Gel dressings for the treatment of trophic ulcers. Rules for the effective use of bandages and plasters in the treatment of trophic ulcers. What it is

Treatment of trophic ulcers is carried out various methods. There are countless ointments available and medicines. The effectiveness of most of them has not been proven, the benefits are very doubtful. Moreover, the effectiveness of such methods as hyperbaric oxygen therapy, vacuum therapy and many others has been practically unproven.

Treatment of trophic ulcers is also very profitable business. For decades now, the medical industry has been offering a huge range of special dressings to replace conventional dressings: absorbent, gel, antiseptic, etc. Independent studies have shown that none of them is superior to the cheapest and simplest dressings.

Therapy of trophic ulcers has several goals:

Firstly, it is necessary to eliminate swelling; this largely determines the success of treatment
Local treatment is aimed at accelerating the healing of the ulcer, and also includes caring for the skin around the ulcer and eliminating dermatitis
Prevention of return (relapse) of trophic ulcers

Compression treatment of trophic ulcers

Compression therapy is the “gold standard” for the treatment of trophic ulcers and venous insufficiency. This is the most effective method treatment, known since the time of Hippocrates, but its effectiveness has been proven by many modern research. A recent review of the Cochrane Library (the largest and most authoritative medical database) clearly showed that trophic ulcers heal faster with compression therapy than without it.

Treatment of trophic ulcers is possible using several options for compression therapy:

elastic compression
non-elastic compression
intermittent (intermittent) pneumatic compression

For trophic ulcers, compression therapy reduces swelling, improves venous outflow, promotes healing, and reduces pain. Compression treatment for 24 weeks allowed to heal 30-60% of trophic ulcers. Within a year of treatment, 70-85% of trophic ulcers healed. After the ulcer has healed, compression therapy can help prevent the disease from returning. However, compression treatment also has contraindications - diseases of the arteries of the lower extremities, heart failure.

Not elastic compression. This type of compression provides high working pressure while walking, when the muscles are actively working. However, there is evidence that compression at rest is insufficient. Non-elastic compression options include Unna bandage, zinc-gelatin bandage or simply low-elastic compression bandages. This method has been known for quite some time, its effectiveness is beyond doubt. However, analysis by the Cochrane Library showed that combined use elastic and non-elastic materials provides best effect than each of them separately. The disadvantage of a low-elastic bandage is insufficient compression after the swelling subsides and the calf diameter decreases.

Elastic compression

The difference between elastic compression is that the bandage adapts to the changing diameter of the limb and maintains the required pressure both during movement and at rest. Elastic bandages or knitwear can be used: knee socks, stockings, tights. Compression hosiery should provide a pressure gradient - denser compression in the area of the foot and lower leg, and less compression in the area of the knee and thigh. For trophic ulcers, the pressure in the lower leg area should be at least 30-40 mm Hg. Art., and preferably about 60 mm Hg. Art. Knitwear should be removed at night. It needs to be changed once every 6 months or more often, as over time it loses its properties.

An elastic bandage (bandage) is an alternative to compression stockings. Elastic bandages are used to apply the bandage. A recent meta-analysis showed that elastic compression is more effective than low-elastic compression. High compression is preferable. It is better to apply a multilayer bandage combining elastic and non-elastic material. The disadvantage of this treatment of trophic ulcers is that bandaging requires certain knowledge, skills and experience. Patients and medical staff staff do not always apply the bandage correctly.

Intermittent pneumatic compression

Intermittent or intermittent pneumatic compression is carried out by the operation of a pump that pumps air into cuffs worn on the patient's legs. Intermittent compression is less effective than continuous compression. Moreover, it requires expensive equipment. In addition, quite long immobilization is required. This method is more often used in bedridden patients and in cases of contraindications to constant compression.

Elevated position of the lower extremities

Elevation of the extremities combined with constant compression is the standard treatment for trophic ulcers. The legs are elevated above the level of the heart to reduce swelling, improve microcirculation and accelerate ulcer healing. Elevating the lower extremities is effective if done for at least 30 minutes 4 times a day. This regime is quite difficult to maintain in Everyday life.

Dressing materials. A meta-analysis of 42 randomized controlled trials showed no advantage of some dressings over others. Moreover, expensive hydrocolloid dressings did not speed up the healing of ulcers compared to regular cheap dressings. Without clear indications of the benefits of expensive dressings, dressing selection should be guided by ease of use and cost.

Vacuum treatment

Vacuum therapy involves creating negative pressure in the area of a trophic ulcer. This allows you to reduce the depth and area of the ulcer. Vacuum therapy can be used on all types of wounds. However, there is no clear clinical evidence that the method accelerates healing. Available data are insufficient to recommend vacuum therapy for the treatment of trophic ulcers. In addition, this type of treatment cannot be combined with compression.

Drug treatment

Pentoxifylline(Trental) is a platelet aggregation inhibitor. It reduces blood viscosity, which in turn improves microcirculation. Studies have shown that Pentoxifylline at a dosage of 400 mg three times a day improves the results of treatment of trophic ulcers. This drug is effective, again, only in combination with compression therapy. Its side effects include intestinal manifestations- nausea, vomiting, diarrhea, loss of appetite, heartburn. In addition, Pentoxifylline can provoke tachycardia; it should be prescribed with caution to patients with heart disease. The effectiveness of Trental as monotherapy for trophic ulcers has not been proven.

Aspirin at a dosage of 300 mg per day, in combination with compression treatment, accelerates healing and reduces the size of the ulcer. For trophic ulcers, it is recommended to take Aspirin constantly, even after healing of the ulcer, if there are no side effects and contraindications.

Iloprost is a synthetic prostacyclin, a vasodilator that inhibits platelet aggregation. In one study, Iloprost combined with compression accelerated the healing of trophic ulcers compared to placebo. However, the drug is expensive. Data on its benefits are not sufficient to recommend it for routine use in the treatment of trophic ulcers. In domestic practice, the drug of the same group, Vazaprostan, is more often used. It is effective for ulcers of arterial origin (critical ischemia of the lower extremities). Data on its use when venous ulcers ah also not enough.

Zinc- a microelement with an anti-inflammatory effect. A recent meta-analysis including 6 small studies found no benefit of using this drug orally in the treatment of venous ulcers.

Antiseptics and antibiotics Bacterial infection very often accompanies a trophic ulcer and prevents its healing. However, a recent review of the Cochrane Library showed no benefit to systemic antibiotics. Some local antiseptics, such as Betadine, Bactroban (Mupirocin), may accelerate the healing of ulcers, however, at present there is not enough data. Oral antibiotics for trophic ulcers are used only if the infection progresses to subcutaneous tissue And bone tissue(osteomyelitis), which is extremely rare.

Hyperbaric oxygenation

Hyperbaric oxygen therapy is also offered as additional method treatment of trophic ulcers. It has an anti-inflammatory and antiseptic effect. There is evidence of the successful use of this method in diabetic foot, however, for the treatment of venous trophic ulcers, the effectiveness is not so obvious.

Surgery

So-called acute trophic ulcers (up to 3 months old) heal in 70-80% of cases with conservative treatment. While chronic ulcers heal within 6 months of treatment only in 20% of cases. In such situations, when conservative treatment does not provide the desired effect, it is advisable to consider a surgical approach to treatment. Surgical debridement trophic ulcers involves the removal of non-viable tissue. This can be done using surgical instruments(scissors or curette), as well as using enzyme preparations. Even biological techniques using larvae have been studied (as in the movie "Gladiator"). However, there are only a few high-quality studies that directly analyzed the effect of surgical debridement as well as various methods of such treatment. It is important to remember that venous trophic ulcers rarely require wide excision tissues, it is necessary to carefully examine the patient for arterial insufficiency.

Skin transplantation.

Skin grafting is used for large and persistent trophic ulcers. Autotransplantation is the transplantation of a section of the patient’s own skin. Allotransplantation is a skin transplant from another person (donor). There are also human skin equivalents (artificial leather). Skin transplantation is not effective in case of persistent swelling of soft tissues, which quite often occurs with venous trophic ulcers. Results are better if skin grafting is performed after the cause of venous insufficiency has been eliminated. However, there are some fairly high-quality studies in the Cochrane Library that support the positive results of skin grafting.

Operations for trophic ulcers

Surgical interventions in the treatment of trophic ulcers have several goals: elimination of venous reflux, acceleration of healing and prevention of relapse (return) of trophic ulcers.

The following options are possible:

saphenous vein ablation

open or endoscopic dissection of perforating veins

ablation of perforating veins

iliac vein stenting

removal of dilated veins: phlebectomy, miniphlebectomy, stripping

sclerosis of varicose veins, tributaries and perforators.

Despite the large number of studies devoted to the surgical treatment of trophic ulcers, only a few of them can be considered high-quality. In one study, saphenous vein ablation reduced the number of recurrences within a year by almost half, compared with compression therapy.

In another study, surgery increased the number of healed ulcers to 88%, while the number of relapses within 10 months was only 13%. At the same time, there is no data yet that surgical treatment accelerates the healing of trophic ulcers and is superior to drug treatment.

Treatment methods	Comments
Conservative treatment Compression therapy (elastic and non-elastic) elastic bandages, knitwear)	Efficiency has been proven. Is the main method of treatment
Elevated leg position	Effective if used for 30 minutes 4 times a day or more often. Combine with compression
Bandages	Not a single type of dressing has proven its superiority over the simplest and cheapest.
Mechanical treatment	Local vacuum therapy Efficacy not proven
Medicines
Pentoxifylline (Trental)	Possibly effective for intravenous use(not enough data)
Aspirin	Effective in combination with compression therapy, dosage 300 mg per day
Iloprost (Prostaglandin)	Expensive drug Zinc preparations Efficacy not proven
Antibiotics/antiseptics	Prescribed for concomitant infectious complications
Hyperbaric oxygenation	Efficacy not proven
Surgery Surgical treatment of the wound	More research needed
Skin transplantation	More research needed
Faux leather	Possibly effective in combination with compression
Surgical interventions	Effective in advanced cases. Reduce the likelihood of ulcer recurrence

Conclusion

Thus, it can be said that the majority existing methods traditional and alternative therapy trophic ulcers are actually used unreasonably. Only compression therapy and surgical interventions aimed at eliminating reflux, which prevent relapse, are truly effective. Modern technologies make it possible to carry out surgical treatment even with an open trophic ulcer.

Interventions such as RFO, EVLT and sclerotherapy are performed through small punctures with minimal risk of infection. Eliminating reflux at the initial stage of treatment will create ideal conditions for the healing of the ulcer and prevent relapse of the disease in the future. After eliminating pathological discharge through varicose veins, compression therapy comes first. It is extremely important to use compression correctly. The main criterion is the elimination of edema. Usually, compression hosiery It should not be used immediately, since after reducing the volume of the limb, the pressure will be insufficient. Quite often, the swelling is so pronounced that the volume of the lower leg can be reduced by almost 2 times, so the swelling should be eliminated by bandaging (applying a bandage), and then selecting knitwear.

So, the first step should be to use elastic and inelastic bandages. And precisely in combination. It is important that the bandage is applied correctly; the pressure in the lower third of the leg should be about 60 mmHg. Art. The pressure gradient is also important - on the foot and in the lower third of the leg the compression should be stronger, gradually decreasing towards the groin. After the swelling is eliminated, you can select knitwear (socks or stockings). At the moment when the swelling begins to decrease, copious discharge will appear from the ulcer, and the bandages will become very wet. At this stage, the use of special absorbent dressings is justified. When granulation tissue appears, the ulcer may bleed. During this period, it is worth using simple ointment dressings. Gel or colloid dressings are also used, which can be changed less frequently, resulting in less trauma to the delicate granulation tissue.

Complete healing of the ulcer may take some time from several weeks to several months. If there is no positive dynamics against the background of ongoing activities, it should be repeated. duplex scanning in order to find the source of unresolved reflux, most often these are perforating veins. Caring for the skin around the ulcer and general hygiene are also important. The leg should be washed with soapy water 1-2 times a day, including the ulcer itself. It is better to do this with a soft sponge, avoiding tissue injury. Afterwards, the ulcer and the skin around it need to be washed antiseptic solution. If there are signs of dermatitis or eczema, a combination of anti-inflammatory, antibacterial and antifungal ointments. After the ulcer has healed, you should wear compression stockings, at least knee socks, for as long as possible. This will prevent swelling, reduce lipodermatosclerosis and consolidate the treatment result.

CLINICAL EXAMPLE OF TREATMENT OF TROPHIC ULCERS IN OUR CLINIC.

As a demonstration, let me introduce one of my patients who came after many years of unsuccessful treatment. As often happens, the woman tried a lot of different ointments (according to her, more than 40!), took expensive medications and bought various dressings. Not without laser therapy, treatment with leeches, as well as a series folk remedies. During this time, the trophic ulcers only grew, and by the time of her treatment, one extensive ulcerative surface occupied the entire inner surface of the leg, and there were also several smaller ulcers along the outer surface. A short presentation about the treatment of this patient in video format.

More details about this clinical case:

During the diagnosis, it was found that the underlying cause of the ulcers was varicose veins of the large saphenous vein, deep veins were somewhat expanded, but without pronounced violations valve operation. The treatment strategy was based on the sharply dilated perforating veins in the lower leg area. They do not allow the ulcers to heal after standard treatment. varicose veins veins

In addition to the standard radiofrequency ablation of the great saphenous vein, we marked several key preforant veins, as in the diagram below.

To eliminate perforators, we long time used a special RF Stylet radiofrequency catheter, which is shown below, however, recently I prefer laser, and I also have very positive experience using cyanoacrylate glue (we are currently doing scientific work using this method, the results of which are being prepared for publication).

During the operation, we treated 3 perforating veins, the intervention was carried out under local anesthesia and consisted of percutaneous puncture (piercing) of the vein, placement of a stylet catheter in its lumen, creation of a water “barrier” to protect surrounding tissues and radiofrequency treatment at a temperature 80 degrees C.

Subsequently, a complex multi-layer bandage was applied, which should absorb a large volume of fluid released through the ulcerative surfaces and resist infection.

To create compression, a special product Circate was used. Made from low-stretch elastic material, Circate successfully replaces elastic bandages and is much easier to put on than compression socks. We use Circate as often as possible, since even people who could not even bandage their leg themselves due to obesity or arthrosis of the joints of the hands can put it on and wear it correctly. And patients with trophic ulcers very often have such concomitant conditions.

The result of our efforts with the patient was complete healing of all trophic lesions after about 1.5 months. It should be noted that healing of ulcers of such an area is not often possible in such a time frame and without the use of aggressive methods of shaving therapy and skin grafting.

Occurs in 2% of the adult population industrially developed countries. Ulcers of venous etiology account for 70–75% of all skin trophic disorders. The quality of life of patients with venous trophic ulcers is negatively affected by pain (in 80% of patients), resulting insomnia (in 74%), significant everyday inconveniences associated with hygiene procedures (in 90%) and the selection of comfortable shoes (in 78%) . In the countries of the European Community, closure of 1 trophic ulcer per outpatient setting costs 800–1500 euros; in Russia, direct costs for treating 1 case of venous trophic ulcer in a clinic reach 10–15 thousand rubles, and in a hospital - >20 thousand rubles. .

Currently, it is generally accepted to stage treatment of venous trophic ulcers. After the introduction of thermoobliteration methods into clinical practice ( radiofrequency obliteration and endovenous laser coagulation – EVLC) in order to eliminate pathological venovenous reflux, it became possible to carry out the 1st stage surgical intervention, and then - complex conservative treatment, including - local application special wound coverings for the treatment of ulcerative defects in a humid environment. It is also fundamentally important that the vast majority of patients with venous trophic ulcers can be treated on an outpatient basis, which avoids cross and nosocomial infections, reduces treatment costs and disciplines the patient. Complex therapeutic measures determined by the nature of the wound process.

Its required components:

surgical elimination of pathological reflux;
medical and protective regime;
compression of the affected limb;
systemic and local therapy.

According to V. Falanga, modern strategy local treatment of venous ulcers should be based on the concept of their moist healing, which involves the creation favorable climate, similar to natural; this stimulates autolytic wound cleansing, proliferation of fibroblasts and keratinocytes, preservation of local cellular immunity. Modern high-tech dressings are designed to ensure healing in a moist environment. The presented clinical example uses the experience of using modern wound dressings HydroClean plus and Hydro Tac (Paul Hartman, Germany), which create such conditions.

Patient P., 56 years old, sought medical help in May 2016 due to the presence of a long-term non-healing trophic ulcer on the inner surface left leg, pigmentation and induration of the skin of the leg, severe pain in the area of the ulcer, persistent swelling of the leg and foot. In the anamnesis - varicose veins for 20 years; from surgical treatment abstained. The appearance of a focus of skin pigmentation was noted >3 years ago; Subsequently, after an injury to the skin of the left leg, a trophic ulcer formed, which could not be treated with ointments and wound dressings on an outpatient basis in a clinic at the place of residence. In the last 3 months, there has been a tendency towards an increase in the area of the ulcer and an increase in pain syndrome.

Objectively, the condition is satisfactory. The patient is overweight (body mass index – 42.1 kg/m2), the skin and visible mucous membranes are pale pink. Peripheral The lymph nodes not enlarged. Musculoskeletal system without visible deformation. Vesicular breathing in the lungs. Heart sounds are sonorous. Pulse – 72 per minute, rhythmic. Blood pressure – 140/90 mm Hg. Art. The abdomen is soft and painless.

Local status. The lower extremities are pale pink, there is pronounced swelling of the legs and feet. On both legs there is skin hyperpigmentation and lipodermatosclerosis, spreading from the ankles to the upper third of the legs and having a circular pattern. On the anterior surface of the left leg in the lower third there is an irregularly shaped ulcerative skin defect with fibrin deposits and areas of necrosis with scanty serous-purulent discharge. The area of the ulcer is 11.2 cm2.

The surrounding skin is slightly hyperemic, dry, hyperkeratosis is noted, and is moderately painful on palpation (Fig. 1). Active and passive movements in the joints are preserved and occur in full. The pulsation in the main arteries of the lower extremities is distinct and can be detected at all levels. Blood and urine tests are without pathology, glycemia is normal.

Duplex scanning of the arteries and veins of the lower extremities from 05.27.16: superficial and deep veins are passable, completely compressible when compressed by the sensor; the blood flow in them is phasic, no thrombotic inclusions were detected. There is varicose transformation and valvular insufficiency of the trunk of the great saphenous vein (GSV) on the right and left with the presence of vertical venovenous reflux up to the level of the upper third of the legs. The diameter of the GSV at the mouth on the left is 10 mm, on the thigh – 8 mm, at the mouth on the right – 9 mm, on the thigh – 7 mm. Valve insufficiency and horizontal venovenous reflux along the perforating veins of Coquette were detected on the left shin along the inner surface at a distance of 23 cm from the floor, on the right - at a distance of 17 cm from the floor. The valve apparatus of both small saphenous veins (diameter - 3 mm) is wealthy.

Considering the pathogenesis of development trophic disorders in the form of the presence of horizontal and vertical venovenous reflux, after preoperative preparation, at the 1st stage, in order to eliminate reflux, on June 14, 2016, under local anesthesia, an EVLT operation was performed (diode laser “LAMI”, wavelength - 1040 nm, pulsed mode, power - 17 W, impulse – 900 ms, interval – 100 ms) of the trunk of the left GSV from the level of the middle third of the leg to the saphenofemoral anastomosis. Total energy – 4.1 kJ (Fig. 2).

Compression stockings (groin-length stockings) were prescribed with a pressure in the ankle area of 34–46 mmHg. Art. (III compression class); continuous compression for 5 days, then use the stocking only during the daytime.

The dressings were carried out with mandatory ultrasound monitoring of the condition of the target vein after the EVLT procedure to verify the elimination of vertical venovenous reflux as a source of decompensation of the venous circulation (Fig. 3).

Due to the chronic nature of the wound process and the presence of fibrin with areas of tissue necrosis, local therapy was started using HydroClean plus dressings. This choice was due to the basic properties of the dressings and their clinical effectiveness, the prolonged release of Ringer's solution and the simultaneous absorption of wound fluid. In this case, active rehydration and removal of fibrin, a decrease in the concentration of matrix metalloproteases are noted, which prevents the destruction of the extracellular matrix. As a result, it is activated local immunity, the functions of growth factors are preserved, angiogenesis and further regeneration are stimulated.

HydroClean plus dressing – super absorbent; it creates and maintains a moist wound environment for up to 72 hours and at the same time actively promotes painless removal necrosis and fibrin, absorbs wound exudate for a long time due to the content of polyhexanide - an antiseptic with wide range action that effectively inactivates tissue microflora inside the dressing; thus, cleansing is accelerated, the microbial load is reduced and wound healing is stimulated in all its phases. The hydrophobic coating of the bandage prevents sticking, which allows it to be used to control wound process and removing ulcers from the surface is completely painless; the frequency of dressings is 2–3 times a week (Fig. 4).

As a result of the use of hydrotherapy, a gradual cleansing of the ulcerative defect from fibrin and necrotic tissue was noted; the bottom of the ulcer rose to the level of the skin and became covered with well-defined granulations (Fig. 5). Exudation has decreased significantly, inflammation around the wound has completely stopped. The patient noted relief of pain, which allowed her to stop taking analgesics.

From the 10th day, local treatment was continued with Hydro Tac dressings at a frequency of dressings once every 6 days, which accelerated the rate of healing, ensured a progressive reduction in the area of the ulcer and epithelization of the ulcer surface. Hydro Tac dressings made it possible to maintain optimal moisture in the wound bed and create conditions for further epithelization of the trophic ulcer (Fig. 6).

As shown by the above clinical example, staged treatment wounds in a humid environment with sequential use of HydroClean plus and Hydro Tac hydroactive dressings for 1 month against the background of elimination of vertical venovenous reflux made it possible to achieve complete cleansing and active epithelization of the wound surface, which significantly improved the patient’s quality of life (Fig. 7).

Local treatment after eliminating pathological venovenous reflux can be carried out by outpatient surgeons; hospitalization in a hospital is not required.

So, HydroClean plus and Hydro Tac wound coverings are highly effective in the treatment of venous trophic ulcers. Their innovative structure corresponds modern views on the etiopathogenesis of chronic wounds against the background of decompensation of the venous circulation, allows the evacuation of exudate and toxic components from the wound, maintaining high humidity and ensuring proper gas exchange. At the same time, optimal temperature regime, secondary infection is prevented, unpleasant odor is eliminated, and changing dressings is almost painless for the patient.

Literature

Bogdanets L.I., Berezina S.S., Kirienko A.I. The concept of wet healing of venous ulcers // Surgery. – 2007; 5:60–9.
Kiyashko V.A. Trophic ulcers of the lower extremities // Rus. honey. magazine – 2003; 4:221.
Treatment of trophic ulcers of venous etiology. A manual for doctors. Ed. V.S. Savelyeva / M., 2000; 22 p.
Obolensky V.N. Trophic ulcers of the lower extremities: Review of the problem. Educational and methodological manual/ M., 2009; 60 s.
Savelyev V.S., Kirienko A.I., Bogachev V.Yu. Venous trophic ulcers. Myths and reality // Phlebolymphology. – 2000; 11:5–10.
Coleridge-Smith P. Leg ulcer treatment // J. Vasc. Surg. – 2009; 49(3):804–8.
Falanga V. Wound Bed Preparation and the Role of Enzymes: A Case for Multiple Actions of Therapeutic Agents // Wounds. – 2002; 14 (2): 47–57.
Kheirelseid E., Bashar K., Aherne T. et al. Evidence for varicose vein surgery in venous ulceration // Surgen. – 2016; 14 (4): 219–33.
Marston W. Evaluation and treatment of leg ulcers associated with chronic venous insufficiency // Clin. Plast. Surg. – 2007; 34 (4): 717–30.
Raffetto J. Pathophysiology of wound healing and alterations in venous leg ulcers-review // Phlebology. – 2016; 31(Suppl. 1): 56–62.
Verma H., Tripathi R. Algorithm-based approach to management of venous leg ulceration // Semin. Vask. Surg. – 2015; 28(1):54–60.

There are three main types of wipes for trophic ulcers: antiseptic, regenerating and adsorbent. The choice of dressing depends on the condition and size of the skin wound and the patient’s well-being. Wipes can be used at home, as the procedure for applying them is simple, but before purchasing, you should consult a doctor to choose the appropriate type of material.

Principle of influence and composition

Why do you need care for ulcerative wounds at all? Occurring against the background of impaired trophism in tissues, they affect a small area of the skin, but due to insufficient blood circulation the processes in them are disrupted immune defense and regeneration. Over time, the ulcers begin to increase in width and depth, they become a haven for pathogens, since the body does not protect this area well.

The development of pathogens leads to tissue poisoning and death, and necrosis begins. In advanced cases, when large areas of skin are damaged and muscle tissue, a limb has to be amputated because the products of cell breakdown begin to poison the entire body.

Dressings for trophic ulcersdecide different problems(depending on type):

disinfect tissues - wipes contain antiseptics for external use, which eliminate microorganisms in the wound and prevent the entry of new ones;
accelerate tissue regeneration - the material is impregnated with a component that accelerates cell division and restoration, which allows the wound to heal faster;
have an adsorbent effect - the wipes are impregnated with an antiseptic, and their material is capable of absorbing a large volume of exudate, pus and other discharge from the wound.

Antiseptic wipes or dressings with silver for the treatment of trophic ulcers are used in cases where there is an infection in the wound, it becomes inflamed, and because of this the patient’s general well-being worsens.

Wound healing dressings are also used when the skin defect is small in size, there are signs of infection and copious discharge are missing. In such cases, wipes for healing trophic ulcers help heal the wound faster, and they also protect it from external damage.

Adsorbent dressing materials are required in cases where an infection develops in the wound, causing active release of pus or exudate. Salt dressings for trophic ulcers are most often used because of their availability, but if the skin is severely inflamed, the patient elevated temperature body and signs of intoxication, then they cannot be used.

Contraindications

There are practically no contraindications for such products, except for an allergic reaction to the components of the impregnation and extreme forms of pathology, when no one except the surgeon can provide help.

Side effects

Side effects are a consequence of improper use of the bandage for the treatment of trophic ulcers on the legs. They develop due to untimely dressing, applying the bandage too tightly, and failure to maintain sterility when changing the napkin. Undesirable consequences include:

increased secretion of pus or exudate;
tissue inflammation, itching;
the appearance of a rash, prickly heat;
swelling in the area of the trophic ulcer;
swelling of the limb;
discomfort while wearing the bandage.

Mode of application

First, you need to thoroughly wash the skin in the area of the defect with soap, after which you can wash it with a chlorhexidine solution and blot it with a dry, clean cloth. If discharge oozes profusely from the wound, you need to remove it with a sterile bandage until the process stops. After preliminary care, a patch is applied to the skin; it can be kept on for 24-28 hours, depending on the composition (indicated on the package).

Leg ulcer dressings with napkins require a little more attention. The procedure begins according to the scheme described above, the skin must be cleansed and dried. After this, a napkin is applied to the wound, and it must be secured with a sterile bandage; it must protrude beyond the perimeter of the product itself to hold it in place.

Review of popular tools

You should not choose external care products on your own and treat trophic ulcers with them, so the information below is presented for informational purposes only; recommendations for purchase will be given by your attending dermatologist.

Antiseptic

Proteox - wipes for trophic ulcers on the legs with an antiseptic effect, containing trypsin and mexidol. The first component is an enzyme that destroys the protein component of pathogenic microorganisms, and the second is a substance with disinfecting properties, it also improves blood circulation in tissues. Proteox wipes are often prescribed as they are highly effective in fighting infection, and the cellulose backing absorbs discharge from the wound, providing comfort while wearing.

Biathene - wipes with silver for trophic ulcers, have a pronounced antiseptic effect, since the atoms of this metal inhibit the vital activity of pathogenic microorganisms. The backing is made of absorbent material, so they are used for weeping wounds.

“Activtex” is a brand of plasters for trophic ulcers; there are different types of products with different active substance in impregnation (furagin, chlorhexidine and others). It is more convenient to wear such a product, since it adheres well to the skin and does not require a bandage.

Regenerating

Hartman dressings for trophic ulcers accelerate wound healing, improve tissue nutrition, and relieve swelling and inflammation. The brand has wipes with different active ingredients; their choice depends on the condition of the skin defect and its size.

Activtex - wound dressings containing an antiseptic component - chlorhexidine and vitamins E and C, which accelerate cell regeneration and prevent their destruction.

Absorbent

Absorbent wipes (Cetuvit E, Voskopran, Biaten, Branolind and others) have the same effect; they contain cellulose, salts and similar components in the substrate that attract water molecules. Often, the impregnation contains antiseptic components (chlorhexidine, miramistin, furigan and others).

A dressing for the healing of trophic ulcers is a necessary component of external therapy, since without superficial care of the wound it will be constantly susceptible to infections and injuries, which will worsen the healing process. Antiseptic, regenerating or absorbent wipes are selected by the doctor after an external examination of the skin, since when purchasing it is necessary to take into account the size, depth of the lesion, the presence of infection and other parameters.

Useful video about medications for trophic ulcers

It is recommended to use a patch for trophic ulcers to fix bandages on wounds with the drug. The adhesive base of the products is securely attached, covers the damaged area from dirt, dust and water, and protects against secondary infection. The patches allow the ulcer to heal, providing Free access air to the area of inflammation. The products have gel or film coatings and also contain antimicrobial and regenerating components.

What is the composition?

To heal wounds on the legs, plasters are used that look similar to a regular medical product, but are endowed with greater adhesive “abilities.” Worn for a long time. Can be used while taking a shower. The patch itself can be:

Hydrogel in the form of a sorption gel, which is securely fixed on a transparent membrane. Such a product not only maintains moisture in the wound, but also simultaneously absorbs excess exudate, providing optimal healing conditions.
Epidermatic, that is, intended only to protect the damaged area from harmful influences, to bring wound edges closer together, which speeds up healing. Necessary for fixing bandages.
Endermatic with medicinal substances. Has a healing effect on sore skin.
Diadermatic, in which the medicine penetrates the skin, producing a deep effect.
With silver bridges serving as conductors. Essential for speeding up recovery skin in places of deep scars.

The following components are included in patches for the treatment of trophic ulcers:

Polyurethane film serves as the basis for such dressing material.

For the base:
- polyurethane film;
- synthetic elastomer;
- sodium carboxymethylcellulose (astringent);
- hydrogel and propylene glycol as hygroscopic substances.
Medicinal components:
- silver ions;
- furagin;
- Mexidol;
- propolis.
Additional substances:
- sodium alginate (as an antacid);
- mineral oils.

How do they work?

Due to their composition, patches for the treatment of trophic ulcers on the legs help prevent microorganisms, dirt and water from entering the area of inflammation. Mixing with antiseptic, the hydrogel sticker releases useful regenerating and analgesic components that penetrate the skin and act in the tissues. The patch contains a special gel, thanks to which the tissues receive oxygen, and a moist environment is created in the ulcers themselves. This starts the process of epithelization and granulation, and also accelerates the cleansing of necrotic or purulent filling. After removing the self-adhesive bandage, a layer of hydrocolloid gel remains on the skin; it must be washed off with water and then evaluate the effect of the patch on the ulcer.

The patch is sterile and can be used at home. The product removes decay products from wounds, relieves pain and reduces the amount of immunoglobulins in tissues, which cause ulcers.

Application

The bandage is glued to the wound after it has been treated.

Healing hydrogel patches are used when it is impossible to carry out dressing procedures and change the bandage daily to ensure long-lasting therapeutic effect or to secure the bandage when. The wound surfaces are treated with an antiseptic, after which a self-adhesive coating is applied to it, which can not be removed for 2-5 days. When the required period has arrived, the patch is removed and the tissue is again treated with a disinfectant. The gel adhesive coating does not cause irritation, is easily removable, is almost invisible to the skin and is resistant to external irritants such as water, high humidity or high ambient temperatures.

What types of patches are there for trophic ulcers?

Topical wound healing agents against leg ulcers may contain various additional components. To disinfect the surface, preparations with silver, chlorhexidine, and propolis are used. The following patches are considered popular:

"Hydrofilm";
"Hydrocol";
"Evans"
"Plastofix";
"Comfil Plus";
"Omifix Elastic".

Wipes and dressings for ulcers

Special dressings may contain chlorhexidine.

When there is heavy discharge or a lot of dead tissue, it is additionally recommended to use bandages or wipes together with patches to treat trophic ulcers on the legs. Some of them must first be moistened with an antiseptic or water. The composition contains the following components:

Mexidol;
furagin;
miramistin;
chlorhexidine;
derinat;
trypsin;
silver;
triglycerides.

For wet damage, it is recommended saline dressings. If there is a large amount of necrotic tissue in the wounds, ointment wipes are recommended. For faster healing Collagen bandages are suitable for skin restoration. They are used together with adhesives for reliable fixation. Popular among effective means the following are considered:

With the help of a collagen bandage, the wound will begin to heal faster.

"Hartman"
"Koletex";
"Proteox TM";
"Multifarm";
"Branodind N";
"Avitex";
"Voscopran";

Treatment of trophic leg ulcers usually includes conservative methods and surgery. Among conservative methods, the use of special napkins impregnated with various antiseptic and wound-healing substances is widespread. The advantages include ease of use, as well as the fact that this method of therapy does not cause any discomfort.

List of effective ones and their characteristics

Wipes against trophic ulcers on the legs are presented in a wide range, so for each clinical case it is possible to choose the most optimal treatment. The undoubted advantage of this method of treatment for trophic ulcers is their ease of use, as well as their ability to qualitatively clean the wound surface of various types of contaminants and purulent-necrotic masses. Let's consider what remedies exist for the treatment of trophic ulcers on the legs and their mechanism of action.

Antiseptic

Almost all medicinal wipes used in the presence of trophic ulcers on the legs have antibacterial properties. They contain various antiseptic components. For example, such as:

Chlorhexidine, also known as Miramistin.
Furagin.
Substances saturated with silver.

In addition to antibacterial substances, the wipes also contain components that stimulate tissue repair and regeneration processes. Most often you can find medicinal wipes with propolis, derinat or mexidol.

You can find various options in pharmacies this tool. Some of the most common are Activtex, Koletex, Proturks, Hartman, Multiferm. Each type of napkins has its own characteristics, and the principle of their use may differ slightly. Activtex are intended against trophic ulcers on the legs; these wipes are made on the basis of medical knitwear, impregnated with medicinal substances and a polymer with a gel-like structure. There are three types of products from the Activtex series. They differ from each other in composition, and, accordingly, the effect of their use will differ. For example:

Activetex X. The main active ingredient is chlorhexidine. That is why the index X is added to the name of napkins for the treatment of trophic ulcers on the legs. Chlorhexidine is known not only as an antiseptic; one of its additional properties is considered to be the ability to accelerate the process of eliminating hematomas and bruises.
Activtex F. The main component is furagin. This substance is highly active against many pathogenic microorganisms and can suppress their reproduction. As a result, not only is a barrier created against the entry of pathogenic microflora, but it also has a preventive effect on the development of opportunistic microorganisms.
Activetex HF. These are the most effective medicinal wipes for therapy. pathological changes on foot. Based on the name, it is clear that the composition includes both antiseptic substances - furagin and chlorhexidine. Thanks to this, as a result of treatment, it is possible to clean the wounds on the legs from detritus and speed up the healing process.

Almost all wipes have antibacterial properties.

Atrauman, which are known as napkin-bandages, have also proven themselves as a treatment for trophic ulcers on the legs. They can be used at any stage of the flow pathological process. Substances saturated with silver are used as an antiseptic. The product is convenient in treatment, as it contains neutral and fatty acid. Thanks to this, such wipes are easy to use and do not cause discomfort even for people with sensitive skin.
Hartman is also used for dressing trophic ulcers on the legs. The series presents various options. But, despite the differences in composition, all napkins effectively cope with the main symptoms of pathology on the legs.

Absorbent

In addition to antiseptic wipes and bandages, various absorbent materials are used to treat trophic ulcers on the legs. This direction in treatment is also of significant importance, especially at the stage of exudation. Wipes are used if there is copious discharge from the wound. At the same time, they absorb exudate and protect the wound from infection. Examples are Biaten, Voskopran, Cetuvit, Branolind.

Reparation stimulants

Most wipes have properties that accelerate tissue regeneration.

It is known that with trophic ulcers on the legs, the main problem is a long-term lack of healing. In this regard, the use of drugs that can activate the processes of regeneration of damaged tissues is indicated. They are available in the form of napkins or patches, and their coating is usually represented by a coating or film substance. Some of them contain a special absorbent pad that prevents excess moisture from forming under the napkin. Thanks to the presence of different layers, the product prevents moisture from getting under the bandage, but at the same time ensures the supply of oxygen, which increases the effectiveness of the treatment. The most famous among this type of napkins for trophic ulcers on the legs are the following representatives:

Sterilized.
Advance.
Plastofix.
Hydrofilm.
Omnifix.

The range of napkins for the treatment of trophic wounds and ulcerations on the legs is quite wide. They can be divided into three large groups - antiseptic, moisture-absorbing and stimulating healing. All of them are used on different stages treatment. Therefore, you should always consult your doctor before starting use. As for the method of application, it depends on the type medicine. Most of them are applied to the affected area of skin for 24-48 hours. If necessary and if indicated, changes can be made more often. But, again, the decision is made by the attending physician.