Management of venous leg ulcers

In the management of leg ulcers two aspects should be considered, i.e. the exact underlying condition (main cause and contributing factors) and local conditions. Concomitant peripheral arterial occlusive disease must systematically be excluded. Effective compression therapy (35 mmHg pressure at the distal calf) is the corner-stone in treatment of venous leg ulcers. Superficial venous reflux can be the major cause of chronic venous insufficiency. Careful examination of reflux patterns helps to distinguish between indications for conservative treatment and indications suitable for surgical treatment. To what extent the stripping of varicose veins and/or endoscopic subfascial perforator vein discision really improves the outcome and prevents recurrence still remains to be shown in controlled trials. Local treatment considers ulcer wound bed and border. Modern synthetic wound dressings follow the concept of moist wound healing whilst local application of growth factors is currently under clinical evaluation. Management of eczema includes avoidance of potent or known allergens, patch tests in severe cases with suspicion of contact dermatitis and an adapted local therapy.