damaged area of ​​the body will heal much faster if it is carefully treated immediately after the injury has been received. Particularly difficult cases require qualified assistance from medical professionals who will suture if necessary and help the victim with valuable advice and useful advice.

If qualified specialist is not nearby, it is recommended to use any antiseptic agents that are at hand to treat the damaged area of ​​the body: brilliant green, iodine, hydrogen peroxide, etc. After treatment, the wound should be covered with a temporary sterile bandage. You need to bandage the damaged areas at least 2 times a day and remember that you need to use different means to treat wet and dry wounds.

External manifestations of a trophic ulcer at the initial stage

A trophic ulcer is a limited lesion of the skin, in which its outer surface is damaged. With these violations, defects occur - small wounds that gradually begin to bleed. The main cause of the disease is tissue malnutrition, which is why the term "trophic" is used. Outer layer begins to be rejected by the body, forming inflammation, and after healing, scars remain. Consider what a trophic ulcer is, what are the methods for diagnosing and treating the disease.

Etiology

A trophic ulcer on the leg occurs due to a malnutrition of tissues - with a disorder of local blood circulation. If healthy person each cell receives a sufficient amount of products for life, then with a decrease in blood flow, oxygen deficiency occurs. Also, decay products accumulate in the intercellular space, which have a destructive effect.

The main causes of trophic ulcers include:

• In the first place in their education is - this disease forms stagnation of the veins of the lower extremities, which prevents the flow of a new portion of blood. Gradually, in certain areas, cells of the outer, and later - of the inner layers begin to die off;
• Postthrombophlebic syndrome - the mechanism of development is similar to the previous one, but with PTFS, the cause of stagnation in the veins is a clot that clogs the lumen of the vessel;
• - leads to the formation when, against the background of a reduced outflow of blood, cells located along the veins are damaged;
• - pathology is accompanied by the formation of plaques on inner wall arteries. As a result, the flow of arterial blood is blocked, trophic disorders occur. Sometimes atherosclerotic lesions of the veins are detected;
• Some genetic diseases - there are varieties of pathologies accompanied by arterial hypertension, adversely affecting blood vessels. Deformities of arteries or veins are often detected, leading to a slowdown in blood flow;
• Heart disease - many variants of defects and functional abnormalities are complicated by edema in the legs and the development of trophic changes in the skin;
• Infection - some types of microbial pathogens (viruses, bacteria, fungi) that affect the state of the vascular wall and blood clotting can also be a trigger mechanism;
• Pathologies of the lymphatic system - accompanied by disorders of the immune system, after which the body's defenses decrease and ulcers can form on the legs;
• Damage nervous tissue- the brain and spinal cord, as well as nerve trunks regulate the activity of blood vessels. When they are damaged by microorganisms, as well as with some injuries, the innervation of the arteries and veins is disrupted, which gradually leads to local trophic disorders;
• Damage to the pancreas - can cause illness, as it often occurs with damage to the skin and blood vessels. Gradually arise;
• Allergy - in such conditions, its own immunity attacks the cells of the skin, causing their death and rejection by the body;

• Burns and frostbite - if areas of the skin are exposed to strong thermal effects, tissue death gradually occurs, followed by the formation of trophic ulcers;
• Oncology - often tumors lead to systemic disorders, which are complicated by circulatory disorders and the formation of blood clots. If the neoplasm compresses the vessel, ischemia gradually develops, which is one of the triggers of skin damage.

All of these reasons lead to ulceration in two ways - by affecting the blood flow or the condition of the blood. Some pathologies lead to both types of disorders - in this case, the clinical course of the ulcer will be more severe.

On a note!

It is highly undesirable to swim in the sea and wet the area of ​​damage - water plays the role of an irritant and makes the wound less protected against infection.

Clinicians identify risk groups that can provoke the appearance of leg ulcers:

• People suffering from varicose veins - according to statistics in 70% of cases this pathology accompanied by trophic disorders;
• Wearing tight shoes - constricts blood vessels and impedes blood circulation in the legs;
• Occupational hazards - work in which changes in temperature and humidity occur can lead to the development of the disease;
• If the patient is diagnosed with obesity - excess weight overloads the legs and is usually complicated by atherosclerosis, thrombosis, venous or heart failure, which leads to edema and congestion in the veins of the lower extremities;
• Smoking and alcohol - negatively affects the state of the blood and vascular wall, provoking hypertension and atherosclerosis.

Risk groups imply the development of the disease in predisposed individuals; trophic disorders do not arise in a healthy person. But most often, these patients have a decrease in the body's defenses, so it is worth taking measures to prevent the occurrence of leg ulcers.

How pathology develops

Constant chemical processes take place in cells, which is the basis of their life. For the normal functioning of the epithelium of the skin, two conditions are necessary: ​​the supply of oxygen with nutrients into the cell and the removal of decay products. The main functions of ensuring the constancy of the internal environment of the body are performed by blood - it transports the necessary substances and removes spent elements.

Under the influence of the reasons, blood circulation in the legs is disturbed and trophic disorders appear: the cells do not receive the necessary substances, and the waste products are not removed. The latter have toxic effect- poison cells, causing their death. First, the surface layers of the skin are destroyed, then the wound deepens and the process of tissue rejection begins.

Most often, ulcers are recorded on the feet and legs - these areas have the least amount of spare blood supply pathways. Wounds are especially dangerous on areas that are in constant contact with clothing or shoes - on the feet or heels, as well as on the toes.

Clinical picture

The trophic ulcer code according to ICD 10 corresponds to the code L 98.4 - but this is not the whole classification. In many diseases, trophic complications develop, therefore, when diagnosing some diseases, the designation of the main pathology is displayed, which already implies an ulcerative complication.

The first symptoms of a trophic ulcer appear quickly, usually in the background common features the main pathology. Usually, there is limited redness of the skin area, indicating the occurrence of an inflammatory reaction, then an unnatural shine of the skin appears - the damaged area begins to get wet and itchy.

A few days after the appearance of the defect, the following symptoms join:

• Edema - speaks of the appearance of necrosis - the death of local tissues;
• Increased bleeding develops - capillary bleeding may occur even from a slight touch or rubbing with clothes or shoes;
• Loss of sensitivity in the area of ​​damage - speaks of cell death and impaired innervation.

Initially, the size of the ulcer is small - on the order of several centimeters. As the pathology progresses, the spot may begin to increase in size, covering adjacent healthy tissues. If you do not take action, the symptoms can be aggravated by the appearance of purulent foci in the lower leg or foot, the development of seizures, the progression of edema, as well as the appearance of a burning sensation and irritation at the site of the defect.

Expert opinion!

Many are afraid of contracting ulcers, and this fear is fully justified, but only partially. You can "pick up" pathology options that have arisen against the background of infection - which are caused by syphilis, leishmanias, leprosy, etc. If you do not know the type of pathogen, you should avoid tactile contact with the patient and his household items.

Stages of a trophic ulcer:

• Exudation - characterizes the onset of inflammation and the appearance of the first skin defects;
• Repair - inflammatory processes decrease and recovery processes begin;
• Epithelialization - there is no edema, the wound is tightened with epithelium;
• Scarring is the replacement of an area of ​​damage with connective tissue.

Symptoms largely depend on the type of disease - the manifestations of pathology are influenced by the types of affected vessels and the causes of the onset of pathology.

Venous ulcer

With venous lesions, trophic ulcers of the leg are most often observed. This type of violation speaks of venous damage - all symptoms of the disease are characterized by a decrease in the outflow of blood from the legs to the heart and the occurrence of stagnant in the venous bed.

The main signs of the disease:

• The first harbingers of pathology is the increasing swelling of the legs, especially in the evening. By morning, the symptom is partially or completely eliminated;
• Pain appears - usually pressing or aching in nature, worse at night. When this symptom appears, you should suspect varicose veins;
• Cramps - usually appear in the calf muscles, less often in the sole area. The symptom usually runs in parallel with the onset of pain or immediately after it;

• Darkening of the skin - develops due to the accumulation of pigment in the cells. Usually this symptom indicates the severity of the course - the more pronounced the disease, the darker the skin color;
• As the destruction of erythrocytes in the area of ​​the lesion, the wound begins to bleed and itch, irritation of neighboring areas joins. Often a trophic ulcer develops with a strong release of moisture - the skin acquires a characteristic shine with a bright shade;
• With a severe course of the disease, the affected area not only expands, but also deepens - as deep tissues are involved, soreness in the legs also increases;

If the ulcer is not treated, the calf muscles are gradually affected, and in severe cases, the lower leg bones. First, on the surface of a weeping trophic ulcer, colorless droplets of liquid are observed, which darken after a few days. Later, a purulent infection may join.

Arterial ulcer

In most cases, trophic ulcers in the arteries develop due to atherosclerosis - when plaques block the lumen of the vessel and obstruct blood flow.

The main symptoms of this lesion are:

• Fatigue in the legs - first appears during exertion, and then at rest. This sign indicates insufficient blood flow from the heart to the legs;
• The patient is worried about periodic lameness - on initial stages appears after a long walk, and then at rest;
• Trophic ulcers of the foot are affected, mainly its dorsal surface. As the progression progresses, the wounds can spread to the plantar surface;
• The structure and pattern of a trophic ulcer resembles a small semicircle or oval with uneven edges. Around the wound, the skin is of a characteristic yellow color with a dense consistency;
• This form is characterized by the release of purulent contents - which indicates the addition of an infectious flora.

Hypertensive ulcers

When lifting blood pressure vascular damage often occurs, leading to trophic disorders. Often, complications are so serious that they can lead to ulcers. This condition is characterized by the following symptoms:

• A slight red bump appears on the skin;
• After a few days, the neoplasm begins to bleed and degenerates into an ulcer;
• Basically, the wounds are located in the middle of the lower leg;
• At the initial stages, the pain is insignificant, but later it increases markedly, causing suffering to the patient.

Interesting!

An important distinctive point is that ulcers with hypertension are formed simultaneously on the right and left shins.

Diabetic ulcer

It occurs against the background of diabetes mellitus, the distinctive symptoms are:

• The appearance of numbness in the limbs, loss of sensitivity;
• Soreness at night;
• Ulcers are located on back surface toes or in the area of ​​the feet.

Neurotrophic ulcers

The main reasons for their appearance are head injuries or spinal cord as well as nerve trunks. Features:

• The wounds are deep, can reach the surface of the bone or muscle;
• The sensitivity in the affected area is reduced;
• A small outer opening that widens under the skin
• A neurotrophic ulcer is characterized by bad smell with purulent discharge.

Pyogenic ulcers

They develop due to the weakening of the body's defenses against the background of non-compliance with personal hygiene. Lesions are small, scattered over the entire surface of the legs and feet, mainly the surface layers of the skin are affected.

Complications

If you do not treat trophic ulcers, an aggravation of the clinical picture of the disease and the development of bleeding, malignancy, and infection are possible. In severe cases, gangrene or sepsis may develop. In order to avoid undesirable consequences, it is necessary to carry out treatment in a timely manner, do not wet the wound and protect it from contamination.

Establishing diagnosis

Diagnosis of a trophic ulcer requires an external examination by a doctor and an ultrasound examination of the vessels. As additional methods, you may need MRI and radiographic methods with the use of a contrast agent - to identify the underlying cause of the disease.

You can take the first steps in identifying an ulcer yourself if you know what it looks like:

• We recommend that you familiarize yourself with the photo of the initial stage of a trophic ulcer on the legs - outwardly small areas of redness are noted, yellow skin about the periphery of the wound;
• If the patient suffers from pathology for a long time, bleeding of ulcers, the release of gray exudate or pus is observed. There may be swelling of the skin, as well as scars from old wounds.

Treatment

Now let's find out how to treat trophic ulcers on the legs. After identifying the pathology, it is important to start therapy as soon as possible - this approach will reduce the likelihood of complications.

On a note!

If you suspect leg ulcers, you should contact a phlebologist surgeon. The doctor specializes in vascular diseases and their complications.

Drug therapy

The application is aimed at relieving pain symptoms, as well as fighting infection and accelerating the healing process of the skin. For this, the following drugs are used:

• Antiplatelet agents and (Heparin, Aspirin, Prostaglandins) - effective method improve blood flow and normalize tissue nutrition;
• Medicines that improve metabolic processes in tissues (Actovegin, Ebermin, Sulfargin) - accelerate wound healing processes;
• (Nise, Indomethacin) - it is recommended to take it in the form of tablets, local application can provoke irritation;
• (Miramistin, Geksikon, Levometicin, Fuzidin,) - are indicated if an infection is suspected. The most optimal is the use of ointments for direct action on the pathogen.

Older patients periodically ask themselves the question - how to treat trophic leg ulcers in the elderly? For the selection of drug therapy, a phlebologist's consultation is mandatory even in the presence of one or two ulcers - the doctor will correct the most effective and safe treatment.

Physiotherapy and compression treatment

Treatment of trophic ulcers of the lower extremities with the help of physiotherapy is aimed at improving blood circulation in the legs and healing skin defects. For this purpose, the following applies:

• Magnetotherapy;
• Iontophoresis;
• Oxygenation;
• Low-frequency laser treatment;
• Iontophoresis;
• Wellness baths.

ethnoscience

Perhaps - one of the ways is to use folk remedies:

• Vishnevsky's ointment, which is applied to the site of injury after treatment with iodine or alcohol, heals well;
• You can apply sterile gauze with birch tar for 2-3 days;
• The Golden Us helps - the leaves must be crushed into powder and sprinkled on the wounds until they are completely healed.

Should be used only as an adjunct to primary treatment. Before using prescriptions, it is advisable to consult with your doctor.

Surgery

For treatment can be used and operational methods- but are prescribed only when conservative measures are ineffective, or when delay can lead to serious complications.

Types of surgical interventions:

• Vacuum drawing of pus from wounds;
• Catheterization of large lesions;
• Suturing of the branches of the artery and vein supplying the damaged area.

Prophylaxis

To prevent the occurrence of ulcers, it is necessary to follow the doctor's recommendations - both during treatment and during the rehabilitation period. The patient should know the basic rules for preventing the disease - they include drug therapy once every six months, wearing compression underwear. You should avoid physical overload and engage in physiotherapy exercises, which will improve blood circulation, strengthen your blood vessels. To draw up a complex, you need to contact a physiotherapist.

Trophic ulcers arise as a complication of vascular diseases of the lower extremities. Pathological changes can aggravate the underlying pathology, and in severe cases, it can be complicated by gangrene or blood poisoning. Do not delay treatment - at the first manifestations of the disease, effectiveness conservative therapy very high.

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

Types of trophic ulcers and their specificity

All types of trophic ulcers are the result of diseases associated with impaired blood flow in the legs, leading to insufficient nutrition of epithelial cells and their gradual death. From what served as the root cause of this ailment, several types of manifestations are distinguished:

• Venous ulcers;
• Arterial ulcers (atherosclerotic);
• Diabetic ulcers (in the background);
• Neurotrophic, associated with traumatic brain injury or spinal injury;
• Martorell ulcers or hypertensive;
• Pyogenic (infectious).

Arterial (atherosclerotic) ulcers

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

Venous ulcers

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

1. The calf swells, there is a feeling of heaviness;
2. Convulsions are noted at night;
3. The skin of the lower leg begins, a mesh with noticeably enlarged veins appears on it;
4. Gradually, the veins merge into spots of a purple hue, turning into violet, spreading to ever larger areas;
5. As the disease progresses, the skin becomes denser, acquires a specific shine and smoothness.

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

Diabetic ulcer

Diabetes mellitus is a disease that causes many different complications, one of which is a diabetic trophic ulcer. Its development begins with loss of sensitivity of the lower extremities, associated with the death of individual nerve endings. This is felt when you run your hand over your leg (it remains cold to the touch). Night pains occur. Symptoms are similar to arterial ulcers. But there is also a significant difference - there is no intermittent claudication syndrome. The location of the ulcer is most often on the thumbs. Often, the causes of its appearance are trauma to the corns on the sole. Another difference from an arterial ulcer is a deeper wound of increased size. Diabetic ulcer is very dangerous because it is more often than other forms exposed to various infections, leading to and amputation of the leg. One of the most common causes of diabetic ulcers is neglected.

Neurotrophic ulcers

The causes of this type of trophic ulcer are head or spine trauma. The area affected by them is the lateral surface of the heel or part of the sole from the side of the heel tuber. Ulcers - in the form of a deep crater, the bottom of which is bone, tendon or muscle. Moreover, their external dimensions are insignificant. Pus accumulates in them. An unpleasant odor comes from the wound. The tissue in the area of ​​the ulcer socket loses sensitivity.

Hypertensive ulcers (Martorella)

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

Pyogenic ulcers

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

Video: questions to a phlebologist about trophic ulcers

Ulcer treatment

Treatment of trophic ulcers of the lower extremities is strictly individual for each individual patient. This is due to the variety of reasons that cause their appearance. Therefore, it is important to correctly diagnose the type of ulcer. For this, cytological, histological, bacteriological and other types of research are carried out. Also, methods of instrumental diagnostics are used. After an accurate diagnosis has been established, they begin medical procedures. It is possible to treat a trophic ulcer, both surgical and medication... Into the complex treatment measures includes local treatment aimed at cleansing the wound from purulent contents and necrotic tissue, treating with antiseptic solutions and applying ointments that promote scarring of wounds and restore the epithelium. Great importance physiotherapy and traditional medicine play a role in recovery.

Surgical methods

Surgical methods are surgery, during which the excision of dead tissue and the removal of the focus of inflammation are performed. These include:

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

Drug therapy

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

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

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

1. Washing the wound with solutions of antiseptics: potassium permanganate, furacilin, chlorhexidine, decoctions of celandine, string or chamomile;
2. Applying bandages with medicinal ointments (dioxycol, levomikol, streptolaven, etc.) and carboneta (a special bandage for sorption).

Also, according to the situation, blood purification (hemosorption) can be carried out. In the second stage, which is characterized by initial phase healing and scarring, healing ointments for trophic ulcers are used in the treatment - solcoseryl, actvigin, ebermin, etc., as well as antioxidant drugs, for example, tolkoferon. Character is also changing local treatment... At this stage, special wound dressings are used, sviderm, geshispon, algimaf, algipor, allevin, etc. Treatment of the pronounced surface is carried out with curiosin. At subsequent stages, drug treatment is aimed at eliminating the underlying disease that is the cause of the trophic ulcer.

Compression bandages in the treatment of trophic ulcers

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

Physiotherapy procedures

To improve efficiency treatment procedures, at the healing stage, one of the physiotherapeutic (hardware) procedures is prescribed.

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

Treatment of complex forms of trophic ulcer

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

Traditional medicine in the treatment of trophic ulcers

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

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

Prickly tartar

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

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

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

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

Video: treatment of trophic ulcers with folk remedies

Prevention of trophic ulcer

Even after a trophic ulcer is completely healed, its relapses are possible. Therefore, it is important to follow all the recommendations of the attending physician. Be sure to spend twice a year preventive treatment... Monitor the status blood vessels... Places with healed ulcers from time to time need to be lubricated with oil infused with St. John's wort, calendula or chamomile. They have the ability to regenerate tissues. Stress on the legs must be avoided. It is recommended to wear special underwear that creates long-term compression. If possible, use treatment at balneological resorts. Contact a physical therapy room to find a set of physical exercises for you aimed at increasing the elasticity of blood vessels and reducing the risk of new ulcers.

Video: trophic ulcers in the program "About the most important thing"