Features and distinctive signs of a bite wound on the lower leg, thigh or foot: ICD-10 code

Almost every second inhabitant of the earth suffers from diseases of the veins of the lower extremities - just not everyone knows about it, and some simply do not attach due importance to swelling and heaviness in the legs. The blue network of veins that stands out under the skin is also often mistaken for a “normal variant.”

And the person does not even suspect that with his negligent attitude towards his own health he is simply “triggering” varicose veins. “Grows” complications, including acute or chronic thrombosis, thrombophlebitis, blockage of pulmonary vessels by detached blood clots, CVI, which is fraught with disability, and, of course, trophic ulcers

A trophic ulcer looks extremely unpleasant: a non-healing inflamed wound with pus on purple skin. And trophic ulcers ooze bloody-lymphoid discharge mixed with pus - and in general they have a very specific smell of rotting meat. We hope we scared you just enough so that you see the need to be more attentive to your health - and do not tolerate pain in your legs, but immediately make an appointment with a doctor.

How does a trophic ulcer appear: prerequisites and mechanism of development

The main factor in the development of a non-healing ulcer is a serious violation of tissue nutrition. As you understand, with varicose veins , characterized by impaired venous outflow, this is exactly what happens.

Non-functioning venous valves cause blood to flow back (reflux). That is, blood no longer circulates from top to bottom, as in normal conditions. These hemodynamic features are both a consequence and a cause of varicose veins.

Due to the fact that blood stagnates in the tissues of the lower extremities, tissue nutrition deteriorates. The pathology of the venous system progresses, but the ulcer does not develop immediately. First, the skin of the lower leg (most often varicose ulcers occur in the lower third of the lower leg) becomes denser and acquires a characteristic glossy shine. Patients complain of increased swelling in the calf muscle, heaviness and a feeling of fullness.

The affected area begins to itch, small drops of lymphoid fluid appear on the surface of the skin (this occurs due to the development of local lymphostasis).

Then the patient notices increased hyperpigmentation of the skin. After a while, a “harbinger of a future ulcer” develops in the affected area - a whitish area of ​​atrophied tissue. As soon as a person even slightly damages the area of ​​atrophy (for example, touching it with the fabric of trousers), an ulcer appears in this place.

At first, the ulcer looks like a superficial wound with a crust, but as the pathological process progresses, it deepens into the soft tissues of the leg. In addition, its area is expanding.

Usually at this stage a person tries to heal the ulcer on his own using the usual methods (for example, regenerating ointments) - but he will fail. The wound surface becomes infected, begins to fester and ulcerate.

The contents of the separated biological fluid depend on the presence and number of attached bacteria. As a rule, at first the wound oozes bloody-lymphoid discharge, then the ichor becomes more cloudy, and finally acquires a characteristic rotting smell.

In some cases (for example, when the patient’s immunity is weakened), not only a bacterial, but also a fungal infection may occur. This fact further aggravates the person’s condition and somewhat worsens the prognosis.

Symptoms of trophic foot ulcers

A diabetic foot ulcer is characterized by a painless area of ​​skin defect on the sole of the foot. When examining the surface sensitivity of a patient’s foot, near areas with absent sensitivity, zones in which sensitivity is completely preserved are determined. When infection occurs, wet gangrene quickly develops.

Trophic ulcers in essential thrombocytopenia are localized on the dorsum of the foot. They become covered with purulent-necrotic masses. There may be dead tendons at the bottom of the wound.

Arterial trophic ulcers of the foot develop against the background of the clinical picture of obliterating diseases of the arteries of the lower extremities:

• Intermittent claudication, the intensity of which progressively increases and reaches 150–50 meters;
• Feelings of chilliness, cold limbs, fatigue when walking and when climbing stairs;
• Reducing the intensity of hair on the toes.

With inadequate therapy, first night and then constant pain in the legs, ulcerative-necrotic changes on the fingers or in the interdigital spaces, on the dorsum of the foot, and heel appear. The appearance of an ulcer is provoked by a traumatic factor:

• Minor skin damage;
• Soft tissue bruise;
• Damage to the skin when wearing ill-fitting shoes with rough inner seams.

In conditions of reduced arterial inflow under the influence of these factors, a trophic foot ulcer appears. It quickly progresses in size and causes severe pain, for the relief of which doctors are forced to prescribe narcotics.

The formation of a venous trophic ulcer occurs in several stages. First, an area of ​​increased pigmentation forms on the foot. After some time, a thickened area of ​​skin appears in the center of the pigmented area. It takes on a whitish, varnished appearance, reminiscent of paraffin. Subsequently, minimal trauma leads to the development of an ulcerative defect. When treatment is started in a timely manner, it closes quite quickly. Otherwise, the area and depth of the trophic ulcer progressively increases, the soft tissue around it becomes inflamed - acute indurative cellulitis develops.

Why you won’t be able to heal a trophic ulcer on your own

The reason that the ulcer does not heal for a long time is the same as the reason for its initial occurrence: insufficient tissue nutrition. In the affected area, the ability to regenerate tissue is sharply reduced - which leads not only to the spread of pathology, but also to life-threatening complications. This is why it is so important to see a doctor on time.

Moreover, treatment of the trophic ulcer itself will be unsuccessful until you eliminate the main cause of its occurrence. And, as medical practice shows, no one has yet been cured of varicose veins and, especially, its complications at home.

Why attempts to self-medicate a trophic ulcer are life-threatening

Firstly, because in this way you will not only delay a timely visit to the doctor - and the wound will not only not shrink, but will also grow deeper into the tissue. And the purulent-necrotic process can spread all the way to bone tissue (in this case, trophism can cause the development of osteomyelitis ).

In addition, the lack of adequate medical care for trophic ulcers is fraught with complications such as:

• Malignant degeneration of a trophic ulcer
• Reduced mobility of the ankle joint (pronounced limitation of capacity - and, as a consequence, disability)
• Phlegmon or sepsis

Often, small trophic ulcers on the surface of the lower leg merge into one wound space. The patient may develop inguinal lymphadenitis, purulent thrombophlebitis or erysipelas of soft tissues.

Classification of bite injuries to the lower extremities

Animals do not like the smell of alcohol, sudden movements, or attempts to interfere with eating or sleeping. This causes aggression in predators. Most often they bite on the legs: legs, feet, knees, less often on the arms. Wounds in the face and head are especially dangerous.

Bite wound of the leg ICD 10 code: W54 when attacked by a dog, W53 by a rat, W55 by another mammal. Such injuries are highly likely to cause infection with tetanus and the rabies virus. Prevention of infection is mandatory.

Bite injuries can be located on different parts of the leg.

On the shin

ICD-10 code: S81.9 Open wound of unspecified location.

A bite on the leg: knee, shin, ankle is characterized by uneven edges and any depression. The skin may have scratches, abrasions, and teeth marks resulting from an animal attack.

Locations of associated wounds:

• muscle fibers;
• nerves;
• vessels;
• bones;
• articular joints.

The size and severity of the injury is determined by the size and force of the attack.
Even a layman can see the symptoms of an open bite wound on the leg. Main clinical signs of the condition:

• skin rupture;
• hiatus;
• leakage from the blood cavity - weak or significant;
• the edges of the epidermis on the lower leg extending in different directions;
• pain in the wound.

On the hip

A bite wound on the thigh, ICD 10 code: S71.1, is a deep injury. The difficulty of treatment is that surgical suturing is prohibited in the first three days after the attack.

Most of these defects take a long time to heal, causing inconvenience to the patient. A bite wound on the lower leg or thigh is constantly subjected to friction by clothing and its seams; the skin becomes stretched when moving, slowing down recovery.

On the foot

Bite wound of the foot ICD 10 code: S91. It presents the same difficulties in therapy as damage to the lower leg or thigh.

The defect immobilizes the patient, up to complete limitation of activity.

The presence in this section of the leg of many vessels, nerve endings, articular joints with a small fat layer makes the bite wound as deep as possible. It is problematic in terms of treatment and healing, unlike other localizations.

Diagnosis of trophic ulcers and pathologies that became the root cause of its development

• The following features indicate that the patient’s leg is not just an infected wound, but a trophic ulcer:
• The typical localization of a trophic ulcer is the lower third of the leg
• The skin around the wound surface is usually thickened
• The skin in the immediate vicinity of the wound has pronounced pigmentation
• With intense palpation, characteristic “pits” form in the soft tissues
• The wound surface itself and nearby tissues show signs of inflammation (redness, swelling)
• The wound oozes, the ejected contents have an admixture of pus and a specific smell of rotting

If a person has pronounced manifestations of vascular pathologies (for example, dilated tortuous veins resembling bunches of grapes), then it makes sense to talk not just about the vascular cause of trophic development, but about an advanced stage of varicose veins.

Often patients with trophic ulcers are admitted to the hospital after suffering thrombophlebitis.

By the way, sometimes a person does not even realize that he has suffered thrombosis - because the pathology proceeded without pronounced signs. However, with increased blood clotting, episodes of surgical interventions, or prolonged immobility of the patient, it makes sense to talk about a high probability of thrombosis.

To assess the condition of the venous system of the lower extremities, doctors at the ANTIREFLUX Center use high-precision innovative technologies: the “gold standard” for diagnosing venous diseases - ultrasound angioscanning, as well as spiral computed tomography, which provides images in three-dimensional implementation. This research method allows us to identify even hidden vascular pathologies.

Prolonged wound healing

Diabetes

Atherosclerosis

HIV

61781 03 November

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Prolonged wound healing: causes, diagnosis and treatment methods

Definition

Regeneration (restoration) of skin and tissues is an important and complex physiological process. It depends on the area and depth of damage, concomitant diseases and many other factors.

Long-term non-healing wounds bring significant discomfort to everyday life, as they are accompanied by pain, swelling, discharge of clear fluid, blood or pus from the wound, an unpleasant odor from the wound, and a feeling of fullness in the damaged area.

Types of non-healing wounds

Depending on the cause of occurrence, all long-term non-healing wounds can be divided into traumatic (appearing as a result of mechanical injury, burn, etc.) and trophic (appearing as a result of circulatory disorders in the affected area).

Possible reasons for prolonged wound healing

Prolonged wound healing is a symptom of many pathological conditions characterized by disruption of the normal physiological processes of tissue regeneration.

Factors influencing wound healing:

1. Age has a direct impact on the process of tissue repair. Children's wounds heal much faster than those of older people. This is due to a more active metabolism in the child’s body compared to adults.
2. Body weight affects metabolic processes in the body. Adipose tissue does not require intensive blood circulation, therefore an increase in its amount several times relative to the norm (obesity) leads to slower tissue regeneration and frequent complications of the wound process. With extremely low body weight, there is a slowdown in metabolism in the body due to a decrease in the amount of energy, therefore, all wounds heal more slowly.
3. Adequate blood circulation in the area of ​​damage provides the tissue with sufficient nutrients and oxygen for recovery. Insufficient arterial blood flow and impaired venous blood outflow significantly slow down the course of the wound process and contribute to the development of various complications. Prolonged compression of tissues when in a forced position (for example, in bedridden patients) leads to the development of bedsores, which are also characterized by prolonged healing.
4. Wound infection disrupts the regeneration process due to the active proliferation of microorganisms, their impact on tissues and the constant activation of a pronounced inflammatory process. A large amount of purulent exudate is formed, areas of necrosis are formed and general intoxication increases.
5. The adequacy of the inflammatory response and the body’s ability to resist the addition of a secondary infection depend on the state of immunity.
6. Concomitant diseases, such as diabetes mellitus, severe infections, disorders in the hematopoietic system, cardiac and respiratory failure, slow down regeneration by impairing the formation and delivery of necessary substances to the wound area, as well as the removal of toxic metabolic products from the body.
7. The use of certain medications and treatments can have a significant impact on the normal wound healing process. Thus, uncontrolled use of painkillers (non-steroidal anti-inflammatory drugs) can lead to a slowdown in regeneration due to the suppression of inflammatory processes that normally occur in any wound. The use of radiation and chemotherapy can also cause delayed wound healing, since not only tumor cells die, but also cells responsible for tissue regeneration. At the same time, the malignant tumor itself takes a large amount of nutrients for its growth, which negatively affects all processes in the body.

Diseases leading to prolonged wound healing:

1. Chronic venous insufficiency (also manifested by varicose veins) is one of the most common causes of long-term non-healing leg wounds.
   The venous outflow from the lower extremities and the delivery of nutrients to the tissues are disrupted, and hypoxia increases (decreased oxygen flow to the tissues). Subsequently, metabolic disorders occur in the tissues and long-term non-healing trophic ulcers are formed. People suffering from chronic venous insufficiency require constant careful skin care, and in the event of a trophic ulcer, prevention of enlargement of the wound surface and its infection.

1. Atherosclerosis of the arteries leads to the closure of the lumen of blood vessels and a decrease in the flow of oxygen to tissues. With atherosclerosis, the metabolic processes of proteins and fats in the body are disrupted, damage to the vascular wall occurs with the accumulation of cells filled with protein-cholesterol complexes in its layers. Subsequently, the damaged vessel grows with connective tissue. The arteries become hard and rigid. Conditions arise for the formation of thrombi (blood clots) in the lumen of blood vessels, which disrupts tissue nutrition and leads to a long wound healing process.
2. Diabetes mellitus is an endocrine disease characterized by an imbalance in the delivery of glucose and its use in the body. When blood glucose levels are high, the vascular wall is damaged and many systems malfunction.
   With diabetes, any wounds, even the smallest ones, take a long time to heal.

   The most dangerous wounds are located in the foot area. Such wounds often appear as a result of accidental minor injuries. Chronic or non-healing wounds in diabetes mellitus are characterized by impaired growth of the epithelium (top layer of skin) and prolonged inflammation.

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1. Chronic heart failure occurs due to various heart diseases and can develop unnoticed over many years. The work of the heart gradually deteriorates, swelling and the need to increase the concentration of oxygen in the blood appear, then shortness of breath and rapid heartbeat.
   Blood flow slows down and the flow of oxygen and nutrients to tissues decreases.

   Edema also slows down the process of tissue regeneration.

2. Anemia is a decrease in the number of red blood cells (erythrocytes) and hemoglobin in the blood. The disease is characterized by oxygen “starvation” of tissues.
3. Oncological diseases are another reason for prolonged wound healing. The tumor grows and takes over part of the circulating blood with all the nutrients and oxygen. Also, with tumors there is often an intoxication syndrome that affects all processes in the body, including the process of tissue regeneration. Currently, chemotherapy and radiation therapy are widely used in the treatment of cancer. Both methods have long-term non-healing wounds as a side effect.
4. Chronic lung diseases are accompanied by impaired gas exchange in them. As a result of this pathological process, oxygen saturation of hemoglobin worsens, oxygen transport to tissues decreases, which slows down wound healing.
5. Due to immune problems, wounds in HIV patients heal very poorly.

Which doctors should you contact if wounds are healing for a long time?
Long healing of wounds forces the patient to seek medical help. First of all, a consultation with a surgeon is required. If you have chronic diseases, you may need to consult a hematologist.

Diagnostics and examinations for long-term wound healing

In most cases, the doctor will prescribe the necessary set of laboratory and instrumental research methods.

1. Clinical blood test: general analysis with platelet count, leukoformula, ESR (with microscopy of a blood smear in the presence of pathological changes).