Trophic ulcers in varicose veins. Sclerotherapy and laser technologies as one of the most effective ways to address the problem.

What are trophic ulcers?
Trophic ulcers are a pathology in which the basal layer or epithelial tissues of the skin are deeply affected. The disease has a progressive inflammatory nature. The consequences of trophic ulcers include loss of skin elasticity and scarring of the epidermis.

What causes this condition?

Etiology of trophic ulcers
This pathology is triggered by various factors. The most common cause of trophic ulcers is venous insufficiency. There are also other etiological factors, which is why ultrasound diagnostics for trophic ulcers are crucial to ensure the therapy is targeted at the root cause for optimal results.

The most common causes of trophic ulcers include:

• Chronic venous insufficiency
• Chronic lymphovenous insufficiency
• Chronic lymphatic insufficiency
• Ischemia of the lower extremities
• Diabetic damage to the extremities
• Autoimmune diseases
• Skin cancer
• Dermatological conditions

When trophic ulcers are linked to venous insufficiency, they are often referred to as venous ulcers.

Venous ulcers
In 94% of cases, venous ulcers develop on the inner surface of the lower third of the shin, less commonly on the outer or posterior surface. Venous ulcers are caused by impaired blood flow from the legs and are considered complications of varicose veins. This contributes to the growth of the ulcer. Initially, its surface is covered with a brown or black crust, indicating tissue necrosis.

Over time, the ulcer begins to secrete accumulated exudate, which provides an ideal environment for microorganisms present on healthy skin and nearby. These microbes cause inflammatory processes with a prolonged chronic course. Inflammation leads to swelling and metabolic disorders, creating a "vicious pathological cycle" where the trophic ulcer is both a provoking factor and a consequence of severe damage to the venous system of the limb and surrounding tissues. Metabolic pathology results in highly unpleasant and painful manifestations.

Additional symptoms of trophic ulcers of venous origin include:

• Heaviness in the calves
• Nighttime leg cramps
• Swelling
• Itching in the shin area
• Hardening, shine, and smoothness of the skin
• Extensive purplish-red spots resulting from merging affected veins

How does the disease manifest?
Before the initial symptoms of trophic ulcers appear, the patient may suffer from varicose veins for several years. The ulceration process begins with redness and itching in the lower shin area. This is followed by eczema, which gradually transitions into a trophic ulcer.

Without urgent intervention by a phlebologist or surgeon, the skin takes on a characteristic sheen and is covered with white spots, which quickly transform into ulcerative areas. These become entry points for infections, complicating treatment. A prolonged inflammatory process is indicated by the appearance of a milky-white crust resembling paraffin flakes. If treatment is not initiated at this stage, the ulcer deepens and enlarges, leading to skin damage and potentially affecting the Achilles tendon, calf muscle, and even the periosteum of the tibia.

Without proper and timely medical intervention, complications of trophic ulcers can include:

• Inflammation of lymph nodes in the groin
• Erysipelas
• Thrombosis in the vessel lumen
• Purulent abscess

In severe cases, the disease may cause irreversible enlargement of lymphatic vessels and elephantiasis of the shin. There have even been cases of sepsis with fatal outcomes.

Stages of the disease
Trophic ulcers are divided into four stages:

1. Onset and rapid progression: In cases of severe tissue malnutrition, the skin develops a lacquer-like texture and a pinkish-red hue, followed by purplish areas that evolve into small wounds. These gradually widen, deepen, and merge.
2. Exudate secretion: Clear, white, or purulent fluid (if infection is present) begins to ooze from the rounded wounds. Pain and itching intensify. The primary treatment focus at this stage is cleansing the wound surface.
3. Proliferation at the edges, granulation in the center: The edges of the ulcer gradually contract toward the center.
4. Healing: Scar tissue and granulation cover previously affected areas.

Treatment
Even in the era of advanced medicine, treating trophic ulcers on the legs is challenging due to disrupted cell nutrition, known as trophism (hence the disease's name). This results in reduced protective functions of the body and a partial loss of regenerative abilities.

Therapy for trophic ulcers is demanding and requires patience from both the patient and the doctor. Surgeons and phlebologists at the “Medical Center ‘Zhyttia’” utilize the most modern and effective treatments, allowing for significant improvement in the patient's condition in a short time. All methods avoid general anesthesia.

The treatment method is determined based on the stage of the venous ulcer. Each clinic has its own approach to addressing this severe pathology, depending on its resources and experience in treating the disease.

We use a comprehensive approach to treat trophic ulcers. For venous ulcers, eliminating chronic venous insufficiency is a crucial aspect of treatment.

For this purpose, we employ the most modern methods, such as:

• Sclerotherapy
• Laser ablation

These methods target the root cause of the disease—in this case, venous insufficiency caused by varicose veins.

Therefore, self-treatment or resorting to alternative medicine (e.g., leeches or compresses) is not advisable. The only correct solution is to consult a phlebologist.

Traditional open surgical methods for removing varicose veins are highly traumatic and require prolonged hospitalization.

Modern techniques allow vessels to be "sealed" without damaging the skin or surrounding tissues using laser radiation or sclerosing medication, leading to rapid ulcer healing.

Combating hypodynamia
Addressing hypodynamia is a key aspect of venous ulcer treatment. For this purpose, our doctors recommend that patients walk regularly while wearing compression stockings. Muscle contractions and external compression improve venous outflow, enhance tissue metabolism, and accelerate healing.