Трофическая язва – это заболевание, характеризующееся образованием дефектов кожи или слизистой оболочки, возникающий после отторжения некротизированной ткани и отличающийся вялым течением, малой тенденцией к заживлению и склонностью к рецидивированию.
Как правило, они развиваются на фоне различных заболеваний, отличаются упорным длительным течением и с трудом поддаются лечению. Выздоровление напрямую зависит от течения основного заболевания и возможности компенсации нарушений, которые привели к возникновению патологии.
Такие язвы не заживают в течение длительного времени – более 3 месяцев. Чаще всего трофическая язва поражает нижние конечности, поэтому лечение нужно начинать при обнаружении первых признаков на начальной стадии.
Причины возникновения
Нарушение кровоснабжения участка кожи ведет к развитию расстройств микроциркуляции, недостатку кислорода и питательных веществе и грубым метаболическим нарушениям в тканях. Пораженный участок кожи некротизируется, становится чувствительным к любым травмирующим агентам и присоединению инфекции.
Спровоцировать возникновение трофической язвы на ноге способны такие факторы риска:
- Проблемы венозного кровообращения: тромбофлебит, варикозное расширение вен нижних конечностей и прочее (обе болезни способствуют застою крови в венах, нарушая питание ткани и вызывая омертвение)— язвы появляются на нижней трети голени;
- Ухудшение артериального кровообращения (в частности, при атеросклерозе, сахарном диабете);
- Некоторые системные заболевания (васкулиты);
- Любые виды механического повреждения кожи. Это может быть не только обычная, бытовая травма, но и ожог, обморожение. В эту же область включены язвы, которые образуются у наркозависимых людей после инъекций, а так же последствия облучения;
- Отравление токсическими веществами (хромом, мышьяком);
- Кожные заболевания, например, хронические дерматиты, экзема;
- Нарушение местного кровообращения при продолжительной неподвижности вследствие травмы или болезни (образуются пролежни).
При постановке диагноза очень важна болезнь, которая вызвала образование, поскольку тактика лечения трофической язвы на ноге и прогноз в значительной степени зависит от характера основной венозной патологии.
Симптомы трофической язвы
Образованию язвы на ноге, как правило, предшествует целый комплекс объективных и субъективных симптомов, свидетельствующих о прогрессирующем нарушении венозного кровообращения в конечностях.
Пациенты отмечают усиление отека и тяжести в икрах, учащение судорог икроножных мышц, особенно по ночам, появление чувства жжения, «жара», а иногда зуда кожи голени. В этот период в нижней трети голени увеличивается сеть мягких синюшных вен небольшого диаметра. На коже появляются фиолетовые или пурпурные пигментные пятна, которые, сливаясь, образуют обширную зону гиперпигментации.
В начальной стадии трофическая язва располагается поверхностно, имеет влажную темно-красную поверхность, покрытую струпом. В дальнейшем язва расширяется и углубляется.
Отдельные язвы могут сливаться между собой, образуя обширные дефекты. Множественные запущенные трофические язвы в отдельных случаях могут образовывать единую раневую поверхность по всей окружности голени. Процесс распространяется не только вширь, но и вглубь.
Осложнения
Трофическая язва очень опасна своими осложнениями, которые имеют очень серьезный характер и плохие перспективы. Если вовремя не обратить внимания на трофические язвы конечностей и не начать процесс лечения, впоследствии могут развиться следующие неприятные процессы:
В обязательном порядке лечение трофических язв на ногах должно вестись под наблюдением лечащего врача без какой-либо самодеятельности, только в таком случае можно минимизировать последствия.
Профилактика
Основным профилактическим средством для предупреждения возникновения трофической язвы является немедленное лечение первичных заболеваний (нарушения кровообращения и оттока лимфы).
Необходимо не только применять лекарства внутрь, но и наносить их наружно. Местное воздействие поможет остановить патологические процессы, подлечить существующую язву и предотвратить последующее разрушение тканей.
Чем опасно заболевание?
Прогрессирующая трофическая язва может со временем занимать значительные участки кожи, увеличивать глубину некротического эффекта. Гноеродная инфекция, попавшая внутрь, может провоцировать появление рожистых воспалений, лимфаденита, лимфангита, септических осложнений.
В дальнейшем запущенные стадии трофических язв могут перерастать в газовые гангрены, и это стает поводом срочного оперативного вмешательства. Длительно незаживающие раны, подвергшиеся воздействию агрессивных веществ — салициловая кислота, деготь, могут развиваться в злокачественные перерождения – рак кожи.
Лечение трофической язвы на ноге
При наличии трофической язвы на ноге одним из главных этапов лечения является выявление причины заболевания. С этой целью необходимо проконсультироваться у таких врачей, как флеболог, дерматолог, эндокринолог, кардиолог, сосудистый хирург или терапевт общего профиля.
Поздние стадии заболевания лечатся обычно в хирургических стационарах. Однако помимо выявления и устранения причины возникновения трофической язвы, необходимо также не забывать о ежедневном уходе за поражённой областью.
Как лечить трофическую язву нижних конечностей? Используют несколько вариантов, в зависимости от запущенности патологического процесса.
- Консервативная терапия , когда больному назначают такие препараты, как флеботоники, антибиотики, антиагреганты. Они помогут вылечить большую часть симптомов заболевания. Больным часто предписывают следующие лекарственные препараты: Детралекс, Токоферол, Солкосерил, Актовегин. Такое медикаментозное лечение может назначать только врач.
- Местная терапия , при помощи которой можно вылечить повреждения тканей и кожи. При диабете используют мази, содержащие антисептики и ферменты. Эти средства заживляют раны и оказывают местное обезболивание. Мази, усиливающие кровообращение запрещено наносить на открытую поверхность трофической язвы. Такие мази, как Диоксиколь, Левомеколь, Куриозин, Левосин оказывают ранозаживляющее действие. Мазь наносят на компресс и ли делают специальные повязки.
- Хирургическое вмешательство , которое производится после заживления язв. В ходе него восстанавливается кровоток в венах в области поражения. Такая операция включает шунтирование и флебэктомию.
Для обработки ран используют такие препараты: Хлоргексидин, Диоксидин, Эплан. В домашних условиях можно использовать раствор фурацилина или перманганата калия.
Оперативное вмешательство
Хирургическое лечение трофических язв нижних конечностей показано при обширных и тяжелых поражениях кожи. Операция заключается в удалении язвы с окружающими нежизнеспособными тканями, и дальнейшего закрытия язвенного дефекта, на втором этапе проводят операцию на венах.
Есть несколько различных хирургических методов :
- Вакуумная терапия, которая позволяет быстро удалить гной и уменьшить отёк, а также создать влажную среду в ране, что будет сильно мешать бактериям развиваться.
- Катеризация – подходит для язв, которые не заживают в течение очень долгого времени.
- Чрезкожное прошивание – подходит для лечения гипертонической язвы. Его суть в разобщении венозно-артериальных фистул.
- Виртуальная ампутация. Отсекается плюсневая кость и плюснефаланговый сустав, но анатомическая целостность стопы не нарушается – зато удаляются очаги костной инфекции, что позволяет эффективно бороться с нейротрофической язвой.
При размере язвы менее 10 см², рану закрывают собственными тканями, подтягивая кожу в сутки по 2-3 мм, постепенно сближая края и за 35–40 дней полностью ее закрывая. На месте раны остается рубец, который необходимо оберегать от любых возможных травм. Если площадь поражения больше 10 см², применяют кожную пластику, используя здоровую кожу больного.
Медикаментозная терапия
Курс лечения препаратами обязательно сопровождает любую операцию. Лечение медикаментами делится на несколько этапов, в зависимости от стадии протекания патологического процесса.
На первом этапе (стадия мокнущей язвы) в курс лекарственной терапии входят такие препараты:
Местное лечение на данном этапе направлено на очищение язвы от отмершего эпителия и болезнетворных микроорганизмов. Оно включает в себя такие процедуры:
- Промывание раны растворами антисептиков: марганцовки, фурацилина, хлоргексидина, отварами чистотела, череды или ромашки;
- Использование повязок с лечебными мазями (диоксиколь, левомиколь, стрептолавен, и пр.) и карбонета (специальной повязки для сорбции).
На следующем этапе, который характеризуется начальной фазой заживления и формированием рубцов, в лечении применяются заживляющие мази при трофических язвах — солкосерил, актевигин, эбермин и пр., а также препараты-антиоксиданты, например, толкоферон.
Также на этом этапе используются специально разработанные для этого раневые покрытия свидерм, гешиспон, альгимаф, альгипор, аллевин и др. Обработка изъявленной поверхности проводится куриозином. На финальных этапах медикаментозное лечение направлено на ликвидацию основного недуга, который спровоцировал появление трофической язвы.
Как лечить трофическую язву на ноге в домашних условиях
Приступая к лечению трофической язвы по народным рецептам, необходимо обязательно проконсультироваться с лечащим врачом.
В домашних условиях можно использовать:
- Перекись водорода . Нужно капнуть на саму язву перекись, потом посыпать на это место стрептоцид. Поверх нужно положить салфетку, предварительно смоченную в пятидесяти миллилитрах кипяченой воды. В эту воду добавьте две чайных ложки перекиси. Затем накройте компресс пакетом и перевяжите платком. Меняйте компресс несколько раз в день. А стрептоцид подсыпайте, когда рана станет увлажняться.
- Заживляющий бальзам в лечении трофической язвы при сахарном диабете. В его состав входят: 100 г можжевелового дегтя, два яичных желтка, 1 столовая ложка розового масла, 1 чайная ложка очищенного скипидара. Все это нужно смешать. Скипидар лейте потихоньку, иначе яйцо свернется. Этот бальзам наносится на трофическую язву, затем покрывается повязкой. Это народное средство является хорошим антисептиком.
- Порошок из высушенных листьев татарника . Ранку промыть раствором риванола. Припорошить приготовленным порошком. Наложить повязку. Утром следующего дня вновь присыпать порошком, но рану перед этим не промывать. Вскоре язва начнет зарубцовываться.
- Трофические язвы можно лечить антисептиками : раны промыть теплой водой с хозяйственным мылом, наложить антисептик и перевязать. Эти повязки чередуют аппликациями из раствора морской или поваренной соли (1 ст. л. на 1 литр воды). Марлю сложить в 4 слоя, смочить в солевом растворе, слегка отжать и наложить на рану, сверху компрессная бумага, держать 3 часа. Процедуру повторять дважды в день. Между аппликациями перерыв 3-4 часа, в это время язвы держать открытыми. Вскоре они начнут уменьшаться в размерах, края, зарозовеют — значит, идет процесс заживления.
- Чесночные припарки или компрессы применяются при открытых язвах. Взять многослойную марлю или махровое полотенце, намочить в горячем отваре чеснока, отжать лишнюю жидкость и сразу же приложить к больному месту. На припарку или компресс положить сухую фланелевую повязку и грелку или бутылку с горячей водой, чтобы дольше сохранить тепло.
- Нужно смешать белок яйца с медом так, чтобы эти ингредиенты были в одинаковом соотношении. Взбейте всё и нанесите на язвы, включая вены, которые болят. Потом накройте обратной стороной листьев лопуха. Их должно быть три слоя. Оберните целлофановой пленкой и перебинтуйте полотняной тканью. Оставьте компресс на ночь. Вам необходимо проделать такое лечение пять-восемь раз.
Помните, что при отсутствии своевременной и правильной терапии могут развиться такие осложнения, как: микробная экзема, рожистое воспаление, периостит, пиодермия, артроз голеностопного сустава и др. Поэтому использовать только народные средства, пренебрегая при этом традиционным лечением не стоит.
Мази для лечения
Для лечения данного заболевания можно также применять различные мази, как натуральные, так и приобретёнными в аптёке. Эффективно заживляют раны и оказывают противовоспалительное действие мази арники, окопника, а также комнатной герани.
Часто также применяют мазь Вишневского. Из мазей, которые можно купить в аптеке особо выделяют диоксиколь, левомеколь, а также стрептолавен и ряд аналогов.
Трофическая язва — особый вид повреждения кожных покровов. Возникает при отторжении с поверхности кожи омертвевших участков из-за нарушения трофики (питания) и расстройства локального кровообращения. Эта патология чаще всего формируется на фоне уже имеющихся хронических заболеваний, отличается трудностью заживления. Поэтому трофические язвы на ногах и их лечение представляют серьезную хирургическую проблему.
Причины возникновения трофических язв
Основная проблема, приводящая к развитию трофических нарушений на ногах, — это расстройство микроциркуляции крови. Приводит к указанному явлению чаще всего венозная недостаточность, реже — плохой артериальный кровоток или ухудшение оттока лимфы. К появлению трофических язв на ногах могут привести следующие причины:
- варикоз вен нижних конечностей;
- посттромбофлебитический синдром (развивается после тромбофлебита);
- сахарный диабет;
- атеросклеротическое поражение сосудов ног и брюшного отдела аорты;
- гипертоническая болезнь;
- лимфедема;
- ожоги и отморожения ног;
- экзема.
При отравлении химикатами, содержащими мышьяк или тяжелые металлы, возможно возникновение трофических язв. Васкулиты и некоторые инфекционные заболевания могут становиться причиной этой патологии.
Нередко отмечается развитие плохо заживающих язв у малоподвижных пациентов — после инсульта, травм спинного мозга.
Более чем в 75% случаев появляются трофические язвы при варикозе, поэтому пациенты в большинстве случаев лечатся у флебологов.
Нарушенный венозный кровоток приводит к депонированию (накоплению) крови в ногах. Застой крови приводит к понижению питания тканей — в первую очередь страдают кожные покровы, как самые “ненужные”. Малейшие царапины такой кожи становятся причиной язв, так как питательных веществ в крови элементарно не хватает на процесс репарации (заживления).
Ишемия сопровождается снижением местного иммунитета, что приводит к присоединению инфекции — язвы часто нагнаиваются и воспаляются.
Симптомы
Перед появлением самой язвы на ногах можно заметить типичные симптомы, свидетельствующие о прогрессирующем заболевании вен. К этим симптомам относятся:
- появление отеков — сначала на стопах, а затем и на голенях;
- зуд в икрах;
- чувство тяжести в ногах;
- судорожные подергивания отдельных мышц ног;
- появляется гиперпигментация — на коже ног появляются более темные участки из-за накопления в коже гемосидерина (продукт распада гемоглобина).
Дальнейший прогресс заболевания приводит к тому, что развивается дерматит и экзема. Кожа за счет отечности становиться плотной, отмечается болезненность при прикосновениях. Затруднение лимфодренирования приводит к пропотеванию лимфы, она собирается на коже в виде небольших желтоватых капель.
Дальнейшее развитие патологического процесса — формирование белой атрофии, представляющей пограничное предязвенное состояние. Выглядит она как белесый участок в центре измененной кожи. На этом этапе малейшее механическое воздействие на кожу становится причиной формирования язвы.
Уже на этой стадии можно понять, как выглядит трофическая язва: она локализуется на поверхности кожи, отличается насыщенным бордово-красным цветом и покрыта коркой. В дальнейшем отмечается явная тенденция к расширению и углублению язвенного поражения.
Чем опасны трофические язвы
На первой стадии этой патологии возможно образование сразу нескольких мелких язв, которые затем увеличиваются в размере и сливаются в одну большую. В особо запущенных вариантах язвы могут формировать общую раневую поверхность циркулярно на всей ноге ниже колена.
Растет язва не только вширь, но и вглубь — поражение подкожной клетчатки и мышц становится причиной сильного болевого синдрома. Запущенная трофическая язва — главная причина опасных осложнений:
- Периостит — развивается, когда некротические изменения затрагивают надкостницу большеберцовой кости.
- Остеомиелит — еще более грозное осложнение, при котором через язву в кость попадают микроорганизмы и вызывают воспаление кости. Возможна деструкция кости, сопровождающаяся патологическими переломами.
- Артрит голеностопного сустава. Расползание язвы с поражением околосуставной области приводит к реактивному воспалению непосредственно сустава. В тяжелом случае может возникнуть контрактура сустава.
На фото начальной стадии трофических язв на ногах иногда отмечаются какое-то отделяемое — в большинстве случаев это гной, который является признаком инфекционного поражения. Обычно отделяемое мутного характера, в нем определяются полоски фибрина.
Очень часто от трофических язв исходит неприятный запах. У пожилых людей, а также пациентов с сильно ослабленным иммунитетом в качестве возбудителя инфекции часто выступает грибок, что усугубляет прогноз лечения.
Опасность инфицирования заключается в развитии еще большего количества осложнений, способных в ряде случаев привести к гибели человека:
- пиодермия;
- рожа;
- тромбофлебит;
- аллергический дерматит;
- лимфаденит;
- флегмона ноги;
- сепсис.
Хроническая местная инфекция сказывается на состоянии лимфатических сосудов — у 40% пациентов возникает вторичная лимфедема.
Диагностика
Заподозрить это заболевание относительно просто — достаточно один раз увидеть трофическую язву на фото.
Главная задача состоит в определение основной причины болезни, так как от этого зависит, какая схема терапии будет применяться. При трофических нарушениях, обусловленных венозной патологией, терапия значительно отличается от терапии язв на фоне сахарного диабета или артериальной гипертонии.
Диагностические мероприятия направлены на исследование сосудов и состояние свертывающей системы крови. В пользу венозных расстройств нижних конечностей говорят:
- прием КОК;
- хронические болезни или травмы, сопровождавшиеся периодами длительной вынужденной малоподвижности;
- болезни, сопровождающиеся нарушением свертывающей системы крови (тромбофилии, антифосфолипидный синдром).
Обращает внимание и расположение патологического очага: типичное место при венозных трофических язвах — голени с внутренней стороны чуть ниже середины. На нижних конечностях отчетливо видны измененные варикозом вены.
Обязательно пациентам с трофическими язвами проводят УЗДГ сосудов нижних конечностей: и вен, и артерий. Реовазография помогает установить степень нарушения микроциркуляции в ногах. Так как у пациентов с трофическими язвами чаще всего имеется еще целый букет болезней, то необходимы консультации многих специалистов (кардиолога, терапевта, эндокринолога и др.). Полноценное обследование пациента с такой патологией включает ЭКГ, мониторинг АД и пульса, анализы крови (клинический и биохимический), исследование коагулограммы.
Трофические язвы на ногах и их лечение
Во время лечения язв перед врачом стоит задача не просто избавиться от них, а снизить до минимума проявления той патологии, которая и послужила причиной их развития. Большие усилия направляются на борьбу с инфекцией.
Лекарственная терапия включает несколько групп препаратов:
- антиагреганты и антикоагулянты — нужны для улучшения микроциркуляции;
- венотоники — способствуют поддержанию и восстановлению тонуса вен, уменьшая венозный застой;
- антибиотики — назначаются по результатам микробиологического исследования, позволяющего определить чувствительность инфекционного агента.
Дальнейшие усилия заключаются в местном воздействии: измененная поверхность аккуратно санируется (очищается). Эффективность очищения повышается с помощью ферментных средств, которые разрушают некротизированные ткани. С помощью антисептических растворов осуществляется местная борьба с бактериальной инвазией. После очищения раны и устранения признаков воспаления накладывают марлевые повязки с препаратами, стимулирующими заживление.
Важно! Консервативное лечение трофических язв — это затяжное действие. До полного заживления может пройти несколько месяцев
Хирургическое лечение в виде иссечения язвенного дефекта малоэффективно — оно не позволяет устранить причину патологии. Среди хирургических способов борьбы с этим заболеванием самыми эффективными являются операции по нормализации кровообращения в ногах. Флебэктомия и минифлебэктомия позволяют с достаточно высокой эффективностью восстановить венозное кровообращение.
Народные методы лечения
Неосложненные трофические язвы можно попробовать вылечить с помощью народных средств. Допускается применение травяных отваров, например, ромашки, календулы, зверобоя. Отваром этих трав следует промывать язву, или же применять в виде ванночек для ног. После обработки язвенная поверхность высушивается. Настой или отвар коры дуба обладает дубящим эффектом, поэтому им тоже можно обрабатывать измененную кожу.
Не повредит и раствор марганцовки, только нужно не забывать о правилах безопасности при его приготовлении — после растворения марганцовки нужно профильтровать раствор, чтобы кристаллы ее не попали на кожу. Цвет раствора — бледно-розовый!
Врачами категорически не рекомендуются народные рецепты с листьями подорожника, капусты, с яйцами. Укрывание язвенных дефектов плотными листьями или целлофаном повышает риск возникновения инфекции. Фигурирующие в некоторых рецептах мед и яйца представляют собой идеальную питательную среду для микроорганизмов.
Профилактика
Предупредить возникновение трофической язвы можно только путем своевременной диагностики и лечения сосудистой патологии. Для этого рекомендуется обратиться к хирургу или флебологу при любых жалобах, свидетельствующих о проблемах с сосудами ног (тяжесть в ногах, онемение, отеки, судорожные подергивания).
Пациенты с варикозными венами должны носить компрессионный трикотаж или бинтовать ноги эластичными бинтами. Степень компрессии должен определять врач, основываясь на результатах обследования.
При хронических заболеваниях вен необходимо воздержаться от работы, требующей длительного пребывания в вертикальном положении. Работа в условиях постоянного переохлаждения или перегрева тоже противопоказана.
Контролируемая физическая нагрузка на ноги необходима — она позволяет активизировать венозный возврат за счет сокращения мышц голени.
Такой патологический процесс у пациента, как трофическая язва, во много раз усложняет течение большинства заболеваний. При этом нарушается нормальное кровообращение, происходят разрушения верхних тканей, изменяется функциональность нервных окончаний. Процесс лечения требует комплексного влияния, а его продолжительность может быть достаточно долгой.
Болезнь слизистой или кожного покрова, которая появляется из-за нарушения поступления необходимых веществ в ткани, называется трофической язвой. Формированию такого патологического процесса могут способствовать многие факторы, начиная от внешнего воздействия на покров (ожоги, пролежни, раны) и заканчивая общими заболеваниями организма (инфекции, болезни обмена веществ и крови).
Классификация трофических язв нижних конечностей
В медицинской практике они классифицируются по нескольким показателям.
- По морфологии. Различают первичные, вторичные. Первые представляют собой самостоятельное заболевание. Признаки трофической язвы первичного характера появляются в результате разнообразных травматизаций кожного покрова или слизистой. Вторичные представляют собой патологические процессы, возникающее как осложнение на фоне других заболеваний организма.
- По этиологии развития. По этой классификации выделяют венозные, артериальные, гипертонические нейротрофические, диабетические, пиогенные.
- По площади поражения и стадии трофической язвы. По этому критерию различают малые (до 4 см в диаметре), среднего размера (до 10 см), крупные (до 20 см), обширные. Последние появляются при соединении в одно нескольких язв.
Взгляните на стадии трофической язвы на фото ниже:
Трофические язвы нижних конечностей в большинстве случаев возникают, как следствие болезни, которая связана с патологическим изменением нормального кровоснабжения в этой области. Это приводит к уменьшению питания тканей эпителия и, как следствие, отмиранию.
Как видим, трофические язвы и причины их развития могут быть разнообразными, но выяснение этиологии имеет в медицине немаловажное значение, так как от понимания, что спровоцировала возникновения этого патологического процесса на кожном покрове или слизистой зависит и дальнейший механизм лечения.
Причины возникновения трофических язв на ногах
Трофическая язва и ее причины возникновения в медицине делятся на две большие группы. Первая состоит из факторов, которые связаны с внешним воздействием на кожу или слизистую. Вторая – это воздействие внутренних процессов, которые протекают в человеческом организме и представляют собой один из видов осложнения, вызванных основным заболеванием.
К первой группе причин относят такие факторы:
- разноплановые травмы;
- обморожение или ожоги;
- пролежни;
- постоянное воздействие на кожу химических компонентов;
- неудобная, тесная обувь;
- лучевое облучение.
Вторая группа включает:
- инфекционные заболевания кожи или слизистой;
- сахарный диабет;
- дерматологические болезни кожных покровов;
- патологические изменения в венозном и артериальном кровоснабжении;
- нарушения в процессе оттока лимфы;
- резкое увеличение массы тела;
- полученные травмы головного и спинного мозга;
- сифилис, туберкулез, ВИЧ-инфекция;
- слабый иммунитет и т. д.
Но какой бы не была причина возникновения трофической язвы и ее первых признаков, они имеют общую характеристику – недостаточное питание веществами и кислородом тканей.
Первые признаки трофической язвы на ноге
Трофическая язва с ее симптомами на начальной стадии нередко пациентами игнорируется, и может быть воспринята за симптоматику других заболеваний. Ощущение тяжести в ногах, появление изменений цвета кожных покровов (имеет схожесть с синяком), отечность нижних конечностей, судороги – это те признаки, которые могут сигнализировать о начале заболевания. Далее присоединяется чувство жжения или зуда, уплотнение пораженного участка кожи, появляются водянистые выделения.
Далее уместно рассмотреть основные характеристики изъявлений в зависимости от их этиологии.
Атеросклеротические. Образуются такие изъявления на подошвах, больших пальцах ног, внешней стороне стопы, пятке.
Посмотрите трофические язвы атеросклеротического типа и симптомы на фото:
Они небольших размеров, полукруглой формы, имеют ровные, уплотненные края. В середине изъявлений находится гнойное содержимое. Первая симптоматика – это хромота, чувство постоянного холода, боли по ночам.
Венозные. Локализация изъявлений – нижняя внутренняя сторона голени. Бывают редкие случаи расположения на задней наружной ее части, но они крайне редки. До появления венозных трофических язв отмечают отечность и чувство тяжести в икрах, судорожные проявления в ночное время, зуд кожных покровов, появление пурпурных пятен, уплотнение и появление специфического блеска и гладкости в месте поражения. Далее в месте локализации болезни появляются белесого оттенка струбцины, которая и переходит в небольшую язву. Такие признаки трофической язвы на ноге при отсутствии лечения будут быстро прогрессировать. Поражение кожи переходит на ахиллово сухожилие, мышцы икры, кость. Изъявления на этой стадии имею неприятный гнилостный запах.
Нейротрофические. Поражаться может пятка, подошва. Изъявления имеют глубокие кратеры, вплоть до кости, сухожилия или мышцы. Но при этом они не большие по своему диаметру.
Раны такого характера извлекают неприятный запах, а ткани вокруг поражения теряют свою чувствительность.
Диабетические. Первые признаки это снижение или потеря чувствительности в месте локализации (большие пальцы ноги, внешняя сторона стопы). Это связано с гибелью нервных окончаний. Больной жалуется на ночные боли. Диабетические изъявления имеют схожесть с атеросклеротическими язвами, но отличаются более глубокой раной и большими размерами.
Гипертонические. Начальная стадия болезни отличается образованием папулы или пятна синюшного оттенка, имеющую незначительную болезненность. В процессе прогрессирования болезни они превращаются в изъявления. Поражение происходит симметрично – это основная особенность этого подвида. Гипертонический вид трофической язвы на ноге, причины которой, скачки кровяного давления, локализуется на наружной части поверхности обеих голеней. Такие изъявления идут совместно с болью, которая держится в течение всего дня.
Пиогенные. Локализация таких изъявлений – это любая поверхность кожного покрова. Появляются раны одиночно или сразу несколько. Они имеют небольшую глубину и овальную форму.
Пролежни – некрозы тканей кожи, плохо заживающие трофические язвы и изменения патологического характера в целостности кожи – появляются в местах длительного давления. Чаще всего это наблюдается у лежащих больных, которым не обеспечен должный уход. Например, если больной лежит на боку, то изъявления появляются в суставах таза и коленей, если на спине, то в области локтей, крестца и копчика, пяток, лопаток.
Любая трофическая язва в процессе своего развития характеризуется усилением болевого синдрома, что связано с углублением патологического процесса вглубь. Характер отделяемого из места изъявления во многом зависит от вторичной присоединившейся инфекции. Зачастую это бактериальная составляющая, но у пациентов пожилого возраста это могут быть и грибковые поражения.
Лечение трофических язв на ногах в домашних условиях
Проблема трофических язв и их лечения — многоплановая и сложная. И она имеет большое практическое значение в медицине.
Лечение небольших трофических язв проходит в домашних условиях. Цель терапии – пролиферация эпидермиса, для этого необходимо:
- уменьшать отеки: с помощью диуретиков; возвышенным положением ног при сидении; ограничением ходьбы и стоячего положения; наложением эластичного бинта;
- трофическая язва и методы ее лечения состоят из систематической очистки очага, удаления экссудата и струпа, применяя 3-5% перекись водорода, эусол, наложение влажно-высыхающих повязок с физиологическим раствором;
- применять повязки: с вазелиновым или цинковым маслом; с гидроколлоидными пленками; с сульфодиазином серебра; с регенерирующими средствами типа ассоциата цинка – гиалуронат цинка (куриозин); при гнойном экссудате – мази с антибиотиками;
- на края изъявлений наносят анилиновые красители: метиленовый синий, генцианвиолет, шотландский эозин, фукорцин;
- кожу вокруг язв обрабатывать кортикостероидными мазями (избегая попадания кортикостероидных препаратов на само изъявление);
- на чистую жизнеспособную язвенную поверхность с достаточным кровоснабжением и естественной эпителизацией краев язвы показано применение пластики трансплантатами малыми или расщепленными кожными лоскутами;
- при отсутствии противопоказаний применять хирургическое лечение соответствующих заболеваний кровеносных сосудов.
Домашнее лечение трофических язв для лежачих больных, что минимизирует появление пролежней, а также их профилактику, включает в себя хороший уход за пациентом, а именно:
- гладкую постель, без складок;
- частую смену положения больного в постели;
- специальные матрацы или матрацы из губки, валики, ватные подушечки, резиновые круги, оплетенные бинтом;
- частое мытье, вытирание, растирание, похлопывание подушечками пальцев, массажи, присыпки, кремы;
- появившиеся покраснения кожи протираются спиртом каждые 2 часа.
Труднейшим делом и очень ответственным, может быть, самым важным, является гигиена тяжелобольного. Трофическая язва с ее симптомами и ее лечение пройдет быстрей и эффективней при выполнении ряда гигиенических правил:
- туалет кожи больного дважды в день, включая очищение полости рта, умывание, мытье, а также подмывание, смена постели и нательного белья, причесывание;
- уход при нарушениях физиологических потребностей, когда пациенты оправляются или мочатся в постель, или имеют постоянные катетеры;
- еженедельная ванна, мытье головы в постели;
- профилактика осложнений, связанных с неподвижностью, т. е. опрелостей и пролежней.
Тщательный гигиенический уход необходим при многих тяжело протекающих дерматозах, в частности при пузырчатке, опоясывающем лишае, распространенной экземе и т.п.
Также важно в процессе лечения ограничить больного в употреблении острой и соленой пищи, продуктов, относящихся к легкоусвояемым углеводам. Все это может способствовать улучшению состояния пациента.
Лечение трофических язв препаратами и операционными методами (с фото)
О том, как лечить трофическую язву на ноге, которая имеет природу, связанную с нарушением венозного кровотока, знает врач флеболог. В процессе терапии решается комплекс основных задач. В первую очередь устраняется или снижается уровень влияния основного недуга, которые и явились причиной появления изъявлений. Далее – борьба с вторичной инфекцией и лечение патологического процесса на коже.
Препараты, которые используются для лечения трофических язв на нижних конечностях, — это средства для нормализации работы вен:
Для борьбы с вторичной инфекцией применяют местные антисептические средства. После устранения воспалительного процесса назначаются мази с ранозаживляющими препаратами. Также назначаются противовоспалительные и противоаллергические лекарственные средства. Это методы консервативной терапии.
Трофическая язва на ноге может включать лечение и операционными методами. Проводятся они после нормализации общего состояния больного, снятия воспалительного процесса. Основная цель таких операций – это лечение причины. В ходе оперативного вмешательства восстанавливают правильный кровоток в пораженной области:
- удаляют варикоз;
- проводят шунтирование.
Посмотрите, как выгляди трофическая язва в процессе лечения на фото:
В хирургической практике используют также и прямое воздействие на изъявление. Используют при обширных поражениях кожных покровов трофическими язвами ног, а также, если лечение в домашних условиях не дает желаемого результата. Для этого применяют такие способы терапии.
- Лечение воздействием низких отрицательных токов. Быстро удаляет гнойные выделения, уменьшает отечность, глубину и размер изъявлений.
- Катетеризация используется в лечении глубоких венозных и гипертрофических язв.
- В оперативном лечении гипертрофической язвы применяется метод прошивания артериальных фистул. Проводится по краям изъявлений.
Любая тактика терапии должна быть назначена лечащим врачом, который внимательно изучит и устранит не только причины возникновения язвы, но и назначит лечение, которое даст быстрый результат.
Лечение трофических язв на ногах народными средствами
Лечения такого заболевания очень сложное и трудоемкое. Изъявления трудно поддаются очистке от гнойного содержимого, что в свою очередь тормозит заживление раны. На фоне проводимой медикаментозной терапии трофических язв, народное лечение может давать свои положительные результаты.
В процессе промывания изъявленной лунки можно воспользоваться отварами лекарственных трав, которые обладают антисептическими и противовоспалительными свойствами:
Чистотел, ромашка;
Календула, череда и т. д.
Лечение трофических язв нижних конечностей народными средствами может включать в себя и использование домашних мазей. Они направлены не только на снятие воспалительного процесса, но и улучшают регенерационные способности покрова, способствуют быстрому заживлению. Отметим, что трофическая язва и ее лечение народными средствами дает не такой быстрый положительный результат, как медикаментозная терапия. Но при использовании рецептов совместно с врачебными назначениями, процесс улучшения не заставит себя ждать.
Вот несколько рецептов.
- Очищенное изъявление прижигают спиртовой настойкой прополиса. Далее на рану наносится мазь Вишневского. Основной ее компонент – это березовый деготь. Некоторые методы народного лечения трофических язв на ногах предполагают использование ихтиоловой мази.
- Если ранки долго не заживают, то рекомендуется использование повязок, пропитанных дегтем. После наложения оставляют на 2 суток, потом меняют. Проделывают такие процедуры до полного выздоровления.
Посмотрите, как накладывается повязка на трофическую язву на ноге и как ее лечить, на фото:
Как лечить трофическую язву на ноге в домашних условиях (с фото)
Особо сложно поддается лечению диабетические изъявления. Это связано с повышенным сахаром в крови у пациента, что не способствует быстрому заживлению. Нормализовать уровень глюкозы – это первое необходимое правило для таких пациентов. Потом можно обратиться к народной медицине, и узнать, как лечить трофическую язву в домашних условиях. В таких случаях рекомендовано применять такие рецепты.
- Ранка промывается и припорашивается порошком высушенных листьев татарника. Накладывается повязка. Следующая процедура проводится на утро, но без промывания.
- Ватные диски пропитываются соком Золотого Уса. Некоторые рецепты рекомендуют вкладывать в ранку мелко измельченные листья этого растения.
- На 100 г гусиного жира берут 30 г прополиса. Варят в течение четверти часа на водяной бане. Остывшую мазь закладывают в лунку и забинтовывают. Если нет гусиного жира можно использовать нутряной или обыкновенный свиной (внутренний).
Посмотрите трофическую язву на ноге и как ее лечить при помощи АСД на фото:
Фракцию АСД принимают и внутренне и наружно. Для обработки изъявлений используют раствор препарата с растительным маслом (1:20). Для внутреннего применения используют схему: в течение 5 дней пьют разведенный 0,5 мл АСД в половине стакана жидкости. Далее трехдневный перерыв и повторение.
В ходе лечения, пациенту не рекомендуются тяжелые физические нагрузки, избегать травматизации, исключить употребление сахаров в чрезмерном количестве. Трофическую язву на ноге и о том, как ее лечить при помощи народной медицины может подсказать и лечащий врач. Нередко доктора сами рекомендуют такие рецепты своим пациентам параллельно назначенной медикаментозной терапии.
Трофические изъявления – это достаточно сложное заболевание, которое может, при отсутствии соответствующего лечения дать серьезные осложнения (лимфангит, сепсис, рожа и т. д.). В некоторых случаях невылеченные язвы могут стать причиной перерождения клеток в патологических очагах в злокачественные. Поэтому к терапии данного заболевания необходимо подойти серьезно и ответственно и придерживаться рекомендаций лечащего врача.
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