Why dressing is not just changing a bandage
At each dressing change, the doctor evaluates the phase of the wound process and changes tactics depending on it. In the exudation phase, absorbent dressings are needed to remove copious discharge; in the granulation phase - coatings that maintain a moist environment and protect young tissue; in the epithelialization phase - atraumatic coatings that do not stick to the wound. Using the same product at all stages is a common mistake that slows down healing for months. At the same time, a compression bandage is applied, without which local treatment is ineffective. If there are signs of infection, cultures are taken and therapy is adjusted.
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.