Chronic persistent ulcers of the lower limbs are chronic ulcers that occur in the boot area of the lower limbs (distal calf and foot) for months or even years or decades, and the cause is mostly related to vascular diseases, partly due to diabetic foot, which seriously affects the quality of life of patients and even leads to amputation and should be treated actively.
The majority of chronic persistent ulcers of the lower extremity occur in the boot area, where arterial blood supply and venous blood return are poor and soft tissues are thin, so ulcers are prone to occur under the action of various pathogenic factors, and ulcers do not heal easily and are prone to recur after healing. Most of the chronic and persistent ulcers of lower limbs are caused by vascular surgery diseases, which are divided into venous ulcers and arterial ulcers. Venous ulcers are mainly caused by varicose veins of the saphenous vein and the insufficiency of the valves of the traffic veins of the lower leg (traffic branch regurgitation). Arterial ulcers are caused by ischemic necrosis and detachment of distal tissues of the lower extremities due to arterial occlusion of the lower extremities.
We believe that the treatment of chronic intractable ulcers of the lower extremities should be a combination of Chinese and Western medicine and integrated therapy. In recent years, we have applied the comprehensive measures of removing the cause, local antibacterial drug exchange, extensive suturing of the traffic vein around the ulcer, free skin implant, direct suturing of the ulcer and actively improving the general condition to treat chronic ulcers of the lower extremity. The treatment characteristics have been gradually formed.
Patient 1 had a huge ulcer near the inner ankle of the right calf that had persisted for 40 years and had undergone suture ligation of the traffic vein around the ulcer.
Two weeks after the operation, the suture was removed and the wound surface was neat and fresh after local antimicrobial dressing change.
The skin was taken from the right medial femur (medium-thick skin piece) and the right calf ulcer free skin grafting (intraoperative) was performed, and the skin piece was sutured and fixed.
Two weeks after the operation, most of the skin pieces were viable, and only a little trauma remained at the distal end.
Four weeks after surgery, the ulcer was completely healed.
The ulcer did not recur at the six-month postoperative follow-up.
The right medial femoral donor wound healed well.
Patient 2 had a chronic right calf ulcer caused by saphenous varicose vein and atherosclerotic occlusion of the lower extremity that had persisted for 20 years.
One week after admission, after local antimicrobial dressing change, small incision saphenous vein stripping, and peri-ulcer suture ligation, the right lower limb arterial occlusion segment was opened with simultaneous intervention.
Two weeks after admission, after punctate skin grafting, the wound surface was neat and the granulation was fresh, and all the punctate skin pieces implanted were viable.
Four weeks after admission, the ulcer was significantly smaller than before and was about to heal completely.
Six weeks after admission, the right calf ulcer was completely healed.
Patient 3 had a chronic ulcer of the calf caused by saphenous varicose vein, and the improper treatment outside the hospital caused severe infection.
One week after admission, after active anti-infective treatment and local antibacterial dressing change, the wound surface was neat and fresh granulation, and the surrounding tissue redness and swelling completely subsided.
Two weeks after admission, after small incision saphenous vein high ligation stripping, peri-ulcer suture ligation and dotted skin grafting, the ulcer wound was significantly smaller than before, and the new epithelial growth was obvious.
Four weeks after admission, the ulcer wound was completely healed and the skin removal wound was well healed.
Patient 4 had a chronic ulcer on the lateral side of the left calf that persisted for half a year, and had undergone peri-ulcerative traffic vein suture ligation, and the sutures were removed.
Two weeks after the punctiform skin graft, all the punctiform skin pieces were viable.
New epithelium had grown around the punctate skin pieces and fused with each other, and the wound surface had been significantly reduced.
The ulcer was completely healed 40 days after admission.
No recurrence of the ulcer was observed at the postoperative follow-up of 3 months.
Patient 5 had multiple ulcers of the lower leg caused by saphenous varicose vein and diabetes mellitus, with necrotic tissue and purulent exudate visible on the surface and marked erythema of the surrounding tissues, which persisted for 3 months.
One week after local antimicrobial change, active anti-infection and control of diabetes, the ulcers were smaller than before, the wound surface was neat and fresh, and the redness and swelling of the surrounding tissues were significantly reduced than before.
One week after saphenous vein ligation and stripping and suturing of peri-ulcerous tissues, the ulcers were significantly smaller than before and were about to heal completely.
Nineteen days after the patient was admitted to the hospital, all the ulcers of the affected limb were completely healed, and the redness and swelling of the surrounding tissues had completely subsided.
Patient 6 Chronic ulcers of the lower leg that appeared after surgery for saphenous varicose vein in an external hospital had been persistent for more than six months.
After local antimicrobial dressing change and suturing of peri-ulcerous tissues, the ulcer wound was significantly smaller than before, and the wound surface was neat and freshly granulated.
The right calf ulcer was completely healed 21 days after admission.
Patient 7 had a chronic giant ulcer on the left calf that had persisted for two years.
In the same patient, two weeks after admission, the wound surface was neat and the granulation was fresh after local antimicrobial dressing change.
In the same patient, two weeks after admission, a medium-thickness skin slice free implant was performed (intraoperative).
In the same patient, two weeks after surgery, most of the implanted skin pieces were viable, and the residual wound was neat and fresh granulation.
In the same patient, 3 weeks after surgery, the ulcer wound was basically healed.
Two weeks after surgery, the left thigh skin donor wound was healed at grade A.