[Current therapeutic guidelines and differential diagnosis of venous leg ulcers]

In the majority of patients with venous ulcers, there is intrafascial venous insufficiency as well as varicosis. That is why it is important to determine the value of both factors to treat the ulcer. It is recommended that the patients be classified into four therapeutic groups, which is based on the progress that has been made in noninvasive angiological diagnostics. Refluxes in the deep leg veins can be detected by Doppler ultrasound. Determination of venous pressure and light reflection rheography show whether it is possible to improve chronic venous insufficiency by the elimination of varicosis. The differential treatment of varicosis, compression therapy, topical external medication and the manner in which patients must live are explained in detail. Most of the methods are doubtful or even impossible if there is simultaneous arterial occlusive disease. Special guidelines for the management of mixed venous arterial ulcers are explained.