Complex treatment of trophic ulcers: a case report / Inga Guogienė, Julija Stirbienė, Aurimas Dobilinskas, Mantas Kievišas, Kęstutis Braziulis

Background. Trophic ulcers usually occur in the poorly vascularized body areas, such as lower part of the leg, ankle, rear side of the foot. It is difficult to treat such ulcers due to impaired blood flow, neuropathies, chronic infections and other comorbidities. Therefore, in order to avoid serious complications, a proper treatment of trophic ulcers is very important. In this clinical case we aimed to share an example of strategy and results of chronic trophic ulcer treatment. Desihn/methods. A 62 years-old female patient suffered from venous insufficiency and chronic trophic ulcers in her calves that were not healing for more than 10 years. Wounds were highly exudative and covered with fibrin coating. Surrounding skin hyperpigmentation and oedema were also present. Chronic venous insufficiency was suspected, so duplex ultrasonography (DUS) was performed. DUS identified signd of marked venous valve imcompetence. Therefore, endovenous laser ablation (EVLA) was recommended for the patient. Prior to EVLA, a conservative treatment with antibiotic therapy based on the bacterial culture and antimicrobial susceptibility tests, drugs improving blood flow and nonsteroidal anti-inflammatory agents were prescribed for the patient. Multiple debridements and once-daily antiseptic dressing changes were performed. In addition, compression therapy with elastic stockings was applied. After the EVLA, conservative treatment was continued. Hydrocolloid dressing were chosen for further wound care. At two months after the treatment, leg oedema, pain, skin pigmentation and wound exudation reduced. Wounds were clean and covered with granulation tissue. Finally, split-thickness skin grafting was performed. Results and discussion. At four months from the beginning of treatment, skin grafts were fully healed and wounds were completely epithelialized. In addition, oedema, lymphostasis and pain were significantly decreased, which allowed for better function and improved patien. [...].