Trichic ulcers affect more than two million people worldwide. Despite contemporary medicine's advancements, this condition is difficult to treat and poses a major hazard. A trophic ulcer on the leg is characterised by extensive soft tissue injury that can sometimes reach the bone, as well as destruction of the skin or mucous membranes. Constant inflammation weakens the body's defensive characteristics over time, making disease treatment more difficult.
DEFINITION
A trophic ulcer is a skin lesion that destroys the outer layer of the skin. After the rejection of dead tissue, it results in ischemic necrosis and ulceration of the skin, which can spread to deeper subcutaneous tissue structures and does not heal after 6 weeks or more. Local injury to the circulation or innervation of tissues causes trophic ulcers in a variety of disorders marked by a protracted course and difficult therapy (eg tumors, psoriasis).
A trophic ulcer of the lower extremities is a lesion on the skin and mucous membranes of the surface that develops after surface tissues are destroyed. Reduced blood flow, infection, and other conditions can cause extensive damage. The patient then develops difficulties with his or her blood vessels, which widen and make treatment more difficult.
Trophic ulcer differs from other diseases in that it is: long-lasting (up to a month or more) and periodic in nature; the lesion spreads not only on the surface of the skin, but also deep into the tissues, all the way to the bones; the ability to regenerate in the damaged area may be lost; and the characteristic development of a rough scar at the lesion site after treatment.
The lesion begins as a papule (a solid swelling less than 1 cm in diameter - warts, insect bites, etc.) on the lower thigh, most typically at the trauma site. It quickly spreads, causing a pustule (a pus-filled bladder) that necrotizes. Pain, fever, and malaise are all symptoms of ulcers. The ulcer grows larger after a few weeks, and a surface odorous, purulent, black coating appears.
Because these locations have the least collateral for blood supply and are also exposed to extended pressure during walking, lying down, or other activities, trophic ulcers most commonly arise on the feet and legs (in more than 95 percent of cases). Wounds on the foot, heels, and/or toes are especially harmful since they are constantly in contact with the ground, clothing, or shoes.
It occurs far less commonly in the upper limbs, trunk, and head, and is usually unrelated to any vascular illness. Venous ulcers of the lower extremities alone affect at least 0.8-1.5 percent of the population in Europe and North America, with a prevalence of 3.6 percent in people over 65. The expenditures of treating ulcers account for 1-2 percent of the total health budget for these illnesses.
STAGE OF DEVELOPMENT
Because this illness is a progressive disease, it can progress from one stage to the next. Swelling, heaviness in the legs, warmth, and itching are common symptoms that accompany the development of the disease.
Trophic ulcers can be divided into three stages:
The first stage of pathology (exudation) is marked by the formation of the first skin lesions and the commencement of inflammation. The patient's first symptoms are red areas on the lower extremities that are intensely peeling and signal the start of skin degradation. Certain areas gradually begin to itch and create discomfort.
Instead of red patches, wounds of a darker tint occur in the second phase of the pathology's progression. A blister appears on the wound's surface, which might discharge fluid and impede healing. The patient begins to complain about his or her health deteriorating, as well as a high fever.
The third stage of the lesion is when pus begins to flow freely from the wound. The wound grows in size and takes on an abnormal shape. The ulcer can sometimes spread deep into the legs, causing excruciating discomfort.
The fourth phase (reparation) is characterised by the reduction of inflammatory activities and the initiation of recovery processes.
The fifth stage (epithelialization) is characterised by the absence of edema and the narrowing of the lesion as the surrounding epithelium multiplies.
Sixth phase (scars): also the final stage of the disease, in which connective tissue replaces injured skin cells and subcutaneous tissue.
The progression of a trophic ulcer is such that neuropathy leads to a loss of sensation (sensibility) and, in some cases, a deformity of the foot, which results in an uneven gait pattern. Increased biomechanical strain on the foot can be caused by loss of sensation, foot abnormalities, and limited and irregular motion.
Biomechanical strain increases pressure in some parts of the foot, causing skin thickening (callus, blister), which in turn increases the load, sometimes resulting in subcutaneous bleeding and eventually trophic ulceration due to neuropathic changes produced by the loss of protective sensation in the foot. If patients are not educated and preventive steps are not implemented, these diseases are frequently followed by decreased wound healing, which can swiftly lead to infection and gangrene.
CAUSES
Prolonged rest and immobility in one position might stimulate the creation of a trophic ulcer owing to pressure on the skin, which interferes with blood circulation in the contact region. They're most commonly located near bony protrusions like the heel and knee. An ulcer forms once the ischemic skin ruptures, which is frequently followed by bacterial penetration and an inflammatory response.
Symptoms of trophic ulcers are most commonly seen in the difficult course of varicose veins or thrombophlebitis, according to statistics. In this situation, the condition is caused by a blockage of venous blood outflow from the lower limbs, resulting in blood stagnation in small veins, disruption of capillary tone in the microvasculature, and impairment of the vascular system's arterial link. Blood flow and, as a result, the supply of oxygen and nutrients to tissues below the site of atherosclerotic plaque deteriorates in arterial atherosclerosis.
The most prevalent cause of trophic ulceration of the foot is neuropathy, which is characterised by decreased somatic and autonomic nerve fibre function. Peripheral neuropathy is caused by a variety of factors, the most common of which is diabetes.
Peripheral neuropathy is caused by metabolic abnormalities, one of which is a condition in which excess glucose is broken down into sorbitol, which is then turned into fructose. A number of problems, such as microvascular damage to the retina, kidney damage, and nerve damage, are frequent among diabetics.
Diabetes patients are at a higher risk of developing neuro-osteoarthropathy. Autonomic nerve dysfunction is assumed to be the source of this illness, which causes decreased blood flow to the bones of the feet, resulting in bone fragmentation and ulceration. Due to a lack of responsiveness, complete deterioration of bones and joints can also occur.
A trophic ulcer on the feet in diabetics can be triggered by a slight injury (e.g., damage caused by unsuitable footwear, walking without shoes, or acute injury) because it occurs from the simultaneous existence of two or more risk factors, with peripheral neuropathy playing a prominent role.
The following are the most common causes of trophic ulcers:
Heat injuries, such as frostbite or burns; diabetes and its sequelae; chronic dermatitis, including allergic dermatitis; obliterating atherosclerosis of various caliber arteries in the lower limbs;
Autoimmune connective tissue diseases accompanied by systemic blood flow in arterial, microcirculatory, and venous channels, including antiphospholipid syndrome; Anatomical and inflammatory diseases of lymphatic vessels - acute and chronic lymphostasis; Injuries to nerve fibers with subsequent violation of integrity; Autoimmune connective tissue diseases accompanied by systemic blood flow in arterial, microcirculatory, and venous channels, including antiphospholipid syndrome.
The formation of pathological phenomena that affect the blood supply and innervation of certain skin and subcutaneous tissue (usually the lower extremities) and trauma that causes primary injury at the site of future ulcer defect are usually two processes that have the same meaning in the formation of trophic ulcers.
SYMPTOMS
The condition is dangerous since the signs that assist detect a trophic ulcer come unexpectedly. Swelling and intense discomfort in the limbs, on the other hand, may signify the start of the development of a trophic ulcer.
The following are the most important symptoms that suggest the probability of trophic ulcers:
itchiness in the lower limbs
muscular cramps that occur during sleep significantly enlarged and elevated appearance of the skin surface accompanied by acute pain
external changes in the skin, such as the appearance of sudden hardened areas with a shiny surface skin sensitivity to touch the appearance of an ulcer with an unpleasant odor the presence of purple spots that spread in volume and depth external changes in the skin, such as the appearance of sudden hardened areas with a shiny surface
These symptoms appear in the veins, most commonly on the inside of the thighs. This is owing to the fact that the disease develops in the locations where the veins are located, where it presents as little lesions. The ulcer has the shape of a volcano crater, with a probable purulent discharge at the end due to inflammatory processes. Inflammatory processes and artery destruction are the most common causes of artery damage.
DIAGNOSIS
A medical history, as well as a history and examination by a surgeon, are required for the diagnosis of trophic ulcers. Hereditary varicose veins or some of the causes of venous illness are almost always present in primary varicose veins. In addition to a physical examination, other examinations (tests) are required to determine the origin of the condition, such as ultrasound inspection of blood vessels, electromyography, MR tomography, and contrast-enhanced radioangiography. Today, the color doppler vein is the most basic and reliable method of diagnosis.
TREATMENT
The key to successful ulcer treatment is correctly identifying the origin of the condition. Before beginning treatment for the disease, the patient must undergo a series of cytological and bacteriological tests to assist decide the best course of action.
Treatment for trophic ulcers should focus on removing the disease's primary source and planning for surgery, as this is the only option to permanently treat the condition. When surgery is not an option for treating a skin lesion, the person should endeavor to prevent the lesion from spreading. As a result, ulcer therapy and treatment should be complete.
In some circumstances, the doctor may recommend surgical surgery in addition to pharmacological therapy (nonsteroidal anti-inflammatory drugs, broad-spectrum antibiotics and antihistamines).
In the case of neurotrophic and atherosclerotic ulcers with pus-filled narrow canals, surgical intervention is required. If the ulcer affects a substantial section of the soft tissue, the doctor may recommend that it be removed and cleaned to prevent infection. To diminish the size of the lesion and stop the inflammatory process, extensive ulceration is divided into multiple tiny surgical treatments. In rare circumstances of large lesions, the patient may be given a skin transplant to minimize the wound's size.
Regular cleansing, washing, and cleaning of the wound, followed by bandaging, are all examples of conservative treatment. A doctor will prescribe ointments for trophic ulcers on the legs based on the particular peculiarities of the patient's condition.
If the ulcer is accompanied by severe edema and has a venous origin, you must use compression bandages after applying the ointment. They minimize edema by temporarily narrowing the affected area's diameter, making treatment more effective. If the disease improves, ordinary compression bandages can be replaced with customized socks.
Tubulcus is a tubular orthosis used to treat venous open wounds and diseases that put larger venous wounds at risk of opening. It works on the principle of gradual pressure application, which means that the pressure in the tubulcus is clearly defined and strongest in the area of the medial maleolus, and as it climbs higher up to the knee, the pressure gradually drops, assisting the veins in returning blood to the heart. The extra tissue fluid is pushed back into the veins, and the venous valves seal better, as the external tubule achieves the correct pressure. It restores blood flow to the heart and lowers the internal pressure in the legs. Simultaneously, when the pressure falls, the skin and tissues receive more oxygen. The ulcer closes and healing begins.
We recommend the following actions to help with venous ulcers:
wearing correctly shaped footwear and, if needed, orthopedic insoles - Inflated feet with inadequate statics and loose ligaments are more likely to develop venous foot disease.
Weight loss - Gaining weight is a well-known risk factor for varicose veins.
avoiding prolonged standing and sitting, occasionally elevating your legs, avoiding excessive heat (saunas, solariums, thermal pools), and avoiding excessive sun exposure
Carrying large burdens and engaging in vigorous physical activity should be avoided since the pressure in the abdomen rises, causing the veins in the legs to dilate.
Following the advice of a doctor, wearing elastic stockings, daily dressing and ulcer cleanliness
WHEN SHOULD DR. LUIGI'S MEDICAL PRODUCTS BE USED?
Luigi medical footwear relieves biomechanical and medical issues, promotes blood circulation, and provides a pleasant and calming effect on wearers' general psychophysical state.
People who have difficulties with joints, bones, and spine circulation, as well as varicose veins, should use the medical goods of the firm Dr. Luigi, according to eminent experts in the field of foot illnesses.
CONCLUSION
It is always easier to prevent a sickness than it is to cure it. For prevention, it is recommended that veins be carefully monitored, that circulation-improving gels and ointments be applied on a regular basis, that prolonged standing or sitting be avoided, and that regular exercise be performed to improve circulation and stimulate the "muscle pump" of the lower extremities.
Recreational walking is a good exercise for veins since it protects them and relieves discomfort.
jogging for pleasure
cycling is a recreational sport.
Ulcers that go untreated can cause scarring and, in the worst-case scenario, incapacity. The nature and course of the underlying disease, as well as the capability of compensating for the traumas that caused the trophic ulcer, all play a role in recovery.
