Trophic skin disorders, its derivatives (hair, nails) are often detected with peripheral damage nervous systemThis is especially true of damage to the median and tibial nerves.

The most severe trophic disorders occur with the combined defeat of the nerves and vessels. The smoothing of the folds of the skin, the pallor of it, with a brilliant, and sometimes the crimson is the usual signs of skin lesions. These changes in some cases are the character of ichthyosis, scaly deprived, often developing pronounced hyperkeratosis in the area of \u200b\u200bthe skin innervation of the damaged nerve. Nails change markedly, they become brittle, rollers, pits appear with transverse allocations; The color of the nails is brown or yellowish. Hypertrichosis is described as a frequent sign of damage to the peripheral nervous system, but it is sometimes observed in the absence of a disorder of the intake of nerve trunks.

Trophic skin disorders Usually grow slowly and are most pronounced at the later dates. However, they can develop and quickly after injury, if the nerve damage is accompanied by symptoms of strong irritation, for example, during causalgic syndrome.

Trophy disorders in the bones, mounted radiographically, are detected in all cases of damage to the peripheral nervous system. The degree of severity and nature of these changes depend on the nature, degree and level of damage to the nervous trunk, as well as the age of the wounded and features of the individual innervation of bones. The main feature of the trophic changes in the bones in early time after injury is osteoporosis (thinning of bone beams in combination with decalcification), pronounced most clearly in the brush and distal bones of the bones of the forearm under the lesions of the nerves of the upper limbs, in the foot and distal bones of the leg bones (during nerve damage lower limbs).

In later dates, there are thickening of bone trabeculus, enrichment of lime. Sometimes osteolysis is found in this period (the disappearance of the bone structure), expressed in varying degrees; In the penetration of infection, a typical picture of osteomyelitis is developing with the formation of sequesters.

The unanimity in assessing the severity of trophic changes in the bones with a full or partial violation of the conductivity of the affected nerve is not. Some features of trophic changes in the bones are revealed during damage to the individual nerves of the upper and lower extremities at the later dates after injury. For example, when rebuilding the bone structure, the formation of a cyst is noted during damage to the median, radial nerves, which is not observed during the defeats of the elbow nerve.

Trophic ulcers They are one of the manifestations of trophic disorders developing more often on the lower limbs and localized mainly on the heel, the first half of the foot (three points of the support traumatized when walking). These ulcers are characterized by cornly-thickened, deprived of vessels by the edges, bottom, covered with sluggish granulations, easily bleeding, with a gray colors. When the nerves of the upper limbs are injured, after burns or cooling on the fingers of the hands, fluxes can be developed with subsequent ulceration. Trophic ulcers are usually developing at the later time after injury, however, with partial damage to nerve trunks, accompanied by symptoms of irritation, these ulcers may occur before.

How to carry out the treatment of trophic ulcers in varicose veins? Specialists offer three ways

The article will deal with one of the complications of varicose disease - trophic ulcers. Complication is considered extremely dangerous and heavy.

In the launched form, do not do without intensive intervention. If strong trophic skin changes are visible in varicose veins, the use of plastic surgery is necessary.

If the varicose ulcer did not grow too much, then the treatment of ulcers can be carried out with laser therapy, sclerotherapy or limited to conservative treatment.

general information

The trophic ulcer is a non-surging damage to the leather cover. It is often accompanied by complications, for example, the development of infections.

Before the development of ulcers, there is a long period of trophic skin changes in varicose veins. Vessels and leather For many weeks and months are subject to stress, voltage.

Ultimately, the skin surface becomes white, an unhealthy shade and shine appears. Such symptoms are considered a critical point.

After that, the ulcer begins to quickly progress. In the worst version, the defeat reaches bone tissues, irreversible consequences may occur, and even lethal cases are recorded.

The treatment of varicose ulcers is two species - conservative and surgical. Surgery comes to the rescue in the most difficult cases when they need immediately, and there is no time for medication therapy.

With weak lesions, they can be relatively effective. Consider carefully how to treat ulcers from varicose veins.

Conservative treatment

First of all, the patient is diagnosed. Doctors must establish the cause, the nature of the disease and prepare a plan of therapy.

The cause of trophic ulcers is truly most often varicosezing. His account more than half of the registered cases.

But arterial diseases, diabetes, severe damage to the back / nervous system can provoke ulcerative processes. Doctors should also find out the type of microorganisms that multiply in the wound. Some of them may be resistant to widespread antibiotics.

Conservative treatment is local and common. Under general, the reception of medicines, injection and so on.

We give an approximate course of local treatment. First of all, the wound is purified from pus, for example, with the help of vacuum therapy or simply wash it with a sponge, and then remove the dead cloth with chymotrypsin.

An ulcer and the surface around it should be treated with a single-surfactant solution of iodopiron. If the wound is located on the foot, and nails are close to it, they should also be treated with solution.

This is carried out due to the possibility of the existence of the fungus on the nails. Please note that the patient may not notice the presence of fungus. If there is intolerance to the drugs with iodine, then you can replace iodopouron to Trestosan.

Then the trophic ulcer is smeared with Argosulfan cream. Top are wrapped with a bandage. Active active substance Mazi - Sulfatiazole Silver.

It has high antimicrobial activity. In addition, Argosulfan accelerates wound healing, reduces pain. Bandage should be changed every day.

Local procedures must be complemented and enhanced by medication. The most appointed are veotonic, antibiotics, anticoagulants, anti-inflammatory products, vitamins, immunomodulators.

From the ventonikov regularly prescribed "Detralex" or "Phlebodia 600". Preparations improve the overall condition of vascular tissues, lymphatic drainage.

Ambenne-N is a popular anti-inflammatory agent. If the examination revealed the presence of microorganisms in the wound, antibiotics based on penicillin, doxycycline, tetracycline can be prescribed.

Surgical intervention

Unfortunately, conservative treatments cannot always guarantee complete recovery. In this case, more intensive procedures are necessary.

They are aimed at eliminating the cause of varicose veins. Modern methods allow you to avoid scalpel and general anesthesia.

Two common methods are considered highly efficient and reliable. Laser coagulation and sclerotherapy. But there are other new procedures, for example, a cryogenic effect, hyperbaric oxygenation. According to performance, they do not extend to classic operations at all.

Laser therapy (EVLK) does not leave any cuts, the rehabilitation period is only a couple of hours. The exact definition of damaged sites is carried out by ultrasound equipment. The outbreaks of the laser burn the thermal impulse sick vessels. Over time, they overgrow with a connective tissue and are absorbed.

The drug glues the walls of the vessels, due to this, it is possible to eliminate the cause of peptic processes. The period of rehabilitation is similarly in just a few hours. Contraindications for sclerotherapy can serve as heart problems, pregnancy, diabetes mellitus.

Classical surgery is used mainly with very extensive skin damage. To eliminate injuries make plastic skin transplant operation.

Leather cover takes with honeybee or patient belly. It is perforated and imposed on a clean ulcer. Loskut is taken away, as a rule, for 7-10 days. In addition, surgery is used for necruretomy, neurolization, adjustments for venous and blood flow.

Intensive treatment methods are characterized by high efficiency. But they are not always used, since conservative treatment is usually quite good can cope with even a trophic ulcer.

Folk Methods

Folk methods should be attributed to conservative treatment. Independence on degree of confidence in such methods is strongly recommended to undergo a survey from a doctor.

Trophic ulcer - an extremely dangerous complication. Even if you avoid conventional medicines for any reason, the doctor must decide how to treat trophic ulcers in varicose veins. Perhaps the doctor will approve the phytotherapy, or another traditional way. Otherwise, the patient is very risking his health and even life.

A good healing effect shows a remedy with a golden mustache.

1. One leaf of the plant is thoroughly washed under warm water and tear into small pieces, about one or two centimeters.
2. The pieces are laid out in the enameled pan and begin to put pressure until juice appears.
3. The mixture is imposed on an ulcer and closed with gauze and bandage. Bandage make at night and remove only in the morning.
4. Pump must be washed with hydrogen peroxide.

Another option is the camel barrel (Tatarnik).

1. To do this, take dry sheets of the Tatarn and grinding into a small crumb.
2. It is sifted through the sieve and stored in the bank, in a dark place.
3. The wound should be treated with a pharmacy riban, and sprinkle it with a powder from camel spines.
4. Ulcer bandage at night, and give medicinal substances Act until morning.

1. In warm water, manganese is bred in the middle concentration (before the appearance of pale pink color). An ulcer should be in her half an hour.
2. Then the calendula should be divorced, 100 milliliters of calendula per liter of water. Similarly, they hold the wound in the solution for another half an hour.
1. The third, the last bathroom will be a solution with eucalyptus. After this ulcer bandage.

Therefore, the result may be minimal or completely absent. This once again emphasizes the importance of consultation from a professional physician.

Conclusion

Conservative treatment is made to divide into two types - local and common. Under local understand the removal of dead fabrics, disinfection, sterilization of the wound. General treatment includes receiving various medicines. The patient is most often prescribed by veotonic, antibiotics, anti-inflammatory drugs, as well as an anesthetic.

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Trophic skin changes in varicose veins and methods of their treatment

Varicose veins - it is a pathological condition that leads to a change in their width and length. Bloodstock is broken, the valves cease to work correctly. There is a disease as a result of pathologies of veins walls.

Trophic skin changes in varicose veins are not uncommon, but they appear, as a rule, only in the launched state. For speedy recovery, it is recommended to combine the methods of traditional and folk Medicine in treatment.

Causes of varicose development

There are many reasons that can lead to varicose veins, allocate among them the following:

1. Stay for a long time in the standing position. There are great pressure on the legs, in the case of specific conditions when people have to spend a lot of time in such a position, the development of varicose varicoses is unlikely to succeed. To aggravate this factor may and obesity - in this case there is even greater pressure on the legs.
2. Hereditary predisposition. If both parents have diagnosed with such a disease, with a probability of 70% and higher the child inherits pathology.
3. Maintaining a larger lifestyle. At this time, this is the most common cause of the development of the disease. Many phlebologists argue that this is the so-called computer varicose veins. Those people that spend a long time in the sitting position, are several times more often faced with varicose veins.
4. Violations in hormonal background. In women, the reason meets more often than men. The fact is that in their body is often an insufficient estrogen, but yellow bodies will be produced on the contrary to twice the quantities. It is they who contribute to the weakening of the muscle tissue, the tone of the vessels weakens.
5. Blood outflow on the veins is broken. This may occur for mechanical reasons - an obstacle is formed, as a result, blood does not move fully. It may be a tumor, a thrombus or something else.

The cause of the disease may cause a person's lifestyle. Alcohol, smoking, drugs, all this affects the tone of vessels. In any case, only the doctor can determine the reason for the development of a notem and appoint appropriate treatment.

Symptoms of varicose

At the initial stage of development of varicose veins, there are practically no symptoms, which is why many are asked for help late.

To prevent the further development of the disease and to avoid complications, the main signs that may be present:

1. At the end of the working day, the legs swell. Shoes can become close, after a complete rest, it usually happens by morning, the symptom disappears.
2. Another characteristic symptom for varicose veins is a sensation of a cannonal nucleus, which is riveted with shackles to the leg. A sense of cutting in the calf muscles appears, especially after a long stay on the legs or after the time spent at the computer. If you have a good rest and warm up, then the next day the symptom will disappear.
3. There are so-called hot sensations in the legs, or rather in caviar. Vienna become very noticeable.
4. Another warning pointing to what is happening something wrong - the feet cramps at night.
5. Under the skin of the feet there are vascular splashes in the form vascular starsFirst, they barely noticeable, but after some time they begin to shift.

If you do not pay attention to all these symptoms, and numerous complications will begin to appear.

Diagnostics

If a man or woman sees at least one symptom, which is listed above, it is necessary to seek advice from the phlebologist. It is this specialist who is being treated and examining such problems.

In order to prevent complications, to delay a visit to the doctor in no case. The forecast depends only on how long therapeutic measures will be taken.

The diagnosis begins with the fact that the doctor examines the patient, the affected area is palpable. The next stage is the instrumental examination. As practice shows, a direction for ultrasonic doppler is given.

Analyzes may give as a supplement. After the diagnosis, appropriate treatment is prescribed. In this case, self-treatment is prohibited.

Trophic skin changes

Against the background of impaired blood circulation in the lower limbs, the development of trophic changes is possible, the course of their chronic. Even after the surreal treatment has passed, external signs may remain. Below we will look at the basic such violations.

On the video in this article describes in more detail about what violations can be.

Lipodermatosclerosis

Due to permanent edema, the cell power process is broken. Due to the violation of the venous outflow, the pressure in the vessels begins to increase.

Plasma and cells, that is, blood components are capable of passing through the walls of the capillaries, localizing the skin in the subcutaneous fat layer. All components are destroyed, chronic develops inflammatory processAll this leads to trophic.

Hyperpigmentation

Most often, the trophic changes are formed at the bottom of the tibia, as well as inside the ankle. The skin becomes less sensitive, the color becomes dark, the shade can be brown.

Skin eczema with varicose veins is not at all uncommon. After the blood is stirred, the local immunity is struggling with the pathogenic microflora, which is on the skin. In the place of the inflammatory process, the pathogens of the infection are multiplied.

Immunity on the stimulus corresponds to an allergic reaction. In the place where eczema appears, the skin is closed, small films are separated, wounds appear, as if abrasions. The quality of life of the patient is reduced.

Atrophy skin

Pigmented leather after some time will begin to be brightened, but this does not mean that he has come recovery. On the contrary, this is the next stage of the destruction of cellular nutrition - white atrophy. The skin becomes more densely, plots are formed in the form of a fifth. Feet in this place can decrease in volume.

Varicose dermatitis is a chronic inflammatory process arising due to insufficient blood circulation. Plots with scales appear, skin is atrophy. Overweight human weight can aggravate the situation. Influence this can also be harmful habits or wearing uncomfortable shoes.

Trophic ulcers

Chronic currents, for a long time they do not heal, can become more and more. Periodically, the wounds can be heard, but after time they open again. It is dangerous to determine them, as an infection can join.

Methods of treatment varicose

In the early stages of the disease, minimally invasive methods are rare, which is why drugs are based on therapy. In order to improve the condition of the veins, it is recommended to use medicines from several groups: vetonic and angioprotectors.

Medications can be removed unpleasant symptoms - pain, swelling, inflammation, fatigue. It will be possible to increase the elasticity of the vessels, the blood will become more liquid, the clomes will not begin to form.

Preparations, the following may be assigned to treatment:

Therapy can be supplemented by wearing compression linen.

Important! Only a doctor can prescribe drugs, independent treatment can lead to a deterioration in the state.

Hirudotherapy

In order to eliminate the disease at an early stage without surgery, highheeps can be used, that is, treatment with leeches. In their saliva there is a girudine, after the bite, he gets into the blood. Viscosity indicators are reduced, thrombosis is warned.

Assign the procedure may exclusively with a doctor, contraindications to its use may be as follows:

• pregnancy in women;
• allergic to the secret to the leeches;
• depletion of the body;
• blood diseases.

In addition, it is impossible to conduct a procedure for inflammatory diseases developing on the surface of the skin.

Minimally invasive treatments for treatment

These effective procedures, operational intervention do not require, patients are not in the hospital and do not pass a long rehabilitation period. Such methods are small-acting, as well as painless. Before patients, local anesthesia is set.

Sclerotherapy

Through injection, sclerosis in Vienna is introduced. The active substance allows you to block the damaged area, the blood will start moving along the circulatory system and will not fall into the closed place.

After some time, the pathological vein will resolve independently. Sclerotherapy is the main method of treating varicose veins, it is controlled by ultrasound.

Laser ablation

A procedure is carried out under an ambulatory, its duration from half an hour to two hours. Immediately after manipulation, the patient can go home. In order for the patient to suffer, everything is fine, it is placed by local anesthesia.

A light guide is introduced into the affected vein, it is located along it. The laser beam turns on and is carried out back, under its effect, blood turning occurs. The walls of the vessels are migrated, they stick together, and all because the affected area is cleaned.

Radio frequency ablation

This is not the most traumatic technique used for treatment. It can be carried out on any veins regardless of which diameter they have. Local anesthesia is placed, the operation itself is controlled by ultrasound.

The necessary puncture is done in Vienna, after which the radio frequency catheter is introduced there. Then the anesthetic is introduced, the surrounding tissues will be protected from radio waves. The rehabilitation period lasts no more than two weeks after this time the patient may return to a full-fledged lifestyle.

Microflebectomy

With the help of special hooks, the doctor will eliminate the affected vein. Enter the hooks under local anesthesia, the incision is small, does not exceed one millimeter. After the treatment has passed, the rehabilitation period takes only a few days, after that a person can start work.

Bruises may remain, but after 3-4 weeks they will solve themselves. The first few weeks are recommended to wear. compression knitwearIn order to secure the result. The main advantage of the procedure is that the affected vein is completely removed.

Phlebectomy

The procedure is more often conducted under spinal anesthesia. After the operation, a few days the patient must be in the hospital.

Indications for the procedure are as follows:

• pronounced blood flow;
• complications of varicose trophic Yazv etc.

A probe is introduced through a small incision. The extended vein plot is removed, it follows it with a mechanical way. The incision after removal needs to be sewn. The duration of the procedure is no more than two hours.

Prevention

In order to protect itself from the development of such a disease, a whole range of measures should be observed.

Select among them the following:

• it is recommended to alternate rest and work;
• it is impossible to stay in a long time in the sitting position, it is also not recommended to cross the legs, it will contribute to circulatory disorders;
• with a forced position sitting, try to change poses as often as possible;
• wearing squeezing body things are not recommended;
• women should not wear shoes with high heels, if necessary, time spends on it as little as possible;
• each day make hiking;
• follow your power, eat as many products of rich in vitamins and useful substances.

Thin skin with varicose veins can cause many complications. Remember that the inflammatory process appears in varicose veins can be developed for years. If the changes are not seen on time, and the treatment will be absent, it will not be possible to avoid complications.

Frequent questions to the doctor

Complications from varicose veins

My brother was diagnosed with varicose veins, swollen veins were already noticeable. Until today, he did not deal with treatment, tell me what it can lead to?

If the veins became noticeable, then most likely the brother may threaten the operation. What kind of her species will be applied, depends on what the results of the survey will be shown.

• varicosis 148.
• varicocele 75.
• thromboflerbit 36.
• atherosclerosis 22.
• spasm of vessels 15.
• aneurysm 7.
• thrombophilia 4.
• vegetoe Vascular Dystonia 1

Neurologist, experience 4.5 years. Hello everybody. I will not advise anything concrete. Write your questions, will understand. But my dear: how would you not asked your question in detail and no matter how timefully you were answered, I'd better sign up for me (I now live and work in Moscow) or my colleagues at the reception. It is very difficult to give specific recommendations without seeing the picture entirely.

Doctor therapist. Often they treat me for helping the elderly, everyone needs to help. But most people themselves are to blame for the fact that the last 20 years have introduced a sitting lifestyle. What can I advise: buy a complex of vitamins and do not read more about the recipes of traditional medicine. Powerful drugs only in extreme cases and only when observing the doctor.

Flaboball doctor with 8 years old. I think that all problems of vessels because of the wrong lifestyle. Do sports and do not eat every fast food and feel perfectly well.

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Under the eczema, the inflammatory process in the skin is usually chronically, with exacerbations and periods of remission. The origin of such inflammation determines the type of eczema. In addition to primary (idiopathic), there are several other species accompanying various pathology as complications - injuries, infectious lesions.

Varicose dermatitis is considered an option for microbial eczema, when against the background of the microcirculation disorder, the introduction of microorganisms, the reaction to the conducted drug treatment on the skin arise with inflammatory foci up to ulceration.

After healing the ulcers or surgical treatment of varicose disease, eczema, as a rule, disappears independently.

The features of microbial (varicose veins) eczema is considered the asymmetric location of the foci of damage, which have quite clear boundaries, and along the periphery there are peelaning of the epidermis in the form of elevation. Due to the fact that the varicose disease is striking the lower limbs, this type of eczema also occurs on the legs - where there are extended vessels, ulcers, bubbles appear, the healing sites in the form of scars.

Causes and stages of varicose eczema

Venous eczema occurs more often in the elderly, among patients more women, many, in addition to veins pathology, have concomitant diseases - diabetes, obesity, atherosclerosis.

The factors predisposing to eczema are similar to those for varicose disease - overweight, long-term static loads, pregnancy and childbirth, leg injuries, heredity. Create skin damage can chronic infections, decrease in immunity, metabolic diseases, heart impairment.

The direct cause of the ecratese lesion of the skin in varicose disease is considered a progressive disorder of microcirculation, venous insufficiency and stagnation, tissue edema. In the absence of treatment of varicose veins, the chances of the appearance of eczema increase.

Several stages of the development of venous dermatitis are distinguished:

1. In the first stage, initial signs of trophic disorders appear - peeling of the skin, itching, color change.
2. At the second stage, swelling of soft tissues is noticeable, foci of peeling, erosion, redness, comb, bubbles arise on the skin.
3. The third stage is accompanied by peeling the epidermis in the form of bubbles, which are open, the wound surface is constantly wet (mocking), characterized by the attachment of the secondary infection.
4. At the last stage, the inflammatory process will gradually fade, the wounds are covered with crusts, scars are formed.

Manifestations of varicose eczema

The manifestations of varicose dermatitis depend on the stage of the disease, but many patients may find both initial signs and foci, characteristic of the later deadlines of the disease, including scars. The defeat is located on the legs, that is, where varicose veins is manifested - legs, feet, an area of \u200b\u200bankle joints. It is possible to defeat both one limb and both at once.

The main sign of venous eczema - skin symptoms:

• Hyperhemia (redness) of inflammatory character, the skin is hot to the touch;
• Itching, burning, the feeling of heat in the affected area;
• Swelling of soft tissues;
• Vesiculi, including shut-off.

manifestations of varicose eczema

In the first stage, the patient experiences itching, occurs periodically, closer to the evening and at night, not too intense. The skin becomes red shiny. Over time, bubbles filled with serous contents appear. Gradually increases swelling of soft tissues, pain is possible.

When progressing the trophic changes, it becomes constant and rather painful, rasack appear, the number of newly formed vesicles, which empty, giving the surfaces of the skin is a wet look. Such erosions represent a good nutrient medium for multiplication of microorganisms, so the secondary infection is a permanent component of varicose eczema.

Change of periods of exacerbations and temporary improvements leads to a further change in the skin. It becomes dense, acquires a brown or shiny shade, peeling, scarring plots alternate with fresh bubbles.

The final stage of dermatitis against the background of varicose veins can be not only sclerosis with sealing and thinning of the skin, but also the formation of trophic ulcers penetrating deep into the dermis. Inevitably joins the infection, which is also promoted by comb.

The presence of varicose eczema of the lower extremities changes the gait: the patient begins to wipe, trying not to load the striking leg. Dermatitis is reflected on general condition patient. Considering the chronic inflammatory process, such symptoms like weakness, fever, permanent itch disrupts sleep, the patient becomes restless and irritable. An important meaning is also a cosmetic defect caused by pathology, because of what women are especially experienced to abandon skirts, shoes on the heel.

Varicose ulcers characterize a far-seated process, when inflammation is spreading deep into the leather, the skin in the ulcer zone is necrotized, the wet surface is wet, covered with brown, gray-yellow crusts, soft fabrics are empty. At this stage, patients complain about intense itching and pain in the affected limb.

The complications of varicose dermatitis become purulent processes due to the attachment of the secondary bacterial flora. This phenomenon is very dangerous to generating and sepsis, especially in individuals with exchange disorders, diabetes, expressed venous insufficiency.

Treatment of varicose eczema / dermatitis

Varicose eczema requires an integrated treatment approach - drug therapy, both local and in the form of drugs taken inward, labor and recreation, rational food. In some cases, the question of the need to remove varicose extended veins is surgically by. Everyone without exception patients is recommended to wear a compression knitwear.

Local impact

Local treatment includes various creams, ointments, lotions and baths. It is especially effective at the initial stages of dermatitis. The task of local therapy is to moisten, soften and disinfect the skin. To this end, experts advise regularly lubricate the skin of the shins and stop by moisturizing cosmetics, special oils. Well, if the patient refuses ordinary soap in favor of dermatological gels, more mildly cleansing skin surfaces without overpowing it.

Hygienic procedures in conditions of insufficient trophy are very important, so you should not neglect them. Clean the affected skin needs every day, preferably - neutral soap. Mocking surfaces are dried with sterile napkins or wool, and the surrounding skin is treated with solutions of antiseptics.

With the appearance of bubbles and wet erosioned areas, it is possible to use drying ointments and bolts manufactured in a pharmacy according to the recipe of a dermatologist. Ointments and creams based on zinc, naphthalan, silver nitrate you can buy already ready, the chatter prepared individually.

Resorcin, rivolol, silver nitrate solution are used in the form of lotions and are effective due to antimicrobial, drying and astringent action. Hormone-based preparations (Lorinden, Sinalar, Advantan) have anti-inflammatory properties, help reduce itching.

In most cases, 1-2 stages of dermatitis, symptoms decrease under the action of local treatment. To improve the trophic and acceleration of healing erosion and ulcers, drugs reinforcing skin regeneration are solisuril, methyluracyl.

Medical and surgical treatment

In addition to local therapy, in some cases there is a need for additional treatment with the help of drugs taken inward:

So, if the eczema proceeds with a microbial infection, do not do without antibiotics. With fungal damage, antibiotics are not prescribed, antimicotic drugs are used instead. Antihistamines - Pipolfen, phenkarol, Loratadine are used to relieve itching. Many patients with severe varicose dermatitis need sedatives - Valerian, mother-in-law, tranquilizers.

Considering that the direct cause of skin lesions is varicose veins and veins pathology, it is advisable to appoint an appointment inwards and vascular funds (Actovegin, Pentoxifillain, Detralex).

Surgical treatment is shown in severe dermatitis forms that are not amenable to conservative therapy. This produces either removal of veins during operation, or minimally invasive and non-operative techniques. Laser, sclerotherapy is very popular.

General Tips for the treatment of varicose dermatitis include changing the mode, diet. Patients should be avoided long staying on the legs, walking on long distances (and at the same time hypodynamine); Wearing close shoes and synthetic clothes should be excluded.

To normalize the blood flow through veins, a compression knitwear is used - golf, stockings, tights that are selected strictly individually taking into account the stage of the disease and the parameters of the patient's feet.

Diet with venous eczema should include products with high content of vitamins, especially groups in, trace elements, protein. It is necessary to limit the use of irritant, spicy, sharp dishes, alcohol, which provoke the strengthening of the local allergic reaction.

Folk and non-traditional therapy also offer a lot of recipes from varicose dermatitis. Among the most popular - baths, sinks with solutions medicinal plants, Hardherapy leeches.

The use of leeches is due to their ability to ignite blood, thereby improving blood flow in veins, microcirculation in fine skin vessels. The Hirudotherapy procedure is originally recognized and acceptable to every patient, but it is better to conduct it at a specialist with medical education in a medical institution.

ethnoscience

Folk remedies in varicose eczema are quite actively used, because the grass is available to everyone, can be used at home and independently. Typically, patients are preparing ragners of medicinal plants. Effective can be chestnut extract, grape leaves, daisy and calendula flowers, oak bark, possessing antiseptic, wound-healing and anti-inflammatory properties.

Healing helps the use of various oils - almond, coconut, wheat germs. Oils are recommended to process the affected areas of the skin after thorough hygienic procedures.

Adherents of traditional medicine can prepare more complex compositions based on medicinal herbal. For example, the ointment cooked at home from plants can reduce itching and soften the skin. To get it takes on the tablespoon of the grass of the burdock, Ivan-tea and daisies pharmacy, mixed with a spoonful of butter and heated in a water bath until a thick substrate is obtained. After the composition cools, it is mixed with glycerin and processed the affected skin.

It is easier to treat varicose eccase, the sooner to proceed to this process, but no less important is the prevention of this unpleasant and dangerous complication of veins pathology. It is important to pay due attention to physical activity - walking, running, swimming, etc. In order to increase the tone of muscles and veins of the legs. Useful massage, cold and hot shower, breaking cool water.

With the beginning, eczema should not refuse movements, on the contrary, they enhance the microcirculation and accelerate the healing of the wounds. Long static loads better exclude at all, and if labor activity Does not allow this, then it is worth trying to minimize the time spent on the legs.

Wearing convenient shoes, correctly selected in size, clothes made of natural fabric - the need for patients with the already started eczema. If during varicose ladies, it is recommended to limit the wearing high heel, then with dermatitis about it it is better to completely forget, as well as about the objects of the wardrobe from synthetic tissues.

Varicose dermatitis proceeds chronic, years, leading to irreversible changes in the skin of the legs, therefore, so as not to launch the disease and in time to carry out the most effective treatment, you should always consult a specialist. Patients with varicose disease at least once a year should visit the phlebologist or surgeon to control the flow of pathology.

The appearance of venous eczema speaks of a serious impaired blood flow in the veins, and the forecast is far from always favorable, because ulcers can be formed in a matter of months. This shape of the skin manifestations of varicose veins is most difficult to amenable to therapy, but success depends on how quickly the patient falls to the doctor and how carefully will fulfill its recommendations. Subject to the effectiveness of some folk recipesAlternative medicine is not able to heal from the illness, and self-treatment must be completely excluded.

Strong load on the legs, which is regular, leads to the problem of varicose veins. Subsequently, if the treatment is not engaged in treatment, trophic ulcers appear on the skin. Such modifications are manifested in red or even blue spots on the skin, cause painful sensations.

Trophic ulcers can be treated with drug or surgically, if the problem is not very launched, the techniques of traditional medicine can be used. There is a possibility to be treated for atmights, but it is necessary to comply with all the recommendations of doctors.

The concept of trophic ulcers

When the blood circulation mechanism is broken, stagnation processes begin in veins.

This leads to expansion. blood vesselsVaricose.

If a person is in no hurry to treat the problem, running it, then trophic ulcers can appear on the skin, and they will be present on the legs not in a single version.

The trophic ulcer is a complication of the flow of varicose veins, has pronounced signs.

The problem can be easily described as follows:

• the problem belongs to the category of complications arising from launched varicose cases;
• the trophic ulcer is a problem of strong damage to soft tissues;
• the pigmentation of the skin in the affected area increases, additionally occurs dermatitis or eczema;
• the skin on the affected area has a matte appearance.

Such a problem suggests that blood in the vessels is stirred, the outflow of lymph is broken. The problem is accompanied by painful sensations, observing the epidermis is observed, dry crust appears in the wound.

Note! If the trophic changes of the lower limbs are not treated, then over time the problem may affect the muscles and it will deliver incredible pain. In this case, it will be possible to treat the problem solely by surgical path.

What types of treatments are customary to use

Trophic changes in skin require treatment at mandatory. The selection of the method of impact on the problem will be carried out depending on which stage of the problem of the problem in a particular patient. For patients with such a disease, the following types of treatment can be applied:

1. Surgical intervention.
2. Conservative treatment (use of tablets, ointments, injections).
3. Application of recipes and methods of traditional medicine.
4. Conduct physiotherapeutic treatment.

The use of folk remedies should not be fulfilled independently.

Before applying in practice, some technique, the patient is be sure to consult with their attending physician.

Trophic skin changes in varicose veins are not only an external problem, but also deliver discomfort in terms of sensations.

The larger and deeper the wrecks, the stronger the limbs will be sick, a person will face such a concept as strong swelling directly.

Conservative

Conservative or drug treatment of trophic ulcers is to need to drink certain drugs and make certain external manipulations using pharmacy medicines. To perform the conservative treatment of trophic skin changes, doctors recommend using the following medicines:

• antibiotics in the form of creams and ointments of externally and tablets inside (iodine and green not use);
• special pharmacy bandages and sponges, bandages;
• elastic compression;
• non-steroidal anti-inflammatory drugs;
• intravenous antiagregants;
• antihistamines.

If we talk about the use of specific drugs, then due attention is worth to give the funds of Iruksol, Streptolaven, Dioxisc, Levomecol. If bandages from an elastic bandage are used, they are soaked with some kind of drugs, superimposed on the wound and change as necessary.

It is important! Iodine and greencraft are also antiseptic substances, but their impact is too sharp and precisely because of this, the trophic wounds should not impose such funds.

Surgical

If the trophic ulcer does not pay attention to not pay, then it becomes a serious problem that is necessary to eliminate surgically. Trophic changes in the skin and subcutaneous fiber deliver a lot painful sensations And that is why the problem has to be solved in the hospital. The essence of surgical intervention with such a problem consists of the following moments:

• patients of veins are removed, which caused trophic changes;
• surgeons are trying to bring the system of blood flow limbs to normal;
• the problem with violations of the outflow of lymph is solved.

The operation can be carried out under general anesthesia or using epidural anesthesia.

If the second option is used, then the person will be conscious, but the pain should not be felt.

Narodi

Folk methods are often used to treat trophic ulcers on the skin. There are many funds that are used to treat the presented problem, and among them the most popular are those:

• home ointment prepared on the basis of egg protein and natural honey (take one protein and tablespoon of honey, mix ingredients, insist 3 hours, use as ointments);
• a mixture of egg yolk and iodine (one yolk need a jar of iodine);
• ointment of spruce resin, bee wax and pork bale (take 100 grams of spruce resin, the same amount of wax and swine baking, boil the ingredients, cool);
• divorced in warm water of manganese (you need to take so much manganese, so that when it dissolves, the water had a light pink color).

Most of the funds are used to impregnating bandage dressing. Such ointments are superimposed at least 6 hours.

Note! Without consulting with her attending physician, a person should not use any of the presented methods of traditional medicine. If you actively engage in self-medication, you can make even worse.

Preventive measures

To prevent the appearance of trophic skin changes, people need to learn how to conduct competent prevention. The essence of preventive measures will consist of the following points:

• prevent too heavy loads on the feet;
• do not wear too high heels;
• if the varicose veins occurs, immediately engage in competent treatment;
• carefully monitor hygiene.

Prevention will reduce the risk of problems, but will not be able to deliver one hundred percent. There is also such a factor as a genetic predisposition to the occurrence of the disease, and it is completely impossible to fix it.

Read on the prevention of varicose veins on your feet.

Conclusion

Treatment of trophic skin changes on the lower limbs can be performed in several ways. Treatment technique for a particular person must be selected by a doctor. Treatment of this disease will be vigilant and at the same time carefulness is required, and even discipline.

Most often, drugs are used to perform treatment, but they are not worth buying themselves. If this problem occurs, a person should consult a doctor and only to select a competent method of treatment with it. Trophic ulcers can become very deep and therefore, the faster to start their treatment, the better.

Varicose trophic skin change: how to treat from ailment

What is a trophic ulcer

This term is called a chronic skin defect, most often in the area of \u200b\u200bthe shiny. Without treatment, ulcers almost do not heal until the end and appear again and again, the cause of their occurrence is varicose.

According to many specialists, the reason for the appearance of varicose varicoses in humans has become its sineware, as a result - increased load on legs.

And indeed, if you look at any four-way animal, none of them will meet varicose veins. If the walls of the vessels are weak initially, the risk of the appearance of varicose varicosis is only increasing.

If the disease is not treated in time, the walls of the vessels gradually become thinner, the elasticity of the skin in the area of \u200b\u200bthe sick veins is reduced.

The fabric cease to obtain the required amount of nutrients and oxygen, and carbon dioxide content rises. In addition, the impaired blood circulation leads to the fact that decay products are not output from tissues on time.

The first sign of trophic changes of the lower extremities is to change the color of the skin, it becomes darker. In addition, you can see:

• burning and itching;
• allocations of lymphs on the skin;
• female;
• skin seal, appearance of unhealthy shine;
• dermatitis;
• in the center of the affected area, a white spot appears (dead fabrics).

Gradually, the ulcer begins to deepen, grow up and fog. If the trophic formations are somewhat, they grow together.

Important! Almost all trophic ulcers caused by varicose veins appear in the ankle area.

The development of trophic ulcers from the appearance before healing takes place in four stages:

1. Appearance and expanding of ulcers. In the process, the destruction of skin cells around the wound occurs.
2. Purulent discharge.
3. Scarring. During this period, the body is trying to cope with an ulcer on its own.
4. Restoration of the damaged skin area.

The whole process takes an average of about 1.5 months. However, the greatest danger of ulcers in relapses. In the launched cases, the defeat of the tissues becomes deeper, reaching the bones.

Some of the greatest consequences of trophic lesions of the skin are cancer and gangrena, which in the last stages leads to the amputation of the limb. Therefore, at the very first symptoms, you need to consult a doctor and do not try to cope with the disease yourself.

Types of treatment of trophic ulcers in varicose

The type of treatment of trophic ulcers on the legs depends on the stage of the disease and individual characteristics of the patient. Of all directions, three most famous are distinguished:

1. Conservative treatment.
2. Surgical intervention.
3. Ethnoscience.

At the same time, the doctors are skeptical to folk treatment methods. First of all, this is due to the fact that to achieve the effect of the same phytotherapy, too much time should pass. In addition, herbs and parcels will not help cure ulcers at their later stages.

Treat ulcers only with the main disease. Since varicose veins is not the only cause of trophic changes in tissues, it will take full diagnosis of all organism systems.

Conservative treatment

Conservative treatment includes drug therapy, washing the ulcers and their subsequent processing. To achieve the desired effect, a set of measures is used:

1. Treatment aimed at improving blood flow and dissolving thrombus.
2. Purification of ulcers from pus.
3. Wearing therapeutic linen.
4. Therapeutic gymnastics and massage.

To treat trophic skin changes in varicose veins, regular antiseptic wound treatment is required. It is necessary to prevent suppuration.

In addition to antiseptics, wound-healing and anti-inflammatory ointments are used. Also do not forget about the preparations aimed at strengthening veins and small vessels.

Infectious diseases make it difficult for treatment, so during this period it is important to support immunity. To do this, it is necessary to take a complex of vitamin preparations, as well as carefully follow health.

Surgery

The most effective method of treating trophic ulcers. It includes any options for surgical interventions up to plastic Operations With a change of healthy skin on the affected area. In addition to transplant, the affected areas of veins are removed.

Before any operation, ozone therapy is first performed to clean the bowl of bacteria. Recovery after surgical intervention in the skin transplant is fast, the patient does not feel pain the next day.

The extreme measures include amputation limbs. This can occur if the patient did not fulfill the recommendations of the doctors after the operation.

When you ignore further therapy using topical drugs, the ulcer will return again. If the treatment is tightened, the risk of skin cancer only increases.

Folk Methods

Despite the achievements modern pharmacologyFitotherapy is still popular. Sometimes the treatment of herbs advise the doctors themselves, but only in the complex with the main therapy.

Most often home ointment and compresses are used, herbal baths, sometimes patients take chasters or tincture inside. Such treatment is effective only at the initial stages of the disease, here are some simple recipes:

1. Degtyar ointment. For the preparation of this, it will take 100 grams of fiction (juniper), two raw yolk and a few drops of rose oil. The ingredients are stirred to a state of homogeneous mass. Ointment is applied to the amazed plot for 20 minutes twice a day.
2. Lungwort. The grass can be used in a fresh form or in a brave. Thuster fresh leaves are applied to the wound as a compress for 30 minutes daily. A decoction on a dry medullae is used to wash the trophic ulcers 6 times a day.
3. Blue clay. Therapeutic properties of clay are well known, you can buy a dry powder in a pharmacy at an affordable price. Clay is divorced by instructions on the package and applied to the ulceration at the specified time.
4. Streptocidal ointment. For preparation, 1 tablespoon of unrefined vegetable oil will be required, as many fish fat and 25 pills of strepticide. The oil is boiled on a steam bath for 20 minutes, then fishery and waiting for another 20 minutes. The latter is added streptocide powder from chopped tablets, the mixture must be kept on fire for another half an hour. Finished ointment is applied to patients with skin sections and are interbated.

Before using ointments and compresses, the skin must be pre-deliberate. All used bandages must be sterile, so as not to put into the wound infection.

Important! Most of the folk recipes contains allergenic components. Before using ointments, you first need to check their action, apply a small amount to the bend of the elbow or wrist. If nothing happens during the day, the tool can be used.

Preventive measures

To prevent trophic changes in the skin and subcutaneous fiber due to progressive varicose varicose variations, much easier than to treat consequences. Therefore, it is important to take measures not only against the emergence of ulcers, but also try not to allow the appearance of varicose veins. What can be done:

1. Take preparations, strengthen vessel walls and improving blood circulation.
2. Move an active lifestyle, play sports, and when sitting, try to get a time on the warm-up.
3. Eliminate alcohol consumption.
4. Wear comfortable clothes and shoes, not pursuing the legs of the legs.
5. If there are already varicose veins, it will be necessary to regularly wear compression linen. You can choose stockings or golfs only after consulting with your doctor.
6. To improve blood circulation, yoga classes are helpful, especially exercises in which the legs are located above the level of the body.

And the main thing in the prevention of the disease is a regular visit to the phlebologist for preventive inspections. Then it will be possible to detect the disease in the early stages and quickly cure it without serious consequences and costs.

Conclusion

Complications after trophic ulcers caused by varicose veins are too serious to neglect timely treatment and prevention. An integrated approach to the treatment of ulcers and the underlying disease will faster return the health of the legs and veins.

One of the most serious consequences of varicose veins are trophic skin changes on the legs. Ulcers are hard to heal, and their treatment takes time if you miss the moment, the risk of losing the leg is great. That is why it is so important to treat varicose veins in the early stages even before the formation of non-healing wounds.

• ← Chapter 7. Reconstructive and restorative interventions in post-terrolic occlusion and valve insufficiency of the main veins.
• Content
• → Chapter 9. Conservative treatment of patients with chronic venous insufficiency of lower extremities.

Trophic ulcers of the lower extremities are perhaps the most severe manifestation of chronic venous insufficiency. Despite the obvious progress in the diagnosis and treatment of diseases of the lower extremities, the prevalence of trophic ulcers of venous genesis remains a kind of constant (1-2% of the adult population), detected as a result of numerous studies over many decades. It should be noted that the ulcers of the lower extremities became the object of attention of the doctors even during the existence of ancient civilizations. Probably, the first mention of the varicose expansion of veins and trophic shin ulcers can be considered eBers (1550 BC). Hippocrates believed that the ulcers of the lower limbs are associated with increased veins, which appear as a result of a relaxed position of the legs when in the saddle. In the treatment of ulcers, Hippocrates used puncturing of extended veins and binting the lower extremities. The treatment of such ulcers with the help of the bandage also offered the Averali Cornelius Celsis, who lived in the first century BC. In 1336, G. de Chauliak suggested that the "liquid lowers down" according to the limb vessels as a result of a long stay in a vertical position and contributes to the formation of an ulcers. G. Sanctus in 1555 noted the role of pregnancy and childbirth in the development of trophic body disorders of the lower extremities, and J. FEMEL believed that ulcers were caused by blood concentration. Interesting, facts indicating the difficulties with which the doctors of antiquity were found in the treatment of patients with the trophic ulcers of the lower extremities. So Avicenna did not believe in the possibility of healing the skin's ulcerations in the elderly and, if they heal, offered to destroy the skin. A similar opinion was adhered to many scientists throughout the centuries before the beginning of the XIX century.

R. WISEMAN The main surgeon at the courtyard of the English king of Charles II in 1676 came to the conclusion that the failure of the vein valves is the result of venous dilatation, and ulcers can be due to stagnation as a result of blood supply disorders. He first used the term "varicose ulcer". However, this scientist, suggesting stockings and bandage for the treatment of varicose veins, believed that the ulcers of the lower limbs could not be treated due to the danger of the "appearance of madness, pleuritis, hemoptia, pain in the kidneys and apoplexy." R. Wiseman gave the original description of the postpartum thrombosis, which leads to non-healing ulcers.

In the middle of the XIX century (1868), J. Gay and A. Spender, independently of each other, demonstrated that venous thrombosis plays an important role in the development of trophic ulcerations of the lower limb skin. J. Gay noted that "the appearance of an ulcer is not a direct consequence of varicose veins, and serves as the result of other changes in the venous system such as obstruction of stem veins, or arises due to violations from veins or insolvency of artery, as well as combinations of both". He described the perforana ankle, as well as the processes of thrombosis and recanalization.

In 1916, J. Homans noted the development of the insolvency of perforant veins after the trombous matter of the trunk veins. He first introduced the term "post-felubitic syndrome" to denote the effects of deep veins thrombosis. In 1938, he also described two types of trophic ulcers: varicose ulcers, which are easily cured by removing varicosely extended veins and venous ulcers, which are often not amenable to treatment (post-tombotic). J. Homans emphasized the insolvency of perforated veins resulting from thrombosis and subsequent recanabilities.

F.V. Cocket in 1953, S. Arnoldi and K. Haeger in 1967 convincingly probustly proved the insolvency of perforant veins valves in the development of trophic skin disorders of the lower extremities, and investigated the anatomy of these vessels in detail.

Analyzing a brief historical excursion Obviously, many modern views on etiology and methods of treating the trophic ulcers of the lower limbs are based on the unshakable foundation of the past.

As a rule, the detection of trophic ulcers during inspection does not cause special difficulties, but not all chronic ulcers of the lower extremities are associated with venous diseases. Figure 1 shows the distribution of trophic ulcers of the lower extremities depending on the causes of their occurrence.

Fig. 1. Distribution of trophic ulcers of lower extremities depending on the causes of their occurrence.

The presented data is eloquently indicate that the trophic violations of the lower extremities may be caused by various diseases, with venous etiology ulcers in the total morbidity constitute the overwhelming majority.

Studies relating to the prevalence of venous trophic ulcers were carried out in many countries and their data is very disgraced. This is primarily due to various methods for creating a sample. Frequency indicators presented in studies vary from 0.1% to 3.2% of the total population. At the same time, the ratio of women and men varies in the range of 2: 1 - 3.5: 1. The prevalence of trophic ulcers increases with age, and the predominance of women is maintained in all age groups.

The development of venous trophic ulcers is inextricably linked with hypertension in the system of the lower vein vein, which is generated due to the varicose transformation of the venous wall or its thrombotic damage and valve insufficiency. At the same time, not all pathogenetic mechanisms for the development of trophic disorders of soft tissues in venous hypertension are finally investigated.

Normally one of the factors supporting permanent outflow venous blood is the residual pressure created by the heart muscle. However, blood pressure transmitted to the venular part of the hemomicrocirculatory channel (10-12 mm Hg. Art.) It is not enough to provide blood outflow from the lower limbs to the heart. It is possible that the most important mechanism of venous outflow from the lower extremities is the action of the "muscular and venous pump" of the leg. However, in the literature in relation to the work of the "muscular and venous pump" of the shin, there are differences. A number of authors claim that the pumping function of the "muscular-venous pump" is compressed by the cutting muscles of deep trunk veins (Schuro A.G., 1980; Firsa E.F. with Soval., 1992). The point of view is more common that the return of blood is carried out at the expense of the sinus sinuses with the oscillation muscles, which empty and the bloodstream at the same time is significantly accelerated (Vedensky A.N. with et al., 1979,1983; Alimi G.S. et al., 1994). Numerous work on measuring the functional pressure in venous sinuses and deep lines of the legs indicate that the abbreviation of the muscles has a significant effect on the outflow of venous blood (Waldman V.A., 1960; Henderson G. et al., 1936; Hellebrandt Fa et al. , 1939; Barcroft H. et al., 1949; Lundbrook J., 1966). Having influenced blood outflow from intramuscular veins in deep highways, muscle contractions affect not only the influx of blood from the arteriole, but also from surface veins to the relaxation phase (DODD H. et al., 1976; Alimi G.S. et al., 1994). Communication veins play an important role in this regard, although it is also not clear to the end, in which phases are the flow of blood in direct and indirect communicant veins and is there no blood flow in these veins (Shkuro A.G., 1980; Konstantinova G .T. Et al., 1982; Bjordal Ri, 1970). Thus, the "muscle-venous pump" seems to be complex multicomponent formation, which is the main element of which muscular venous sinuses serve. Congenital or acquired insufficiency of valves of surface, perforant and deep veins reduces the effectiveness of the "muscular-venous pump". Its activation in a similar situation leads to the inverse blood flow along the venous system of lower extremities (Dumpe E.P. from Sovut., 1982; Shaydakov E.V., 1999; Shevchenko Yu.L. et al., 2000). In varicose disease, two pathogenetic mechanisms are leading in the development of chronic venous insufficiency. In one case, the blood discharge occurs through the mouth of a large and low subcutaneous veins, in another - through perforant veins. Structural changes in deep veins (Ectacasia, valve insufficiency) lead to hemodynamic violations with the development of retrograde blood flow, dynamic venous hypertension, the formation of "voltage chambers". The following stage is the development of pathological venous venous shunts with blood reflux through the saffe-femoral, saffaine-ponedstray and through perforate veins that cause hypertension in the system of subcutaneous veins. The dilatation of venous walls, varicose veins, pathological deposit of blood in surface veins is growing. The last stage of the development of hemocirculatory disorders is changes in the microcirculation system.

The arising first as a physiological response to violations of venous macrohemodynamics, these changes pass serial stages ending with tissue exchange disorders and deep dystrophic changes in the skin, subcutaneous tissue and other anatomical structures of the lower limb.

As the disease progressing, there is a gradual increase in the permeability of the endothelial wall of capillaries and Vuls with respect to the macromolecular fractions of blood plasma (Kuzin M.I. et al., 1979; Szwed I.I. et al., 1980). This, in turn, leads to shifts of protein fractions in the blood flowing from the affected limb, increasing the share of globulins and accelerating the aggregation of uniform elements of blood. Further changes are to accumulate albumin, and then more severe protein fractions in the intercellular space and the edema of the interstice.

The degree of violation of the transcapillary exchange depends on the state of venous macroheremodynamics. In the works of B.N. Zhukov with co-authors (1979, 1993) indicates that with varicose disease in the compensation stage, the transcapillary transfer of the main plasma components is within the normal range. The decompensated course of the varicose disease flowing under conditions of pronounced static and dynamic venous hypertension is characterized by an increase in capillaries permeability for the main plasma components (protein and oxygen).

N.L. Browse and K.G. Burnard (1982) In their studies, they expressed the opinion that an increase in permeability is associated with the expansion of spaces between the endotheliocytes of capillaries, which is due to venous hypertension. In their opinion, the increased permeability of the endothelium allows to fall into the interstitial space to large blood plasma molecules, in particular, fibrinogen. In the future, the polymerization of the fibrinogen in the fibrin outside the vascular channel is occurring, which leads to the formation of fibrin "cuffs" around the micrososcience. It is believed that these "cuffs" are a barrier for diffusion of oxygen from capillaries in tissue with the development of ischemic damage to the latter and, ultimately, the formation of trophic ulcers. With the help of immunohistochemical methods, the authors investigated the composition of pericapillary couplings. It was shown that they contain collagen IV type, laminin, fibronectin, tenscine and fibrin. N.L data obtained Browse and K.g. Burnard gave the origin of the theory of pathogenesis of trophic disorders in chronic venous insufficiency, which in foreign literature was called the "Theory of the Fibrin Cuffs" (Browse N.L., Burnard K.G., 1982).

One of the pathogenetic mechanisms leading to the formation of trophic ulcers is considered to be disruption of tissue oxygenation. Numerous studies have shown that in chronic venous insufficiency in the compensation stage, the voltage of oxygen in the tissues of the lower limb is not different from the norm. In the development of decompensation of blood outflow in the tissues, hypoxia develops, manifested by a pronounced decrease in the partial voltage of oxygen (Stacey M.C. et al., 1987, Solomon S. et al.1995). Right opposite data were obtained by H.J. Dodd with co-authors (1985). They found that the partial tension of oxygen in the skin of the lower limbs in patients with severe forms of chronic venous insufficiency is higher than in healthy people. Similar results were obtained by other authors (BINAGHI F. ET AL. 1995; Smith P. D., 1996; Schmeller W.T., 1997). The diffusion of gases on clearance of xenon was also conducted (Cheatle T.R. et al., 1990), which did not reveal violations of tissue oxygenation. Calculations using the theoretical model of gases diffusion made by C.C. Michel with co-authors (1990) was demonstrated that fibrin deposits, 99% consisting of water, do not affect the transport of small molecules at all. Based on the research conducted, it was concluded that not only hypoxic damage to tissues plays a role in the pathogenesis of trophic disorders in the chronic venous insufficiency of the lower extremities.

In 1987, S. Moysees with co-authors showed that with an increase in pressure in the lines of the lower extremities of a healthy person in a microcirculatory bed, leukocytes are launched. P.R.S. Thomas and co-authors (1988) repeated this study. They it was noted that after staying in the position of sitting for 60 minutes the number of leukocytes in the blood, taken from a large subcutaneous vein in patients with chronic venous insufficiency increased by 30%, and in healthy only 7%. J. Edwards in 1998 received similar results using leukocytes labeled with technetsis. Leukocytes, delayed in the microcirculatory course during venous hypertension, damage it and, if this impact continues for many years, the final trophic ulcers are developing.

Damage to tissues by leukocytes includes a number of pathogenetic mechanisms. In venous hypertension, the expansion of capillaries is noted and a significant reduction in blood flow rate in them. Under these conditions, intravital microscopy showed that leukocytes in capillaries move more slowly erythrocytes, which is explained by their large volume and spherical form. This leads to the accumulation of red blood cells behind each leukocyte when it passes through the capillaries. Finding into a post-cellular venue with a large diameter, the red blood cells shifted white blood cells to the periphery of the vessel, where the part of them sticks to the endothelium, the phenomenon of "edible standing" leukocytes occurs (Schmid-Schoenbein G.W. et al, 1975, 1980). The adhesion of leukocytes to the endothelium leads to their activation, isolating free radicals, proteolytic enzymes and tissue damage. Neutrophils can also migrate through the vascular wall into the extracellular space. Continuing for a long time, it leads to deep trophic disorders of soft tissues. It should be noted that the extravasation of blood cells - a multistage process, which includes the activation and release of adhesive molecules as leukocytes and endothelium cells, the interaction between these cells and the release of reactive substances (leukotrienes, interleukins, free oxygen radicals, etc.) (Thomas PRS ET Al., 1988; Scott HJ et al., 1990; VeraArt JCet Al., 1993; Wilkinson Ls et al., 1993; Smith PD, 1996) (Fig.2).

Fig.2. "Leukocyte aggression" when Hood.

It was shown that in healthy people after staying in the standing position for 30 minutes, elastase and lactoferrine appear in the blood - enzymes contained in the granules of neutrophils (SHIELDS D.A. et al., 1994). Similar studies were carried out in patients with varicose expansion of the lower limbs with the development of lipodermalmatosclerosis and trophic ulcers (Coleridge Smith p.d., 1994; Shields D.A. et al., 1994). At the same time, it was noted that the activity of elastase and lactoferrin was significantly higher in patients with veins pathology compared to healthy people of the same age and gender. In later studies, it was shown that the adhesion of leukocytes to the endothelium in venous hypertension leads to direct damage to the endothelium, which is accompanied by the appearance of soluble adhesive molecules in the systemic blood flow. In endothelium, with venous hypertension, the expression of the antigen is increasing, similar to the factor VIII and adhesive molecules, especially ISAM-1 (molecule of intercellular adhesion type 1). These factors contribute to the adhesion of a large number of leukocytes (Veraart J.C. et al., 1993; Wilkinson L.S. et al., 1993).

We have a study of oxygen-dependent and oxygen-dependent biocidity of neutrophilic garburocytes of the microcirculatory bed in patients with trophic ulcers of lower extremities in chronic venous insufficiency. The study was carried out using a lysosomal-cationic test and a test with a nice tetrazolium in capillary blood from a patient of the lower limb. The data obtained show that activated neutrophils release the factors of their aggression (cationic proteins and active forms of oxygen), for which the endothelocytes of the microcirculatory channel can serve as target cells. It is noted that oxygen-dependent biocidacy mechanisms are activated earlier, with less pronounced venous insufficiency, when the formation (or sharp activation) of oxygen-dependent factors has not yet occurs (Fig. 3, 4)

Fig. 2. Neutrophilic blood granulocytes from the lower limb with different degrees of oxygen-dependent biocidity.

Coloring durable green and azur A. Increased 10x100.

Figure 3. NST Positive neutrophilic blood granulocyte from the lower limb.

Coloring ParasolTrotrazoliye blue and methyl green. An increase of 10x100.

Thus, it is currently accumulated data that makes it possible to draw conclusions that the activation of leukocytes is one of the leading mechanisms in the pathogenesis of trophic disorders of soft tissues in the chronic venous insufficiency of the lower extremities. However, the question of the reason for the mass activation of white blood cells, as well as the role of various factors of leukocyte aggression in the development of the tissue damage process remains unclear.

At the microcirculatory level, the arteries and arterioles of the hypoderma occur. The vessels are surrounded by collagen couplings, sharply cry and twisted, are rarely located and uneven. In the arterial department, there are often signs of spasm arteries of small caliber and arterioles. When the amount of prokapillars and the constant distance between them, both the number and length of the capillaries, which corresponds to atrophy and flattening the papillary layer, occurs between them. The greatest changes are observed in the venous venous venous vessels, while deep venous plexus often remains intact. Electroscopy data indicate significant disorders of the ultracellular structure of the endothelium in the form of edema of endothelial cells and expansion of the endothelial pores through which the extravasia of the erythrocytes occurs. (Mazaev P.N. et al., 1987, Gazeshev V.K., Khokhlov A.M., 1991, Liebovich S.j. et al., 1987, Scott H.J. et al., 1990).

Significant changes occur in lymphatic leather vessels. They are characterized by almost complete destruction of the surface lymphatic plexus of the lower extremities (A. Bollinger, 1982).

Chronic venous hypertension leads to pronounced violations of the hemomic crystral channel of the lower extremities. These multifactor disorders are characterized by changes in all links of the microcirculation system.

A microbial factor plays a very important role in the development of trophic disorders of soft tissues. In case of bacteriological studies of material from the resulting trophic ulcers, the minorganisms of the types of Staphylococcus, Pseudomonas, Escherichia, Proteus, Citrobacter are found in the crops, and the staphylococcus aureus (up to 30% of cases) is often seen in the monoculture. More than half of the cases of microorganisms are allocated in the form of microbial associations. Also characteristic of the Mushroom Association of Candida genus with the microorganisms of childbirth Staphylococcus, Pseudomonas, Klebsiella (up to 27%). Wound infection beyond toxic action The surrounding fabrics reduces the overall and local resistance, causing microbial sensitization of the body and exacerbating trophic disorders.

Thus, ulcers in the chronic venous insufficiency of the lower limbs are characterized by a polyvalent development mechanism, unifying venous outflow disorders, microcirculation, systemic and local response to microbial aggression.

Clinic, instrumental diagnostics and differential diagnosis. Trophic ulcers in chronic venous insufficiency are, as a rule, on the inner surface of the lower third of the lower leg in the projection of the perforate veins (Fig. 5).

Fig.5. Venous trophic ulcer

At the same time, sometimes a peptic defect can be located on the outer and front surface of the leg, which happens in cases of a pronounced valve insufficiency of the perforate veins of this localization. In the most difficult cases, trophic ulcers circularly cover the shin. The size of the ulcerative defect may vary from the insignificant area of \u200b\u200bulceration to circular ulcers, which occupy most of the surface of the lower leg. Given that the area of \u200b\u200btrophic ulcers is important in determining the tactics of treatment, in clinical practice we use the classification proposed by Professor V.Ya. Vazutkov according to which the trophic ulcers are divided into small (up to 10 cm 2), medium (11-26 cm 2), large (26-50 cm 2) and extensive (more than 50 cm 2).

The appearance of trophic ulcers is preceded by a number of symptoms indicating the decompensation of blood outflow from the lower limb. The progression of violations of venous outflows against the background of varicose or post-terrombotic disease leads to an increase in swelling edema, pain in the lower limbs, night cramps, skin itch. The extravasation of uniform elements and proteins of blood plasma into soft tissues is clinically manifested by the formation of pigment spots, sealing subcutaneous tissue. In the future, the zones of hyperpigmentation and liposclerosis merge, the skin is thickened, becomes intense, fixed, painful. Adopting in soft tissues The decay products of the shape of blood elements, having antigenic properties, cause an inflammatory reaction that manifests the skin hyperemia and ancase dermatitis. This also contributes to the immediate damaging effect on the tissue of cationic proteins and the active forms of oxygen of neutrophilic granulocytes. The destruction of lymphatic plexuses leads to intradermal lymphostase and lymph transduction. The skin of the shin becomes the appearance of the "orange crust", the drops of transparent liquid accumulate on it. In the future, in the zone of the largest pathological changes, the focus of the exfoliation of the epidermis is arisen, which looks outwardly as a spish of whitish color, resembling Note Paraffin. Such a prevailing condition is called - white skin atrophy. Against this background for the formation of a ulcerative defect of a sufficiently slighted injury.

With small sizes of ulcers, its surface is usually covered with stamp. The lack of proper treatment leads to an increase in the area of \u200b\u200btrophic ulcers, which occurs either by expanding the borders, or due to the merger of several ulcerative defects. The bottom of the varicose ulcers at this stage is represented by a combination of necrotic tissues, fibrin, sluggish granulations. The increase in the area of \u200b\u200bthe ulcer defect is usually accompanied by penetration of ulcers in depth. If initially damage is limited only to the skin, then subcutaneous fiber, fascia, and sometimes deeper tissues are involved in the process. The muddy-separated muddy with an admixture of fibrin, when the microbial infection is attached, the appearance of purulent exudate is characterized. In this case, the course of the disease is often complicated by microbial eczema.

The clinical diagnosis of venous trophic ulcers is based on the identification of subjective and objective symptoms of chronic venous insufficiency, external signs of the pathology of venous vessels (varicose veins), anamnestic data on the suffered thrombosis of deep veins.

In order to diagnose the peculiarities of the disturbance of blood outflow, ultrasound methods for the study of the vessels of the lower extremities are used. Assess the presence and nature of pathological venous refluxs on superficial, perforant and deep veins. In the most difficult cases, when the listed research methods are not enough to assess the state of venous outflow, X-ray-district phlebography is used.

The formation of an ulcer, as mentioned earlier, can be not only a manifestation of decompensation of blood outflow during chronic venous insufficiency, but also a symptom of other diseases.

Repruting atherosclerosis and endarterite. The occlusive diseases of the arteries suffer more than a man. Differential diagnosis is based on identifying complaints of chronic arterial obstruction. The most cardinal symptom is intermittent chromoty. Also characterized numbness and cooling limbs. In case of inspection, attention is noted depletion of the hair cover, muscle atrophy, deformation and fungal lesion of nail plates. The ulcer-necrotic process with obliterating atherosclerosis and endarteritis is localized in the field of the foot. The edges of the ulcers are bezed, have clear contours. The bottom is represented by necrotic tissues with a meager separated with an unpleasant odor. Often, the necrotic process extends to the deep tissues of the lower limb with the exposion of the tendons and bones. The main diagnostic criterion of the ischemic nature of trophic ulcers is the weakening or absence of pulsation on the arteries of the limb. Ultrasound scanning allows you to put the correct diagnosis.

Diabetes. Trophic ulcers in diabetes mellitus arise due to the specific damage to vessels and nerves. The pathological process in large arteries is characterized by the development of arteriosclerosis (sin. Mediocalcinosis, media cartridge, medioclerosis, mediogeneration) Menseberg - calcinosis of the middle shell of the arteries of various diameters in the absence of damage to the inner and outer shell. In the capillaries, the basal membrane thickening occurs due to the increased synthesis of glycoproteins against the background of hyperglycemia. Activation of enzymes that contribute to the conversion of glucose into osmalically active sorbitol, with difficulty penetrating through biological membranes, causes swelling and damage to the nervous tissue with the development of neuropathy. Trophic skin changes are developing, as a rule, with type II diabetes. They are localized on the end phalanges of the fingers of the feet and are often combined with the gangrene fingers and phlegmon of the fiberglass of the foot. Laboratory studies of the state of carbohydrate exchange make it possible to put the correct diagnosis in the absolute majority of cases.

Neurotrophic ulcers As a result of denervation of sections of the lower limb in the injuries of the spine and peripheral nerves. They are characterized by a stubborn flow, are located more often on the plantar or side surface of the foot. Despite the small dimensions, these ulcers are characterized by a significant depth. The bottom of the ulcerative crater is represented by a necrotic cloth with a scanty serous-grinding separated. The processes of natural reparation in neurotrophic ulcers are so reduced that the granulation fabric is either completely absent, or is represented by areas of scanty granulations.

Martorella's syndrome. In 1944, Marorellem describes rarely found trophic tibia ulcers on the basis of hypertensive disease. This disease is more often observed in women and rarely in men. The cause of the formation of these ulcers is the focal ischemia of tissues in hypertensive in connection with endothelial proliferation and subendothelial hyaline in small arteries and arteriols, causing the narrowing of their lumen. Trophic ulcers in Martorella syndrome are more often located on the outer surface of the tibia. A characteristic feature of the disease is pronounced pain in the zone of ulceration.

Skin cancer. Difficulties B. differential diagnosis Venous trophic ulcers and malignant neoplasms of the skin arise either in cases of malignancy for a long existing trophic ulcer, or with necrosis and decay of a malignant tumor. In both cases, the presence of the growth of the tissue (plus the cloth) along the periphery of ulceration requires cytological or histological research. In cancer pathology, the cells of the flat-milk (rare basal cell) cancer are determined in the preparations.

Treatment. "The shin ulcers represent the true cross of surgeons in their wise perseverance and the difficulty of cure." These words of Academician S.I. Spaskukotsky fully reflect all the difficulties arising from the doctor in the treatment of patients with the trophic ulcers of the lower extremities.

Today, there is no doubt that only the integrated effect allows not only the healing of the ulcerative defect, but also a long-term unqualified period. It is this result that can be considered satisfactory in the treatment of patients with severe pathology of the lower extremities.

Regardless of the cause of the occurrence of venous trophic ulcers, its size and phase of the wound process, treatment must be started with a complex of conservative measures, the purpose of which is healing or a decrease in the area of \u200b\u200bulceration, the relief of inflammatory reactions and complications, preoperative preparation, improved quality of life.

Conservative treatment should begin with the necessary patient's treatment regimen. The patient's stay in the bed with a 25-30 °-raised foot end contributes to the improvement of venous outflow, and often it leads to a decrease in trophic ulcers and the relief of cellulite phenomena. Postural drainage can also be provided with a roller, uniformly lined under the affected lower limb.

Elastic compression. Currently an indisputable fact is that no compression can be successfully implemented by none of the known methods of treatment of diseases of the lower extremities. Moreover, it can be said that compression treatment is the only pathogenetically reasonable, safe and practically no contraindications by the method.

With chronic venous insufficiency with pronounced trophic disorders of soft fabrics of the limb, as a rule, elastic bandages of short extensibility and compression knitwear of the class III are used. Compression products in patients with trophic ulcers should be superimposed on top of the dressings containing topical drugs. In this case, an inelastic cottage-gauze bandage serves as an adsorbing material with a pronounced exudation from the surface of the trophic ulcers. The formation of an elastic bandage must be carried out in the Trendelenburg position (with the lower head level raised above). It is also important to create a uniformly decreasing degree of graduation of the limb from the ankle to the knee joint. After relieving acute inflammation in the trophic ulcer zone and, accordingly, reducing exudation, it is advisable to use a special healing knitwear with a compression goal. Unconditional advantages are simplicity and aesthetics of application. A variety of elastic compression is a zinc-gelatin bandage proposed by P.G. Unna more than 100 years ago. The therapeutic effect of the zinc-gelatinite bandage consists in segmental compression of extended surface veins, preventing retrograde blood flow on them, local exposure to a trophic ulcer (zinc bactericidal action on some types of microorganisms, osmotic action, etc.).

Pharmacotherapy. Currently, pharmacotherapy of chronic venous insufficiency firmly occupied its locally as one of the main types of treatment of this pathology. In patients with trophic ulcers of the lower extremities, it is necessary to carefully carefully approach the choice of conservative therapy. The severity of trophic skin changes dictates the need to prescribe various drugs pharmacological groups, and the stage of the wound process and the propensity of patients with allergic reactions is a thorough individual selection of medicines. Unfortunately, some part of patients with the pathology of the lower limbs for various reasons cannot be made radical surgical interventions, or their execution must be divided into several steps. For these patients, conservative treatment is the only possibility to reduce the manifestations of chronic venous insufficiency.

Indications for the use of different groups of drugs depend on many factors, including from the stage and severity of the course of the disease, the risk of developing complications. At the same time, it should be recognized that objective criteria that allow you to develop the optimal tactics of pharmacotherapy until there is no. However, the use of medication tools should be associated with the phase of the wound process.

At the first stage, when the manifestations of acute inflammation and destruction of soft tissues prevail, the main purpose of the use of pharmacological preparations is the rapid elimination of symptoms of inflammation, the fight against infection.

Fig.7. Troopic shin ulcer in the stage of acute purulent inflammation

Appoints therapy with non-steroidal anti-inflammatory agents (diclofenac, indomethacin, ketoprofen, meloxicami, etc.), disagreganites (acetylsalicylic acid, dipyridamol, clopidogrel), antihistamine (ketotifen, celestine, industrial), antioxidants (WIT. E, EMOXIPIN, Mildronat). The use of antibiotics for a long time was considered absolutely shown in the presence of trophic ulcers of the lower extremities. Currently, looks somewhat changed. Indications for holding antibacterial therapy It occurs with extensive trophic disorders flowing with pronounced perifocal inflammation, as well as in the presence of purulent separated from trophic ulcers. Local use of antibiotics is currently recognized in an ineffective. Given the microbial landscape, the most effective antibacterial agents are semi-synthetic penicillins, cephalosporins II -Sh generations, fluoroquinolones.

At the second stage, when the process of tissue destruction and the phenomena of acute inflammation are stopped, the correction of microcirculatory disorders is the main task of pharmacotherapy. At this stage, it is necessary to create conditions for the "start" of the regeneration of tissues, transition from the catabolic phase to the anabolism phase. At this stage, it is advisable to prescribe polyvalent phlebotropic drugs. They represent a group of heterogeneous to the chemical structure of drugs in which the leading mechanism of action is phlebotonic activity. These are drugs containing diosmin and hesperins (DETRAX, cycle-3-fort), hydroxirutosides (venorutant, trocserutrutin, verkinzine), heptamine (gincor-fort). In addition to increasing the tone of veins, the medical effect of these drugs is implemented by improving the lymphodent function, eliminate microcirculatory and hemorrheal disorders, the relief of inflammation. The discovery of the activation of leukocytes in the pathogenesis of trophic disorders in chronic venous insufficiency of the lower limbs was the impetus for the development of pharmacological preparations affecting the metabolism of leukocytes. Prostaglandin E 1. The preparation has a significant effect on microcirculation, reducing the activation of leukocytes and cholesterol content in the vessel wall, and also inhibits the aggregation of platelets. At this stage, it is advisable to continue the use of disagregantes and antioxidant therapy. Full relief of inflammatory manifestations, the beginning of the active epithelization of the ulcerative defect indicates the success of the treatment and at this stage, as a rule, monotherapy is carried out using one of the modern phlebotropic drugs. Phlebotonics with severe forms of chronic venous insufficiency should be applied for a long (several years) of time, courses for 2-3 months with short-term interruptions. It should be noted that the inclusion of phlebotonic drugs into the treatment diagracent of patients with trophic ulcers of the lower limbs not only improves the results of treatment, but is also cost-effective.

Local treatment. Throughout the history of medicine, not only the great set of drugs, but also various biological tissues, mineral and vegetable substances, as well as physical means of exposure (ultrasound cavitation, magnetic field, etc.) were used for the local treatment of trophic ulcers of the lower extremities. According to modern views, with the presences of trophic Yazvtopical tools should be applied depending on the phase of the wound process. In the first phase of the wound process, given the presence of pronounced exudation and fibrin-necrotic plates at the bottom of the trophic ulcers, are used, as a rule, water-soluble ointment, solutions of antiseptics, sorbing dressings, as well as enzyme preparations. A good effect gives washing ulcers with soap solution with its subsequent irrigation by antiseptics. The presence of symptoms of eczema and dermatitis requires the use of corticosteroid ointments, silver nitrate solution, zinc paste.

The choice of topical drugs acting in the second and third phases of the wound process is determined by their ability to stimulate the granulation and epithelization processes of the ulcer surface. To this end, methyluracil ointment, ointment and gel "SolkoSeril" can be used, vegetable preparations (sea buckthorn oil, rosehip), polyfunctional wound coatings (allevin, algiop, algimaf, gemspron, comobutek, biocol, granufeples, etc.), zinc hyaluronate. The implantation of cell cultures (fibroblasts, keratinocytes) is reasonably used during the epithelial period.

The study of the parameters of microcirculatory blood flow using laser doppler flumetria at various times of conservative treatment showed that against the background of conservative therapy there is an increase in the skin perfusion of the lower extremities, the mechanisms of microcirculatory blood flow are restored associated with pulse and venous pressures. At the same time, the function of arterioles and prokapillary sphincters, i.e. The active mechanisms for maintaining tissue perfusion are significantly slower, and part of patients are practically not corrected using conservative treatment methods. Inspection studies conducted a month after the end of the conservative therapy rate, showed that a significant decrease in the microcirculation index appears indicating the deterioration in the perfusion of tissues. Under the influence of conservative therapy, the activity of enzyme granulocyte systems is normalized, which is responsible both for oxygen-dependent and oxygen-dependent biocytic processes. At the same time, the cessation of treatment leads to over-activation of lysosomal enzymatic neutrophil systems of the microcirculatory bed. The obtained evidence suggests that conservative treatment is positively affected by one of the leading factors of pathogenesis of trophic disorders in chronic venous insufficiency - violations in the hemomicration system. However, the effects of conservative treatment are unstable and short-period.

Conservative therapy in patients with decompensated forms of chronic venous deficiency of the lower limbs is not a radical method of treatment. However, it can significantly reduce the severity of the disease. At the same time, the instability and shortest possible effects of conservative treatment strongly requires regular re-courses. Conservative therapy cannot be opposed to other, more radical methods for the correction of venous outflow, given that patients with severe trophic disorders of soft tissues, it is often the first stage of comprehensive treatment.

Surgery. The question of the use of a surgical treatment method in patients with trophic ulcers, developed against the background of chronic venous insufficiency, it is not always possible to solve unequivocally. The trophic changes in the soft tissues of the lower extremities, on the one hand, significantly complicate the execution of operational intervention, on the other hand, are an additional argument in favor of the surgical treatment method.

There is no doubt that in a patient with a trophic ulcer, surgical treatment is optimally carried out after its epithelialization, but this does not mean that the presence of a ulcerative defect is contraindicated for the operation. If the complex conservative treatment does not lead to the healing of ulcers for 3-4 weeks and its bottom is made with a granular tissue without a purulent or fibrinous separated, then in this case surgical intervention is justified.

In a varicose disease and the presence of a small area of \u200b\u200ba small area, one-step phlebectomy is possible with a teal of instelligent perforated veins from cuts of 1-2 cm long. Performance of surgical manipulations on varicosely extended subcutaneous veins must be carried out using the most gentle techniques (laser coagulation of the trunks and tributaries of subcutaneous veins. , miniflebectomy).

With the presence of pronounced lipodermatosclerosis and (or) multirentrate blood discharge from deep veins into the surface in the lower third of the leg, the endoscopic subfascial dissection of perforant veins should be considered optimal by eliminating low horizontal venous reflux (SEPS) (Fig. 8).

Fig. 8. Endoscopic dissection of perforant veins

The endoscopic method of dissection of perforant veins during phlebectomy should also be used in patients with medium-sized trophic ulcers.

In patients with large and extensive ulcers, operational treatment should be carried out in two stages. At the first stage, the trunk of a large subcutaneous vein and its modified tributaries on the thigh outside the trophic change zone are produced. The execution of this surgical intervention allows you to interrupt vertical pathological reflux in a large subcutaneous vein, which helps to reduce venous hypertension and thereby creates good conditions for tissue reparation. After 3-4 weeks, the second stage of surgical treatment is performed. Optimal is the use of SEPS techniques.

The use of the SEPS technique is justified and when performing corrective operations during post-terrombotic disease. When identifying in a patient with trophic disorders of soft tissues of post-commobotic recanalization of the rear tibial veins, the fulfillment of their remote obturation according to the method of A.N. Introduced. This operation allows you to eliminate the retrograde blood flow both by proper perforant and in the veins of the foot, thereby limiting the spread of hypertension into the trophic disorders zone.

Operational interventions on deep veins with post-terrorship disease are carried out, as a rule, with trophic ulcers healing.

The implementation of pathogenetically substantiated operational interventions on the venous system of lower extremities allows to eliminate blood outflow disorders, to stop the main manifestations of venous hypertension and create conditions for the epithelization of trophic skin defects.

Thus, the surgical tactics in patients with hoptions and trophic disorders of soft tissues of the lower extremities depends on the characteristics of regional disturbances of the outflow of blood and the severity of trophic changes of soft tissues. The differentiated approach to surgical treatment of this category of patients avoids complications, without reducing the radicality of the operational manual. The surgical correction of venous outflow in patients with decompensated forms of the lower limbs leads to a resistant improvement in microcirculation functional indicators, which is manifested by a decrease in the pathologically elevated capillary permeability and functional activity of neutrophilic granulocytes in a microcirculatory line, as well as an increase in skin perfusion with the legs of the laser Doppler floutry.

Requires a separate consideration to the issue of performing an outdooramplasty of a peptic defect with excision of trophic ulcers or without it. It should be noted that carrying out such a type of operational interventions without eliminating the causes of venous hypertension in the lower limbs, as a rule, does not lead to success. In most cases, some time after the operation, there is a relapse of the disease or non-transplant necrosis in the nearest postoperative period. The histological studies of the material from trophic ulcers convincingly prove that the growth of young epithelium occurs both at the expense of the edges of the ulcerative defect and at the expense of the epithelium of the secretory and output sections of the sweat glands. Thus, even with the presence of an extensive area of \u200b\u200bulceration, there are all prerequisites for its epithelization during the correction of hemodynamic disorders (Fig. 9).

Fig.9. Appearance patient with an extensive trophic ulcer before and after treatment

The need for plastic closure of a ulcerative defect may occur with a long flow of a pathological process, which led to irreversible changes in the skin and subcutaneous tissue with the full loss of regenerator abilities. In such cases, after the correction of violations of venous outflows are performed by dermatolypectomy, followed by the closure of the defect cleaved skin flap. The need for such surgical interventions occurs quite rarely - in 0.05 -1% of cases.

In conclusion, it should be noted that the treatment of patients with trophic ulcers in chronic venous insufficiency requires the integration of the efforts of the specialists of fundamental sciences, doctors of specialized hospitals, a polyclinic and patient himself. Only under this condition is possible to successfully implement an extensive medical program necessary to patients with severe blood outflow disorders from the lower extremities.

Literature.

1. Bauerzax J., Fleming I., Bussse R. Pathophysiology of chronic venous insufficiency. // Phlebolimphology. - 1998. - № 7. - P. 1 - 7.

2. Vastekov V.Ya., Protsenko N.V. Trophy ulcers of the leg and foot. - M.: Medicine, 1993. - 160 s.

3. Vedensky A.N. Varicose disease. - L.: Medicine, 1983. - 207 p.

4. Saveliev V.S., Gogogorsky V.A., Kiriyenko A.I. Phlebology: guide for doctors / ed. V.S. Savelyev. - M.: Medicine, 2001. - 641 p.

5. Gazesheev V.K., Khokhlov A.M. Pathogenesis of trophic ulcers in varicose veins of the lower extremities. // Surgery. - 1991. - №10. - P. 100 -105.

6. Kiriyenko A.I., Grigoryan R.A., Bogachev V.Yu., Bogdnets L.I. Pharmacoteripia chronic venous insufficiency of lower extremities. // Consilium Medicum. - 2000. - arr. 1. - C.16 -22.

7. O, Donnel T. F. Jr., MCenroe C.S., Heggerick P. Chronic Venous Insufficiency. // Surg. CLIN. North Am. - 1990. - №70. - P. 159-180.

8. Stonko Yu.M., Shaydakov E.V., Yermakov N.A. Complex treatment of chronic venous lack of lower limbs in the stage of trophic disorders. // Consilium Medicum. - 2001. - Admission. - P. 28 - 31.

What worries you?

Varicose veins - it is a pathological condition that leads to a change in their width and length. Bloodstock is broken, the valves cease to work correctly. There is a disease as a result of pathologies of veins walls.

Trophic skin changes in varicose veins are not uncommon, but they appear, as a rule, only in the launched state. For a speedy recovery, it is recommended to combine the methods of traditional and traditional medicine in treatment.

Causes of varicose development

There are many reasons that can lead to varicose veins, allocate among them the following:

1. Stay for a long time in the standing position. There are great pressure on the legs, in the case of specific conditions when people have to spend a lot of time in such a position, the development of varicose varicoses is unlikely to succeed. To aggravate this factor may and obesity - in this case there is even greater pressure on the legs.
2. Hereditary predisposition. If both parents have diagnosed with such a disease, with a probability of 70% and higher the child inherits pathology.
3. Maintaining a larger lifestyle. At this time, this is the most common cause of the development of the disease. Many phlebologists argue that this is the so-called computer varicose veins. Those people that spend a long time in the sitting position, are several times more often faced with varicose veins.
4. Violations in hormonal background. In women, the reason meets more often than men. The fact is that in their body is often an insufficient estrogen, but yellow bodies will be produced on the contrary to twice the quantities. It is they who contribute to the weakening of the muscle tissue, the tone of the vessels weakens.
5. Blood outflow on the veins is broken. This may occur for mechanical reasons - an obstacle is formed, as a result, blood does not move fully. It may be a tumor, a thrombus or something else.

The cause of the disease may cause a person's lifestyle. , Drugs, all this affects the tone of the vessels. In any case, only the doctor can determine the reason for the development of a notem and appoint appropriate treatment.

Symptoms of varicose

At the initial stage of development, there are practically no symptoms, which is why many are treated for help late.

To prevent the further development of the disease and to avoid complications, the main signs that may be present:

1. At the end of the working day, the legs swell. Shoes can become close, after a complete rest, it usually happens by morning, the symptom disappears.
2. Another characteristic symptom for varicose veins is a sensation of a cannonal nucleus, which is riveted with shackles to the leg. A sense of cutting in the calf muscles appears, especially after a long stay on the legs or after the time spent at the computer. If you have a good rest and warm up, then the next day the symptom will disappear.
3. There are so-called hot sensations in the legs, or rather in caviar. Vienna become very noticeable.
4. Another warning pointing to what is happening something wrong - the feet cramps at night.
5. Under the skin of the legs, vascular intrinsic spraces appear in the form of vascular stars, first they barely noticeable, but after some time they begin to shift.

If you do not pay attention to all these symptoms, and numerous complications will begin to appear.

Diagnostics

If a man or woman sees at least one symptom, which is listed above, it is necessary to seek advice from the phlebologist. It is this specialist who is being treated and examining such problems.

In order to prevent complications, to delay a visit to the doctor in no case. The forecast depends only on how long therapeutic measures will be taken.

The diagnosis begins with the fact that the doctor examines the patient, the affected area is palpable. The next stage is the instrumental examination. As practice shows, a direction for ultrasonic doppler is given.

Analyzes may give as a supplement. After the diagnosis, appropriate treatment is prescribed. In this case, self-treatment is prohibited.

Trophic skin changes

Against the background of impaired blood circulation in the lower limbs, the development of trophic changes is possible, the course of their chronic. Even after the surreal treatment has passed, external signs may remain. Below we will look at the basic such violations.

On the video in this article describes in more detail about what violations can be.

Lipodermatosclerosis

Due to permanent edema, the cell power process is broken. Due to the violation of the venous outflow, the pressure in the vessels begins to increase.

Plasma and cells, that is, blood components are capable of passing through the walls of the capillaries, localizing the skin in the subcutaneous fat layer. All components are destroyed, a chronic inflammatory process develops, all this leads to trophic.

Hyperpigmentation

Most often, the trophic changes are formed at the bottom of the tibia, as well as inside the ankle. The skin becomes less sensitive, the color becomes dark, the shade can be brown.

Eczema

Skin eczema with varicose veins is not at all uncommon. After the blood is stirred, the local immunity is struggling with the pathogenic microflora, which is on the skin. In the place of the inflammatory process, the pathogens of the infection are multiplied.

Immunity on the stimulus corresponds to an allergic reaction. In the place where eczema appears, the skin is closed, small films are separated, wounds appear, as if abrasions. The quality of life of the patient is reduced.

Atrophy skin

Pigmented leather after some time will begin to be brightened, but this does not mean that he has come recovery. On the contrary, this is the next stage of the destruction of cellular nutrition - white atrophy. The skin becomes more densely, plots are formed in the form of a fifth. Feet in this place can decrease in volume.

Dermatitis

Varicose dermatitis is a chronic inflammatory process arising due to insufficient blood circulation. Plots with scales appear, skin is atrophy. Overweight human weight can aggravate the situation. Influence this can also be harmful habits or wearing uncomfortable shoes.

Trophic ulcers

Chronic currents, for a long time they do not heal, can become more and more. Periodically, the wounds can be heard, but after time they open again. It is dangerous to determine them, as an infection can join.

Methods of treatment varicose

In the early stages of the disease, minimally invasive methods are rare, which is why drugs are based on therapy. In order to improve the condition of the veins, it is recommended to use medicines from several groups: vetonic and angioprotectors.

Medications can be removed unpleasant symptoms - pain, swelling, inflammation, fatigue. It will be possible to increase the elasticity of the vessels, the blood will become more liquid, the clomes will not begin to form.

Preparations, the following may be assigned to treatment:

• troksevazin;
• voison;
• phlebodia 600.

Therapy can be supplemented with wearing.

Important! Only a doctor can prescribe drugs, independent treatment can lead to a deterioration in the state.

Hirudotherapy

In order to eliminate the disease at an early stage without surgery, highheeps can be used, that is, treatment with leeches. In their saliva there is a girudine, after the bite, he gets into the blood. Viscosity indicators are reduced, thrombosis is warned.

Assign the procedure may exclusively with a doctor, contraindications to its use may be as follows:

• pregnancy in women;
• allergic to the secret to the leeches;
• depletion of the body;
• blood diseases.

In addition, it is impossible to conduct a procedure for inflammatory diseases developing on the surface of the skin.

Minimally invasive treatments for treatment

These effective procedures, operational intervention do not require, patients are not in the hospital and do not pass a long rehabilitation period. Such methods are small-acting, as well as painless. Before patients, local anesthesia is set.

Sclerotherapy

Through injection, sclerosis in Vienna is introduced. The active substance allows you to block the damaged area, the blood will start moving along the circulatory system and will not fall into the closed place.

After some time, the pathological vein will resolve independently. Sclerotherapy is the main method of treating varicose veins, it is controlled by ultrasound.

Laser ablation

A procedure is carried out under an ambulatory, its duration from half an hour to two hours. Immediately after manipulation, the patient can go home. In order for the patient to suffer, everything is fine, it is placed by local anesthesia.

A light guide is introduced into the affected vein, it is located along it. The laser beam turns on and is carried out back, under its effect, blood turning occurs. The walls of the vessels are migrated, they stick together, and all because the affected area is cleaned.

Radio frequency ablation

This is not the most traumatic technique used for treatment. It can be carried out on any veins regardless of which diameter they have. Local anesthesia is placed, the operation itself is controlled by ultrasound.

The necessary puncture is done in Vienna, after which the radio frequency catheter is introduced there. Then the anesthetic is introduced, the surrounding tissues will be protected from radio waves. The rehabilitation period lasts no more than two weeks after this time the patient may return to a full-fledged lifestyle.

Microflebectomy

With the help of special hooks, the doctor will eliminate the affected vein. Enter the hooks under local anesthesia, the incision is small, does not exceed one millimeter. After the treatment has passed, the rehabilitation period takes only a few days, after that a person can start work.

Bruises may remain, but after 3-4 weeks they will solve themselves. For the first few weeks, it is recommended to wear a compression knitwear in order to secure the result. The main advantage of the procedure is that the affected vein is completely removed.

Phlebectomy

The procedure is more often conducted under spinal anesthesia. After the operation, a few days the patient must be in the hospital.

Indications for the procedure are as follows:

• pronounced blood flow;
• complications of varicose veins in the form of trophic ulcers and so on.

A probe is introduced through a small incision. The extended vein plot is removed, it follows it with a mechanical way. The incision after removal needs to be sewn. The duration of the procedure is no more than two hours.

Prevention

In order to protect itself from the development of such a disease, a whole range of measures should be observed.

Select among them the following:

• it is recommended to alternate rest and work;
• it is impossible to stay in a long time in the sitting position, it is also not recommended to cross the legs, it will contribute to circulatory disorders;
• with a forced position sitting, try to change poses as often as possible;
• wearing squeezing body things are not recommended;
• women should not wear shoes with high heels, if necessary, time spends on it as little as possible;
• each day make hiking;
• follow your power, eat as many products of rich in vitamins and useful substances.

Thin skin with varicose veins can cause many complications. Remember that the inflammatory process appears in varicose veins can be developed for years. If the changes are not seen on time, and the treatment will be absent, it will not be possible to avoid complications.

Frequent questions to the doctor

Complications from varicose veins

My brother was diagnosed with varicose veins, swollen veins were already noticeable. Until today, he did not deal with treatment, tell me what it can lead to?

If the veins became noticeable, then most likely the brother may threaten the operation. What kind of her species will be applied, depends on what the results of the survey will be shown.