The compression bandage also acts as a firm resistance healing tendency. This applies especially to the varicose
surface which helps to restore at least partially the func- veins passing through the ulcerated area and the proce-
tion of the calf-muscle pump and improve its effective- dure – when carried out by an experienced and skilled
ness. When compression therapy is carried out in the sclerotherapist – often results in rapid healing.
proper manner, relief of pain and initial signs of healing
are observed within a short time, which is seen as an Sclerotherapy within or close to areas of atrophie blanche
encouraging sign by patients and can motivate them to must remain the exception. If sclerotherapy is unavoid-
persist with the often protracted course of treatment. able, a much lower concentration of sclerotic agent must
The mode of action of compression therapy, important be used than would be indicated for an area of healthy
information on bandaging materials and bandaging tech- skin.
niques for compression bandages as well as contraindica-
tions are described in detail from page 62 onwards. If the chronic venous insufficiency cannot be compensat-
ed on the basis of functional diagnostic criteria, after the
Invasive therapeutic procedures for compensation ulcer has healed at least the surrounding perforating
of chronic venous insufficiency veins should be ligated to provide hemodynamic relief.
In modern phlebology, sclerotherapy and surgery are
mutually complementary therapeutic approaches. hich Surgical treatment of ulcers
method is to be used ultimately depends on the anatomi- For obstinate, therapy refractory ulcers, a surgical inter-
cal localization of the disorder of venous return and the vention proximal from the ulcer in the scar-free skin
degree of chronic venous insufficiency. areas may be required. Procedures with good success
Vein stripping, “pulling-out” an
rates include especially Hach's paratibial fasciotomy and
insufficient vein segment
In primary varicosis, remediation may possibly be its more advanced form, Hauer's endoscopic perforator
achieved by sclerotherapy of peri-ulcer varicose veins, ligation.
surgical treatment of saphenous insufficiency or scle-
Healed venous leg ulcer after
rotherapy of lateral branch varices. Compression treat- Hach's procedure is based on the notion that splitting the
paratibial fasciotomy
ment, performed initially using a compression bandage muscle fascia along the entire edge of the shinbone
and later with a compression stocking, must always be allows capillaries to grow from the well perfused muscle
continued until complete healing of the ulcer is achieved. tissue into the ulcer region, thereby promoting tissue neo-
genesis. With Hauer's method, hemodynamic aspects pre-
In secondary varicosis and when there is severe venous dominate in the presence of insufficient Cockett's perfo-
hypertension in the suprafascial venous system, perma- rating and simultaneous insufficiency of the deep vein
nent closure of insufficient perforating veins supplying system.
the ulcer is rarely successful. The temporary sclerotic
process induced by the sclerotherapy, however, provides
temporary hemodynamic relief and greatly improves the
Therapy [26.27]
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