MODERN APPROACHES TO THE TREATMENT OF TROPHIC ULCERS VENOUS ETIOLOGY. PHOTODYNAMIC THERAPY

Abstract

Chronic venous insufficiency, which is the cause and complication of most diseases of the lower extremities, is a fundamental cause of trophic ulcers. During the last decade, some progress has been made in addressing venous trophic ulcers both theoretically and practically. The modern concept of treatment of patients with trophic ulcers of venous origin suggests a reasonable combination of the following treatment methods: local, compressive, as well as medicinal, surgical, low-invasive and additional methods (physiotherapy, photodynamic and others). The main goal of treatment is to eliminate the ulcerative defect, after which measures are taken to correct the root cause (chronic venous insufficiency) and prevent recurrence. However, the most successful treatment of patients with trophic venous ulcers is still not defined and needs further improvement. In particular, the method of photodynamic therapy using special pharmacokinetics photosensitizers deserves to be studied and its prospects for clinical use extended. The mechanism of photodynamic action is based on the ability of photosensitizers to accumulate in microbial and pathological cells. Under local light exposure, the photosensitiser becomes excited and charges oxygen associated with erythrocyte hemoglobin. Thus, in the cells under exposure, a photochemical reaction is initiated that produces singlet oxygen and its free radicals. Active oxygen forms, in turn, have a damaging effect on pathogenic flora and necrotic tissues. The main advantages of the method are relative simplicity, no risk of developing antibiotic resistance, acceleration of regenerative processes, prevention of secondary infection. Thus, photodynamic therapy allows to optimize local treatment and pre-operative preparation of patients with venous trophic ulcers non-invasively, safely and effectively.