Trophic leg ulcers in diabetes mellitus: local and surgical treatment

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Trophic leg ulcers in diabetes mellitus: local and surgical treatment

Trophic ulcers are a disease that is the most serious complication of diabetes mellitus, and is characterized by the formation of deep defects in the epithelium or basement membrane, due to the development of severe inflammatory processes.

Ulcers form on the feet and legs, and cause the loss of soft tissues on the legs, and after the healing of the ulcerative formations, the patient has scars and scars on the skin.

Despite the fact that in the modern world medicine is quite developed, the treatment of leg ulcers in diabetes mellitus is a complex process. Since ulcerative formations are directly related to diabetic neuropathy, as a result of which the functioning of nerve endings is impaired, and the process of tissue nutrition is upset.

In addition, the immune system is weakened, the protective functions of the body are significantly reduced, as a result of which the regenerative abilities are partially lost.

It is necessary to consider what drug treatment can significantly improve the patient’s quality of life and cure the most serious complication? And also find out when surgery is recommended?

Treatment: general principles

If a patient develops a leg ulcer due to diabetes mellitus, treatment is required immediately.

This disease is dangerous because the affected area is exposed to various infectious processes, and ignoring the situation can lead to gangrene, and, as a result, amputation of the limb.

In the early stages of diabetes, a person’s legs lose their former sensitivity, because nerve cells die. This state does not remain without a trace, it can be felt, for example, if you touch your hand with your leg, it will seem icy to the touch.

The sore is usually located on the large phalanges of the lower extremities. In the vast majority of cases, it is formed due to corns on the soles of the feet.

It is necessary to treat ulcerative formations on an individual basis, since there are a huge number of reasons that lead to this pathology in humans against the background of diabetes mellitus. To identify the etiology of ulcers, various analyzes and instrumental studies are performed.

Treatment can be as follows:

  • Surgical intervention.
  • Medication therapy.
  • It is permissible to add local therapy to the complex of the selected treatment, as a result of which ulcerative formations are cleared of purulent masses and “dead” tissues.

As for the last point, it is advisable to use antiseptic solutions and foot ointment for diabetes mellitus, which help restore tissue, as a result of which wound healing is carried out. 

Surgery to treat ulcers

Treatment of a diabetic ulcer through surgical intervention involves excision of “dead” tissue, as a result of which the inflammatory focus is also removed. This series of operating procedures includes curettage, evacuation, vacuum treatment.

During therapy, the doctor acts on the affected area with reduced pressure, and applies polyurethane dressings. The negative pressure used in this procedure is -125 mm Hg.

Catheterization is used when the patient has hypertensive, venous and trophic ulcers that do not heal for a long period of time.

Virtual amputation is a technique that is quite often used to treat trophic ulcers in diabetes mellitus. The method is based on resection of joints and bones. It should be noted that this procedure allows you to maintain the anatomical integrity of the bone, while removing bone infection and difficulties with high pressure.

Exposure to negative pressure can achieve the following effects:

  1. Remove ulcerative formations, pus accumulated in them.
  2. Reduce swelling of the lower extremities, the size and depth of ulcers.
  3. Strengthening full blood circulation in the legs.
  4. Start a new granulation process.
  5. Reduce the risk of future potential complications.

In addition, negative pressure creates a “moist” environment inside the wounds, which reliably protects against the penetration of bacterial and infectious diseases.

Drug therapy

As a rule, drug therapy always accompanies any surgical intervention.

However, treatment with medication can be independent, but only in cases where the patient has mild or moderate ulcerative formations.

When choosing a treatment, a doctor relies on the stage of the disease, according to which he selects drugs. In any case, the treatment can be divided into specific stages.

If the patient has an early stage of weeping ulcerative formations, then it is advisable to prescribe antihistamines, broad-spectrum antibiotics, antiplatelet agents (administered intravenously), as well as anti-inflammatory drugs.

At an early stage of the disease, local therapy is also used to help remove dead cells and bacteria from the ulcers. Such therapy includes the following points:

  • Using antiseptic solutions to flush out ulcers.
  • Therapy with compresses based on local healing agents – cream, ointment.
  • Specific dressings for ulcerative formations for sorption.

In a number of situations, if necessary, the attending doctor may recommend a special blood purification procedure.

At the second stage of drug therapy (when the wounds heal, scars are formed), it is advisable to use ointments with healing properties, as well as antioxidants.

At the final stage of the disease, it is necessary to establish the causes that led to the ulcerative lesions of the lower extremities. Having established certain factors, the doctor recommends a treatment regimen aimed at eliminating the underlying disease.

Diabetes mellitus is an insidious disease that fundamentally changes the lifestyle of every patient. The correct choice of footwear and impeccable foot cleanliness are absolutely necessary conditions to prevent the development of trophic ulcers.

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