A COMPREHENSIVE REVIEW OF PATHOLOGICAL CHANGES IN DUSHTAVRANA WITH SURGICAL AND NON-SURGICAL MANAGEMENT, WSR TO CHRONIC NON-HEALING ULCERS

Vrana is one of the clinical pathology which is described in Ayurvedic science by almost all classical texts which can be considered as wound in contemporary science. Acharya Sushruta mentioned Vrana gatra vichoornanae vranayati iti vrana which means break in the continuity of the surface epithelium. When this fails to heal by its own or early treatment later this Vrana changes to Dushta Vrana following with many Avasthas and because of Krichra Sadhyata and Dheergha Kalanubandhi will proceed with many surgical and non-surgical choices. Dushtavrana is an important clinical condition described in Ayurveda, characterized by delayed healing and unhealthy local features such as abnormal discharge, foul odour, discoloration, pain, induration and altered wound-bed characteristics. In contemporary science, chronic non-healing ulcers are a significant clinical challenge and may arise due to diabetes mellitus, venous or arterial insufficiency, pressure, infection, neuropathy, trauma and other systemic or local factors. The clinical understanding of microenvironmental changes from Vrana to Dushta Vrana will guide us for proper treatment assessment. The clinical approach of Dushta Vrana will be diagnosed by Vrana Pariksha, Vrana Srava Lakshanas, Vrana Vasthu, Vrana Varna and Vrana Avastha, analyzed and treated by the principles of Shodhana, Ropana and Shashti Upakrama Chikithsa. Depending upon the stage and condition of the wound, both local and systemic measures, along with appropriate surgical and non-surgical treatments are explained elaborately. Contemporary management emphasizes identification and correction of the underlying cause, wound-bed preparation, debridement, infection control, maintenance of an appropriate wound environment, vascular assessment, pressure relief and nutritional optimization. This review explores the surgical and non-surgical approaches to Dushta Vrana with special reference to chronic non-healing ulcers and examines the possible relationship between classical Ayurvedic principles and contemporary wound-care practices with management of associated systemic factors and prevention of recurrence.