[Administration of prostaglandins Ei and immunotherapy in management of various-genesis trophic ulcers]

Abstract

Objective: To study the dynamics of the indices of microcirculation and the immune status in patients suffering from indolent trophic ulcers with the preserved arterial blood flow, as well as a possibility of treating them by means of PGEi-group preparations combined with immunocorrection.

Patients and methods: From 2002 to 2006 in the Clinic of Vascular Surgery of Municipal Clinical Hospital No 3 of the city of Chelyabinsk, we examined a total of 158 patients suffering from indolent trophic ulcers of the lower extremities with the preserved arterial blood flow (venous ulcers and cutaneous angiitis). Also studied were the immune status and tissue perfusion indices, cytology of the ulcers' surface. Treatment was carried out using <<vasaprostan>> and immunocorrecting therapy (prednisolone and delagil).

Results: At baseline, all the patients were found to have decreased indices of tissue perfusion, with a direct correlation observed between lowered tissue perfusion and the duration of lingering trophic disorders. Venous pathology and dermohypodermal angiitis were observed to be accompanied and followed by similar alterations in the immune status. Upon completion of the therapeutic course, we noted a statistically significant increase in tissue perfusion in the groups studied. Clinically noted was decreased oedema of the lower extremities, disappearance of the pain syndrome, and positive dynamics of the healing of trophic ulcerative defects. Complete epithelisation was achieved in 100% of the patients with venous insufficiency and the initial surface of the ulcer up to 60 cm2. In patients presenting with vasculitis and the baseline area of the trophic ulcer up to 38 cm2 four months after therapy ulcers were noted to epithelialize completely in 61% of cases.

Conclusion: Combined therapy of various-genesis trophic ulcers with the preserved major blood flow by prostaglandins Ei preparations (vasaprostan) and immunocorrecting preparations (prednisolone and delagil) turned out pathogenetically substantiated and clinically efficient. The authors have for the first time proposed herein using the drugs of PGEi -group in therapy of venous trophic ulcers.