Trophic ulcers have been known since ancient times. They are even mentioned in the Bible. Ulcers have been found in mummies in Egyptian tombs. For centuries, people have tried to find cures and ways to treat trophic ulcers.

This remains a problem for people and a challenge for the healthcare sector today. Trophic ulcers are very difficult to treat.

A trophic ulcer leads to impaired working capacity and disability. The patient cannot take a shower on his own, wear normal shoes, clothes, visit the beach, swimming pool. If you do not pay attention in time and do not start the process of treating trophic ulcers, a long-term chronic infection may begin, which will eventually lead to complications of the immune system, heart, lungs, kidneys, etc. In patients with ulcers that have not healed for a long time, there is a high risk of the ulcer degenerating into cancer.

Treatment of trophic ulcers in Kyiv

It is necessary to understand that a trophic ulcer does not arise by itself, but as a result of a complication of a particular disease. A trophic ulcer is a complex of symptoms that arises as a result of a violation of tissue nutrition (for example, due to poor blood circulation or poor blood outflow or a violation of nervous regulation or due to other reasons or their combination). Conditionally, the treatment of trophic ulcers can be compared to the tip of an iceberg, in which the greater part, as well as the source of the disease, is hidden.

There are many types of trophic ulcers. During my medical practice, I have cured a large number of patients with trophic ulcers. And each case was different from each other. Treatment is always very individual. It is not the trophic ulcers that need to be treated, but the patient. Sometimes, to treat a patient, it is necessary to solve not one, but several causes. For example: a trophic ulcer was formed as a result of varicose veins, and then the patient developed diabetes, osteoporosis, hypertension, fungal skin lesions, microbial eczema, etc., and all this needs to be treated comprehensively.

The patient can change dozens of ointments, go to different specialists, take many pills, but remain without the expected result. Out of despair, the lack of results in the treatment of trophic ulcers, the patient resorts to traditional medicine presented by healers, but the lack of results remains.

Even modern high-tech methods cannot guarantee getting rid of ulcers. There are cases of treatment of trophic ulcers, which are difficult to treat. For example, pain syndrome in patients with Martorell’s ulcer is not relieved even by narcotic analgesics.

Statistics show that today venous trophic ulcers occur in 2% of the population of developed countries. And this is millions of people

• In almost every fifth patient, a chronic ulcer becomes the cause of ossified periostitis due to the spread of the disease to the bones;
• In 1.6-3.5% of cases, a complication of trophic ulcers of the lower extremities is malignant degeneration;
• In a significant proportion of patients, the underlying pathology is associated with ankle arthrosis;
• trophic ulcer complicated by erysipelas and purulent thrombophlebitis

Some options for ulcer formation:

• due to damage to venous blood flow (varicose veins, thrombophlebitis, post-thrombotic disease);
• due to impaired arterial blood flow;
• due to impaired lymph drainage (lymphostasis, elephantiasis, i.e. elephantiasis);
• due to impaired nerve innervation of tissues (neurotrophic ulcers are formed due to damage to nervous tissues and nerve trunks);
• due to systemic diseases (blood, kidney, metabolic diseases, vasculitis, collagenoses, etc.);
• pyogenic (infectious) ulcers are formed due to decreased immunity and microtrauma, folliculitis, furunculosis, pyoderma, purulent eczema (the cause of infectious ulcers can also be tuberculosis, syphilis, leprosy, etc.);
• ulcers are formed as a result of exposure to physical factors (in particular, radiation ulcers);
• ulcers that form as a result of exposure to chemical factors (acids, alkalis, solvents, etc.).
• the formation of a trophic ulcer due to the action of other negative factors

Treatment of trophic ulcers

As mentioned above, it is not the trophic ulcer that needs to be treated, but the patient with the trophic ulcer. Only in this case will there be a result. We require one thing from the patient – recovery. This requires a comprehensive approach to the patient and his disease.

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In the middle of the last century, the Spanish doctor Fernando Martorell Otzet described a trophic ulcer of the lower extremities, which he called “Martorell’s hypertensive ulcer”. He believed that its occurrence was associated with arterial hypertension. In addition, according to the doctor, the pathophysiology of hypertensive ulcers is based on impaired blood circulation in the skin.

When a patient is diagnosed with a trophic ulcer, or Martorell ulcer, this is an accurate definition of the type of disease.

Martorell’s ulcer

The location and spread of Martorell ulcers (hypertonic ulcers) has its own characteristics – most often they form on the front, outer or back of the surface of the lower legs and feet. This disease mainly affects women over 40 years of age. At the initial stage of development, shallow ulcers are observed, without visible granulation, minor wounds, in places there are areas of black dermis necrosis. If you do not pay attention to these signs in time and do not consult a doctor, the size of the ulcers will increase, a secondary infection will join them.

However, the most characteristic feature of hypertensive ulcers among other types of lower limb ulcers is the intense pain syndrome: This pain causes severe suffering for the patient. Even a minor dressing turns into a painful procedure for the patient. There are cases when the pain syndrome cannot be removed or weakened even by strong analgesics. During my practice of treating Martorell ulcers, I have met patients who had suicidal thoughts, which arose as a result of prolonged and continuous pain. Because of this pain, patients are deprived of normal sleep, they develop significant psycho-neurological disorders.

During this disease, pathophysiological changes in the vessels are also observed, which can be detected during duplex examination; this examination can also show whether there is damage to the main arteries and veins. The diagnosis of Martorell’s ulcer is also confirmed by microscopy of a biopsy of the skin and subcutaneous tissue, which reveals hyalinosis of the walls and endothelial proliferation with complete disappearance of the vascular lumen.

Martorella’s trophic ulcer in its “pure” form, as described by the Spanish doctor Fernando Martorella, is not very common. Patients, in addition to arterial hypertension, may also have concomitant pathology – varicose veins, obliterating atherosclerosis, diabetes mellitus, overweight, etc. If concomitant pathology is added to Martorella’s ulcer, the diagnosis and treatment of arterial ulcers becomes even more difficult.

The treatment process of Martorell’s trophic ulcer

Treatment of hypertensive ulcers is an extremely difficult task. Even the slightest touch to the surface of the ulcer during bandaging can cause the patient not only discomfort, but also unbearable suffering. All medications and ointments that are applied to the surface of the ulcer only cause a sharp increase in pain. Depending on the stage of the disease, the drugs used to treat the ulcer are selected. Sometimes it is necessary to change several dozen ointments, creams, and powders to achieve a positive result. During the treatment of Martorell ulcers, or Martorell syndrome ICD 10, it is necessary to correct blood pressure.

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