In some respects, treatment approaches differ depending on the cause.
For venous leg ulcers, the focus is on compression treatment with tight bandages wrapped around the leg or compression stockings. Studies have shown that the healing rates of the other therapies are also increased when compression therapy is used. It is supplemented by regular walking training. Varicose veins or poorly functioning veins can be surgically eliminated.
Compression therapy – not always the right treatment of choice
As important as compression therapy is for venous disorders – they have the opposite effect on arterial leg ulcers, since they compress the vessels and thus possibly bring the remaining blood flow to a standstill. Therefore, depending on the extent of the circulatory disturbance, surgical measures for vasodilatation or bridging by means of vascular prosthesis are used.
Wound treatment
In addition, the wound itself is treated – the ulcer is regularly cleaned (with active substances or mechanically by ablation) and covered with a special (“hydroactive”) wound dressing that keeps the wound moist without sticking it.
Antiseptic substances, which can reduce or prevent germs, are used only when necessary; if there is a pronounced infection, antibiotics are given. The wound can also be surgically ablated and covered with a skin graft (shave therapy).
Sometimes therapy with cortisone is also indicated. A therapeutic option that has been rediscovered in recent years (which takes some getting used to but is very effective) is the application of fly maggots that feast only on the dead tissue and thus clean the wound.
Promoting blood circulation and healing
Medications that promote circulation, such as pentoxyfilline and heparin, can improve symptoms if necessary, and exercise therapy and lymphatic drainage are supportive. So-called growth factors can possibly be applied locally to promote wound healing (e.g., a gel containing PDGF-beta).
The use of gene therapy is at an experimental stage. With its help, attempts are being made to introduce growth factors directly into certain skin cells, to genetically “boost” a skin graft so that it forms better vessels, or to introduce the gene for a growth factor into the wound with the help of a carrier virus.
