Main
- A trophic ulcer does not heal on its own: a defect of the skin and tissues persists for weeks, expands and requires elimination of the cause of impaired blood flow.
- Such a condition is managed by a vascular surgeon, phlebologist or surgeon: they assess the veins and arteries of the legs, check pulsation and oedema.
- Examination looks for the cause of non-healing: examination of the ulcer, ultrasound examination of the vessels, measurement of pressure in the arteries of the legs, blood tests.
- Urgently see a doctor if the ulcer grows rapidly, with severe pain, redness around it, purulent discharge or fever.
- Prevention of exacerbations relies on daily examination of the skin of the legs, even cutting of the nails and comfortable footwear without constricting edges.
What is a trophic ulcer
A trophic ulcer is a long-healing damage to the skin and underlying tissues that occurs due to impaired blood supply or lymph outflow. It usually appears on the legs and requires treatment of the underlying disease, not just local wound care.
What happens in the body
A trophic ulcer forms where the skin and underlying tissues stop receiving enough nourishment from the blood. Blood brings cells oxygen and substances needed to repair damage, while the venous and lymphatic systems carry away waste fluids. When the inflow of blood through the arteries weakens or the outflow through the veins and lymphatic vessels is impeded, fluid accumulates in the tissues and metabolism is disrupted. Because of this, even a small scratch or graze does not heal in the usual way, but turns into an open area. The edges of such an area gradually become firm, the base becomes covered with a coating, and swelling and discolouration of the skin appear around it. The longer the nutritional deficit persists, the deeper the underlying tissues are damaged and the harder recovery becomes. Therefore, treating the wound itself without addressing the cause of the impaired blood flow usually does not lead to healing.
What causes it to develop
- Chronic venous insufficiency: the veins cannot cope with returning blood from the legs to the heart, and fluid constantly stagnates in the tissues.
- Atherosclerosis of the leg arteries: the lumen of the vessels narrows, and the muscles, skin and subcutaneous tissue receive less blood than they need.
- Diabetes mellitus: elevated glucose levels damage small vessels and nerves, so the nourishment of the foot tissues suffers particularly noticeably.
- Lymphoedema: impaired lymph outflow leads to persistent swelling, which stretches the skin and makes it easily damaged.
- Injuries and prolonged pressure: tight shoes, a cast or a motionless position compress an area of skin and trigger the formation of a defect.
- Impaired sensation in the feet: a person does not notice minor injuries and does not reduce the load on that area in time.
Who encounters this more often
A trophic ulcer is more common in people with long-standing vascular diseases and with diabetes mellitus. In venous insufficiency, it mainly affects middle-aged and older women who have been troubled by swelling and heaviness in the legs for more than a year. In atherosclerosis of the leg arteries and diabetes, the picture is different: here the proportion of men and people who already have impaired sensation in the feet is higher. A separate group consists of patients after injuries, operations and forced immobility, when an area of skin is under pressure for a long time. Lifestyle also plays a role: prolonged work standing or sitting, excess weight and lack of movement worsen the outflow of blood from the lower limbs. Age also matters, since over the years the vessels lose elasticity and the skin becomes thinner and more vulnerable. If a person has already had such an ulcer, the risk of it appearing in the same place is noticeably higher, so the legs need constant attention.
What symptoms can there be?
The symptoms of a trophic ulcer develop gradually, and they are easily mistaken for ordinary tiredness or chafing. It is important to notice the changes in time and to understand when urgent medical help is needed.
How it is noticed at the very beginning
A trophic ulcer is most often located in the lower part of the shin or on the foot, so a person associates the first changes with long walking or uncomfortable shoes. At first, a small break in the skin appears that does not heal for a long time, and it is often put down to tiredness or an accidental scratch. Gradually the wound widens and deepens, and the skin around it becomes indurated, pigmented or oedematous. The pain may be mild or pronounced, sometimes itching is added, and discharge with an unpleasant odour appears from the wound. The person notices that the usual care measures do not help, and the lesion persists for weeks without improvement. Over time, the size of the ulcer increases, and it involves ever new areas of skin. If a wound on the leg does not heal for a long time, this is a reason not to wait, but to see a vascular surgeon or a phlebologist.
Signs that occur most often
- A long non-healing wound on the leg: the lesion persists for weeks and does not close over, which distinguishes it from an ordinary graze.
- Swelling and change in skin colour around it: the tissues next to the ulcer swell and change shade, this indicates impaired nutrition of the skin.
- Pain or itching in the area of the ulcer: the sensations may be mild or pronounced, sometimes they make walking and sleeping difficult.
- Discharge from the wound: the discharge may have an unpleasant odour, which indicates added inflammation.
- Induration and pigmentation of the skin: the skin around it becomes denser and darker, such areas recover less well.
- Increase in the size of the ulcer over time: if the lesion widens and deepens, a visit to the doctor cannot be postponed.
When to seek help urgently
Examinations and tests
Examination for a trophic ulcer is aimed at finding the cause that prevents the wound from healing. The doctor assesses the ulcer itself, the condition of the surrounding skin and the function of the leg vessels.
How the examination begins
The first step is an examination of the ulcer, during which the doctor assesses its size, edges, discharge and the condition of the surrounding skin. At the same time, the pulsation of the vessels in the legs and the severity of oedema are checked, since these signs indicate impaired blood flow. It is important for the doctor to understand which disease led to the formation of a long-healing wound. Without this, any local treatment of the ulcer remains superficial and does not eliminate the cause. The vessels are then examined and concomitant conditions that can slow healing are checked. If the wound does not heal for a long time, a swab or biopsy is taken if necessary to rule out infection and other causes. It is worth bringing all previous discharge summaries and results to the appointment: this saves time and helps the doctor see the full picture.
What is prescribed and what it shows
What to prepare for the appointment
- Discharge summaries: all medical documents describing previous visits, operations and conclusions on the vessels — this helps the doctor reconstruct the history.
- Images and reports: the results of ultrasound examination of the vessels and measurement of pressure in the leg arteries, if they have already been performed previously.
- Blood tests: previous laboratory results, so that the doctor can see the dynamics and does not order the same tests again.
- Observations: write down how long ago the ulcer appeared, whether its size and discharge have changed, and what preceded this.
- Questions: formulate in advance what exactly is troubling you and what is unclear about the condition of the wound, so that you have time to discuss this at the appointment.
Which doctor should I see?
This section explains which doctor to consult for a trophic ulcer, what happens at the first appointment and what areas the care consists of. Below are guidelines for choosing a specialist and understanding how follow-up is organised.
Which specialist manages this condition
A trophic ulcer is managed by a vascular surgeon, and in their absence care is provided by a phlebologist or a surgeon. A vascular surgeon assesses the condition of the veins and arteries, because the ulcer is almost always secondary to vascular pathology. A phlebologist deals with the venous cause, which is the most common, and selects compression therapy. A surgeon performs the initial examination, treats the wound and determines whether surgery is needed when there are indications. At the first appointment the doctor examines the ulcer, clarifies its size and the condition of the surrounding tissues, and checks the pulsation of the vessels. If a specialist of the relevant profile is not available nearby, start with a surgeon at the polyclinic: they will assess the situation and refer you further along the right pathway. Do not postpone the visit if the discharge from the wound has changed colour or odour, and the skin around it has become red and hot.
What the treatment consists of
- Treatment of the underlying vascular disease: without addressing the cause that led to the ulcer, the wound heals slowly or opens again, so this area is given the main attention.
- Local wound care and selection of dressings: the doctor cleans the surface, removes non-viable tissue and selects a dressing that maintains a moist environment and protects against contamination.
- Compression therapy for the venous cause: pressure on the limb helps venous blood move towards the heart, reduces swelling and creates conditions for healing.
- Physiotherapy: certain techniques are used as a complement to the main care; they stimulate blood flow and metabolism in the tissues around the wound.
- Medication as prescribed by the doctor: only a specialist selects the remedies, taking into account the condition of the vessels and concomitant diseases; they must not be taken on your own.
- Surgery when indicated: intervention on the vessels restores blood flow, and the decision about it is made when conservative measures do not give the required effect.
What depends on the patient themselves
The outcome in a trophic ulcer largely depends on regular follow-up with a specialist and precise adherence to their recommendations. Dressings must be changed in the prescribed regimen, and not only when the dressing has become wet or pain has appeared. Compression garments are worn as the doctor explained: an item removed for the day reduces the benefit to zero and slows healing. The condition of the wound changes gradually, so photographic records or notes about its size help to notice a shift earlier than it becomes obvious. If the doctor has prescribed physiotherapy or medication, omissions through forgetfulness lengthen the timeframe and increase the risk of complications. Any change — increased pain, swelling, the appearance of discharge — is a reason to contact the doctor rather than wait for the scheduled visit. Write down the date of the next appointment straight away and mark it, so that follow-up is not interrupted.
What helps prevent an exacerbation?
Preventing exacerbations of a trophic ulcer largely depends on the person's own everyday decisions. Below are the habits, indicators for regular monitoring and timing of routine check-ups with a specialist.
What to change in habits
Daily care of the skin of the legs and protection from injury directly affect the risk of exacerbation of a trophic ulcer. The skin of the feet and lower legs is examined every day in order to notice redness, dryness or damage in time. Nails are cut straight, without catching the corners, since an accidental small wound may take a long time to heal. Shoes are chosen comfortable, without rough seams or pinching edges, so as not to create extra pressure on the tissues. Compression garments are worn only on the doctor's recommendation, selected to size, and not at random. Prolonged standing or sitting with the legs down increases congestion, so the position of the legs is changed during the day. If the skin is prone to dryness, it is moisturised, but products are not applied to open areas without a specialist's advice.
What should be kept under control
- The underlying condition: venous insufficiency, atherosclerosis or diabetes mellitus are treated in time, because it is they that maintain the risk of exacerbation.
- The condition of the skin: a daily examination helps to notice the first changes — redness, dryness, cracks — before they become a problem.
- The integrity of the feet: any wound, chafing or blister is shown to a doctor, as a minor injury takes a long time to heal.
- Pressure and load: prolonged standing, tight shoes and a monotonous position of the legs create conditions for repeated damage to the tissues.
- Compression garments: they are worn as prescribed by the doctor and replaced as they wear out, otherwise they stop maintaining the required regimen.
- Routine check-ups: a visit to a specialist even when feeling well allows changes to be noticed before they become visible outwardly.
How often to see a doctor
A regular examination by a specialist is needed even when the leg looks calm and nothing is troubling you. The doctor assesses the condition of the skin, the function of the veins and the overall course of the underlying condition that maintains the risk of exacerbation. In diabetes mellitus, the sensation of the feet is checked separately, since reduced sensation makes it harder to notice damage in time. If swelling, a change in skin colour or a wound that does not heal for a long time appears, the visit is not postponed. Routine check-ups allow care and load to be adjusted before the condition worsens. A person who comes for an appointment on schedule faces a sudden exacerbation less often. Book a convenient date for the next visit in advance, so that monitoring does not turn into solving an urgent problem.
What is worth remembering
A trophic ulcer is a condition that almost always develops gradually and remains unnoticed for a long time against the background of the underlying disease. Therefore, the discussion of it should be concluded with a few conclusions that will help the reader make a balanced decision.
Main conclusions
A trophic ulcer rarely appears suddenly on healthy skin, without preceding changes, and this is important to understand when the first alarming signs appear. The healing of such a wound is almost always slow, because it is based on impaired blood supply or outflow, and not only on skin damage. If a trophic ulcer does not heal for a long time, its appearance changes or new sensations appear, one should not postpone a visit to the doctor. Independent attempts to close the defect with improvised means often only mask the picture and prevent the specialist from assessing the condition. The underlying disease, against the background of which the trophic ulcer appeared, requires no less attention than the wound itself. Regular examination of the skin of the legs and a timely response to any changes help to notice the problem earlier. Relying on the doctor and consistency in actions mean more for a trophic ulcer than any quick solutions.
