Therapy of Chronic Leg Ulcers According to Evidence-Based Medicine

Introduction

Chronic trophic defects on the lower extremities usually arise in the context of chronic venous insufficiency (CVI) and can be complicated by concomitant macro or microangiopathy. They very often also appear in diabetics, most commonly on the feet, where the prevalence is 2–10%. The third most common cause of chronic wounds on the lower extremities are pressure ulcers, with common sites of occurrence including the heel bone, ankle, knee joint, or pelvis.

Surgical and Conservative Causal Therapy

Basic therapeutic modalities for venous-origin leg ulcers include compression, surgical, and symptomatic therapy. Compression therapy in the form of compression bandages or stockings is still considered the basic treatment. Meta-analyses have shown that compression therapy is important not only for accelerating the healing process but also for reducing the recurrence of the disease. Surgical causal therapy represents solving the problem by eliminating venous reflux, for example, using endovascular thermal procedures or sclerotherapy.

In the case of diabetic trophic defects, systemic therapy, interventional or surgical revascularization is appropriate for verified peripheral arterial hemodynamically significant occlusive disease. Several studies have also confirmed the importance of regimen measures in the form of unloading and relieving pressure on the limb; however, this biomechanical approach is significantly dependent on patient compliance. Of course, symptomatic therapy and secondary prophylaxis in the form of diabetes compensation and associated diseases are also essential.

For the therapy of pressure ulcers, it is absolutely crucial to relieve pressure that causes tissue ischemia and additionally symptomatic local therapy in the form of possible debridement of the covered wound and moist dressing. It is also important to monitor the patient's overall condition and possibly compensate for malnutrition. In the case of non-healing pressure ulcers, reconstruction of the skin cover is appropriate.

Symptomatic Therapy

Symptomatic local therapy in the form of dressings and moist wound healing is an essential part of the treatment of trophic defects of any etiology. Moist dressing contributes to the healing of chronic wounds by maintaining a constant wound temperature, preserving gas exchange, absorbing and removing exudate, not traumatizing the wound during dressing changes, and extending the intervals between individual dressings.

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Sources:

1. Kahle B., Hermanns H. J., Gallenkemper G. Evidence-based treatment of chronic leg ulcers. Dtsch Arztebl Int 2011; 108 (14): 231–237, doi: 10.3238/arztebl.2011.0231.
2. www.hemagel.cz