Trophic ulcer according to ICD 10. Coding of a trophic ulcer of the skin in ICD

Trophic ulcers rank first in prevalence along with purulent infections. This disease is long and painful. Trophic ulcers can form on any part of the skin, but most often they form on the legs - from the foot to the knee. What you need to know about this pathology and how to treat it?

Causes of the disease

Trophic ulcers are assigned 183 ICD code 10. These are inflammatory wounds that do not heal for a long time. As a rule, they are a consequence of some pathologies. Trophic ulcers in medicine are not considered an independent disease. The causes of the disease are divided into two groups. The first group includes external irritants: frostbite, burns, radiation exposure, exposure to chemicals, bedsores.

Trophic ulcers of the lower extremities can create quite a lot of trouble, not only physical, but also psychological.

The second group includes diseases such as:

diabetes;
tuberculosis;
AIDS;
syphilis;
violation of the lymph flow;
disturbed metabolism;
spinal and brain injuries;
autoimmune diseases.

All causative factors have a common feature, namely, an insufficient supply of oxygen and nutrients. Trophic ulcers 183 ICD code 10 can be triggered by a combination of several causes from both groups. In 70% of cases, the disease is caused by pathologies associated with impaired venous blood flow. One of these pathologies is varicose veins. With varicose veins, venous blood flow is disturbed, which leads to stagnation of blood. The venous blood does not contain nutrients, so the skin does not receive useful substances for it. Under such conditions, it "starves" and gradually collapses, which leads to the appearance of wounds.

Most often, this pathology develops in the absence of adequate treatment of venous insufficiency, other diseases of the blood vessels.

The second most common cause is venous thrombosis. The lumen of the vessel narrows and because of this, the blood stagnates. At the site of thrombus formation, small superficial wounds first appear, which later turn into weeping ulcers.

Stages and types of pathology

ICD 10 trophic ulcers of the lower leg L97 occur gradually. An insufficient flow of oxygen and nutrients is observed with venous congestion. Against this background, the tissues begin to inflame. First, the inflamed skin becomes thinner and then thickens. The subcutaneous tissue becomes thicker. The skin becomes darker. In violation of tissue trophism, the protective properties of the skin are reduced. As a result - the appearance of weeping wounds on the lower extremities. Ulcers do not heal well and are prone to recurrence.

Doctors classify several degrees of trophic ulcers

Phlebologists distinguish several types of lesions:

venous;
arterial;
diabetic;
neurotrophic;
hypertonic;
pyogenic.

The venous type of ulceration is considered the most common. Often, wounds develop on the lower leg. At the initial stage of the disease, heaviness in the legs, swelling, cramps and itching appear. An enlarged vein becomes visible on the lower leg. With the progression of the disease, the veins merge into spots and acquire a purple hue. The skin becomes dry and smooth. If timely treatment is not started, then the superficial wound deepens and begins to fester. In this case, sepsis may begin.

Arterial ulcerations develop against the background of obliterating atherosclerosis. Hypothermia of the feet or wearing tight shoes can provoke the development of ulcers. Localized arterial wounds on the foot. This type of defect has a round shape, with ragged and dense edges. Arterial ulcers are painful and cause a lot of inconvenience to a person. Without treatment, the ulcers spread throughout the foot.

Diabetic wounds develop in diabetes mellitus. They are very painful. As a rule, they are often exposed to infections leading to the development of gangrene or limb amputation.

Trophic ulcer: Symptoms, features, causes

The neurotrophic type of ulceration also develops on the feet. The cause of their appearance is a trauma to the head or spine. These are deep and painful wounds. Hypertensive ulcers are formed against the background of increased heart pressure. This type is characterized by the symmetry of the lesion. Wounds develop immediately on both legs. With their appearance, a person experiences excruciating pain day and night. Pyogenic ulcers develop against a background of weakened immunity. These are oval and shallow wounds that can be located singly or in groups.

Clinical symptoms

Trophic ulcers of the lower extremities develop in stages, so the signs of pathology can be divided into two main groups:

early (pallor of the skin, itching, burning, cramps and swelling);
late (dermatitis, purulent, mucous discharge, fetid odor).

Fourth stage of varicose veins

At the initial stage of the development of the disease, the skin becomes thinner. This is due to the lack of nutrients and nutrients that are needed for its regeneration. Paleness appears due to insufficient blood volume in the capillaries.

Symptoms such as burning and itching also indicate the presence of pathological changes. These symptoms cannot be ignored. Without treatment, swelling is added to the symptoms. With stagnation of blood, the fluid goes beyond the bloodstream and accumulates in the tissues. Puffiness is usually observed in the evening. With a lack of oxygen in the tissues and nerve fibers, a person develops convulsions. They are of short duration. Hypoxia also leads to the destruction and death of tissues. The skin takes on a purple or crimson hue.

As the disease progresses, dermatitis and a superficial wound develop. This is dangerous because pathogens are able to start a chain of inflammatory processes. Wounds don't heal well. Without treatment, a purulent discharge and an unpleasant fetid odor appear.

Features of treatment

Trophic ulcers of the lower extremities are treated depending on the type of ulceration and the cause that provoked them. Treatment is prescribed on the basis of histological, bacteriological and cytological examination. A trophic leg ulcer can be treated in two ways:

Medical.
Surgical.

Conservative treatment includes taking angioprotectors (acetylsalicylic acid, Heparin), antibiotics (Levomycetin, Fuzidin), as well as drugs that stimulate tissue regeneration (Actovegin, Sulfargin). The wound surface is cleaned of pathogenic microorganisms with a solution of "potassium permanganate", "Chlorhexidine". Alternative medicine is also effective: a decoction of chamomile flowers, celandine, coltsfoot, strings.

Trophic ulcers - pathological changes in the structure of the skin - appear due to impaired venous circulation. This leads to venous insufficiency and provokes the occurrence of non-healing wounds.

What factors contribute to the development of the disease, what to do to prevent the progression of the disease and how to avoid negative consequences, we will consider further.

For ease of identification, each disease has been assigned a specific classification according to ICD-10.

Trophic ulcers of the lower extremities, the ICD-10 code (with the varicose nature of the formation) are included in class IX - diseases of the circulatory system and have their own codes:

183.0 - varicose veins of the lower extremities with an ulcer;
183.2 - varicose veins with ulcers and inflammation.

With the formation of trophic changes against the background of other factors, they are defined as class XII - diseases of the skin and subcutaneous tissue (subgroup under code L98.4.2 - trophic skin ulcer).

Types of trophic ulcers

The appearance of trophic ulcers is associated with impaired blood supply, which leads to nutritional starvation in tissues and causes their further death.

Ulcers by type of education are:

venous;
diabetic;
atherosclerotic.

Trophic skin changes occur as a result of impaired venous blood flow in the chronic form of varicose veins.

Skin lesions predominate on the inner sides of the legs, they are accompanied by such changes:

the skin of the legs becomes smooth and shiny;
there is a feeling of heaviness and swelling of the lower extremities;
night cramps occur;
dark-colored spots form on the surface of the lower leg, which over time capture large areas;
the skin itches, this leads to thinning of the skin and the formation of whitish scabs;
when combing, purulent wounds are formed.

If the treatment was not carried out on time, a small sore appears, which deepens within a few weeks, reaching the bone tissue. A complicated course of the disease can lead to blood poisoning, elephantiasis of the lower leg.

Diabetes mellitus is one of the causes of trophic ulceration. Due to the increased level of sugar in the blood, tissue trophism is disturbed, sensitivity is lost. The affected area is located mainly on the big toes.

Diabetic wounds are dangerous because bacterial infections often join them, which can lead to infection, gangrene (with subsequent amputation of the leg).

atherosclerotic ulcers

The disease predominates predominantly in the elderly, accompanied by damage to the main arteries. As a result of atherosclerosis, small wounds with purulent contents are formed, they are located on the sole, heel, on the phalanx of the thumbs and the outer part of the foot.

The onset of the disease is accompanied by lameness, soreness, chilliness. Without appropriate treatment, the wound surface captures the entire surface of the foot, which causes irreversible consequences.

Causes of the disease

The disease is chronic in nature, the following factors contribute to its occurrence:

genetic predisposition;
overweight;
vein thrombosis;
violation of venous return;
oxygen starvation of tissues;
chemical, thermal, mechanical damage to the skin;
skin diseases (eczema, dermatitis);
diabetes;
atherosclerosis;
phlebeurysm.

With a predisposition to the disease, wearing uncomfortable shoes, lifting weights, excessive physical activity can also cause trophic ulcers.

Symptoms of manifestations

The disease develops gradually (turning into a chronic form), is difficult to treat and has the following clinical signs:

the appearance of a vascular network on the lower leg;
thinning and ulceration of the skin;
the appearance of puffiness;
release of purulent contents;
redness of the leg at the site of the lesion;
increase in body temperature;
inflammatory processes (attachment of infections);
severe pain;
occurrence of bleeding.

Diagnosis of the disease

To conduct an examination and clarify the nature of the disease, people prone to the appearance of this disease should consult a phlebologist.

Diagnostics includes:

examination of the wound;
taking tests (blood and urine) to determine the level of sugar;
ultrasound examination of blood vessels;
expert advice.

Properly carried out diagnostics allows you to identify violations in the body and determine the appropriate treatment.

Treatment Methods

After the examination, the patient is prescribed a comprehensive treatment program, including taking medications:

venotonics (Detralex, Phlebodia, Troxevasin) - to improve venous outflow;
antibacterial agents (Levomekol, Actovegin, Solcoseryl, Argosulfan), which help cleanse tissues, restore and heal damaged cover;
gels and ointments (Troxerutin, Heparin, Troxevasin) to relieve inflammation, reduce swelling;
antibiotics (for infectious lesions) - used only as directed by a doctor after testing.

Additionally, physiotherapy procedures are used:

ozone therapy - helps to cleanse the surface of the wound, enhances tissue regeneration when oxygenated, prevents the spread of infection;
intravascular laser blood irradiation - relieves vasospasm, improves blood flow in damaged tissues;
magnetotherapy - allows you to clean wounds from purulent discharge, accelerate the process of granulation, eliminate ulcerative defects;
lymphatic drainage massage - improves lymph circulation, blood supply, reduces swelling;
electromyostimulation - activates tissue microcirculation due to the inflow of arterial blood to the legs.

If no improvement is observed after complex treatment, the wound surfaces occupy a significant area, then plastic surgery is required.

They are performed using the body's own tissues. A noticeable improvement occurs immediately after the operation.

Preventive actions

Constant wearing of compression products (tights, golf, stockings).
Performing a set of exercises aimed at improving blood circulation in the limbs.
Body weight control.
The use of special ointments and gels.
Use of a roller under your feet during sleep.
Compliance with the rules of personal hygiene.
Regular visits to the doctor.

Do not forget that the disease is easier to prevent than to cure. Do not self-medicate, seek medical help in a timely manner.

The International Classification of Diseases has assigned a common code to the trophic ulcer (ICD code L98.4.2). However, in accordance with the varieties of causes and course, the codes of this disease may differ.

Types of trophic ulcers

Phlebologists distinguish the following types of skin pathology:

The root causes of an ulcer determine its symptoms, course features and therapeutic measures. Takes into account these features and the international classifier of diseases.

atherosclerotic

It is a complication of atherosclerosis occurring in a severe, advanced stage. Accompanied by formations of a purulent nature, localized in the region of the lower leg and foot. In the greatest part of this form of pathology of the skin, elderly people in the age category over 65 years old are affected.

If there is a predisposition, even minor external factors can provoke the appearance of a trophic type ulcer: wearing uncomfortable shoes, increased physical activity, general hypothermia of the body. (code for atherosclerotic trophic ulcer according to ICD-10 - L98).

Hypertensive

In official medicine, it is called the Martorella syndrome. An ulcer occurs in patients suffering from hypertension, arterial hypertension occurring in the chronic stage. With steadily elevated blood pressure, papules form on the skin of a person, gradually transforming into painful ulcerative lesions.

A distinctive feature of the disease is symmetry - expressions on both legs appear simultaneously.

Trophic ulcer in diabetes mellitus

Against the background of diabetic pathology, trophic ulcers are a fairly common phenomenon. The disease develops as a result of an increased level of sugar in the blood, a violation of normal trophism, tissue nutrition, and circulatory processes.

This form of the disease is the most dangerous, because in the absence of proper timely trembling of diabetes mellitus, diabetic foot syndrome can cause blood poisoning, gangrene, and even amputation of the affected limb.

Venous trophic ulcer

It develops against the background of varicose veins due to violations of the processes of blood flow, microcirculation and blood circulation, venous insufficiency. In the absence of timely measures taken, the disease can lead to the development of sepsis, blood poisoning, arthrosis of the ankle joint.

Stages of development

A trophic ulcer on the legs develops gradually, passing through the following stages:

Appearance - the skin acquires a specific lacquer reflection. The affected area turns red and swells. Gradually, white spots form on the skin, under which scabs form. If the pathological process is provoked by infectious factors, it is possible to attach symptoms such as fever, general weakness.
Purification - at this stage, the expression itself appears, from which the contents of a purulent, bloody, purulent-mucous nature come out. The purification phase lasts about 1.5 months. The patient suffers from pain and itching.
Granulation - develops against the background of competent therapy, subject to medical recommendations. This stage is characterized by a decrease in the wound surface.
Scarring is the final healing of a skin lesion, the formation of a scar tissue structure. A long process that can drag on for several months or more, depending on the type, form, and degree of the disease.

Start off treatment trophic type ulcers are recommended in the initial stages: this increases the chances of achieving positive results and avoids numerous consequences.

Possible Complications

In the absence of timely adequate treatment of ulcers in a neglected form, they can cause the development of adverse consequences:

joining the infection;
sepsis, blood poisoning, gangrene;
oncological processes (with prolonged development of non-healing lesions of a purulent nature);
erysipelas;
damage to the joints and violation of their functional mobility;
purulent thrombophlebitis;
amputation of the affected limb.

Doctors emphasize that if trophic type ulcers are not treated, this can lead to the patient's disability or even death. To avoid such dangerous consequences, timely diagnosis and a set of recreational measures prescribed by a doctor will allow.

Treatment regimens

Therapy of trophic ulcer pathology involves, first of all, the identification of its root causes and the elimination of the underlying disease. The main method is drug therapy, but an integrated approach is also used:

Preparations for internal, oral use - are prescribed for varicose veins, diabetes, hypertension. Patients may also be recommended medications for symptomatic therapy of analgesic, antibacterial, anti-inflammatory action.
External means - ointments, gels, solutions. Ulcerative lesions are treated with antiseptics. There is a large list of drugs that have anti-inflammatory, regenerative, analgesic properties. All medicines are prescribed by a doctor depending on the stage and form of the course of the pathological process, general symptoms. The doctor also determines the regimen for the use of drugs and the optimal dosage.
Physiotherapy: radiation, magnetic exposure, laser therapy, ultraviolet radiation.

The surgical method involves the removal of the lesion, followed by cleansing, is carried out in the most severe advanced situations, when amputation of the limb may be required.

The optimal scheme of the therapeutic course is prescribed by the attending physician on an individual basis. Folk remedies are used only as an auxiliary element of complex treatment.

Prevention

To prevent the appearance of trophic ulcers, the following recommendations must be observed:

balanced diet;
timely treatment of provoking diseases;
the use of venotonic ointments and gels;
quitting smoking and alcohol abuse.

Trophic ulcers have many varieties and forms, causes. However, this pathology progresses rapidly and can lead to a number of complications, and therefore requires proper, comprehensive treatment.

Trophic ulcer of the lower extremities - according to ICD-10

A trophic ulcer is a purulent wound. Most often, it appears on the lower extremities, namely, on the lower leg or foot. This disease progresses rapidly and prevents the patient from leading a full life. Without proper treatment, a trophic defect can lead to serious consequences.

Causes

According to the International Classification of Diseases (ICD 10), trophic ulcers have the code L98.4. The development of purulent wounds is associated with a violation of normal blood flow, a lack of oxygen and nutrients in the tissues. Trophic ulcers of the lower extremities develop against the background of:

Trophic ulcer is listed in the ICD-10 classifier and has the code L98.4

violations of lymphatic drainage;
arterial diseases (thrombangiitis, Martorel's syndrome, macroangiopathy and atherosclerosis obliterans);
injuries;
skin damage.

Trophic wounds, according to ICD 10, can develop against the background of diabetes mellitus or autoimmune diseases. The causative factor may be kidney disease, liver disease, heart disease or excess weight.

Purulent formations can develop for various reasons. They do not act as an independent disease and are always the result of the harmful effects of the external and internal environment. Trophic defects are presented as a special form of soft tissue damage. As a result, wounds do not heal well. A complete diagnosis allows you to identify the root cause of the development of ulcers. Without an appropriate examination, therapy does not bring the desired result.

Trophic formations can be hereditary. In this case, the weakness of the connective tissue and the formation of the leaflets of the venous valves by it is transmitted from close relatives.

Trophic ulcers are purulent wounds that occur on human skin as a result of a number of reasons.

In medical practice, trophic defects according to ICD 10 have several types:

Varicose veins without treatment leads to the development of chronic venous insufficiency. Blood circulation in the lower extremities is disturbed. As a result, tissue nutrition deteriorates. The first symptoms of insufficiency are a feeling of heaviness and pain in the legs. Over time, cramps and swelling appear. The skin becomes dark brown in color. Against the background of these changes, weeping wounds form in the lowest parts of the limbs. In the affected area, stagnation of blood is observed. Tissues do not receive proper nutrition and accumulate toxic substances in themselves. The venous wound is accompanied by skin itching. When injured, the trophic ulcer increases and does not heal.

Arterial defects develop as a result of tissue necrosis and impaired arterial blood flow in the lower extremities. If medical care is not provided to the patient in a timely manner, then the affected limb can rarely be saved.

Arterial purulent formations mainly appear on the nail phalanges, foot, heel or fingers. Purulent wounds have uneven borders. The bottom of the ulcers is covered with fibrinous plaque.

The problem can occur in any area of the body, but most often affects the feet, lower legs

The pyogenic type develops as a result of infection. Most often it is formed on the lower leg. Purulent defects are caused by hemolytic streptococci, staphylococci or Escherichia coli. Pyogenic ulcers are not deep, with a flat bottom, covered with a scab. They never get crusty. To the touch, purulent wounds are soft and painful.

The diabetic type is a complication of type 2 diabetes. Trophic formations appear in places of strong friction. The feet and ankles are most commonly affected. The ulcer has a purulent discharge. When a bacterium or infection is attached, purulent elements may increase in size.

Stages of development

The trophic ulcer of the lower leg has four stages of development:

It is very important to recognize the disease in time and not to start it, but to start timely treatment.

A rapid increase in a purulent defect can cause a microbial infection. Symptoms include fever, chills, and general weakness. With the formation of several defects, the ulcers merge into one large one. Such changes can be accompanied by severe pain and high body temperature.

The last phase can last several months. The healing process is long. Whitish areas of young skin are formed on the wound surface. The scarring process begins.

The main reason why trophic ulcers form on the body (according to the ICD-10 classification) is a violation of normal blood circulation

Trophic ulcers with ICD code 10 L98.4 progress rapidly, therefore, in order to avoid serious complications, it is necessary to start treatment immediately. Possible complications that can be fatal include sepsis, gangrene, or skin cancer.

Therapy

Treatment is prescribed for each patient strictly individually. Before proceeding with treatment, the root cause and type of defect should be identified. For this purpose, doctors conduct a bacteriological, histological and cytological examination. Treatment includes:

drug therapy;
surgical intervention.

At the initial stage of the development of a purulent wound, doctors prescribe antibiotics, anti-inflammatory drugs (Diclofenac, Ketoprofen), antiallergic drugs (Suprastin, Tavegil) and antiplatelet agents (Reopoglyukin and Pentoxifylline).

Conservative treatment includes cleansing the wound surface from pathogenic bacteria. Purulent formations are washed with a solution of potassium permanganate, chlorhexidine. As an antiseptic at home, you can prepare a decoction of chamomile, string or celandine. After treating the wound, a therapeutic bandage based on Levomekol or Dioxicol should be applied.

Physiotherapy will help to strengthen the result of local treatment. Effective is ultraviolet irradiation, laser and magnetic therapy. Physiotherapy procedures will relieve swelling, expand blood vessels and stimulate epidermal cells to regenerate.

With the ineffectiveness of drug therapy, doctors are forced to resort to radical methods of treatment. In modern medicine, vacuum therapy is carried out. The principle of treatment is the use of special sponge dressings. With the help of low pressure, sponge dressings remove purulent exudate from the wound, which leads to a decrease in edema and restoration of blood microcirculation in soft tissues. With large areas of damage, skin grafting is performed from the thighs or buttocks.

Trophic leg ulcers: symptoms, photo stages

Causes

Venous insufficiency. Deep vein thrombosis of the lower extremities and varicose veins can lead to the formation of trophic ulcers on the lower leg.
arterial insufficiency. Ulcers on the feet occur due to thromboangiitis and atherosclerosis.
Diabetes. Pathological processes caused by impaired carbohydrate metabolism lead to diabetic foot syndrome.
Infection of the integumentary tissue with reduced immune protection.
Diseases and injuries of the spine, neurological diseases.

Symptoms

Symptoms of a trophic ulcer appear sequentially:

Feeling of heaviness, increased swelling and night cramps in the limbs, burning, itching and manifestation of dermatitis or eczema, as well as lymphostasis. The skin in the affected area thickens, soreness appears.
The manifestation of a pre-ulcerative condition is atrophy of the epidermis.
Ulcerative lesions of deep tissue layers with a sharp increase in pain.

Remember that a trophic ulcer is chronic and has the ability to degenerate into a malignant formation!

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Diagnostics

The Center for Modern Surgery offers the whole range of diagnostic methods for detecting trophic ulcers, from the clinical minimum of analyzes to high-precision methods, such as:

Duplex ultrasound scanning of arteries and veins.
X-ray examination of the affected limb.

Trophic ulcer on the leg symptoms in the photo

Treatment at the Center for Modern Surgery

The process of treating the disease poses a number of complex tasks for the doctor, requiring an integrated approach, which requires:

Take measures to eliminate or minimize the manifestation of the disease that led to the formation of the ulcer.
Fight secondary infection.
Treat the trophic ulcer itself.

In the fight against a trophic ulcer, our phlebologists use conservative therapy and surgical treatment.

Drawing up a treatment program requires a strictly individual approach to each patient. This is a labor-intensive process, which can only be handled by highly qualified specialists.

Our Center employs professionals who can help people get rid of such a serious illness, which is confirmed by hundreds of grateful patients.

Trophic ulcer on the leg

A trophic ulcer on the leg is a defect in the skin and surrounding tissues, which is accompanied by inflammation. This deep, wet, purulent wound does not heal for six or more weeks. Trophic ulcers of the lower extremities appear due to impaired blood supply and nutrition of keratinocytes (epidermal cells).

Trophic ulcer according to ICD-10

ICD 10 (International Classification of Diseases, Tenth Revision) was developed by WHO (World Health Organization). It is used for coding and deciphering medical diagnoses. Trophic ulcer code according to ICD-10 - L98.4.2.

What does a trophic ulcer look like

deep veins of the lower extremities

A trophic ulcer in the photo may look different. This skin defect changes appearance depending on the duration of the pathological process. First, swelling appears on the leg. Then - bluish spots, eventually transforming into several small sores.

If the process is started, they will merge together and one large skin ulcer will appear. The wound often exudes an unpleasant odor.

A trophic ulcer on the leg is festering and bleeding (see photo).

Symptoms

Early signs of the development of pathology include:

swelling of the legs (especially after drinking a large amount of liquid, waking up, sitting in one place for a long time);
heaviness in the legs (first in the evenings, due to physical exertion, then in the mornings);
painful cramps, concentrating in the calf muscle (mainly at night);
skin itching;
local fever (at the site of the ulcer), burning.

As the disease progresses, the following symptoms are observed:

thin tortuous veins visible through the skin;
shine, bluish pigmentation of the skin;
skin thickening;
pain in the affected area;
droplets on the surface of the skin (due to impaired lymphatic drainage).

Stages of a trophic ulcer

There are four stages in the development of pathology:

Stage of emergence and progression. The skin turns red, shiny, swells, oozes drops of lymph, then turns white. White spots indicate tissue necrosis. Then a scab forms on the skin, increasing in size. A burgundy weeping trophic ulcer (or several) appears. The duration of the initial stage is from 3-4 hours to several weeks. The onset of an ulcer is usually accompanied by weakness, fever, chills, severe pain, fever, and incoordination.
Cleansing stage. The formed ulcer acquires round edges, bleeds, fester, exudes an unpleasant odor.
Scarring stage. Pink spots appear on the surface of the ulcer, eventually transforming into young skin. The area of the wound decreases, scars appear on its surface. With improper treatment, the process can return to the initial stage.
Stage of granulation and epithelialization. Takes several months. As a result, complete healing of trophic ulcers occurs.

A trophic ulcer on the arm has the same stages of development.

Trophic ulcer on the leg photo

Wound coloring

Trophic ulcers of the lower extremities in the photo may have a different color. Coloring tells about the nature of the trophic ulcer and determines the tactics of treatment:

A dark red wound indicates an infection;
Pink color indicates that healing of trophic ulcers on the legs is taking place.
A yellow, gray or black trophic ulcer indicates the chronic nature of the pathology.

Types of trophic ulcers

The most common trophic ulcers are:

atherosclerotic ulcers

Pathology develops mainly in the elderly: against the background of obliterating atherosclerosis, due to ischemia of the soft tissues of the lower leg. An arterial trophic ulcer is located on the heel, sole, distal (final) phalanx of the thumb, on the foot (on the outside). In the presence of such wounds, the legs hurt and get cold at night. The skin around the ulcers turns yellow. Pathology results from

hypothermia of the lower extremities;
foot skin injuries;
wearing tight shoes.

Atherosclerotic trophic foot ulcers are small in size, round in shape, compacted with uneven edges, and purulent contents. Their imminent appearance can be predicted by the presence of intermittent claudication in the patient. When the process is running, wounds occur on the entire surface of the foot.

Trophic ulcer on the leg with diabetes mellitus

Such a trophic ulcer is similar to an arterial ulcer in terms of symptoms and appearance, but has two significant differences:

its appearance is not preceded by intermittent claudication;
the wound is deeper and bigger.

A trophic ulcer in diabetes mellitus most often occurs on the thumb. Of all trophic ulcers, diabetic ulcers are the most vulnerable to infections, and therefore can lead to the development of gangrene and amputation of the lower limb.

Venous trophic ulcer

Such a trophic ulcer often occurs with varicose veins (symptoms), due to impaired blood circulation in the legs. It is localized on the lower leg, usually on its inner side, from below. Sometimes occurs on the back or outer surface.

Prevention

Trophic ulcers never appear on their own. They are always preceded by other diseases. It is necessary to regularly visit a doctor and monitor the course of existing pathologies, in particular

In the presence of the above diseases, it is important to follow all the recommendations of the doctor.

In addition, it is necessary

protect your feet from exposure to low temperatures and sunlight;
beware of injuries (and if you receive any, contact the clinic immediately).

Ointment for trophic ulcers

There are folk recipes for ointment for the healing of trophic ulcers. Under no circumstances should you use them! Self-medication can lead to the progression of pathology and dangerous complications. You should consult a doctor for qualified medical assistance. Ointment from trophic ulcers on the legs is not recommended to be used alone. There may be a blockage of the wound, as a result of which it cannot be cleaned. This will lead to erysipelas.

How to smear a trophic ulcer? The wounds are washed with warm water using laundry soap, then an antiseptic agent for trophic ulcers is used (solution of miramistin, dioxin, chlorhexidine, boric acid).

Tablets for trophic ulcers

Such remedies for trophic ulcers on the legs are also taken only as directed by a doctor. Self-administration of painkillers and antibiotics can aggravate the course of the pathology and cause complications. For example, if it is unreasonable to take an antibiotic for a trophic ulcer, microorganisms resistant to its effects may appear in the wound. Also, uncontrolled medication can lead to the development of severe allergies.

Treatment

Improper treatment and treatment of a trophic ulcer or lack of therapy leads to complications:

the transition of the disease to a chronic form;
the spread of purulent-inflammatory processes in muscles and bones;
the occurrence of gangrene;
the development of sepsis;
erysipelas;
lymphadenitis;
malignant transformation.

More about treatment!

At the Center for Modern Surgery, you will be prescribed an individual course of complex treatment, which will help reduce the time for wound healing and avoid the development of complications.

Trophic ulcer: classification and code according to ICD-10

The disease is listed in the International Classification of Diseases of the 10th revision of ICD-10. Due to the large number of etiological factors that can lead to the development of a necrotic process, according to the ICD, the code for a trophic ulcer can be in different headings.

All variants of the ICD 10 code for a trophic ulcer on the leg

E11.5 - with non-insulin dependent diabetes;

E12.5 - with diabetes with malnutrition;

E13.5 - with other forms;

E14.5 - with unspecified diabetes mellitus.

In the international classification, trophic ulcers of the lower extremities are classified as diseases of the skin and subcutaneous tissue. In this category, trophic ulcers belong to other diseases, i.e. not included in the rest of the classification. There are nineteen sections in the subclass, listing various nutritional disorders and skin pigmentation that are not included in the classification in the other subclasses.

The section to which trophic ulcers belong is L98, diseases not included in other sections.

Subsection L98.4 Chronic skin ulcer, not elsewhere classified. But this is the classification of an ulcer if its cause is not established.

A trophic ulcer with varicose veins has a completely different classification. Varicose veins belong to the class of diseases of the circulatory system, a subclass of diseases of the veins and lymphatic vessels.

For varicose veins of the lower extremities, a separate section I83 has been allocated, which includes four different variants of the course of the disease, including I83.0 - varicose veins complicated by an ulcer, and I83.2 - varicose veins complicated by an ulcer and inflammation. Varicose veins with only inflammation but no ulcer are reported as I83.1 and uncomplicated varices as I83.3.

Stages of development

Appearance
cleansing
Granulation
Scarring

The initial stage is characterized by the appearance of "lacquered" skin. There is redness and swelling. Liquid seeps through the "lacquered" skin. Over time, dead skin areas form whitish spots, under which a scab forms. The first stage can last for several weeks.

At the second stage of development, the ulcer has a bloody or mucopurulent discharge. If it has an unpleasant pungent odor, then this indicates the presence of an infection. At the stage of cleansing, itching appears. As a rule, the second stage lasts about 1-1.5 months.

The healing process of a trophic wound depends on the quality of treatment. Subject to all the doctor's recommendations, nutrition and tissue repair in the area of the ulcer is enhanced. Otherwise, a relapse occurs. Repeated trophic wounds respond worse to treatment. In the third stage, the wound surface begins to decrease.

Features of treatment

Causes of the disease

Trophic ulcers of the lower extremities can create quite a lot of trouble, not only physical, but also psychological.

The second group includes diseases such as:

diabetes;
tuberculosis;
AIDS;
syphilis;
violation of the lymph flow;
disturbed metabolism;
spinal and brain injuries;
autoimmune diseases.

Most often, this pathology develops in the absence of adequate treatment of venous insufficiency, other diseases of the blood vessels.

The second most common cause is venous thrombosis. The lumen of the vessel narrows and because of this, the blood stagnates. At the site of thrombus formation, small superficial wounds first appear, which later turn into weeping ulcers.

Stages and types of pathology

Doctors classify several degrees of trophic ulcers

Phlebologists distinguish several types of lesions:

Arterial ulcerations develop against the background of obliterating atherosclerosis. Hypothermia of the feet or wearing tight shoes can provoke the development of ulcers. Localized arterial wounds on the foot. This type of defect has a round shape, with ragged and dense edges. Arterial ulcers are painful and cause a lot of inconvenience to a person. Without treatment, the ulcers spread throughout the foot.

Diabetic wounds develop in diabetes mellitus. They are very painful. As a rule, they are often exposed to infections leading to the development of gangrene or limb amputation.

Trophic ulcer: Symptoms, features, causes

Clinical symptoms

Trophic ulcers of the lower extremities develop in stages, so the signs of pathology can be divided into two main groups:

early (pallor of the skin, itching, burning, cramps and swelling);
late (dermatitis, purulent, mucous discharge, fetid odor).

Fourth stage of varicose veins

As the disease progresses, dermatitis and a superficial wound develop. This is dangerous because pathogens are able to start a chain of inflammatory processes. Wounds don't heal well. Without treatment, a purulent discharge and an unpleasant fetid odor appear.

Features of treatment

To speed up the healing process, drug treatment is carried out in combination with physiotherapy. Ultraviolet irradiation, laser and magnetic therapy have proven themselves well. Physiotherapy relieves swelling, dilates blood vessels and activates cells for regeneration.

In advanced stages, surgical intervention is effective. There are several ways to excise dead tissue and remove inflammation. These methods include vacuum therapy and the catherization method.

Causes and treatment of trophic ulcers on the leg

Such an ailment as a trophic ulcer on the leg is observed in more than two million patients worldwide. This disease is characterized by deep damage to skin tissues and is accompanied by an inflammatory process. If timely treatment is carried out, it is often possible to achieve positive results. Despite all the advances in medicine, the treatment of the disease continues to be a complex process. Even if the trophic ulcers of the lower extremities heal, there is a certain destruction of tissues, and a rather large scar remains at the site of the lesion.

Problems in the treatment of trophic lesions are due precisely to trophism (lack of cell nutrition). This contributes to a decrease in protective capabilities and some loss of recovery abilities. It is from this concept that the name of the disease originated.

Types of trophic ulcers

Trophic ulcers were also included in the international classifier of diseases ICD 10. In the classifier ICD 10, diseases of this type are assigned to the twelfth class. The specialists developing ICD 10 placed trophic ulcers between L80 and L99. However, in ICD 10 you can find another code corresponding to these lesions. So, code I83.0 according to ICD 10 corresponds to an ulcer with varicose veins. The ICD 10 classification of diseases greatly facilitates the work of doctors, because thanks to it it is enough to simply determine the disease code, and referring to it, prescribe drugs and prescribe treatment.

Trophic lesions can be divided into several types, but they all develop as a result of impaired blood supply, lack of nutrition and subsequent tissue death. But the reasons that led to changes in blood supply may be different, which allows us to classify ulcers as follows:

Venous lesions usually affect the lower legs, with the symptoms mainly being observed at the bottom of the internal part, the remaining parts are practically not affected. The reasons for the development are a deterioration in blood flow, in some cases a complication of varicose veins. Before the formation of ulcers, such symptoms usually appear.

There is a feeling of heaviness in the calf, swelling is possible.
There are night cramps.
There is itching of the skin, a network of thickened veins may appear on the calf.
The merging of the veins begins, which subsequently looks like a purple spot, which gradually begins to capture a large area. A color change occurs, the spot may turn purple.
With the development of pathology, the skin thickens, which becomes smoother and shinier.

The initial stage of the disease ends with the appearance of white clamps, which looks like paraffin flakes. If treatment is not started after these symptoms are identified, then skin changes will gradually appear in small sores, which begin to progress over time. Tissue damage will gradually affect the skin, muscles, tendon and periosteum. Pus with an unpleasant odor will begin to stand out from the ulcer.

If a venous trophic ulcer is treated late or incorrectly, then there is a risk of developing more serious diseases, which can result in irreversible disorders. In some cases, tissue damage leads to the development of sepsis and death of the patient.

Arterial and diabetic ulcers

Such a violation of the tissues of the lower leg, as an arterial trophic ulcer, is observed with progressive ischemia, the causes of which lie in obliterating atherosclerosis that affects the main arteries. The most common cause that provokes the appearance of this type of trophism is hypothermia of the legs and skin damage. These ulcers are usually located on the soles or outer part of the foot. They are small, semicircular dimples filled with pus, while their edges are compacted, and changes are visible on the surrounding skin: it acquires a pale yellow color.

In most cases, the symptoms of atherosclerotic tissue lesions are observed in the elderly. The appearance of such lesions is preceded by a slight intermittent claudication, rapid onset of fatigue and a feeling of coldness in the legs. If the disease is not treated already at this stage, then the appearance of ulcers will not have to be expected for a long time, as well as their growth on the entire foot.

Diabetic ulcers are a consequence of diabetes mellitus, which can provoke the development of many complications. The formation of such an ulcer begins with a decrease in the sensitivity of the tissues of the legs, which occurs due to the death of some part of the nerve endings. After a while, a fairly short time, night pains appear.

Symptoms are very similar to arterial lesions. The only difference is the absence of intermittent claudication. Such ulcers appear mainly on the toes, but the rest of the foot can also be affected. In contrast to the arterial ulcer in these trophic lesions, tissue disorders penetrate more deeply, and the wound is large.

The main danger of diabetic ulcers is that their consequence, of course, if left untreated, often becomes the development of gangrene, leading to the need for amputation.

Neurotrophic and pyogenic ulcers

The causes that result in the occurrence of neurotrophic ulcers on the legs are injuries of the spine and head. These wounds are mainly affected by the surface of the heels, their lateral surfaces or the sole. Pathologies have the appearance of deep craters, sometimes reaching the bone. The external dimensions of such ulcers are quite small, the violation of the skin can be quite small. In the wounds, there is always an accumulation of pus, which emits an unpleasant odor. Damage to the tissues in the area of the ulcer leads to a decrease or even loss of sensitivity. Treatment should begin as soon as possible after diagnosis.

Hypertensive ulcers are relatively rare. Their formation is provoked by constant increased pressure, causing hyalinosis and spasm of the walls of blood vessels. Initially, a red papule appears, which has a slight soreness. The development of the disease causes skin disorders and ulceration. Usually hypertensive ulcers appear symmetrically, almost simultaneously on both legs. The resulting lesions develop extremely slowly, with severe and constant pain. These trophic disorders have a high risk of bacterial infection.

The prevalence of different types of ulcers among the population

Pyogenic ulcers are formed due to a decrease in immunity, which is caused by various purulent formations. Most often, tissue damage occurs due to insufficient compliance with hygiene requirements, therefore, people of low social culture are mainly affected. Usually the wounds have a shallow depth and are located both in groups and singly.

Hypertensive trophic lesions are more often diagnosed in women over the age of forty.

Treatment of leg injuries

Treatment of trophic lesions of the legs is carried out strictly individually. Each patient has to be treated differently, depending on the cause of the ulcer. Therefore, it is extremely important to make a correct diagnosis before starting treatment. Although the disease code according to ICD 10 can almost coincide, there can be quite a few reasons that provoke the development of ulcers. For accurate diagnosis, doctors resort to various types of studies (cytology, histology, bacteriology, etc.). In addition, instrumental diagnostics are often used.

Doctors begin to treat trophic ulcers only after making an accurate diagnosis. These ulcers can be treated medically or surgically. Treatment also includes local treatment, which cleans the ulcer from pus, removes necrotic tissues, antiseptic treatment and the application of ointments for better scarring. In this case, occasionally, after local treatment, bleeding may occur, which is stopped by standard procedures. Surgical treatment involves excision of necrotic tissue and excision of the focus of inflammation. There are various methods of surgical treatment, but minor bleeding occurs in almost all cases.

Some forms of trophic ulcers, of mild and moderate degrees of development, can be treated exclusively with drugs. If trophism is treated with medicines, then the process must be divided into several stages, which will be directly determined by the stage of the disease.

Symptoms and treatment of trophic ulcers of the lower extremities, ICD code 10

A disease such as a trophic ulcer (ICD 10 code L98.4.2) is a defect in the mucous membrane and skin, which is characterized by a chronic course, accompanied by spontaneous remissions and relapses. Among the many diseases of a purulent-necrotic nature, trophic ulcers occupy a special position, since they are the most common and, at the same time, are extremely difficult to treat.

Etiology and pathogenesis of the development of the disease

The main reason for the development of trophic defects is a violation of blood circulation, as a result of which the tissues cease to receive the necessary amount of oxygen and nutrients. There is a fairly complete classification of such ulcers depending on the etiology of tissue damage. Thus, there are a lot of reasons for the appearance of trophic ulcers:

A combination of adverse factors can contribute to the appearance of purulent defects, and it is important to determine the root cause, since only in this case can a full-fledged therapy be prescribed. It should be noted that trophic defects are a special form of soft tissue damage, in which the resulting wounds do not heal for a long time. This condition is not an independent disease and always develops against the background of other negative factors of the external and internal environment.

Pathological manifestations

Considering that trophic ulcers are, as a rule, the most severe complication of primary diseases, it is very important for patients to recognize the formation of such a skin defect in a timely manner. The main symptoms of the formation of such a pathology include:

spasms and swelling of tissues;
pain sensations;
chills;
vascular network;
thinning of the skin;
dark spots;
hematomas;
hypersensitivity;
compaction of soft tissues;
characteristic brilliance;
inflammation of the subcutaneous tissue;
increase in local temperature;
the performance of lymph drops;
exfoliation of the epidermal layer;
purulent discharge.

After therapy and healing of the wound, there is a risk of reappearance of the skin defect. At the site of such damage, a rather thin layer of skin is formed, and under it there is almost no fat layer. Depending on the severity of the course, even with proper therapy, symptoms of muscle atrophy can be observed, which predisposes to the appearance of a new focus for the development of a skin defect.

Diagnostics and therapeutic measures

Treatment of trophic ulcers is primarily aimed at treating the underlying disease. Complex therapy involves the use of drugs for both internal use and for local treatment of the wound surface. Among other things, drugs can be prescribed for:

improve blood circulation;
normalization of trophism;
reducing the risk of bacterial damage to the wound surface;
increase the speed of regeneration;
relief of pain syndrome.

To restore tissues and reduce the risk of re-formation of a trophic ulcer, a number of physiotherapeutic procedures are required.

After tissue regeneration, it is very important for a person to follow the rules of hygiene and follow the doctor's recommendations in order to prevent a relapse.

Other diseases of the skin and subcutaneous tissue (L80-L99)

Excluded:

birthmark NOS (Q82.5)
nevus - see alphabetical index
Peutz-Gigers (Touraine) syndrome (Q85.8)

Dermatosis papular black

Confluent and reticular papillomatosis

Wedge-shaped callus (clavus)

Follicular keratosis due to vitamin A deficiency (E50.8+)

Xeroderma due to vitamin A deficiency (E50.8+)

Excludes: gangrenous dermatitis (L08.0)

Plaster cast ulcer

Note. For several localizations with different stages, only one code is assigned, indicating the highest stage.

Excludes: decubital (trophic) cervical ulcer (N86)

If necessary, to identify the drug that caused the lesion, use an additional external cause code (class XX).

Excluded:

creeping angioma (L81.7)
Henoch-Schonlein purpura (D69.0)
hypersensitivity angiitis (M31.0)
panniculitis:
- NOS (M79.3)
- lupus (L93.2)
- neck and back (M54.0)
- recurrent (Weber-Christian) (M35.6)
polyarteritis nodosa (M30.0)
rheumatoid vasculitis (M05.2)
serum sickness (T80.6)
urticaria (L50.-)
Wegener's granulomatosis (M31.3)

Excluded:

decubital [pressure] ulcer and pressure sore (L89.-)
gangrene (R02)
skin infections (L00-L08)
specific infections classified under A00-B99
varicose ulcer (I83.0, I83.2)

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to contact medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

All variants of the ICD 10 code for a trophic ulcer on the leg

The section to which trophic ulcers belong is L98, diseases not included in other sections.

Subsection L98.4 Chronic skin ulcer, not elsewhere classified. But this is the classification of an ulcer if its cause is not established.

Stages of development

Appearance
cleansing
Granulation
Scarring

initial stage characterized by the appearance of "lacquered" skin. There is redness and swelling. Liquid seeps through the "lacquered" skin. Over time, dead skin areas form whitish spots, under which a scab forms. The first stage can last for several weeks.

At the second stage development of an ulcer has a bloody or mucopurulent discharge. If it has an unpleasant pungent odor, then this indicates the presence of an infection. At the stage of cleansing, itching appears. As a rule, the second stage lasts about 1-1.5 months.

healing process trophic wound depends on the quality of treatment. Subject to all the doctor's recommendations, nutrition and tissue repair in the area of the ulcer is enhanced. Otherwise, a relapse occurs. Repeated trophic wounds respond worse to treatment. In the third stage, the wound surface begins to decrease.

Features of treatment

Medical.
Surgical.

Trophic ulcer (ICD-10 code - L98.4) - an inflamed skin wound that does not heal within six months. It develops due to insufficient blood circulation and tissue nutrition. This disease does not occur on its own, it becomes a painful and serious complication of other diseases. Most often affects the skin of the lower extremities against the background of varicose veins. A trophic ulcer caused by varicose veins has the I83 code according to ICD-10.

Among all putrefactive infections, trophic ulcers are distinguished into a special group. Pathology is very painful, aggressive and very difficult to treat. A small bluish spot that appears on the foot or lower leg is the first sign of an ulcer. A purulent liquid may ooze from the wound, which has an unpleasant specific odor. Surgery is often required for complete recovery.

Why does pathology develop

The causes of the development of trophic ulcers of the lower extremities can be both external and internal.

Symptoms

The first signals that speak of this pathology will be a feeling of heaviness in the affected leg and, as noted above, the appearance of a bluish-pink spot. When pressing on the spot, patients experience pain. Often they do not pay attention to these manifestations, attributing everything to fatigue and ordinary bruises. Therefore, in order to prevent the appearance of trophic ulcers, you need to listen to the sensations in the lower extremities.

This is a disease characterized by a deep defect in the skin epithelium or basement membrane, accompanied by an inflammatory process.

The clinical picture is:

noticeable swelling of the legs;
leg cramps, the frequency of which is higher at night;
skin hypersensitivity;
flushes of heat in the legs;
itching, burning;
thickening of the skin on the affected leg;
excretion of a secret resembling sweat in consistency.

When these symptoms appear, even a minor injury leads to the formation of a small ulcer. A purulent fluid with blood impurities can ooze from it. The secreted contents have a fetid odor. Without proper help, trophic ulcers increase over time not only in width, but also in depth.

This causes severe pain that is aggravated by walking. Painful sensations can reach such intensity that a person is forced to lose the ability to move.

Complications

The formation and untimely treatment of trophic ulcers of the lower extremities leads to complications:

Treatment of trophic ulcers on the legs, despite the development of medicine, remains one of the most difficult

Infection of the wound with fungi, staphylococci, streptococci or other microorganisms. The blood and pus secreted by the ulcer is a favorite breeding ground for the development of such infections.
Deformation of the joints due to the destruction of cartilage in inflamed areas.
Formation of venous thrombi.