Trophic Ulcers Research Articles

THE ROLE OF INTRACELLULAR SIGNALING PATHWAYS IN THE DEVELOPMENT OF TROPHIC PATHOLOGIES OF THE LOWER EXTREMITIES AND THEIR REGENERATION UNDER TYPE 2 DIABETES (PART 1)

Introduction. This review article addresses the critical issue of the development and regeneration of chronic trophic ulcers in the context of type 2 diabetes. This pathological process is associated with inhibited cell proliferation, impaired differentiation of various cell types, and disrupted mechanisms that regulate cell death. An analysis of recent scientific literature also highlights the involvement of key intracellular signaling pathways in the development of chronic ulcerative pathologies of the lower extremities, as observed in both experimental animal models and patients with type II diabetes. Despite advancements, this issue remains insufficiently explored in both theory and practice, underscoring its ongoing relevance. The aim of this study is to identify the roles of key signaling pathways—transforming growth factor β (TGF-β), phosphatidylinositol 3-kinase/serine-threonine kinase (PI3K/Akt), and Wnt/β-catenin—in the inflammatory response, regenerative mechanisms, and healing processes of soft tissue damage and trophic ulcers in experimental animals and patients with type II diabetes. Materials and Methods. This study is based on an analysis of current scientific literature that addresses this topic. Results. It has been found out that changes in the content and activity of key molecules of signaling pathways lead to disruption of carbohydrate homeostasis and the occurrence of structural and functional dysfunction in damaged tissues against the background of type II diabetes. These include TGF-β, PI3K, Akt and β-catenin. Analysis of experimental data demonstrated that both under the conditions of type II diabetes development and in the occurrence of chronic ulcers of the lower extremities, against the background of this endocrine disease, there is an increase in the level of TGF-β. At the same time the activity of the PI3K/Akt signaling pathway in the above-mentioned studied groups was reduced. The relationship between the development of type II diabetes and the Wnt/β-catenin signaling pathway has been established. Suppression of its activity was accompanied by impaired regeneration of chronic trophic ulcers in type II diabetes. Conclusion. Thus, the mechanism of type II diabetes and chronic peptic ulcer disease, in the same pathology, is associated with a impaired activity of signaling cascades. This concerns the following cellular systems such as TGF-β, PI3K/Akt and Wnt/β-catenin. They can be considered as potential therapeutic targets for the development of newest methods for the treatment of chronic trophic ulcers in type II diabetes in order to accelerate the recovery process of volumetric tissue damage of the lower extremities.

Comprehensive treatment of the patient with venous trophic ulcer

Improving the results of treatment for patients with varicose veins in the lower extremities, complicated by trophic ulcers, is an urgent task for modern medicine. A long-term, recurrent course of the disease leads to a reduction in working capacity and deterioration in quality of life, as well as permanent disability for patients, whose treatment causes special economic problems. At present, there are virtually no effective methods for conservative therapy, leading to prolonged unsuccessful treatment of such patients. This article presents the clinical case of a 63-year-old patient undergoing complex treatment for chronic lower limb venous insufficiency of class C6 according to the CEAP classification. Conclusion. An effective complex method for treating trophic ulcers in patients with chronic venous disease involves the correction of venous hemodynamic disorders (in this case, through radiofrequency ablation), as well as primary surgical treatment for the ulcerative defect, and simultaneous autodermaplasty with a perforated skin flap.

Umbilical Cord Blood-Derived Products in Autoimmune Systemic Syndromes with Severe Dryness: A Pilot Study

Background and Objectives: Human umbilical cord blood serum (HUCBS) stands out as a potent adjunct to conventional therapies for ocular surface disorders (OSDs) caused by, among many, autoimmune systemic syndromes. By expediting ocular surface regeneration and fostering epithelial integrity, HUCBS not only enhances subjective patient experiences but also improves objective clinical indicators. This makes it particularly useful in patients with corneal ulcers through ocular surface regeneration and anti-inflammatory activity. This study aims to explore the efficacy of HUCBS in patients who had previously received other treatments unsuccessfully. Materials and Methods: This study was a prospective, non-comparative, interventional case series study involving 49 patients (30 females and 19 males) aged 15–82 years with severe OSDs who were unresponsive to standard treatments. The study was conducted at the San Marco Hospital, Catania, Italy. Patients were categorized into four groups based on the etiology of their severe OSDs: Group I consisted of twenty four patients with filamentary keratitis and corneal ulcers associated with rheumatologic diseases such as Sjogren’s syndrome and systemic sclerosis; Group II comprised thirteen patients with graft-versus-host disease; Group III consisted of nine patients with corneal neurotrophic ulcers; and Group IV included three patients with Steven–Johnson syndrome. The outcomes were evaluated before and after treatment using the following assessments: OSDI (Ocular Surface Disease Index) and SANDE (Symptom Assessment in Dry Eye) questionnaires, VAS (Visual Analog Scale), Slit Lamp Examination, Esthesiometry, Lissamine Green Staining, NIBUT (Non-Invasive Break-Up Time), BUT (Break-Up Time), Fluorescein Staining with Photography and Oxford Classification, The Schirmer Test, Best-Corrected Visual Acuity (BCVA), and Meibography. Results: We observed a significant improvement in the outcomes from the SANDE, VAS, and OSDI questionnaires, The Schirmer Test, BUT, BCVA, and Oxford Classification, after treatment with UCBS. Clinical variables, such as corneal inflammation, conjunctivalization, corneal neovascularization, and pain, were also considered individually. Nevertheless, pain and inflammation reduced markedly over time until complete healing was achieved in all cases. Conclusions: Our pilot study highlights the substantial efficacy of HUCBS in patients with systemic autoimmune diseases who have shown inadequate responses to prior treatments for dry eye. This underscores the need for further comprehensive investigations in this field.

TREATMENT OF TROPHIC COMPLICATIONS IN DECOMPENSATED FORMS OF IMPAIRED ARTERIAL BLOOD CIRCULATION OF THE LOWER EXTREMITIES

Summary. The aim of the study was to study the clinical effectiveness of using the developed method of cryopreservation on wound surfaces using a cryopreservation device. Materials and methods. 87 patients with ulcerative-necrotic defects of the lower legs and feet were selected for the study. The condition for inclusion in the study was Phase I of the wound process. Patients were divided into the main and comparison groups. The main group included 41 patients who had their wounds cleaned according to the proposed method, and the comparison group consisted of 46 patients who underwent surgical treatment. Results. The use of cryodestruction of the surface of trophic ulcers of arterial etiology led to rapid cleaning of necrotic masses, fibrin, a decrease in exudation and pain intensity, and the disappearance of unpleasant odors. The effectiveness of the methods lies in the fact that not only necrotic components of the wound surface, fibrin films, as well as the surface layers of ulcer surface cells are destroyed, that is, phenotypically altered cells of the wound edge and base are removed, leading to a violation of regeneration processes. Conclusions. Debridment methods based on the use of controlled cryodestruction of pathological tissues on the surface of trophic ulcers accelerate the transition of the wound process to phase II by 25% in patients with trophic ulcers with critical ischemia of the lower extremities.

Squamous Cell Carcinoma Arising from Trophic Ulcer in a Treated Case of Hansen’s Disease

Squamous Cell Carcinoma Arising from Trophic Ulcer in a Treated Case of Hansen’s Disease

The caretaker-reversible Tarsorrhaphy

PurposeTo present a modification of the reversible tarsorrhaphy that can be opened and reclosed as necessary by caretakers and the patient.MethodsRetrospective case series of patients who underwent the reversible tarsorrhaphy.Materials included intravenous (IV) tubing as bolsters and 4–0 polypropylene suture. The 4–0 suture is first passed through and through one end of IV tubing approximately 20 mm in length. Starting on the lateral upper lid and approximately 4 mm above the lash line, the suture is placed through the skin and into the tarsus. The suture exits through the eyelid gray line. These steps through the eyelid are repeated in the opposite direction. An air knot is tied above the upper eyelid near the base of IV tubing. A second air knot can be tied higher to provide a handle easily allowing the caretaker to close the eyelid.ResultsIncluded were 13 patients (ages 21–95-yeas), indications included lagophthalmos secondary to cicatricial changes from burns (2), keratouveitis (1), neurogenic palsy (3), neurotrophic ulcer (6), and cicatricial changes from skin cancer (1). There were no reported difficulties in maintaining the tarsorrhaphy by either family members or healthcare providers. The first tarsorrhaphy for each patient lasted between 3–19 weeks, with an average of 8 weeks. All were well tolerated.ConclusionsThe caretaker-reversible tarsorrhaphy can be used as a temporizing measure. The technique balances the need for ocular protection with the need for examination/treatment by health care professionals and, equally importantly, the patients and caretakers.

Surgical treatment of osteomyelitis in patients with diabetic foot: clinical experience

Aim. To analyse the results of surgical treatment of osteomyelitis in patients with diabetic foot.Methods. A retrospective analytical study was conducted to assess the outcomes of surgical treatment for osteomyelitis in diabetic foot patients. The study analysed 28 patients with osteomyelitis classified as Grade III according to the Wagner classification. The average age of the participants was 62.5 ± 14.5 years, and the mean duration of diabetes mellitus was 8.2 ± 5.5 years. The cohort consisted of 16 men (67.1 %) and 12 women (32.9 %). All patients presented with a single osteomyelitic lesion located in the anterior region of the foot. The underlying causes of osteomyelitis included trophic ulcers and complications such as abscesses of the toes and phlegmon of the foot, which developed secondary to the trophic ulcers.Results. In the group of patients who underwent both autopsy and drainage of abscesses and phlegmon, followed by one-stage amputation of one or more toes with radical resection of the corresponding metatarsal heads, the average number of hospital bed days was 31.9 ± 15.7. In contrast, the group of patients who were admitted without purulent necrotic complications and underwent one-stage amputation of one or more toes with radical resection of the metatarsal heads had an average of 13.4 ± 2.1 bed days.Conclusion. Prolongation of medical treatment in patients with osteomyelitis of the diabetic foot, leading to the occurrence of purulent-necrotic complications, doubles the length of hospital stay, which entails an increase in treatment costs.

Epidemiological Profile of Chronic Wounds in an Indian Population: A Community-Based Cross-Sectional Observational Study.

Introduction A wound that has not healed in a timely and organized manner to maintain its anatomical and functional integrity is considered chronic. It can last anywhere from four weeks to over three months and could be caused by trauma, diabetes, vascular disease, infection, or pressure.The primary objective of the study was to determine the prevalence of wounds in a rural and urban community in India, and the secondary objective was to evaluate the effect of various chronic wounds on quality of life (QoL) as assessed by the Short-Form Health Survey-36 (SF-36)questionnaire. Materialsand methods The present study is a cross-sectional analytical study done between June 2022 and December 2023, and a total of 10,003 sample population was screened in Varanasi district, Uttar Pradesh, India. The study involved conducting a door-to-door survey of the population sample under interest based on a stratified sampling technique. During the survey, the epidemiological profile of the sample population, a detailed history, and clinical examination findings were recorded in a proforma. The reports of relevant diagnostic investigations were also recorded. Results The overall prevalence of chronic wounds was 1.89 per 1000 (19/10003) population. The prevalence of wounds in urban areas was 1.57 per 1000 (11/6984) population, while that in rural communities was 2.64 per 1000 (8/3019) population. Of the total 19 patients with chronic wounds, the majority of the patients, i.e., seven each (36.8%), had diabetic foot ulcers (DFUs) and neglected/uncared trauma as the etiology for chronic wounds. The remaining five (5.3%) patients were equally divided between cellulitis, venous ulcers, trophic ulcers, tubercular ulcers, and malignancy as the etiology for chronic wounds. The QoL data suggested that 11 (57.9%)patients reported their general health status as fair with wounds, followed by five (26.3%) reporting their general health status as poor. Only three (15.8%) of the patients with wounds reported their general health condition as good. There was no significant difference between the QoL of rural and urban patients with chronic wounds. The overall prevalence of wounds has decreased from 15.03 to 1.89 per 1000 people in the survey locality. The switch from opting for home-based remedies to supervised care under the clinician (be it in a private or public setting) clearly indicates raised awareness regarding the management of wounds, and with time, people have shown an increased interest in healthcare facility treatment under supervision over adopting home remedies for wound treatment. The same domain may be attributed to the prompt management and efficacy of the management protocols by the treating physicians in India. Conclusion The findings of the present study regarding the incidence and prevalence of chronic wounds in connection to demographic factors are important when allocating resources and making healthcare plans. The present study conveys a clear message to healthcare practitioners about the necessity of carrying out large-scale epidemiological research on this topic and offers a solid foundation for future studies.

NLRP3 inflammasomes as a target for hesperidin and diosmin flavonoids in varicose vein disease and its complications

Varicose vein disease of the lower extremities is an inflammatory disorder with abnormal structure and functional activity of the venous valves, venous walls and cells, as well as with abnormal activity of the infiltrating leukocytes. The abnormally changed varicose vein are characterized by increased venous pressure, blood accumulation and congestion, ischemia, and metabolic and energy turnover derangement, which result in clinical manifestations of complications, such as pain, edema and formation of trophic ulcers. For many years, flavonoids have been used to treat varicose veins. The most effective flavonoids used in varicose vein disease and its complications, are hesperidin and diosmin, as well as their combinations. The review sets forth the state-of-the-art knowledge on the universal inflammatory processes playing a leading role in the pathophysiology of many cardiovascular disorders, including venous ones. In the recent years, it has been found that one of the main causes of inflammation is the formation of intracellular protein complexes (inflammasomes), which both produce a set of proinflammatory cytokines and are responsible for their excretion from the cells. In addition, inflammasomes control the development of regulated necrosis (pyroptosis) that takes part in the process of ulceration. The inflammasome activity can be modified by various mechanisms, of which the gene independent synthesis of the inflammasomal proteins has been recognized as the leading one. It has been shown that flavonoids inhibit the activation of a key factor NF-kappa B and suppress the synthesis of proteins, including NOD-like receptor protein 3 (NLRP3) inflammasome components, decrease the expression of NLRP3 receptor, protein ASC and caspase 1, as well as diminish interleukin 1 beta, interleukin 6 and tumor necrosis factor-alpha expression. Thus, this is the explanation of positive effects observed with the use of hesperidin, diosmin and their combination in clinical practice.

The impact of surgical intervention on statographic parameters of patients with diabetic foot syndrome

Taking into account that the prevalence of diabetes mellitus continues to increase worldwide, secondary complications associated with this endocrine disorder are becoming increasingly common. Disruption of glucose homeostasis and hyperglycemia lead to the activation of several pathological metabolic pathways, contributing to the development of vascular insufficiency and neurodegenerative processes in the lower limbs. These processes are the causes of a condition known as diabetic foot syndrome (DFS), which requires special attention and meticulous treatment. Complications in the form of trophic ulcers of the lower limbs are one of the serious consequences of diabetes mellitus (DM) since they often lead to severe medical and social problems, including high rates of limb amputations. The purpose of the research is to investigate the redistribution of plantar pressure depending on the volume of surgical intervention in patients with diabetic foot syndrome (DFS) by measuring individual statographic parameters. The analysis of a series of parameters from statographic studies in patients with diabetic foot syndrome undergoing various volumes of surgical interventions has allowed for a comprehensive understanding of the features of vertical standing of these patients. In the course of the research, it has been revealed that as the support area of the operated foot decreases, there is an increase in body oscillation in both the sagittal and frontal planes relative to the support area. It has been proven that in cases with a normal support area of the foot, the relative body oscillation decreases.

Possibilities of surgical correction of complicated forms of chronic venous insufficiency in patients after coronavirus infection

Introduction. COVID-19 causes generalized endothelitis and impaired arthriolo-venular circulation leading to a slowdown in blood flow and venous hypervolemia. This leads to decompensation of the drainage function of perforated veins and the occurrence of horizontal venous reflux. Aim. To determine the possibilities of surgical correction of decompensated forms of chronic venous insufficiency (CVI) in patients after COVID-19, when determining the localization of pathological venous reflux by ultrasound duplex scanning of the lower extremity veins. To determine the character of microcirculatorydisorders in the examined patients. Material and methods. Ultrasound duplex scanning with a 7.5-10 MHz linear sensor was performed in 59 patients aged 40-78 years, 34 women and 25 men who had suffered from COVID-19 in a moderate form that did not require hospitalization. Patients had not previously noted manifestations of CVI and did not use diosmin drugs. The reason for treatment was the manifestation of complicated forms of CVI, which first appeared after COVID-19. 39 patients of group I underwent surgical correction of horizontal venous reflux, 20 patients of group II received conservative treatment. The microcirculatory bed was examined using a high-frequency ultrasound Dopplerograph on the nail bed of the 1st finger of the upper limb with a 25 MHz sensor. Results. The revealed microcirculatory disorders were characterized by a depletion of the Doppler spectrum, which corresponds to parietal stasis. Isolated horizontal venous reflux was recorded in the area of trophic disorders: pigmentation, induration and trophic ulcers (TU) of the shin. In group I patients, as compared to group II, pain syndrome, edema, induration and inflammation significantly decreased after treatment when assessed by the VCSS scale. More rapid and complete healing of TU was observed. Conclusions. COVID-19 provokes accelerated progression of isolated horizontal venous reflux, due to generalized microcirculatory disorders reported in patients in the post-COVID period. The surgical intervention for its elimination in the nearest future after applying undoubtedly surpasses conservative methods of treatment and allows achieving a good cosmetic and clinical result.

Silver in Wound and Trophic Ulcer Treatment: A Modern View of the Problem

This review presents published data on the history of use, mechanism of action, and effectiveness of silver and silver-based drugs in surgical practice. A literature search was carried out using PubMed, EMBASE, Google Scholar, and E-Library databases. Analysis of available literature data convincingly demonstrates the effectiveness of silver nanocomposites as antibacterial and anti-inflammatory agents. The demonstrated antimicrobial property of silver nanoparticles (AgNPs) against various antibiotic-resistant bacteria is especially significant for clinical use. Silver nanoparticles have clinically proven effective in treating wounds and trophic ulcers.

A STUDY OF PREVALENCE, CLINICAL PRESENTATION AND MANAGEMENT OF LOWER LIMB ULCERS AT A TERTIARY HOSPITAL

Background: Lower limb ulcers are debilitating and painful, greatly reducing patients quality of life. These ulcers are often difficult to treat. The most common aetiologies for lower limb ulcers are venous, arterial, mixed venous and arterial, diabetic and pressure ulcers. However, atypical wounds comprise approximately 20% of chronic wounds and should be kept in mind during differential diagnosis.The successful ulcer management depends upon the accurate diagnosis and treatment of the underlying cause, and it often needs a multidisciplinary approach. Methods: This prospective cross-sectional study conductedin Department of General Surgery atBasaveshwara Teaching and General Hospital, Attached to Mahadevappa Rampure Medical College, Kalaburagi. The study was conducted during the period from June 2022 to December 2023 which included 97 patients presenting withlower limb ulcers and admitted in surgical wards of our hospital. Results: Most of the patients were engaged in agriculture (24%) followed by business (23%) and service (14%). 47.5% of the patients had habit of smoking,alcohol consumption and tobacco chewing. Most of the ulcers were diabetic (36.1%) followed by venous (22.6%) (Z=2.17 p=0). Only 4.1% and 3.1% were malignant and trophic ulcers. Peripheral neuropathy (26.8%) was the most common cause of ulcer followed by venous hypertension (24.7%).In most of the cases, debridement with dressing (32.9%) and Debreidment+dressing+skin grafting (19.6%) was done. At the end of study period, 90 ulcers were healed, 4 were disease free, 2 had recurrence and 1 patient died. Conclusion:A comprehensive assessment of patients general status, personal habits, skin, vascular status, limb, ulcer characteristics are required to determine the etiology and to formulate effective treatment plan. Thus, the study of various cases of lower limb ulcers arouses lot of interest and is mind boggling as far as the treatment of these cases are concerned. With the availability of arsenal of investigation, wide range of antibiotics and with ever improving dressing material, there is certainly a great improvement in treatment of lower limb ulcers. Education and training are vital for all those involved in caring of patients with ulcer.

Utility of Fat Grafting in Chronic Wounds.

Introduction The history of wounds dates back to the evolution of mankind. Throughout the centuries, management modalities of wounds have undergone drastic changes. With the advent of technology, we have multiple options for wound care, but none of them can be called the gold standard of wound care. Autologous fat grafting (AFG) is one of the most routinely performed procedures in aesthetic surgery. Fat grafting has shown beneficial effects in the healing of wounds. The regenerative potential of autologous fat is contributed by the adipose-derived stem cells present within the stromal vascular fraction, which are capable of differentiating into multiple cell types. This study aims to analyze the usefulness of AFG in cutaneous wound healing. Materials and Methods This prospective, study was conducted in our institute between April 2021 and May 2023. Eighteen patients with nonhealing wounds were included in the study. For assessing wound healing all the patients were first managed with conventional dressing for 2 weeks before surgery. After routine preoperative workup, the procedure was performed under local anesthesia in most cases. Fat was harvested from the lower abdomen and after emulsification, was injected into the edge and floor of the ulcer. The dressing was changed on the third postoperative day and the outcome was assessed. Results Eighteen patients (M:F ratio 8:1), with a mean age of 35.61 ± 12. 64 years (range 10-65 years), were included in this study. The most common etiology was trauma (44%), others being postop infection (17%), veno-lymphatic ulcer (17%), burns (11%), insect bite (5%), and trophic ulcer (5%). Majority of the wounds (95%) healed without the need for any extra intervention. The mean period taken for complete wound healing was 5.05 weeks. Conclusion Complete wound healing was achieved in majority of the patients without any complications. We recommend the usage of AFG for nonhealing wounds, as the procedure is relatively simple and can be performed after basic training. Larger-scale randomized controlled trials should be conducted to prove their efficacy in the management of complicated wounds.

A Study of Outcome of Detethering in Delayed Presentation of Tethered Cord Syndrome

Abstract Introduction Tethered cord syndrome (TCS) is a stretch-induced functional disorder associated with tethering of caudal spinal cord to dura mater with inelastic tissue, limiting its movement. It not only manifests in childhood but also noted in adults. Here, we studied the role of detethering on delayed presentation of TCS. Material and Methods All patients of symptomatic TCS from January 2011 to December 2019 were included. Preoperative evaluation was done through X-ray; ultrasonography kidney, ureter, urinary bladder; magnetic resonance imaging spine and brain; and urodynamic studies. Detethering was done and associated pathology was excised. Preoperative and postoperative comparison was done through Necker functional score using chi-squared system. Results Age range was 8 to 30 years with mean age of 13.8 years. Most common presentation was urological manifestations in ∼61.1% of cases followed by pain in 41.6%, sensory deficits in 38.8%, asymmetric weakness in 30.5%, orthopaedic and trophic ulcers in 22.2% each, and bowel abnormalities in 13.8% of cases. Mean duration of symptoms was 5.52 years. Improvement in urological manifestations was in 71.4% patients, pain in 80%, sensory dysfunctions in 71.4%, bowel dysfunctions in 80%, motor weakness in 90.9%, and trophic ulcer in 100% patients. On comparison, chi-squared value was 25.9993 and p-value was 0.000032, which was significant (<0.05). Conclusion Detethering in early ages is already proven with good results. In our study, detethering showed statistically significant improvement even in delayed presentation. So, authors recommend to surgically interfere by detethering, even if tethering is detected late with significant deficits.

Leprosy in Post-elimination Era: A Study Conducted in Rural Tertiary Settings in North India.

Background Leprosy is an age-old disease caused by Mycobacterium leprae. The disease was declared eradicated in India in 2005. Many new cases are still being identified in the outdoor patient department. This study was undertaken to understand the epidemiological, clinical, and social aspects of leprosy among new patients, and assessthe current situation regarding caseload and presentation. Material and methods This study was designed as an observational study. It was carried out in people newly diagnosed with leprosyattending the outpatient department of Dermatology, Venereology, and Leprology in the tertiary care hospital in Uttar Pradesh University of Medical Sciences from July 2022 to January 2024. A total of 231 people afflicted with leprosy were included in the study. The data collected was statistically analyzed to identify demographic and social patterns, clinical presentations, and features associated with leprosy. Result Out of these 231 patients, 139 (60.17%) were male and 92 (39.83%) were female. Most cases belonged to the age group 40-59 years 87 (37.66%). History of close contact with an afflicted person was present in 34 (14.71%). Clinically, most patients belong to the borderline tuberculoid (BT) type. Only 24 (10.4%) patients were found positive for M. leprae by slit-skin smear examination. The ulnar nerve was the most common nerve involved in 63 (27.27%) cases. Trophic ulcers were the predominant deformity in 34 (14.7%), followed by foot drop in 13 (5.62 %). Conclusion The present study provides an overview of the prevailing trends of Leprosy within a specific region in the post-elimination era. The findings underscore the significance of the ongoing National Leprosy Eradication Program (NLEP) program and stress the importance of aligning them with the common goal of eliminating the burden and stigma of Leprosy from society.

PARALYSIE COMPLETE DU NERF OCULOMOTEUR III CAUSEE PAR UN ZONA OPHTALMIQUE A PROPOS DUN CAS

Ophthalmic herpes zoster, a manifestation of the reactivation of the varicella-zoster virus in the region of the trigeminal nerve, is primarily diagnosed based on the clinical characteristics of skin lesions and their localization. Ocular complications, including oculomotor paralysis, require early antiviral treatment to minimize ocular damage. We report the case of a 38-year-old woman presenting typical symptoms of ophthalmic herpes zoster, associated with complete oculomotor nerve III palsy and zoster encephalitis. Antiviral treatment with acyclovir led to a significant improvement. However, the patient retained corneal anesthesia resulting in the formation of a neurotrophic corneal ulcer. The risk of ocular complications associated with ophthalmic herpes zoster is real. The most serious are corneal complications and oculomotor paralysis, highlighting the crucial importance of early antiviral treatment to prevent these complications which can adversely affect the functional prognosis of the eye.

Innovative methods of treating trophic ulcers with films

The article presents data from an analysis of the use of films for the treatment of trophic ulcers. The results of microbiological examination of wound biopsies were compared to assess the effectiveness of treatment

Painful forms of diabetic neuropathy

Diabetic neuropathy is a frequent and severe degenerative complication of diabetes. The diagnosis is easily performed in painful symptomatic patients. Sensitivity disorders responsible for numbness, tingling, and loss of feeling are part and parcel of diabetic foot syndrome and require investigation in view of preventing trophic ulcers. To date, there exists no specific treatment for diabetic neuropathy possibly preventable by careful control of metabolic disorder. Effective management of diabetic patients would make it possible to limit the dramatic consequences of diabetic neuropathy while at the same time acting on other complications.

Distal Bypass Surgery for Critical Ischemia Using a Related Donor Vein

The article presents a case of using the trunk of the great saphenous vein from a living related donor in elective surgery for the main arteries of the lower leg. The possibility of using a vein from a relative in special clinical situations is shown. High risks of repeated interventions aimed at relieving early and late complications of vascular reconstructions remain an urgent problem in angiosurgery. Very often, operations are performed in the presence of extensive necrosis and trophic ulcers (stage IV according to the Fontaine-Pokrovsky classification). The gold standard for choosing a shunt during reconstructive operations on the infrainguinal arteries was and remains an autovenous conduit from the great saphenous vein (C, D type of arterial bed lesion according to TASC II). During repeated reconstructions in the absence of a suitable autovein and with the distal position of the peripheral anastomosis, it is not always possible to use a synthetic prosthesis as a reliable alternative. Unsatisfactory Results of using such materials dictate the need to choose a suitable graft. The problem of using allografts requires further in-depth study. In this regard, the case of using a donor vein as a material for reconstruction is given. It was concluded that it is possible to effectively use allovein from a related donor in a patient after previously performed reconstructive interventions and in the absence of autologous material for bypass surgery.