Peculiarities of Course and Healing of the Lower Limbs Trophic Venous Ulcers

Liulka A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Trophic ulcers of the lower extremities occur with a frequency of 1,48-3,05 per 1,000 population without a significant downward trend. Among the various forms of trophic ulcers in 70-75 % of cases venous etiol- ogy occurs. Frequency of decompensated forms of the disease among them reaches 15-50 %. This results in a grueling treatment, long-term disability and poor quality of life. The degree of disability due to the disease reaches 40-60 %. Therefore, the question of the treatment of trophic venous ulcers is relevant and important medical and social problem of modern surgery. Addressing these issues will result in more carefully and responsibly refer to di- agnostic and therapeutic interventions in trophic venous ulcers, which should improve the results of treatment and prevent relapse. The treatment of 133 patients with venous trophic ulcers of the lower extremities, corresponding to C6 class classification CEAP was analyzed. Men were 33 (24.8 %), women – 100 (75.2 %) among them. Patients were divided into two groups according to etiologic factors. The first group included 101 (75.9 %) patient with varicose veins, the second – 32 (24.1 %) of postthrombophlebitis syndrome. The average age of patients in the first group was 61,3 ± 5,36 years , the second – 63,4 ± 4,83 years. All patients performed the ultrasound color angioscanning of the lower extremities; monitoring the overall clini- cal and biochemical parameters of blood; electrocardiography; spirometry if indicated, chest X-rays, sonography of the abdomen and retroperitoneum, fibro-gastro-duodenoscopy. Area of the venous ulcers was defined by planimetric method using pre-made templates for determining round shape during hospitalization and treatment. By measuring the small trophic venous ulcers considered an area of 1-4 cm І, medium size – 5-10 cm І, large – 11-15 cm І, giant – 16 cm І or more. For control purposes pH-metry of the shin skin was held in 30 patients with venous disease in the places of most frequent localization of ulcers and determined that in normal skin was moderately acidic – 5,38 ± 0,08. These figures correspond to literature data. We examined all patients with open venous trophic ulcers of the definition phase of wound healing and the level of ulcers acidity and surrounding tissues. Acidity of surrounding tissues with trophic changes in patients with cel- lulitis or without each other were not significantly different (5,94 ± 0,32 and 6,44 ± 0,19 respectively). In 32 (24.1 %) patients inflammation (exudation) was dominative stage, in 61 (45.8 %) – granulation, and in 40 (30.1 %) – epithelialization. Area of venous trophic ulcers of the lower limbs was low in 77 (57.8 %), average – in 18 (13.6 %), large – 10 (7.6 %) and giant – in 28 (21 %) patients. Determination of pH carried out at all stages in the course of wound healing and found no significant differences between the groups of patients. In stage of exudation and granulation in both groups pH was within alkali indicators (8,27 ± 0,12 and 8,26 ± 0,11 respectively), and the stage of epithelialization – shifted to the acid side closer to neutral (7.19 ± 0,15 and 5,17 ± 0,31 respectively). Thus, the pH level can be one of the criteria for the effectiveness of treatment of trophic ulcers and the process of healing.

venous trophic ulcer, pH meter

«Bulletin of problems biology and medicine» Issue 3 part 3 (112), 2014 year, 150-153 pages, index UDK 616. 147. 3-002. 44-08