A Modern Multimodal Approach to the Treatment of Venous Trophic Ulcers in Outpatient Settings
Abstract
Background. The treatment of trophic ulcers of the lower extremities is challenging due to their chronic nature, frequent relapses, and significant impact on quality of life.
Aim. This study assessed the effectiveness of a multimodal treatment combining ultrasonic debridement, platelet-rich plasma (PRP), and radiofrequency vein ablation in patients with decompensated varicose veins complicated by trophic ulcers.
Methods. A total of 105 patients with C6-stage varicose veins (CEAP classification) and venous ulcers lasting 2.1 ± 0.6 years (average size – 35 ± 1.7 cm²) were examined. All underwent ultrasound diagnostics to determine phlebohemodynamic disorders. During preoperative preparation, 70 patients received ultrasonic cavitation debridement using the SONOCA 185® device (25 kHz), performed twice at 1–2-day intervals. The control group (35 patients) used chlorhexidine bigluconate for wound cleansing. After debridement, patients were divided into two subgroups: 60 patients received combined PRP and platelet-rich fibrin (PRF) therapy to stimulate tissue regeneration, while 45 were treated with Granuflex® hydrocolloid dressings. Bacteriological and cytological studies were conducted to assess wound regeneration and control infection.
Results. Sequential use of ultrasonic debridement followed by PRP/PRF therapy created optimal conditions for stimulating granulation and epithelialisation in trophic ulcers. This approach provided effective local wound preparation and allowed successful performance of radiofrequency ablation to eliminate the underlying venous reflux responsible for ulcer persistence.
Conclusions. A multimodal strategy combining ultrasonic debridement, PRP/PRF stimulation, and subsequent superficial vein surgery is a highly effective office-based method for treating venous trophic ulcers, promoting faster healing, reducing infection, and enabling timely surgical correction.
Keywords: trophic ulcers; ultrasonic debridement; platelet-rich plasma
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