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Defect of integuments and underlying tissues, developing as a result of their necrosis, with the absence or weakly expressed regeneration processes and chronic course. Ulcers are a polyetiological disease due to the following causes.
1. Disorders of blood circulation and lymph circulation. This group includes ulcers that develop as a result of arterial circulatory disorders during embolism, thrombosis, etc., venous blood flow disorders during varicose veins, thrombophlebitis, and lymphatic flow disorders in patients with elephantiasis, edema, etc.
2. Changes in the walls of blood vessels in arteriosclerosis, obliterating endarteritis, Raynaud's disease, etc.
3. Traumatic injuries: mechanical, thermal, electrical, chemical, radiation and other ulcers.
4. The development of infection. When infected with purulent microflora, a common, vulgar ulcer may appear; when afflicted with syphilis, tuberculosis, leprosy or fungi, specific ulcers arise (tuberculosis, syphilitic, leprosy, actinomycotic, etc.).
5. Disorders of exchange. This group includes ulcers in diabetes mellitus, scurvy, blood diseases, apemia.
6. Trophic disorders. This group includes ulcers that occur during spinal cord, syripgomyelia, damage to nerves, etc.
7. Ulcers 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. Particularly unfavorable conditions are created in tissues with impaired innervation, blood circulation or metabolism. In these cases, even a small injury is enough for tissues with altered trophism to necrotize and an ulcer forms.
The formation of chronic foot ulcers at the site of long-acting pressure in the presence of limb deformity occurs as the appearance of pressure sores in patients with paralysis, i.e. in these cases, the pressure itself is an injury sufficient to form an ulcer.
Violation of the outflow of venous blood with severe varicose veins of the extremities or thrombophlebitis, if the flow of arterial blood persists, leads to pronounced stagnation of blood, hypoxemia of the tissues of the limbs and the development of severe disorders of tissue metabolism, which can result in tissue necrosis, i.e. ulceration. In such cases, for its occurrence, minor damage is enough (bruise, abrasion, scratch, etc.), sometimes it cannot even be established.
The radical is to eliminate the causes that caused the appearance of the ulcer.
Important elements of conservative treatment are:
1) bed rest with a raised limb, which helps to eliminate stagnation of blood and lymph; 2) a thorough toilet of the skin around the ulcer; 3) ensuring the outflow of tissue fluids from the ulcer to the dressing. For this purpose, dressings with a hypertonic solution of sodium chloride are used, which helps to cleanse ulcers, improve nutrition of living bottom tissues, ulcer walls and the formation of granulations. To accelerate the melting of dead tissue, apply proteolytic enzymes (trypsip, chymopsin, etc.), 4) after filling the ulcer with granulations, they go on to use ointment dressings with an indifferent ointment and carefully cauterize granulations with silver nitrate; 5) dressings are rarely performed - after 4-6 days; 6) the limb is immobilized with a plaster cast; 7) by a general effect on the patient’s body, his immunobiological and regenerative abilities are activated, which is ensured by a high-calorie, vitamin-rich diet, physiotherapy exercises, periodic transfusions (1 time in 10-14 days) of small doses (100-150 ml) of blood, etc. Over the following years, red and blue laser irradiation is widely used in the treatment of ulcers and in preparation for skin grafts, which improves survival.
Surgical treatment usually involves two points:
1) the release of the ulcer from pathologically altered granulations and scars that impede the blood supply to the tissues of the bottom and walls of the defect, 2) plastic closure of the tissue defect with skin. Either plastic is used with a flap on the leg, or one of the types of free skin plastic.