What is included in the treatment
The first stage is surgical treatment: removal of necrotic tissue, fibrin plaque and granulations, sanitation of the wound. At the same time, the key task is solved - elimination of venous reflux that supports the ulcer: laser obliteration of the incompetent trunk or treatment of perforating veins under ultrasound control. Without this step, the ulcer will not close or reopen. Next, modern wound coverings are used, selected for the phase of the process, and constant compression therapy. The price includes the first dressing; subsequent ones are carried out according to schedule until complete healing.
Why does the ulcer not heal?
Venous trophic ulcer is not an independent disease, but the outcome of long-term venous stagnation. Blood stagnates in the veins of the leg, the pressure in them increases, the tissues stop receiving nutrition, and the skin is destroyed.
The key takeaway from this is that treating just the ulcer itself is useless. As long as venous congestion persists, the defect will heal for months and open again. Therefore, treatment is always two-component: local treatment plus elimination of the venous cause.
What does treatment consist of?
- surgical treatment of an ulcer with removal of necrosis and fibrin
- culture with sensitivity testing and targeted antibiotic therapy
- modern wound dressings selected for the phase of the process
- compression therapy is the main method, without which the rest does not work
- elimination of venous reflux (laser obliteration, sclerotherapy of perforators)
Mandatory arterial check
Before starting compression therapy, it is necessary to ensure that arterial blood flow is preserved. With concomitant arterial insufficiency, compression is contraindicated and can lead to necrosis - therefore, assessment of the arteries is included in the mandatory examination, especially in elderly patients and with diabetes mellitus.