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Management of venous leg ulcer
Therapeutic activities are concentrated on the following
aspects: The venous hypertension underlying the ulcer
must be remediated as effectively as possible in order to
Venous leg ulcer is a chronic wound with a poor or
improve the nutritive situation in the damaged area of
absent healing tendency. Especially the often extensive
skin. An ulcer can only heal when the edema has sub-
ulcers associated with severe chronic venous insufficiency
sided and venous outflow in the leg has been restored to
a compensated state (Hach). These therapeutic objectives
and pronounced sclerosis of the cutis and subcutis can
can essentially be achieved by means of compression
become a therapeutic crux medicorum requiring protract- treatment and, when appropriate, using invasive thera-
ed treatment and characterized by frequent relapses.
peutic methods (surgery and/or sclerotherapy).
Nevertheless, today’s knowledge of the pathophysiologi-
cal mechanisms implicated in causing venous leg ulcers
Local ulcer therapy is based on appropriate wound man-
agement adapted to match the different phases of heal-
generally allows the application of effective therapeutic
ing. Wound management should also eliminate as far as
concepts. possible all the factors which generally compromise
wound healing, such as infections, concomitant diseases
and side effects of other treatments or negative psy-
chosocial factors.
Compression bandaging as basic therapy
“There is no phlebology without compression therapy”.
This dogma applies unreservedly for the management of
venous ulcer, because the effect of the compression
bandage intervenes causally in the disease process. It sur-
rounds the leg with pressure firm enough to compress the
dilatated veins. This restores and/or a certain degree sub-
stitutes the valvular function, reduces venous reflux from
subfascial to suprafascial and increase the flow velocity
of the venous blood. At the same time, compression caus-
es an increase in the tissue pressure and thereby
enhances absorption in the terminal vessels and the
lymph vessels. The microcirculation is locally improved,
which decisively improves the healing tendency of venous
leg ulcer.
Therapy [24.25]
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