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Defects of integuments and deep tissues, which develops as a result of their death, with the absence or weakly expressed regeneration processes and a chronic course. Ulcers are a polyetiological disease as a result of the following causes.
1. Circulatory disorders and lymph circulation. This group includes ulcers that have developed as a result of violations of the arterial circulation in embolism, thrombosis, etc., disorders of the venous blood flow during varicose veins, thrombophlebitis, impaired lymph flow in patients with elephantiasis, with edema, etc.
2. Changes in the walls of blood vessels in arteriosclerosis, endarteritis obliterans, Raynaud's disease, etc.
3. Traumatic injuries: mechanical, thermal, electrical, chemical, radiation and other ulcers.
4. Development of infection. When infected with purulent microflora, a common, vulgar ulcer may appear; with lesions of syphilis, tuberculosis, leprosy, or fungi, specific ulcers arise (tuberculosis, syphilitic, leprous, actinomycotic, etc.).
5. Disorders of exchange. This group includes ulcers in diabetes mellitus, scurvy, blood diseases, apemias.
6. Trophic disorders. This group includes ulcers that have arisen during the spinal cord, syripgomyelia, nerve injury, etc.
7. Ulceration of tumors.
Each of the listed forms of ulcers has characteristic clinical manifestations. With the formation of ulcers, the state of the tissues is of great importance. Especially adverse conditions are created in tissues with impaired innervation, blood circulation or metabolism. In these cases, even a small injury is enough for the tissue with altered trophism to necrotize and form an ulcer.
The formation of chronic ulcers of the foot at the site of long-acting pressure in the presence of limb deformity occurs according to the type of pressure sores in patients with paralysis in these cases, the pressure itself turns out to be an injury sufficient for the formation of an ulcer.
Violation of venous outflow with severe varicose veins of the extremities or thrombophlebitis, if the flow of arterial blood remains, leads to a pronounced stagnation of blood, hypoxemia of the limb tissues and the development of severe disorders of tissue metabolism, which can result ulceration. In such cases, for the occurrence of its insignificant damage (bruise, abrasion, scratch, etc.), sometimes it is not even possible to install it.
Radical is to eliminate the causes of ulcers.
Important elements of conservative treatment are:
1) bed rest with a raised limb, which helps to eliminate stagnation of blood and lymph; 2) careful toilet of the skin around the ulcer; 3) ensuring the outflow of tissue fluids from an ulcer into a bandage. For this purpose, dressings are applied with a hypertonic solution of sodium chloride, which helps cleanse the ulcer, improve the nutrition of living tissues of the bottom, the walls of the ulcer and the formation of granulations. To accelerate the melting of dead tissue, apply proteolytic enzymes (trypsip, himopsin, etc.), 4) after filling the ulcer with granulations, proceed to the use of ointment dressings with an indifferent ointment and careful burning of granulations with silver nitrate; 5) rarely make dressings - after 4-6 days; 6) the limb is immobilized with a plaster splint; 7) the general effect on the patient's body activates his immunobiological and regenerative abilities, which is provided by high-calorie, vitamin-rich nutrition, physical therapy exercises, periodic transfusions (1 time in 10-14 days) of small doses (100-150 ml) of blood, etc. In subsequent years, red and blue laser irradiation is widely used in the treatment of ulcers and in preparation for skin grafts, which improves engraftment.
Surgical treatment usually involves two things:
1) the release of ulcers from pathologically changed granulations and scars, which impede the blood supply to the tissues of the bottom and walls of the defect, 2) the plastic closure of the skin defect of the tissues. Apply either a plastic flap on the leg, or one of the types of free plastic skin.