Trophic ulcers in varicose veins
Phlebology – 2011
Trophic ulcer – a serious complication of varicose veins. This is a long-term healing of soft tissue defect. Appears in advanced forms of the disease as a result of decompensation of the venous outflow at the bottom of your feet on its inner surface.
The formation of trophic ulcers is slow and gradual. As a result of increased permeability of vascular wall outside the red blood cells leave the bloodstream, they contain hemoglobin undergoes degradation with the formation of hemosiderin, which is deposited in the dermis and stain it a darker color – the site appears on the skin pigmentation. With the progression of this background appears whitish, as if varnished, seal. This is the predyazvennoe state, when any, even the most minor injury can cause the formation of a significant defect. If treated quickly time disappears. Otherwise, the size and depth of the lesion will progressively grow, develop perifocal inflammation of soft tissues and, furthermore, can join a secondary infection that threatens the development of local and systemic septic complications.
Diagnosis of venous trophic ulcers is simple, the main problem – is its treatment.
Treatment involves several steps. The first thing is to get scarring of an existing defect, and then a prompt intervention to prevent relapse.
Regimen tailored to the current phase of ulcerative process. If there is a stage of exudation, characterized by copious amounts of wound, severe inflammatory reaction surrounding soft tissues, as well as very often, and bacterial contamination, the patient is assigned polupostelny mode for two weeks, antibiotics broad-spectrum, non-steroidal anti-inflammatory drugs. If necessary – infusion therapy, and derivatives of nitroimidazole antimycotics. It is mandatory to local treatment is carried out, which includes a daily two-three-time WC ulcerated surface with an antiseptic solution, followed by dressing with a water-soluble osmotically active ointment, a special sorbent compress and elastic bandage. Cleansing the wound surface, the appearance of granulation tissue, reducing the severity of perifocal inflammation and exudation indicate the beginning of the next phase – reparations. Begin to be carried out activities aimed at stimulating growth and maturation of connective tissue elements. For this purpose, appoint polyvalent venotonics, deproteinized calf blood derivatives by type solcoseryl and Actovegin, antioxidants, zinc hyaluronate.
To achieve the therapeutic effect of using a laser and ultraviolet blood irradiation, improving its rheology. Elastic compression is mandatory. At the stage of epithelization – the main task is to protect the ripening of the scar from possible external mechanical damage by wearing medical compression hosiery and elastic bandaging of the lower extremities. Receive flebotonikov continue. After complete tissue closure of the defect, in the absence of contraindications, proceed to the next stage – implementation of the combined surgery.
It is much easier to prevent the occurrence of venous ulcers than to fight them, especially taking into account the fact that they often recur.
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