A REVIEW OF EFFECTIVENESS OF MONOTHERAPEUTIC AND COMBINED TREATMENT OF VENOUS ULCERS

Venous ulcers develop as a complication of chronic venous insufficiency of the lower extremities, which significantly impair the quality of life of patients. The mentioned tissue defects are characterized by slow, frequently incomplete healing, formation of recurrent ulcers. It is important to carry out a detailed assessment of both the defect itself and possible systemic disorders in patients in order to work out the most effective treatment tactics. Compression therapy, minimally invasive interventions, such as scleroobliteration and thermal ablation, traditional methods of surgical treatment (strip-ping), debridement, and diospin/hesperidine-based veno-tonics are conventionaly used to reduce chronic inflam-mation and provide healing of venous ulcers. Compres-sion therapy has been proved to be a major component of venous ulcer therapy, however, surgical treatment can provide effective healing/downsizing of the ulcer area as an additional method or as an alternative method in the absence of the effect of compression. Minimally invasive surgical techniques, stripping with traditional venectomy give similar results regarding the ulcer healing rates, but surgical treatment offers a lower risk of recurrence. Stud-ies of foreign and Ukrainian authors have demonstrated the high effectiveness of combined treatment, that in-cludes the combination of compression (34-46 mm Hg) applied to the lower extremities with minimally invasive techniques for the elimination of pathological venous reflux, prescription of venotonic diospin/hesperidine agents ("Normoven" in particular) and local treatment of ulcerative defects. The use of endovenous biowelding technology (EK300M; “Svarmed”, Ukraine) in automatic mode with originally designed intravascular device has shown promising results regarding venous ulcer man-agement. All patients, who received treatment with the technology described above together with the wearing of III grade compression stockings, a significant healing progress on the ulcer sites was noted during 6 months after surgery. A comparative study on the use of “Normoven” in the complex treatment of patients with venous ulcers (up to 7 cm in size) is being conducted by the Department of Surgery and Vascular Surgery of Shupyk National Medical Academy. The interim results demonstrate a higher rate, a greater percentage of com-pletely healed venous ulcers, and a better quality of life for patients treated with “Normoven” in combination with surgical treatment and grade III compression stock-ings. Negative pressure therapy is regarded as a promising option by certain authors as it increases blood flow, accelerates granulation tissue formation and reduces swelling in the ulcer area. Moreover, dietary regulation, smoking cessation, weight loss in case of obesity, correc-tion of concomitant cardiovascular pathology in addition to the main treatment contributes to the faster healing of venous ulcers resulting in the improved quality of life of the patients and restoration/maintenance of working capacity.