The influence of medications is also to be evaluated.
Diagnosis
Course of treatment
Various pharmacologic agents exert directly deleterious
of venous leg ulcer
H18546 Clinical examination
effects on wound healing, especially immunosuppres-
H18546 Instrumental diagnosis
sants, cytostatics, anti-inflammatories (mainly glucocorti-
H18546 Differential diagnosis (arterial ulcers, mixed venous-
coids) and anticoagulants.
arterial ulcers diabetic ulcers, exgonous, infectious ulcers,
ulcers due to hematologic diseases, neoplastic ulcers)
The patient's psychosocial situation also plays a not
inconsiderable role. The management of chronic wounds
Treatment
always requires a high level of compliance from the
Compression therapy
patient because treatment is not confined to local proce-
dures but also requires the consistent and conscientious
H18546 Permanent zinc paste bandage
H18546 Temporary short-stretch bandage
application of causal therapies such as compression treat-
H18546 General principle: The patient should be as mobile
ment. The patient is to be adequately informed about the as possible with the bandage
purpose of and necessity for the individual elements of
treatment, otherwise compliance will be partially or com-
Invasive therapy
pletely lacking.
H18546 For compensation of CVI: Sclerotherapy, phlebo-
surgery
Local interfering factors usually have their origins in
H18546 For ulcer resection: paratibial fasciotomy or endo-
incorrectly practised wound management. The use of mul-
scopic perforator ligation, as required
tiple topical therapeutic preparations is especially to be
mentioned in this respect. Such practices can not only
Local ulcer therapy
greatly compromise the wound healing process, but also H18546 Surgical debridement
drastically increase the risk of local and systemic aller-
H18546 Physical cleansing by moist wound treatment
gies. Especially those patients who all too readily resort
H18546 Continuation of moist wound treatment during
granulation until spontaneous epithelisation, skin
to the use of “miracle cures” in their understandable wish
grafting if required
to hasten the healing of their ulcer should be persuaded
of the risks involved.
Continuation treatment
Pain management
H18546 Compression stocking to maintain the therapeutic result
Anaesthetic topical therapeutic agents are contraindicat- H18546 Lifestyle promoting healthy veins with as much exercise
ed due to the risk of contact allergies. The following pro-
as possible/elevation of the legs, weight reduction
cedure is therefore recommended for severe pain: apply
where appropriate
H18546 Adjuvant medication with edema-protective agents,
compresses immersed in ice water or cool the ulcerated
where appropriate/venotonicising agents
area with ice packs at intervals during the 20 to 30 min-
utes before bedtime. In most cases the pain subsides rel-
atively quickly with correctly applied compression therapy.
An analgesic can be given to control nocturnal discomfort
in the initial phase.
Therapy [30.31]
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