Trophic Ulcers Of Lower Extremities Research Articles

Интерлейкин-6 у больных пожилого и старческого возраста с трофическими язвами нижних конечностей

Aim. To study the pathogenetic role of interleukin-6 (IL-6) in old patients with trophic ulcers of the lower extremities. Methods. The study enrolled 66 patients suffered from trophic ulcers of the lower extremities. The mean age of study patients reached 77.1±9.1 years (62–97 years). The majority of patients (65.1%) were women. The concentration of IL-6 in the blood (n<7.0 pg/ml) was determined by enzyme immunoassay. Results. Increased level of IL-6 was found in 77.3% of patients. The mean concentration of IL-6 was 14.9±14.6 pg/ml (1.5–288.6 pg/ml), median – 10.7pg/ml. The mean values of interleukin-6 in patients with venous ulcers reached 12.7 pg/ml, arterial – 13.4 pg/ml, mixed – 26.7 pg/ml (p=0.01). Direct correlation was registered between IL-6 level and the number of ulcers (r=0.3; p=0.02). There was a direct correlation between IL-6 concentration and the ulcers duration (r=0.28; p=0.03). There was a trend towards a direct correlation between interleukin-6 and ulcers size (r=0.23; p=0.08). In patients with infected ulcers, the mean IL-6 level was 17.5 pg/ml, in patients without microbiological growth – 11.6 pg/ml, but these differences did not reach the statistical significance (p=0.3). Significant direct correlations were established between IL-6 concentration and the level of C-reactive protein (r=0.61; p<0.000001), leukocyte count (r=0.36; p=0.006), neutrophil count (r=0.39; p=0.002), platelet count (r=0.39; p=0.002), ESR (r=0.40; p=0.003), inverse correlation – with hemoglobin (r=-0.41; p=0.001). There was a direct correlation between IL-6 level and severity of frailty (r=-0.38; p=0.03) and inverse correlation – with instrumental activity in daily life scale (r=-0.35; p=0.03). Patients with elevated IL-6 concentration had higher CRP (18.3 and 6.7 mg/l; p=0.001) and ESR (42.5 and 28.1 mg/l; p=0.04mm/h), but lower hemoglobin levels (114.3 and 125.9 g/l; p=0.01). There was a tendency to a direct correlation between IL-6 level and the age of study patients (r=0.23; p=0.06). Conclusion. Study results indicate a frequent increase in the interleukin-6 level in old patients with trophic ulcers of lower extremities. An increase in IL-6 concentration is associated with number and duration of ulcers as well as with various hematological parameters.

THE USE OF ANTISEPTIC PREPARATIONS IN THE COMPLEX TREATMENT OF TROPHIC ULCER OF THE VENOUS ETIOLOGY IN LOWER LIMBS

For the last decades despite the rapid development of medicine and its significant achievements there is a tendency towards an increase in the number of patients with trophic ulcers. Globally, the number of people suffering from chronic trophic ulcers ranges from 600 thousands to 2 million. Venous pathology is reported as the most common cause of trophic ulcers of lower extremities. Taking into account considerable prevalence of trophic ulcers, which can impede many aspects of life quality of patients, insufficient efficiency of existent conservative methods of treatment, no tendency to the decline in the prevalence of the disease, its prolonged treatment, which mostly lasts 2 – 3 months, and in some patients trophic ulcers do not heal over years, propensity to the frequent relapses in 60 – 70% of patients, considerable economic losses due to the loss of working capacity or disability of patients that ranger from 10 to 67%, and the large expenses for medication pose the trophic ulcer management as a challenging socioeconomic issue. Therefore, the search of new methods of local treatment of trophic ulcers of venous aetiology is remaining as one of the important problems of modern medicine. The article presents the clinical examination findings and treatment outcomes of 47 patients with the trophic ulcers of venous etiology. The participants took the course of treatment at the surgical department, II Municipal Clinical Hospital of Poltava. The treatment included local application of antiseptics. We investigated the clinical parameters of wound healing and check microbiological contamination of wounds. The results of clinical and laboratory investigations have demonstrated that local application of antiseptics in the management of trophic ulcers of venous aetiology of lower extremities promotes healing of trophic ulcers and can considerably reduce the term of treatment and hospital staying.

SURGICAL TREATMENT OF COMPLICATED FORMS OF CHRONIC VENOUS INSUFFICIENCY IN LOWER LIMBS (REVIEW ARTICLE)

Venous diseases of the lower limbs that are accompanied by the development of trophic ulcers are among the medical and social challenges. The vast number of patients is in working age, from 30 to 65 years old. Severe forms of the disease are registered in 27% of the cases; active or healed trophic ulcers are diagnosed in 12.9 % of cases. At present special attention is being paid to the effective surgical treatment of the pathology, to the introduction of the latest surgical interventions, which provide complete radicalism about the causes of trophic ulcers of venous genesis and ensure the maximum cosmetic effect. The aim of this work is to analyze the scientific literature on using the latest surgical techniques in the treatment of venous pathology in patients with trophic ulcers of lower extremities to promote improving the existing and elaborate new surgical interventions in terms of this pathology. Nowadays surgical treatment of patients with chronic venous insufficiency of the lower extremities, especially in case of trophic leg ulcers can be considered as the stage of the integrated treatment of venous trophic disorders. Modern surgical interventions differ in the methods, techniques and tools used, but provide the maximum cosmetic effect and complete radicalism regarding the causes of chronic venous insufficiency. Correction of pathological venous-venous reflux is the main method of eliminating venous hypertension, which underlies the progression of chronic venous insufficiency and promotes the development of trophic disorders, including the ulcers formation. The etiological cause of venous trophic ulcer is the appearance of pathological reflux, which occurs in the superficial, deep and perforating veins and, accordingly, the place of surgery should be those venous segments in which the pathological process is diagnosed. The operation can be performed simultaneously or in two stages: first, the vertical venous-venous reflux is eliminated, followed by the correction of the horizontal reflux. When using modern minimally invasive technologies, adequate and complete correction of venous blood flow in the affected limb is performed simultaneously producing no serious tissue damages to avoid cosmetic effect and to lessen postoperative period. Thus, the analysis of the scientific literatures has shown the unity of views on the strategy of surgical treatment of varicose trophic ulcers that involves the elimination of vertical and horizontal reflux, but the absence of views unity on tactical approaches in solving these issues.

COMPARATIVE ASSESSMENT OF THE MICROBIAL LANDSCAPE OF TROPHIC ULCERS IN PATIENTS WITH DIFFERENT METHODS OF LOCAL TREATMENT

Treatment of trophic ulcers of lower extremities is one of the most important problems of surgery. The aim of the study is to determine the features of the microbial landscape of trophic ulcers in various methods of local treatment. The results of studies on the microflora of trophic ulcers of lower extremities in 245 patients of the main and control groups were analyzed. In 96 patients with trophic ulcers (the main group), Miliacil and magnetolaser therapy were used locally in the treatment of trophic ulcers. For the treatment of 60 patients of the first control group with trophic ulcers, Miliacil and laser radiation were applied topically. In the second control group (59 patients), only Miliacil was used. In the third control group (30 patients), 1% dioxidine solution was used topically for the first 7–10 days, and then the treatment was followed by applying the sea buckthorn oil. The microbiological studies of the trophic ulcer contents demonstrated that Miliacil in combination with laser radiation and especially in combination with magnetic laser therapy had a more pronounced antimicrobial effect than only miliacil and even more so than the 1% dioxidine solution and sea buckthorn oil. It was found that in 161 (65.7%) patients the pathogens were inoculated in the form of a monoculture and in 84 (34.3%) - in the form of microbial associations. According to the composition of strains, among monocultures, 67 (41.6%) patients had Staphylococcus aureus, 39 (24.2%) - Proteus, 24 (14.9%) - E. coli, 20 (12.4%) - Pseudomonas aeruginosa and 11 (6.9%) -Streptococcus. The Staphylococcal associations were predominant, they were found in 68 (80.9%) patients. 336 strains of microorganisms were isolated and 296 (88%) of them were resistant to three or more antibiotics. At the end of treatment, in 87 (90.6%) patients of the main group, there was not observed any microflora in the ulcer inoculations. At the end of treatment, the ulcer microflora was not observed in 51 (85%) patients in the first control group, in 36 (61%) patients in the second control group, and in seven (23.3%) patients in the third control group. Thus, as result of studies conducted the specific features of the microbial landscape of trophic ulcers with different methods of topical treatment have been established.

Influence of Autologous Platelet Concentrates on the Dynamics of Regenerative Processes in Treatment of Trophic Ulcers of Lower Extremities

Influence of Autologous Platelet Concentrates on the Dynamics of Regenerative Processes in Treatment of Trophic Ulcers of Lower Extremities

Efficiency of a New Combined Laser Therapy in Patients With Trophic Ulcers of Lower Extremities and Chronic Venous Insufficiency.

Introduction: Treating patients with trophic ulcers (TUs) of venous etiology (VE) is a complicated socio-medical and economic problem. One of the ways to increase treatment efficiency can be a complex therapy, including combined laser action. Methods: The objective of this study was a comparative evaluation of the efficiency of traditional treatment methods in patients with chronic venous diseases of C6 class, and combined laser therapy (LT) according to a new method by LASMIK® device. External exposure was conducted on the 1-4 affected area during one session for 2 minutes per zone (pulsed mode, light pulse duration of 100-130 ns, wavelength 635 nm, by a matrix emitter consisting of eight laser diodes with a surface area of 8 cm2, at a distance of up to 7 cm, pulsed power 40 W). Intravenous laser blood illumination (ILBI) was conducted in continuous mode with a wavelength of 365-405 nm (UV-spectrum) and 520-525 nm (green spectrum) alternately, during 12 daily sessions, according to a special scheme. Results: The new method reduces time periods for wound surface cleansing from purulo-necrotic masses, stimulates proliferation and epithelialization processes by 2-2.7 times, compared with the conventional method. Conclusion: The high efficiency of a new combined LT has been demonstrated in the treatment of TU of VE in combination with traditional methods of patients' medical treatment.

Complex treatment of patients with trophic ulcers of lower extremities. (Russian)

Complex treatment of patients with trophic ulcers of lower extremities. (Russian)