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Adjuvant medicinal therapy Systemic disorders of wound healing mainly involve fac-
Systemic treatment of venous leg ulcer with the various tors that are generally relevant to the healing process of
pharmacological venotherapeutic agents is mainly of an chronic wounds, and thus also for venous leg ulcers.
adjuvant nature and is intended to support the deconges- Primary factors are the patient's age and nutritional sta-
tion induced by the compression therapy. Three groups of tus, certain basic diseases and also medication related
substances are used: diuretics, vasoactive (venotonicising) effects.
drugs and edema-protective agents.
Findings generated in clinical research allow the conclu-
Diuretics may be indicated for short-term use especially in sion that physiological aging delays wound healing
the initial phase of treatment to mobilise local, reversible processes because of the generally reduced cellular activi-
edema. Under no circumstances, however, should they be ties, which may ultimately also be reflected in a reduction
used to provoke a potent diuretic effect. Contraindications in the quality of the wound healing outcome. Serious dis-
are high-protein edema and lymphedema. orders of wound healing, however, are usually an expres-
sion of the effects of age-related multimorbidity.
Venotonicising drugs are reported to cause a reduction in
the venous cross-section while simultaneously increasing Wound healing requires a sufficient supply of protein,
blood flow velocity and reducing blood viscosity. The vitamins (especially C and A) and minerals (especially
therapeutic objective of edema-protective agents is to iron, copper and zinc). Because of inadequate nutrition,
influence the capillary vessel walls in order to reduce the disorders of absorption or the effects of concomitant dis-
extravasation of fluid into the tissue. Both medication eases, elderly patients frequently exhibit protein and vita-
groups include synthetic and purely plant-derived sub- min deficiency states which should be diagnosed and
stances such as horse-chestnut, boxholly and sweet clover treated. If zinc replacement appears useful, this should
extracts in single-agent or combination preparations. not be done externally with zinc ointments but by pre-
Although the efficacy of the various pharmacological scribing suitable oral zinc supplements.
agents has been increasingly demonstrated in recent
years, they are by no means capable of replacing com- Besides the vascular disorders which increase with age
pression therapy. and which, as already described, create the basis for the
various leg ulcers, other diseases that compromise wound
Identification of wound healing disorders healing are connective tissue diseases (e.g. rheumatic
Although the course of healing of venous leg ulcer may diseases), endocrinopathies (e.g. thyroid, adrenal) and
be expected to be irregular in view of its etiopathologic metabolic disorders (e.g. diabetes mellitus), but also all
origins, a variety of systemic and local influences can also diseases which influence the affected person’s immune
be expected to induce further disorders which delay heal- status, such as malignancies, infectious diseases or hema-
ing of the ulcer for months or even years. It is therefore tological disorders.
important to identify and eliminate possible disorders.
Therapy [28.29]
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