Standards in the surgical treatment of leg ulcers

Abstract

Nowadays we have a broad range of surgical options to heal recalcitrant leg ulcers. They rest upon uniformly recognised standards and prevail against other techniques. The elimination of reflux in venous ulcers is the main aim and reduces recurrence significantly compared to conservative treatment alone. Beside classic venous surgery there are some modern therapeutical options such as laser, radiofrequency ablation, foam-sclerotherapy or cyaonacrylat-embolisation at disposal. For local ulcer surgery shave-therapy with simultaneous meshgraft plastic is the method of first choice to treat non healing leg ulcers. Longterm results with healing up to 85 % are not achievable with any other method. Crural fasciectomy ist nowadays reserved for special indications: Transfascial necrosis, failure after shave therapy and severe tissue calcification are successfully treated by fasciectomy. Beside the right choice of surgical procedure longterm healing rates depend on a standardised wound care in hospital and medical home care.