[Treatment of ulcer and difficult wounds of the lower limbs: our experience]

The purpose of this study is to evaluate the results obtained using traditional and advanced dressings, platelet gel, vacuum therapy and surgical techniques (grafts, flaps and dermal substitutes) in the treatment of ulcers and difficult wounds of the lower limbs to determine a treatment algorithm.

From January 2006 to September 2010 were performed 428 treatments on 377 patients (203 men and 174 women, age between 32 and 90 years). Both medical and surgical treatments were performed: 61 traditional medications, 149 advanced dressings, 25 with platelet gel, 42 with the vacuum therapy, 16 with surgical debridement, 86 with skin grafts of varying thickness, 8 with dermal substitutes and 42 with surgical flaps.

The best results were obtained with the most innovative methods, which showed, on average, a higher healing rate compared to traditional medications. Positive results were also obtained with surgical treatment if properly preceded by a correct wound bed preparation.

The main characteristic that should guide the choice of therapy is the clinical appearance of the lesion: correct management of all its aspects allows to increase the rate of healing and, when necessary to have recourse to less invasive surgical procedures.