1. Introduction and Background
insufficiency of the venous valves, ischemia, ulcers, atherosclerotic, numbness, pain, gangrene, infection, atherosclerotic ischemia, chronic arterial ulcers, atherosclerosis, ulcer, Atherosclerotic
HEALING ULCERS, LEG ULCERS, ISCHEMIA, DISEASE, ARTERIAL LEG ULCERS, ULCERS, GANGRENE, DISORDERS, VENOUS ULCERS, CHRONIC LEG ULCERS, INFECTION, SECONDARY, ARTERIAL ULCER, WOUND INFECTIONS, ATHEROSCLEROSIS, ULCER, COMPLICATIONS
Leg ulcers are a very serious worldwide medical problem. When the ulcer is extensive and deep the prognosis is usually unfavorable. The treatment requires comprehensive solutions that take into account modern specialized medical dressings, and more and more often, selected methods in the field of physical medicine. The study included 30 patients (13 women—43.4% and 17 men—56.6%) with chronic arterial ulcers of the lower limbs. The mean age of the treated patients was 65.63 ± 8.77 years. Patients were randomly assigned to two study groups. In group 1 (16 patients), specialist ATRAUMAN Ag medical dressings and local hyperbaric oxygen therapy treatments were used. In group 2 (14 patients), only specialized ATRAUMAN Ag dressings were used. The treatment was carried out for 4 weeks. The progress of healing ulcers was assessed by using the planimetric method, while the intensity of pain ailments was assessed by the visual analog VAS scale. In both study groups, a statistically significant reduction in the mean surface area of the treated ulcers was obtained, respectively, from 8.53 ± 1.71 cmLeg ulcers, regardless of their etiology, require urgent and multidirectional therapeutic treatment in each case. Patients with lower limb ulcers are at a very high risk of complications from the vascular system and the consequent need to amputate the limbs [The most common type of chronic leg ulcers is venous ulcers caused by excessive pressure in the venous system and an insufficiency of the venous valves. Arterial ulcers are next in frequency, with atherosclerosis being the most common cause. The disease is diagnosed annually in about 40.000 patients. The incidence of atherosclerosis is four times higher in men than in women and the clinical symptoms of atherosclerotic changes are most often visible between 50 and 60 years of age. Despite the intensive development of medicine, the etiopathogenesis of this disease is still not fully understood [The Incidence of arterial ulcers of the lower limbs is estimated in Europe and the United States at 500–1000 new cases per million inhabitants per year, and their incidence is 1.3–2.3% of the population [Atherosclerotic changes cause difficult blood flow in blood vessels and hemodynamic disorders. One of the three main clinical manifestations is atherosclerotic ischemia of the lower limbs, which, in the advanced stage of the disease, may take the form of critical ischemia of the lower limbs. The basic cause is usually the occlusion of large arteries, which gradually reduces the blood supply to the peripheral structures of the limbs at rest, as a result of which, their supply of nutrients is significantly reduced, causing very severe pain, a numbness of the limbs, and difficulty in moving. A reduced blood perfusion leads to changes in the microcirculation and is manifested by foot pain, trophic changes in the skin, non-healing ulcers, or tissue gangrene [The basic methods of the atherosclerosis treatment of the lower limbs are in fact vascular revascularization and endovascular procedures [In the last twenty years, there have been reports in the literature on the use of innovative non-pharmacological methods on the treatment chronic wounds, also used in the treatment of leg ulcers. In addition to the outer cover of wounds, these methods stimulate the natural processes of tissue regeneration, provide the right environment for the healing process, and protect the inside of the wound against the development of infection. Other (alternative) methods of therapy include negative pressure wound therapy (NPWT)—which is also increasingly used—platelet-rich plasma and cellular growth factors, selected methods of physical medicine (low-energy lasers, high-voltage electrostimulation, magnetotherapy, magnetostimulation, ultrasound, deep oscillation treatments, vibroacoustic therapy, ozone therapy), and dressings containing silver with antibacterial and antifungal properties. As a result of the content of active ingredients, such as absorption gels or sodium hyaluronate, modern dressings also create optimal conditions around wounds, favoring the intensification of the healing process. They also play an important role in wound cleaning. Wound cleaning is a very important element of the therapy that affects the course of the healing process. This requires carrying out specific procedures or treatments related to their cleaning, exudating removal. Modern dressings used in the treatment of ulcers are classified as so-called active dressings, i.e., those that support the healing process of ulcers. Firstly, modern dressings maintain a moist wound environment, optimize the level of exudate typical of chronic wounds (balance the enzyme/inhibitor ratio, reduce the concentration of pro-inflammatory cytokines, increase the availability of growth factors and nutrients in the wound), protect the wound from bacterial access, and ensure proper exchange of gaseous and optimal constant temperature without increasing the risk of infection. Such conditions are conducive to biological processes and facilitate cell division, migration, and differentiation, regulate enzymatic activity, and accelerate the reconstruction of protective layers of the epithelium, stimulating granulation. It is also important to isolate and protect the wound against the harmful effects of external factors. The dressing may adhere to the wound surface, but it should be easy to remove from the wound (without damaging the newly formed granulation tissue). It should also have sorption properties and prevent secondary wound infections. Currently, the raw material used in specialist dressings is very often ionic silver with a documented strong bactericidal effect [Among the physical methods used in the treatment of wounds of various etiologies there are also hyperbaric oxygen therapy procedures (in addition to those mentioned above) [A few years ago, hyperbaric chambers for the local application of oxygen therapy appeared on the medical market, which, while retaining all the advantages of systemic hyperbaric oxygen therapy, ensure comparable therapeutic effectiveness, and at the same time, guarantee a greater safety of therapy as they are devoid of typical side effects occurring in the case of systemic hyperbaric oxygen application. Local hyperbaric oxygen therapy also allows the treatment of those patients in whom systemic hyperbaric oxygen therapy is contraindicated for many reasons [The aim of the study was to compare the therapeutic efficacy of combined treatment, including medical active dressings and topical hyperbaric oxygen therapy versus medical active dressings applied alone in the treatment of arterial leg ulcers.