Trophic ulcers

Description:

Trophic ulcer – a heavy pathological complication of a number of diseases which are followed by blood circulation disturbance.

Symptoms of Trophic ulcers:

Ulceration is preceded, as a rule, by the whole complex of the objective and subjective symptoms testimonial of the progressing disturbance of venous blood circulation in extremities. Patients note strengthening of hypostasis and weight in calves, increase of spasms of gastrocnemius muscles, especially at night, emergence of burning sensation, "heat", and sometimes a shin skin itch. During this period in the lower third of a shin the network of soft cyanotic veins of small diameter increases. On skin there is violet or purple nevus pigmentosus which, merging, form an extensive zone of a hyperpegmentation. The hemosiderin collecting in skin has antigenic properties and causes inflammatory reaction with development of purple dermatitis and eczema. Skin in this place is thickened, becomes painful, intense, takes a characteristic "varnish" form. Owing to distribution of an inflammation on a fatty tissue skin becomes motionless and she does not manage to be brought together pleated. The acute indurative cellulitis which is shown diffusion consolidation, a hyperemia and a hyperthermia of skin which takes a form of "orange-peel" owing to an intradermal lymphostasis develops. In this zone skin loses the barrier functions and becomes easily permeable for various microorganisms. The progressing intradermal lymphostasis leads to transudation of a lymph which accumulates on skin in the form of the opalescent droplets reminding dew.
In the subsequent in the center of the site of the affected skin there is a center of exfoliation of epidermis which the whitish look reminds a paraffin leak-in. It is a so-called white atrophy of skin - a predjyazvenny state. Lack of treatment and the minimum injury lead to formation of the small ulcer defect covered with a scab under which there is a wet cerise surface. In process of progressing the form of trophic ulcers changes and their area increases. The size varies them over a wide range. Increase in the area of a trophic ulcer usually results from expansion of limits of one ulcer defect. Besides, merge of several ulcers to rather small initial area is possible. At the long course of a disease and lack of adequate treatment venous trophic ulcers can reach the huge sizes and extend to all circle of a shin. In the beginning process is limited to damage only of skin, and further goes deep into, reaching on the back surface of a shin of an Achilles tendon and gastrocnemius muscles, and on a lobby - a periosteum. The penetration of a trophic ulcer in depth is followed by strengthening of a pain syndrome to which stopping quite often it is required to apply narcotic analgetics. At every fifth patient in a zone of the trophic ulcer which is localized on the front surface of a shin the ossifying periostitis with the osteosclerosis centers develops. In this case accession of consecutive infection can provoke osteomyelitis. Deep damage of fabrics can lead to arthritis and a contracture of an ankle joint over time.
Character separated from trophic ulcers depends on a stage of a wound process, existence and the nature of a bacterial infection. It can be pus with an unpleasant smell, a muddy serous exudate with fibrin threads, occasionally hemorrhagic exudate. Intensity of exudation is defined by the sizes and depth of trophic ulcers. Cases when at corpulent subjects with extensive venous trophic ulcers daily loss of liquid through their surface reached 1000-1500 ml are known.
The condition of skin in a circle of a trophic ulcer under the influence of wound separated worsens and microbic eczema becomes the frequent satellite of chronic venous ulcers. Its progressing is quite often provoked by the various incorrectly picked up bandages, lotions, ointments.
Most hard the mycotic infection which source can be an onychomycosis and intertriginozny mycosis which are often found at patients of advanced age proceeds. A mycotic infection, sensibilizing an organism, aggravates the course of the main process and promotes progressing of trophic frustration.
Against the background of the infected trophic ulcer development of an acute purulent varikotromboflebit, lymphangitis, inguinal lymphadenitis and an erysipelatous inflammation is possible. The frequent outbreaks of a local infection cause irreversible sclerous changes of lymphatic collectors, with development of a secondary limfedema.

Reasons of Trophic ulcers:

Are observed at a number of diseases - a diabetes mellitus, diseases of vessels, dermatological problems. Chronic venous insufficiency and other diseases of veins can become the reason of a long trophic ulcer of a shin.

Treatment of Trophic ulcers:

CONSERVATIVE TREATMENT

Until recently therapies of the chronic venous insufficiency (CVI) paid, unfortunately, not enough attention. Meanwhile it is difficult to revaluate its value. First, most of patients are subject only to conservative treatment; secondly, even if perhaps radical or palliative surgical treatment, many patients need preoperative preparation and postoperative rehabilitation actions; thirdly, the progressing character of HVN does necessary taking measures of secondary prevention, both for prevention of a recurrence, and in order to avoid heavy complications.
Main objectives of conservative actions irrespective of the specific reasons of HVN should be considered elimination of its symptoms, prevention of a recurrence of diseases of veins, working capacity preservation, and also improvement of quality of life of patients.
The main ways of impact on various links of a pathogeny of HVN are compression treatment and pharmacotherapy.