Causes, symptoms and how to treat trophic leg ulcers?
A trophic ulcer on the legs is an open wound located on the skin of the lower extremities and formed against the background of tissue rejection. Trophic ulcers are prone to long-term existence, do not heal for 6 weeks or more. The pathological process involves not only the epithelium, but also the tissues located under it. After the healing of trophic ulcers, scars remain on the skin. Even despite the high level of development of modern medicine, the therapy of trophic ulcers remains one of the most difficult tasks to this day.
The most common are trophic ulcers of the legs and feet. According to statistics, up to 2 million people worldwide suffer from this pathology. About 70% of cases of ulcers are associated with some kind of disorders in the functioning of the venous-vascular bed. Ulcers never arise spontaneously, they are preceded by a rather long process of development of serious pathologies in the body. Such a branch of medicine as phlebology is engaged in the identification and treatment of trophic ulcers.
Content:
- Causes of trophic ulcers
- Symptoms of trophic ulcers
- Stages of trophic ulcer
- Complications and consequences of trophic ulcers
Answers to popular questions
- Is a trophic leg ulcer contagious?
- Is it possible to wet a trophic ulcer on the leg?
- Which doctor treats trophic ulcers?
- How and how to treat a trophic ulcer?
Causes of trophic ulcers
The causes of trophic ulcers are diverse, among them the following factors can be noted:
- The formation of trophic ulcers is primarily caused by a disease such as varicose veins. It is the varicose veins that contribute to the deterioration of the outflow of blood, leading to its stagnation. As a result, fresh blood, rich in nutrients, is unable to deliver them to the tissues of the lower extremities. The result of this starvation is the gradual destruction of cells. Initially, a superficial wound is formed, which gradually transforms into an ulcer;
- Vein thrombosis is another common cause of trophic ulcers. They have the same mechanism of development as in varicose veins, only the result of blood stagnation is a thrombus, which blocks the lumen of the artery;
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Atherosclerosis of the arteries of the lower extremities is characterized by the formation of fatty plaques on the inner walls, which, as they grow, are able to completely block the lumen of the vessels. As a result of malnutrition, pathological processes begin to develop in the tissues, which lead to the formation of ulcers;
- Martorell's syndrome, which develops against the background of an existing hypertension and is capable of leading to the formation of shunts inside the veins and arteries. It also causes poor circulation and becomes a trigger in the formation of trophic ulcers;
- Diabetes mellitus can also lead to the formation of deep non-healing wounds on the legs;
- Certain systemic diseases, for example, vasculitis, collagenosis, blood diseases, metabolic disorders, can cause the development of this pathology;
- If the rules of personal hygiene are not followed, pyoderma occurs, which can lead to the formation of ulcers;
- Lyell's toxic epidermal necrolysis is considered an etiological factor;
- Any diseases of the cardiovascular system can provoke the development of trophic ulcers. They arise as a result of pronounced edema of the lower extremities against the background of circulatory failure;
- Infectious diseases can lead to the formation of trophic ulcers - these are tuberculosis, syphilis, infectious tropical disease, Naga ulcer, onchocerciasis, leishmaniasis, etc.;
- Trophic ulcers can be the result of malignancy of various skin formations or occur with radiation damage to the skin;
- The provoking factors are burns and frostbite of the lower extremities.
According to the available statistical data, in 52% of cases trophic ulcers have varicose etiology, in 14% of cases their occurrence is associated with disturbances in the functioning of the arteries, in 13% trophic ulcers are caused by several factors. The share of ulcers resulting from venous thrombosis accounts for 7% of cases. Due to trauma, ulcers appear in 6% of cases. Diabetic ulcers account for 5% of the total number of diagnoses.
In general, any disease of the veins of the lower extremities (both deep and superficial) with venous insufficiency can lead to the formation of ulcers. Moreover, even minor scratches and wounds can cause a wound that does not heal for a long time.
Trophic ulcer in diabetes mellitus
Trophic ulcer in diabetes mellitus or diabetic ulcer occurs as a complication of the underlying disease. It is known that in diabetes mellitus, glucose uptake is impaired. At the same time, the walls of blood vessels become rigid, diabetic neuropathy and diabetic angiopathy are formed. In the affected areas, blood circulation is hampered, and a lack of tissue nutrition leads to the formation of ulcers.
The danger of a diabetic ulcer is that it can transform into gangrene, which will lead to the need for amputation of the limb.
Symptoms of trophic ulcers
The symptoms of trophic ulcers depend on what caused their formation:
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Symptoms of venous trophic ulcers. The formation of a trophic ulcer of venous origin is always preceded by the occurrence of specific signs indicating the progression of the lesion of the vein system.
- At the very beginning of the disease, people notice that their legs are swollen. A feeling of heaviness arises in the area of the calves and legs.
- At night, seizures may appear, which tend to become more frequent. In parallel, there is a burning sensation and itching in the lower extremities.
- Pigment accumulates in the skin, making the skin darker. As the disease progresses, the hyperpigmented zone increases in size.
- Hemosiderin accumulates in the skin, provoking the development of eczema and dermatitis. The skin itself becomes denser, acquires a varnish shine, and when touched, it responds with painful sensations.
- Lymphostasis increases, it can lead to the fact that lymph seeps through the skin to the outside and appears on its surface in the form of dew drops.
- As the disease progresses, a pre-ulcer condition develops, when a white area of epidermal atrophy appears in the center of the affected area. In this case, a person may not notice such minimal damage to the skin until an ulcerative defect appears in the atrophied zone. At first, it has a small size, and the ulcer itself is located on the surface.
- Over time, the ulcer begins to deepen, becomes larger in diameter. If multiple ulcers develop, they can coalesce to form large lesions.
- The pathological process tends to expand not only to the sides, but also to grow deeper. The deeper the ulcer penetrates, the more intense the painful sensations become.
- Perhaps the involvement of the calf muscles, the Achilles tendon, the frontal surface of the tibia in the process. If the process has spread to the bone tissue, it can trigger the development of osteomyelitis.
- Content of a different nature is released from the ulcer. At first, it is hemorrhagic, then becomes cloudy, may contain fibrin threads or pus. An unpleasant odor emanates from the wound. Microbial eczema often forms around a trophic ulcer.
- There is a risk of secondary infection, which can be triggered by opportunistic bacteria against the background of a decrease in local and general immunity. In the elderly, trophic ulcers are often complicated by mycotic infection. This significantly worsens the prognosis.
Trophic ulcers are accompanied by severe pain and cause unbearable suffering to a person.
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Symptoms of a diabetic ulcer. Diabetic ulcer develops against the background of diabetes mellitus and is expressed in the following symptoms:
- At the initial stage of development of a diabetic ulcer, there is a loss of sensitivity of the lower extremities. This is due to the death of nerve endings.
- At night, a person begins to experience pain.
- The place of localization of a diabetic ulcer is the big toes, or the tops of the phalanges of the fingers. On the sole, it can form in the place where the corns are located - this is the surface of the foot or heel.
- As the disease progresses, a small but deep wound appears. Then it increases in size.
More often than other ulcers, diabetic trophic ulcer is complicated by gangrene and leads to amputation of the limb.
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Symptoms of atherosclerotic trophic ulcers. Atherosclerotic trophic ulcers are formed against the background of vascular atherosclerosis and have the following clinical picture:
- For the initial stage of development of atherosclerotic trophic ulcers, intermittent claudication is characteristic. The sensitivity of the diseased limb is impaired, it gets tired faster, often freezes.
- The place of localization of ulcers is the outer side of the foot, phalanx of the big toe, heel zone.
- Ulcers are small in size, semicircular in shape.
- The edges of the ulcer are denser, torn. The skin surrounding the edges of the ulcer is yellowish.
- The contents of the ulcer are purulent. As the disease progresses, ulcers fill the entire surface of the foot.
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Symptoms of trophic ulcers Martorell. This type of trophic ulcers is formed against the background of an increase in blood pressure. Most often, women aged 40 and older suffer from such ulcers.
A characteristic feature of ulcers in Martorell's syndrome is the formation of papules on the lower limb, which responds with mild pain. As the disease progresses, the papule transforms into an ulcer.
Another distinctive feature of hypertensive ulcers is the symmetry of their occurrence. That is, they occur on both limbs at once, most often in the central part of the lower leg.
Ulceration progresses slowly, and is particularly painful. There is an increased risk of bacterial infection.
Stages of trophic ulcer
In the process of development of the disease, four main stages of trophic ulcer are distinguished, among which:
- The stage of exudation (onset of inflammation, the appearance of necrotic foci);
- Reparation stage (cleansing the surface of the ulcer from necrotic contents, forming granules, reducing inflammation);
- Epithelialization stage (appearance of fresh epithelium, wound tightening);
- The stage of tissue scarring (the final stage, when scar tissue forms at the site of the existing ulcer).
The stages of a trophic ulcer may differ slightly depending on what caused them. These differences are characteristic of the initial stage of inflammation, the stage of repair, epithelialization and scarring, all ulcers pass with an uncomplicated course of the disease.
The initial stage of trophic ulcer
The initial stage of a trophic ulcer with varicose veins is characterized by the appearance of hyperpigmented areas on the skin. As venous insufficiency progresses, the skin becomes thinner, becomes hyperemic, then a whitish spot appears on the skin. If no treatment is carried out, then a scab is formed, which penetrates deep into the tissues.
The initial stage of a diabetic ulcer differs in that the limb loses its former sensitivity, this is due to the destruction of nerve endings (diabetic polyneuropathy).
Against the background of hypertension, the initial stage of a trophic ulcer is characterized by the appearance of intermittent claudication.
In general, the manifestation of the disease is characterized by damage to the skin with perifocal inflammation, necrotic areas, abundant discharge with an unpleasant putrid odor. If treatment is not carried out at the initial stage of ulcer development, then this threatens the development of complications.
Complications and consequences of trophic ulcers
Long-term existence of a defect can cause conditions that are unfavorable to human health, which can lead to hospitalization.
Complications and consequences of trophic ulcers can be as follows:
- Pyoderma;
- Microbial eczema;
- Allergic dermatitis;
- Fungal infection;
- Lymphangitis, erysipelas, inguinal lymphadenitis;
- Varicothrombophlebitis;
- Phlegmon;
- Gangrene;
- Tetanus;
- Arthritis, arthrosis, periostitis, tendonitis, osteomyelitis;
- Malignant wound (from 1.6 to 3.5% of cases);
- Wound myiasis, that is, the settlement of an ulcer with insect larvae;
- Development of bleeding;
- Sepsis;
- Secondary lymphedema.
Answers to popular questions
- Is a trophic leg ulcer contagious? No, a trophic ulcer on the leg is not contagious.
- Is it possible to wet a trophic ulcer on the leg? It is not recommended to wet a trophic ulcer on the leg, as this can lead to the development of complications and the addition of a bacterial infection. It is necessary to treat the ulcer with the help of special antibacterial, antiseptic and drying agents.
- Which doctor treats trophic ulcers? Trophic ulcers are treated by a phlebologist surgeon.
How and how to treat a trophic ulcer?
A phlebologist will tell the patient how and how to treat a trophic ulcer. The specialist and the patient face a whole range of tasks. First, it is necessary to minimize the manifestation of the underlying disease that led to the formation of the ulcer. That is, it is necessary to carry out therapy for varicose veins, lower blood pressure, and treat diabetes mellitus. Secondly, it is necessary to carry out activities aimed at the healing of the trophic ulcer itself.
General conservative therapy is reduced to the use of the following funds:
- Treatment of the underlying disease using phlebotonics, antiplatelet agents, antiplatelet agents. These can be drugs such as Pentoxifylline, Heparin, Acetylsalicylic acid, Prostaglandins. They allow you to correct the processes of blood clotting, help to normalize blood circulation, and prevent venous stasis. Oral administration and administration of drugs in the form of injections are possible;
- Antibacterial therapy is selected taking into account the sensitivity of microorganisms inhabiting the ulcer to specific antibiotics. Effective wound treatment with Levometicin, Hexicon, Fuzidin, Miramistin. It is possible to use preparations in the form of ointments or sprays for topical use. If necessary, antimycotics are prescribed: Fluconazole, Caspofungin, Voriconazole, etc.;
- To accelerate the regeneration processes, drugs are prescribed that affect metabolic processes in tissues. It can be Actovegin, Ebermin, Sulfargin;
- Pain relievers are prescribed to relieve pain.
The toilet of a trophic ulcer should be regular. To begin with, the wound is washed with a sterile saline solution, dead tissue and exudate are removed from it. After the performed sanitation, an antibacterial agent is applied and the ulcer is covered with a bandage. If the wound is in the healing phase, then the dressing should provide normal moisture and breathing of the wound surface. In the event that there is an infection, a dressing should be chosen that can absorb secretions and provide an antiseptic effect. For this, special napkins are used.
It is possible to undergo physiotherapy procedures that help accelerate the healing of the ulcer. The following techniques are effective: ultrasound wound cavitation, UV irradiation, hyperbaric oxygenation, laser therapy, magnetotherapy.
When the ulcer heals and the patient feels well, surgical intervention is possible. It will be aimed at normalizing the venous and arterial outflow, at removing the veins that have undergone varicose veins.
Pain reliever for trophic ulcers
Pain in trophic ulcers is of varying intensity. Therefore, with severe pain, pain relievers are prescribed.
They can be used in the form of ointments and sprays, or they can be prescribed in tablet form:
- Parmidin. Available in the form of tablets and ointments. Helps relieve swelling, reduces pain;
- Acetylsalicylic acid and preparations based on it: Aspirin, Tsefekon;
- Preparations from the NSAID group: Ibuprofen, Ambene, Ketorolac, Naproxen;
- It is possible to use Emla, Dimexid ointments.
- The balm Vinilin and Romazulan has a weak analgesic effect.
Napkins for the treatment of trophic ulcers
Sterile napkins for the treatment of trophic ulcers are used when the wounds do not heal for a long time and fester. The wipes contain antibacterial agents, as well as components that accelerate tissue regeneration.
You can use the following napkins:
- Activetex. They are made of jersey and are impregnated with medicines. So, Activetex F contains furagin, Activetex X - chlorhexidine, Activetex HF combines chlorhexidine and furagin;
- There are also napkins for the treatment of trophic ulcers from the company Hartman, Coletex, Multiferm, Proteox-TM. They all have antibacterial and antiseptic effects;
- It is possible to use absorbent dressings, which are applied when there is abundant discharge from the ulcers. It can be dressings Voskopran, Cetuvit E, Biaten, Branolind N.
Treatment of trophic ulcers should be comprehensive and timely, an indispensable condition is getting rid of the underlying disease. This is the only way to avoid serious complications and prevent a relapse of the disease.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
