Neurotrophic ulcers
Last reviewed: 23.04.2024
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Neurotrophic ulcers occur in patients with lesions of the central or peripheral nervous system. Most often they occur in patients with a neuropathic form of the diabetic foot syndrome, traumas of the central nervous system and peripheral nerves. When excluding diabetes mellitus and traumatic lesions of the nervous system, differential diagnosis of diseases accompanied by sensory peripheral neuropathy should be carried out. These include myelodysplasia, myelomeningocele, syringomyelia, leprosy, multiple sclerosis, amyotrophic lateral sclerosis, dorsal (tertiary syphilis), etc. The leading mechanisms for their development are the violation of sensitivity and the constant or prolonged compression and traumatization of tissues, leading to their destruction. In this regard, neurotrophic ulcers in most cases occur on the supporting surfaces of the limb: the sole, heel region, on the lateral surfaces of I and V of the metatarsophalangeal joints, in the region of the ankles.
Neurotrophic ulcers have a rounded shape, covered with dense fibrinous overlays, sluggish granulations, poorly exuding, surrounded by a dense skin roller with the phenomena of pronounced hyperkeratosis, and are of little use.
They have a weak tendency to self-healing. It is necessary to create conditions that completely exclude mechanical stress on the zone of trophic disturbances, using full or partial unloading of the foot with walking on crutches, use of orthopedic insoles and shoes, application of a removable plaster boot with a hole for care.
It should be noted that attempts at conservative treatment of neurotrophic ulcers in more than 70% of cases do not bring the desired result, and the frequency of their malignancy reaches 10%. If the conservative therapy is ineffective, different methods of plastic surgery with full-layer skin flaps are used: plastic with a skin flap, VY plastic, Italian skin plasty, a free transplantation of the tissue complex on microvascular anastomoses, etc. Neurotrophic ulcers often recur while preserving neuropathy.
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