Comparison of the effectiveness of various conservative treatment options for trophic ulcers and varicose eczema

Abstract

Introduction. It has been for a long time considered that treatment of trophic venous ulcers and varicose eczema should be operative only. However, practice shows that such treatment doesn’t guarantee the complete healing of an ulcer or eczema and doesn’t always prevent the recurrence of pathological processes. It suggests the need for an integrated approach to the treatment of trophic venous ulcers and varicose eczema.Aim. Analyze the effectiveness of various methods of non-surgical treatment of venous trophic ulcers (TU) and varicose eczema (VE) to create an optimal algorithm for managing this category of patients in outpatient practice.Materials and methods. A prospective comparative cohort study of 252 patients with C4-C6 CVD classes (CEAP) was conducted. 178 people (71%) had venous TU , 74 (29%) – VE. 3 groups of patients were formed: 1 gr. – (n = 68) was treated with traditional medicines and standard topical therapy (control); 2 gr. – (n = 90) received MOFF, elastic compression (Pütterbinde bandage), systemic antibiotic therapy for TU and corticosteroids for VE, dressings using Hartmann wound coverings; 3 gr. – (n = 94) in addition to the treatment similar to group 2, sclerotherapy (ST) of pathological venous reflux was performed. The follow-up lasted 6 months (8 visits) with a comprehensive clinical, laboratory and instrumental assessment. Statistical processing of the results was carried out using the STATISTICA software package (StatSoft, Inc., 2001, version 6.0).Results. By the end of the study, the following positive trends were registered in group 2 compared to group 1: the total VCSS index was 1.5 times lower, and according to the 10 – point VAS – 3 times; TU healing/ VE remission occurred 2 months earlier, complete healing of TU was noted in 75% of patients vs 63%, remission of VE-in 81% vs 47%. The combination of elimination of pathological reflux by CT and MOFF therapy (group 3 patients) was particularly effective. When comparing group 1 with group 3, it turned out that in the latter, by the end of the study, the total VCSS index was 3 times lower; the total indicator for the 10 – point VAS was 5.5 times lower for TU, 10 times higher for VE; TU healing/VE remission occurred 4 months earlier, complete healing was noted in TU in 88% of patients vs 63%, remission of VE in 96% vs 47%. Based on the obtained data, therapeutic algorithms were proposed for the management of patients with venous TU and VE in outpatient settings.Conclusions. Conservative treatment of venous TU and VE can be an alternative to surgical treatment, or an addition to it. MOFF is the most effective venotonic of complex action prescribed for the treatment of TU/VE in the form of monotherapy. Sclerosing therapy is a full-fledged element of the complex treatment of venous TU. The use of the proposed treatment algorithms makes it possible to speed up the healing process of venous TU and achieve remission of VE by three times.