Rational Approach to Treatment of Patients with CVI C5 – C6 (CEAP)

This article presents the experience of complex treatment of venous etiology trophic ulcers by using adsorption bacteriostatic wound dressings in the treatment of venous leg ulcers of venous etiology. The purpose of the study was to improve the results of the treatment of patients with KHVS5-C6 (CEAP). Materials and methods of research. The work was carried out on the basis of clinical examination and treatment of 125 patients with varicose veins with CVI C5-C6 (CEAP), who were on treatment at the SI "Zaitsev Institute of General and Urgent Surgery of NAMS of Ukraine "for the period from 2012 to 2017. Results and discussion. The use of wound coverings in the main group contributed to a decrease in microbial contamination by 12% compared to those in the comparison group. This was confirmed by the results of a bacteriological study, according to which in 25% of patients the degree of microbial contamination of the ulcer surface decreased from 106 to 103-4KOE / ML. In 30% of cases there was a change in the microflora for opportunistic and saprophytic. In 40% of the patients the culture became sterile during the treatment. In patients of the comparison group at the beginning of treatment, the average area of trophic ulcers was 11.6 ± 2.3 cm2. On the 7th day of therapy with 10% methyluracil ointment, the size of ulcers in the comparison group was 10.4 ± 1.4 cm2. In 2 patients (2.8%), the presence of a moderate amount of excretion from the wound and the hyperemia of the wound edges remained. At the same time, the average rate of marginal epithelization of the wound per day was 1.6 ± 0.4%. On the 15th day of treatment, the area was 9.0 ± 1.4 cm2. During the examination, a small amount of discharge from the wound was noted; bright granulation was visualized at the bottom of the wound. A distinctive marginal epithelization of the trophic ulcer was observed in 68 (97.2%) patients. Over the past 7 days, the rate of marginal epithelialization was 2.4 ± 0.5%. On the 21st day intensive wound epithelization was noted, with wounds decreasing at a rate of 2.8 ± 0.3% per day. Complete epithelization of venous trophic ulcers in patients in the comparison group occurred within 41.3 ± 2.4 days. The average rate of marginal epithelization over the entire period was 2.6 ± 0.3%. Conclusions. The results suggest that the use of adsorption bacteriostatic wound coverings promote faster regression of clinical symptoms and closure of venous trophic ulcers compared to standard treatment. It also reduces the duration of staying in hospital.