Treatment of trophic ulcers of the lower extremities
Background. In 50 % of cases trophic ulcers (TU) are caused by chronic venous insufficiency, in 10 % – by arterial insufficiency, in 5 % – by disorders of nerve trophic. Treatment of ischemic TU includes conservative and surgical tactics, wound dressings, pain management, use of hydrogel dressings, antibacterial therapy, measures to improve blood circulation.
Objective. To describe the treatment of TU of the lower extremities.
Materials and methods. Analysis of literature data on this issue.
Results and discussion. The pathogenesis of chronic venous ulcers includes persistent venous hypertension and microcirculation disorders. Varicose veins, postthrombotic disease and congenital vascular malformations are the main causes of such ulcers. In postthrombotic disease affecting the veins of the lower extremities in patients with severe symptoms, surgery (femoro-femoral or femoro-caval bypass), percutaneous endovascular recanalization (stenting, balloon angioplasty), combined surgical-endovenous desobliteration, transposition of the segmentary vein valves and relocation of autoveins may be considered. After the operations on veins, surgical interventions for TU are performed. Antibiotic therapy (Leflocin, “Yuria-Pharm”, 500 mg intravenously once before surgery), topical antiseptic Dekasan (“Yuria-Pharm”) and skin disinfectant Gorosten (“Yuria-Pharm”) are used to accompany interventions for postthrombotic disease. Vasodilation disorders, which are one of the links in the TU pathogenesis, are the result of endothelial dysfunction and nitric oxide (NO) deficiency. To eliminate these factors, L-arginine (Tivortin, “Yuria-Pharm”) is used. Tivortin catalyzes the synthesis of NO in endothelial cells, reduces the activation and adhesion of leukocytes and platelets to the vascular endothelium, prevents the formation and progression of atherosclerotic plaques. In the treatment of lower extremity ischemia and TU, it is advisable to use the infusion therapy scheme “TRIO”: Reosorbilact 400 ml + Latren 400 ml + Tivortin 100 ml (“Yuria-Pharm”).
Conclusions. 1. Minimally invasive methods are effective and minimally traumatic option of TU treatment, which should actively displace open methods. 2. Conservative TU treatment includes the microcirculation improvement, the use of antiseptics, strengthening of the vascular wall, antibacterial and rheological support.
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