Open leg treatment

Treatment depends on the cause

Which therapy you choose always depends crucially 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 correctly, but also to find and treat the cause.

Treatment can be lengthy and take several months – so treatment teams and patients need a lot of patience and some perseverance.

Good wound management for an open leg

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

Important components of wound treatment and wound management are

• Wound cleansing: It is important to take good care of the wound by changing the dressing regularly and cleaning it properly – this is done by means of a wet phase with moist compresses, which absorb the biofilm spontaneously or with slight abrasion.
• Wound cleansing: The treatment team removes dead and inflamed tissue during wound treatment. Pain relief is a central concern here.
• Wound dressings: A wide range of wound dressings and products are available to keep the wound slightly moist and hygienically protected.

Treatment of venous ulcers (venous leg ulcers)

If chronic venous insufficiency (CVI) is the cause of the open leg, the following therapies can be considered:

• Compression therapy: Compression treatment with bandages or compression stockings is central to the treatment of chronic venous disease. It combats swelling and overhydration of the damaged skin tissue and supports the venous return of blood from the legs upwards towards the heart. This improves the oxygen supply to the healing wound.
• Varicose veins (varices) are the main cause of every second venous ulcer. They can be closed from the inside using a catheter – usually on an outpatient basis and under local anesthesia – or sclerosed using foam sclerotherapy. In some situations, it is better to remove the varicose veins using the “classic” surgical method.

Treatment of the arterial ulcer (ulcus cruris arteriosum)

Arterial leg ulcers are the result of severe circulatory disorders. The bottlenecks in the vessel can be remedied by the following therapies, for example:

• Balloon dilatation: The treatment team advances a catheter with a small balloon into the affected vessel via the inguinal artery. The balloon is inflated, unfolds and expands the constricted vessel. This allows the blood to flow freely through the vessel again. Sometimes they also implant a vascular support (stent) to keep the vessel open.
• Bypass operation: If arterial narrowings cannot be passed over a longer distance with a balloon catheter, they can often be bypassed by vascular surgery using a piece of vein or an artificial blood vessel.

Skin grafting

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.