Трофическая ЯЗВА: выход есть

 
Трофическая язва ног - довольно частая проблема у больных, которым даже может показаться,

что лечение её бесконечно. Однако при своевременном определении причины, можно расстаться с язвой навсегда. Об этом журналисты «КВ» продолжают беседу с хирургом медицинского центра «Лакрима» Дмитрием Федотовым.
«КВ»: - Дмитрий Владимирович, ли избавить человека от этого заболевания?
Д. ФЕДОТОВ: - Иногда очень сложно. В некоторых случаях приходится работать по 6-8 месяцев, но в результате терпения пациента и настойчивости врачей мы получаем заживление раны.
«КВ»: - Расскажите, пожалуйста, об этапах лечения.
Д. ФЕДОТОВ: - Лечение венозной трофической язвы обычно проходит в пять шагов.
Шаг первый - полноценная диагностика венозных заболеваний. Чтобы излечить трофическую язву, необходимо узнать её причину. Ультразвуковой сканер позволяет проводить детальный анализ состояния вен нижних конечностей. Под контролем ультразвукового сканера выявляется та перфорантная вена, которая и является причиной образования язвы, и которая во время операции тем или иным способом будет убрана. Я, например, выполняю лечение варикозной болезни с помощью лазеров с различной длиной волны, т.к. эти аппараты позволяют убирать сосуды различных диаметров - от 1 мм до 2 см.
Шаг второй - устранение венозного застоя. После диагностики мы должны устранить венозный застой, который формируется патологическим сбросом крови из глубокой венозной системы в поверхностные вены. Кровь с вредными продуктами жизнедеятельности застаивается в коже, вызывая её потемнение и формирование язв. Для устранения венозного застоя необходимо устранить все патологические сбросы. Методы лечения могут быть как хирургические, так и более современные:  лазерная коагуляция варикозных вен или и склеротерапия под контролем ультразвука прекрасно подходят для этих целей. Устранение венозного застоя приводит к заживлению язв обычно за 2-4 недели.
Шаг третий - местное лечение язвы. Любая трофическая язва является инфекционным процессом, на ней обитают миллиарды различных микробов, которые способствуют прогрессированию язвы и развитию осложнений. Задачами местного лечения является устранение микробного загрязнения, стимуляция заживления язвы. При этом мы не заставляем наших пациентов покупать дорогостоящие раневые покрытия. Трофические язвы очищаются значительно быстрее с использованием схемы, разработанной в последние несколько лет.
Шаг четвёртый - пластическое закрытие больших трофических язв. Пластическая хирургия тесно перекликается с сосудистой. Крупные дефекты тканей, которые возникают в результате сосудистых болезней, с трудом заживают даже после восстановления нормальных условий кровообращения пораженного органа. Перед хирургом встаёт вопрос - как добиться полного заживления и выздоровления даже при длительно незаживающих открытых язвенных поверхностях. Для закрытия трофических язв большой площади мы используем методы пластической хирургии. В нашем арсенале имеются как простые методики, так и сложные реконструктивные методы закрытия больших язвенных поверхностей.
Шаг пятый - поддерживающая терапия и компрессионное лечение. Целью лекарственной терапии венозной патологии является уменьшение симптомов и предотвращение осложнений, однако достичь указанных целей непросто. Сегодня обилие средств, которые могут быть применены, породило другой вопрос: какое из них выбрать? К сожалению, большинство предлагаемых препаратов имеют достаточно невысокую эффективность, несмотря на теоретически обоснованную целесообразность их применения.
«КВ»: - Дмитрий Владимирович, что вы могли бы порекомендовать людям с трофическими язвами?
Д. ФЕДОТОВ: - Единственным правильной рекомендацией будет настоятельная просьба - не заниматься самолечением и при появлении подозрений на образование язвы не откладывать лечение на другое время. Помните, что, трофическая язва требует максимально раннего профессионального подхода!

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