Open leg treatment

Treatment depends on the cause

The treatment you choose always depends largely on the cause. If this does not happen, even the best wound treatment and wound care will not help – the leg ulcer will not close or will quickly recur. It is therefore important not only to treat the wound properly, but also to identify and treat the underlying cause.

Treatment can be a long process and take several months—so treatment teams and patients need a lot of patience and some perseverance.

Good wound management for an open leg

A slightly moist wound treatment is more suitable for chronic wounds than a treatment that is too dry. However, this principle applies only as long as there is no severe inflammation and no significant bacterial plaque present.

Key components of wound care and wound management include:

• Wound Cleaning: It is important to properly care for the wound by regularly changing the dressing and cleaning it correctly—this is done through a “wet phase” using moist compresses, which remove the biofilm either spontaneously or with gentle abrasion.
• Wound debridement: During wound care, the treatment team removes dead and inflamed tissue. Pain management is a key concern in this regard.
• Wound dressings: A wide range of wound dressings and products is available to keep the wound slightly moist and provide hygienic protection.

Treatment of venous ulcers (venous leg ulcers)

If chronic venous insufficiency (CVI) is the cause of the leg ulcer, the following treatments may be considered:

• Compression Therapy: Compression therapy using bandages or compression stockings is central to the treatment of chronic venous diseases. It combats swelling and fluid retention in damaged skin tissue and supports the venous return of blood from the legs upward toward the heart. This improves oxygen supply to the healing wound.
• Varicose veins are the primary cause of one out of every two venous ulcers. They can be closed from the inside using a catheter—usually on an outpatient basis and under local anesthesia—or treated with foam sclerotherapy. In some situations, it is better to remove varicose veins using the “traditional” surgical method.

Treatment of the arterial ulcer (ulcus cruris arteriosum)

Arterial leg ulcers are the result of severe circulatory disorders. Blockages in the blood vessels can be treated, for example, with the following therapies:

• Balloon dilation: The treatment team inserts a catheter with a small balloon into the affected blood vessel through the femoral artery. The balloon is inflated, expands, and widens the narrowed vessel. This allows the blood to flow freely through the vessel again. Sometimes they also implant a stent to keep the blood vessel open.
• Bypass Surgery: If arterial narrowings extend over a long distance and cannot be traversed using a balloon catheter, they can often be bypassed through vascular surgery using a segment of vein or an artificial blood vessel.

Skin Graft

Autologous skin transplantation is often used to treat chronic wounds that are particularly difficult to heal. This technically relatively simple procedure can often be performed under local anesthesia and is therefore not stressful even for elderly patients. Various surgical techniques are used. With appropriate treatment, the donor area, which is usually selected on the same side of the thigh, heals spontaneously and without any problems within one to two weeks. Recently, more and more skin equivalents – membranes of different biological origin – have also become available for covering wounds.