notes by dr Claudio Italiano
To learn more:
Sometimes
ulcerated lesions may appear in the lower limbs. What is it about?
Let's ask questions.
Does the patient suffer from varicose veins or does he have problems with
chronic obstructive
peripheric arteriopathy?
Is our patient a diabetic one? Is it a lesion due to diabetic neuropathy or a neuroischemic problem?
In simpler words: does the patient have venous insufficiency or arterial insufficiency with ischemic ulcerative trophic lesions? Which of the two vascular circuits is impaired?
And is the autonomous nervous system efficient? Therefore, before addressing the vascular surgeon, in order to perform an accurate specialist evaluation and the execution of diagnostic investigations, first of all an ecocolordoppler, you can clarify any diagnostic doubts and choose the best treatment with your doctor.
And now we read and try to understand what a phlebostatic ulcer is.
Phlebostatic ulcers are a consequence of varicose veins, ie varicose or curved veins, which are ectasias, ie dilatations and deformations of the veins, especially observable in the lower limbs, where they appear as bluish goblets and swollen tumefactions, with great anxiety for the ladies who see the aesthetics and the beauty of the legs are disfigured and they run not indifferent risks (embolism).
They are defined as permanent dilatations of the of the lower limbs but may involve other localizations (plexus hemorrhoids, nasal septum, esophagus, the pampiniform plexus of the testis, varicocele). Venous insufficiency is the basis for the formation of static drip ulcers, due to the slowing of the bloodstream and the suffering of the tissues of the lower limbs. In those with varicose veins particularly evident, or inadequately treated, or presenting the results of deep venous thrombosis of the lower limbs, the development of a venous ulcer is highly probable. In Italy it is estimated that, on average, one person out of 92 develops a venous ulcer in the course of one's life and 10% of patients with varices develop some of them. These static drip ulcers can become infected and become, therefore, torpid, ending up not to heal anymore. Pain, secretion, infections, and disability are the main problems for which the patient consults the doctor. Once the wound inspection is performed and the wound swab is a simple investigation that allows you to study which infections are afflicting the torpid lesion, proceed with the treatment.
At the base of the treatment, a good dressing, a disinfection of the lesion and debridement from the necrotic tissue, so it is good practice to apply a bandage with medicated bandages with creams based on zinc oxide (Unna technique). However, bandages are carried out by doctors and expert staff at vascular surgery clinics.
Some authors, once the bandage has been removed, usually after a week, or when the secretions make it necessary and necessary maneuver, proceeds with a cleansing of the ulcerated wound, also using simple warm water and soap soaked gauze.
"Marseille", that of the laundry. It is therefore sought to make the lesion bleed from the margins and expects with patient that over the course of months it will heal. However we reiterate that beyond the various medications more or less appropriate, the therapeutic hinge is represented by elastocompressiva therapy with elastic bandages.
Alternatively, elastocompressive stockings are used, with a preventive purpose, that is with a graduated elastocompression at 18 mmHg or therapeutic, which must be fitted, generally, with the help of a person.
Elastocompressive treatment, if well performed, is able to promote 90-95% re-epithelialization of ulcerative lesions within 6-8 weeks depending on the size of the lesion and the type of chronic venous insufficiency that sustains it. Elastocompressive treatment is generally contraindicated in the treatment of other ulcerative skin lesions which do not recognize a phlebostatic genesis. In case of ulcer recurrence, the compression therapy should be carried out with elastic socks of the II ^ or better of the III ^ compression class.
Elastocompression or, worse, zinc oxide bandage is not easy to bear by the patient. However, when the patient or patient becomes aware that their legs have become deflated and their ankles thin, then they willingly accept the cure. In the most demanding cases, the patient may require the execution of surgery or simple sclerotherapy. Also the drugs, always in association with the elastocompressive treatment, can have a complementary role in the treatment of ulcerative lesions especially as regards the control of the edema, of the infection and of the related pain symptomatology. However, the appearance of an ulcer in the lower limbs may not be due solely to the presence of venous insufficiency.
Finally, we remind you that at the base of an infected phlebostatic ulcer
there is the problem of venous varices that often require surgical treatment. In
some conditions a treatment with elastic compression and bandage based on zinc
cream can not always give adequate results. In these cases it is necessary to
carefully evaluate if there are serious lesions of the venous system, for
example deep thromboses.
indice della visita del paziente