General therapeutic principles
On some points, the treatment approaches differ depending on the cause.
In venous leg ulcers, the compression treatment is with solid bandages wrapped around the leg or compression stockings in the center. Studies have shown that the healing rates of 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 switched off.
Compression therapy - not always the right choice
As important as the compression therapy for venous disorders is - with arterial leg ulcers they cause the opposite, because they squeeze the vessels and thus possibly bring the remaining blood circulation to a standstill. Therefore, depending on the extent of the circulatory disorder, operative measures for vascular dilation or bridging by means of vascular prosthesis are used.
In addition, the wound itself is treated - the ulcer is regularly cleaned (with drugs or mechanically by ablation) and covered with a special ("hydroactive") wound dressing that keeps the wound moist without sticking to it.
Antiseptic substances that reduce or prevent germs are only used when needed; if there is a marked infection, antibiotics are given. The wound can also be surgically removed and covered with a skin graft (shave therapy).
Sometimes the therapy with cortisone is also indicated. One in recent years rediscovered (getting used to but very effective) therapy option consists in the application of fly maggots which only do amoung the dead tissue and thus clean the wound.
Circulation and healing promotion
Circulation-enhancing drugs such as pentoxyfillin and heparin may possibly improve the symptoms, supportive exercise therapy and lymphatic drainage. Optionally, local so-called growth factors can be applied, which promote wound healing (eg a gel with PDGF-beta).
At the experimental stage is the application of gene therapy. With their help, it is attempted to introduce growth factors directly into certain skin cells, genetically engineer a skin graft such that it better forms vessels or infiltrates the gene for a growth factor into the wound with the aid of a carrier virus.