RU2146510C1 - Method and device for treating trophic venous ulcers - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves creating injured extremity compression by applying fabric ribbon. A hole is made in tissue at the place the trophic ulcer is located. Peripheral part of the ulcer is covered with porolon ring. Pressing force and positional draining of the extremity and ulcer is applied during the treatment period. To do it, the extremity is given lifted position and cords are tightened. Pressure applied to the extremity can exceed venous pressure value by 10-15 mm in main veins. EFFECT: accelerated treatment course; treating, draining and healing ulcers without taking-off stockings and applying surgical operation and drug consumption. 3 cl, 2 dwg

Description

 The invention relates to medicine and is intended for use in the treatment of complications of chronic venous insufficiency of the lower extremities.

 For the treatment of varicose veins of the lower extremities, a widespread method of creating compressive pressure (compression) acting on the veins to improve venous outflow through the deep veins of the limb, using medical stockings applied to the affected part of the limb (1).

 In case of complications of chronic venous insufficiency, trophic ulcers can occur, the treatment of which requires laborious measures associated with the use of various medications, operations, special continuous compression dressings, etc.

 There is a method of applying compressive pressure on a patient’s leg for anti-embolic treatment by embracing the treated leg with a stocking made in the form of a strip of elastic tissue with overlapping side edges, fastening the side edges on the upper and lower ends of the strip wrapped around the leg, and thus creating compressive pressure on this part of the leg, gradually decreasing from the ankle joint to a level slightly below the knee joint (2).

 Improved medical stockings for varicose veins are known, in which a longitudinal slot is made on their tubular part in the lower leg region, ending with a fastening device made, preferably, in the form of a sliding lock (3).

 A disadvantage of the known method and device of treatment are the aforementioned difficulties associated with the treatment of trophic ulcers, while the fact of drainage of a wound of the distal extremities is not taken into account, which significantly slows the healing of trophic ulcers. Another disadvantage is underdosed compression, which depends on the elastic properties of the stocking and is lost with prolonged use. The average duration of ulcer healing remains high (2-3 months or more), and the percentage of relapse of ulcers in the near and distant periods (up to 60-70%) is high.

 The invention solves the problem of creating a non-drug and non-surgical method for the treatment of venous trophic ulcers of the lower extremities.

 The essence of the invention consists in a method of non-drug and non-surgical treatment of trophic ulcers, which consists in compressing the patient’s limb being treated by applying a strip of tissue to the limb and creating varying pressure along the limb sections - before applying the tissue, a hole (window) is made in it, corresponding to the place and the size of the trophic ulcer, cover the periphery of the ulcer with a ring of foam rubber or soft plastic or cotton-gauze material and apply tissue. In the compression process, a compressive force is dosed along the limb and the magnitude and pressure gradient of the limb during the treatment are regulated by measuring the compressive force gradually from the distal to the proximal extremities, as well as the positional drainage of the limb and ulcer, including through its outer surface.

 A device for treating venous venous trophic ulcers according to the invention is made in the form of an individual, specially selected stocking (boot) with a longitudinal slot provided with a device for fastening the lateral edges of the slot, the stocking (boot) is made of dense inelastic fabric in which a hole (window) is made in place above the trophic ulcer, and the device for fastening the lateral edges of the slot is made with the possibility of changing the attraction of the lateral edges to each other along all the lengths of the slot. In the particular case, the fastening device is made as follows - along the slot of the stocking (boot), a fold is made along its lateral edges, equipped with alternating holes and laces made of soft textile fabric.

 The technical result that can be obtained by carrying out the invention is the possibility of treating, draining and sanitizing a trophic ulcer without removing the stocking (boot), without surgery and without the use of medications. Along with the use of variable dosage compression according to an individual program for each patient, it is possible, if necessary, to subsequently conduct drainage and other operations on the main veins of the limbs, the type of which is established taking into account phlebography and the condition of the tissue in the area of the trophic ulcer.

 A device for implementing the method for functional reasons and specific performance is more convenient in the example embodiment of the invention to be called a “boot”. The invention is illustrated by drawings, where in FIG. 1 shows a general view of an individual compression boot made according to the invention, and FIG. 2 shows a scan of the bootleg of such a boot.

 On the bootleg 1 boot made window 2 at the location and size of the surface of the trophic ulcer of the patient, taking into account the corolla of induction and pigmentation. Position 3 denotes a ring of soft material soaked in an antiseptic solution. The ring may be made of a spongy material, for example foam rubber, of cotton gauze or soft plastic material. The lateral edges of the slot 4, made on the boot, are equipped with fixture elements - double folds 5 of the boot material, in which holes 6 are made for the laces 7. The boot is made of canvas or other dense material that meets hygienic requirements, in terms of shin diameters, foot sizes, and foot heights patient, and the upper edge of the boot should be proximal to the ulcer at least 10 cm and distal to the ulcer at least 7-8 cm.

 During the treatment, a laced boot is put on the patient’s leg, the window 2 of which in the bootleg 1 corresponds to a trophic ulcer (if there are several ulcers, several such openings can be made, the number of which should not violate the required strength of the boot material). A ring 3 is applied to the periphery of the ulcer, the sizes of which are set according to the width of the corolla of induction and pigmentation on the trophic ulcer, tighten the lanyards 7 and, thereby, create compression on a part of the patient’s limb, while the pressure in different parts of it is established by tightening the corresponding part of the laces according to the program determined by the doctor in accordance with the severity and impaired venous circulation. In this case, the ring 3 is fixed over the trophic ulcer tissue of the compression boot using laces. After that, the patient is placed in an elevated position (draining position of the leg) above the level of the heart within 10-30. Drainage is also provided by the outflow of discharge from the ulcer freely outside. During the treatment, the magnitude and pressure gradient of the compressor boot on the veins are regulated by changing the compressive force at different levels of the limb gradually from the distal to the proximal limb by pulling or loosening the laces 7. In addition, the positional drainage of the limb and ulcer is also regulated (by changing the angle of the leg position relative to the level heart), including through its outer surface. Three main categories can be distinguished from the total mass of patients, depending on the degree of increase in central venous pressure: the 1st degree - venous pressure in deep veins, measured by Waldman's apparatus, is 130-160 mm of water column; 2 degree - respectively 165-200 mm; 3 degree - more than 200 mm. At each of these degrees, by means of a compression boot, the pressure on the limb can exceed by 10-15 mm the rate of venous pressure in the main veins. This ensures the cessation of venous blood discharge through communication (perforating) veins from the deep vein system to the superficial veins of trophic changes (zone of impaired trophism). In this case, drainage also occurs through the open trophic ulcer system (the first type of drainage). The length of stay of the leg in the boot should be from 3 to 4 weeks, which leads to the healing of the ulcer.

The effectiveness of the developed method for the treatment of venous trophic ulcers is confirmed by numerous clinical observations (about a hundred patients with a follow-up of two to three years). Clinical examples:
Example No. 1.

 Patient V., 45 years old, was in the clinic of faculty surgery of St. Petersburg State Medical University (St. Petersburg State Medical University). Acad. I.P. Pavlova about a trophic ulcer of the right lower leg 8x6 cm in size against the background of varicose veins and chronic venous insufficiency of the right lower limb. Sick for two years, over the past three years there has been hyperpigmentation, tissue induction on the medial surface of the lower leg, in its lower third, against the background of a trophic ulcer. She was treated in various medical institutions of the city with a temporary effect. However, over the past three months, the ulcer has gradually increased in size and did not tend to heal. After applying to the clinic of the faculty surgery at St. Petersburg State Medical University, the patient wore a compression boot and an open ulcer treatment (drainage and dosed compression) was started. At the control examination, after three weeks, the patient’s ulcer healed.

 Example No. 2.

 Patient B., 43 years old, was in the clinic of faculty surgery at St. Petersburg State Medical University, was worried about a long-term non-healing trophic ulcer of the right foot and lower leg with dimensions of 15x12 cm against the background of postphlebitic disease and type II diabetes mellitus. Repeatedly used plastic methods with a free skin-subcutaneous flap, however, the engraftment of the flaps was not obtained. After applying the open method using a compression boot, the ulcer completely epithelized after four weeks, after which the quality of life improved markedly and the patient returned to work.

 Thus, the developed method and device can significantly accelerate the healing of trophic venous ulcers and reduce the percentage of disease recurrence both in the short and long term, as the proposed treatment can be repeated, if necessary, repeatedly in people of any age and at home. The above observations indicate the high efficiency of the proposed method for combining ulcer drainage with dosed squeezing of tissues with a compression boot with an open window for rehabilitation.

Sources of information
1. UK application N 2180161, A 61 F 3/08, publ. 03/25/87.

 2. US patent N 4513740, A 61 F 3/08, publ. 04/30/85.

 3. Application of France N 2619709, A 61 F 3/08, publ. 03.03.89.

Claims (3)

1. A method of treating trophic venous ulcers, comprising compressing a patient’s limb being treated by applying a strip of tissue and creating varying pressure along a portion of the limb, characterized in that before applying the tissue, an opening (window) corresponding to the location and size of the trophic ulcer is made in it, the periphery is closed ulcers with a foam rubber ring and impose tissue; during treatment, compressive force and positional drainage of the limb and ulcer are metered by tightening the laces and laying chnosti in the raised position within 10-30 ^o above heart level, the pressure on the limb may exceed 10-15 mm measure venous pressure in the main veins.  2. A compression stocking made with a longitudinal slot provided with a device for fastening the lateral edges of the slot, characterized in that the stocking is made of dense inelastic fabric in which a hole (window) is made in place above the trophic ulcer, and the device for fastening the lateral edges of the slot is made with the ability to change the attraction of the side edges to each other along the entire length of the slot.  3. The compression stocking according to claim 2, characterized in that a fold is provided along the longitudinal slot of the stocking along its lateral edges, provided with holes and laces of soft textile fabric.

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