02. A venous ulcer cured by a single treatment of TRAP
KEYWORDS: Three-dimensional Regenerative Ambulatory Phlebotherapy (TRAP), venous ulcer, hydrostatic thrust, sclerotherapy
Three-dimensional regenerative ambulatory phlebotherapy (TRAP) treats the walls of the veins and restores functionally correct circulation. The solution used, which is injected through the vessels is visible to the naked eye or on transillumination, reaches the perforating veins, reducing their diameter, strengthening the vessel walls and restoring continence. The recovery of haemodynamic and hydrostatic functions enables venous ulcers to heal rapidly. Reducing excessive capacity alleviates pain and eliminates the sensation of heavy legs. In the case described here, haemodynamic hypertension had acted locally to create trophic lesions, which gave rise to an ulcer. Caused by an incontinent perforating vein, the ulcer had been present for more than a year. After a single treatment of TRAP, it healed within three weeks.
This ulcer, which was caused by an incontinent perforating vein, healed in three weeks after a single treatment of TRAP.
Ulcers caused by hydrostatic thrust occur in the most distal region of the limb, where the hydrostatic pressure is highest. These dependent ulcers are due to increased hydrostatic thrust, which is directly proportional to the diameter of the vessel. The hydrostatic thrust is the product of the hydrostatic pressure multiplied by the internal diameter of the vein per one centimetre of height. Unlike transmural pressure, which is a relative value, hydrostatic thrust is an absolute value; that is to say, it is a force that can easily be measured in gr/cm² and is able to act on the trophism of the perivascular tissues. If the hydrostatic thrust is excessive, it gives rise to a phlebostatic ulcer. TRAP begins, as always, from the most dependent areas of the limb. Transillumination (together with the new infrared optical systems) enables the veins to be visualised despite the skin dystrophy that is typical of these patients. All of the visible vessels are injected with a quantity of solution that is sufficient to reach the perforating veins. All three regions of the limb are injected: medial, posterior and lateral. Particular care is taken to inject the solution into the perforating veins in the vicinity of the skin ulcer. Nevertheless, TRAP must be carried out on the entire superficial and perforating circulation through every visible access. The video shows the difficulty of injecting the solution into the veins when the skin is dystrophic; it is therefore important to intervene pre-emptively before trophic skin lesions arise. After three weeks, thanks to the restoration of functional integrity, this ulcer had healed, without any change being made in the type of medication applied. Clearly, medication alone is unable to cure a venous ulcer; the haemodynamic or hydrostatic cause of the ulcer must be tackled. By treating the walls of the veins, TRAP restores the correct functioning of the venous circulation by eliminating valvular incontinence, as in this case of an ulcer caused by a perforating vein, or by reducing the diameter of the most dependent veins, as in the treatment of phlebostatic dependent ulcers. In some cases, the ulcer may close even if the underlying cause is not remedied; it will, however, inevitably recur. The extreme efficacy of TRAP suggests that it should be used not only in the treatment of venous caused by haemodynamic alterations or by hydrostatic thrust, bat also in their prevention.
Capurro S .(2009). A venous ulcer cured by a single treatment of TRAP. CRPUB video journal Phlebotherapy section. www.crpub.org
Do you inject a different concentration of Bisclero solution from the concentration used to treat venous insufficiency?
No, the concentration is the same; to begin with, a solution of 3% sodium salicylate in a buffered hydroglycerine vehicle is injected. All vessels visible by means of transillumination are injected with a quantity of solution that is sufficient to reach the perforating veins, up to 5 ml for each single injection.
Does the limb have to be bandaged?
Bandaging or the use of elastic stockings is essential, as this facilitates the regeneration of the vessel wall.
This ulcer healed in three weeks without any changes being made to the medication used. This underlines the importance of functional correction of the circulation. How important is it?
Very important. If traditional or even advanced medications are used, the ulcer may indeed close. However, it is highly likely that it will re-open, as its anatomical cause has not been remedied. Traditional treatments are of little use, and indeed are sometimes harmful, precisely because they do not adequately correct the anatomical cause of the disorder. It must be borne in mind that venous disease is three-dimensional and extends to the entire perforating and superficial circulation.
The video mentions prevention. How important is it?
If prevention is undertaken, ulcers do not form and the skin does not suffer the trophic damage that makes it difficult to inject ectatic vessels.
What does the future hold for TRAP?
We are making every effort to register our solution. Unfortunately, however, we are shackled by the irrational red tape that stifles initiative in the western world. In Italy, for now at least, all doctors can order the solution and use it freely. Abroad, doctors who wish to use the solution have to find a laboratory that can produce it, and then contact our group. In conclusion, the treatment for the most frequent disease in the world has received the attention that the West deserves.
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