Op. Dr. Orhan Coşkun
Varicose vein disease, often accompanied by venous valve insufficiency, progresses and becomes chronic if not treated in a timely and sufficient manner. In such cases, the treatment of the disease becomes more challenging and complex. Early diagnosis and timely treatment by skilled hands are crucial. Vascular surgeons specializing in this field may monitor some patients with medication and exercise recommendations, treat others with sclerotherapy, foam, laser, or radiofrequency, or opt for surgical methods in rare cases. The key is to select the appropriate treatment option for each patient and apply it with the right expertise.
When varicose vein disease is left untreated and becomes chronic, the constant accumulation of blood in these veins with slowed circulation in the legs will elevate the pressure, resulting in changes in the surrounding tissues. This leads to skin discoloration and thickening, nutritional disturbances, edema, and thinning of the skin in the affected area over time, ultimately resulting in venous stasis ulcers. This condition represents the most advanced stage of the disease. Healing these ulcers is challenging, and even if they do heal, there is a risk of recurrence.
For complete healing, it is essential to treat the underlying venous insufficiency in addition to wound care. A comprehensive remedy cannot be achieved with dressing changes and wound care alone.
Other conditions can also cause ulcers on the feet. Arterial narrowings, diabetes, and some orthopedic and neurological diseases can lead to foot ulcers.
Venous ulcers are not commonly found on the fingers; they mostly occur on the ankle and slightly above the leg.
These ulcers are red, exudative, and the surrounding skin is thick and brown.
We can divide the treatment into three parts:
1- Treatment for the Underlying Cause
If the ulcer is associated with venous insufficiency (deep, superficial, or perforator veins), laser, radiofrequency, or foam treatment is applied specifically to address it. In some cases, ulcers may result from previously experienced and inadequately treated deep vein thrombosis (DVT). In such situations, intervention for the underlying cause may not be possible, and only supportive treatments may be effective.
2- Wound Treatment
Firstly, the wound should be cleaned with a saline solution, and the source of infection needs to be eliminated by removing dead tissues (debridement). The process should continue until the patient feels no pain and live tissues are exposed. Subsequently, the wound is dressed with a dry dressing and wrapped with several layers of special bandages.
In addition to oxygen and ozone therapies, Platelet Rich Plasma (PRP) therapy, which has gained popularity in recent years, is also used in wound healing.
3- Preventive Treatment
Despite all treatments, there is a possibility of ulcer recurrence. Therefore, after healing, adherence to preventive measures is essential. Medications, compression stockings, and exercise are commonly used for this purpose. Patients are educated on these measures, and by following the instructions diligently, they can avoid experiencing the same issues again.
From the initial stages, patients are prescribed antibiotics if there is an infection and medications aimed at resolving chronic venous insufficiency, reducing edema, and preventing skin complications. If PRP is to be applied, anti-inflammatory pain relievers should not be administered to the patient.
PLATELET-RICH PLASMA (PRP) IN THE TREATMENT OF VENOUS (ULCER) WOUNDS
Platelets are cells responsible for blood clotting and wound healing found in the blood. With PRP treatment, the damaged tissue area is supplied with 2-4 times more platelets than normal blood flow, accelerating tissue healing and regeneration. The secretions within these platelets provide stimuli to enhance new tissue formation and blood vessel development.
For this procedure, about 10 cc of blood is drawn from the patient, processed through a centrifuge device, and platelets are separated to be applied to the diseased area. Prior to the procedure, dead tissues in the wound are cleaned, and live tissues are stimulated. Afterward, the separated platelets are injected around the affected area with a needle. Since it is a product obtained from the patient’s own blood and does not cause allergies, it is a painless and non-harmful application. After the procedure, the patient can return to their daily activities. The number of sessions may vary depending on the severity of the disease, but it is recommended to have the treatment every 2-4 weeks.
