Modern possibilities of the surgeon in the diagnosis and treatment of trophic ulcers of venous etiology (literature review)

Abstract

The review article presents literature data on the conservative and surgical treatment of trophic ulcers of venous etiology, taking into account modern views on the etiology and pathogenesis of the complicated course of chronic venous insufficiency. One of the mechanisms for increasing the size of trophic ulcers is the emergence of a fibrinoid necrosis zone with the rejection of overlying tissues. Current approaches in the diagnosis of this pathology have been reported. Various methods of treating trophic ulcers in varicose veins and their long-term results are compared, the peculiarities of the use of endovenous laser coagulation and obliteration in practice are considered. The question is raised about the need to unify algorithms for preparing patients with trophic ulcer for minimally invasive intervention, the principles of its implementation and postoperative management of patients in order to achieve good and excellent immediate and long-term results. The national clinical guidelines for phlebology are analyzed, in which until now the priority in the treatment of trophic ulcers is given to local treatment, which unreasonably delays and lengthens the process of their healing. Surgical treatment should be aimed at early elimination of the pathogenetic link in the development of trophic ulcers.