[Indications and methods of LAF therapy]

A variety of techniques for leg ulcer surgery have been developed in the last 20 years. In literature these techniques are always presented as competitive surgical methods for treating different forms of leg ulcers and are compared regarding their success. From our point of view, this approach seems inappropriate. Essentially there are 3 different techniques available: shave therapy, LAF therapy (removal of liposclerosis and fasciotomy) and fasciectomy. The choice of methods must be based on a classification of the ulcers, as each procedure is not suitable for ever type of ulcer. First we have to differentiate between venous ulcers and mixed leg ulcers. The venous ulcers should then be subdivided in ulcers developed in liposclerotic skin and ulcers which developed in atrophie blanche lesions. Finally the liposclerotic ulcers are classified according to Hach's classification system into 4 stages. In case of mixed leg ulcers with relevant occlusive arterial disease, attention should first be directed to improving the arterial blood supply; further approaches depend on how successful this is.