Venous tibial ulcer - conservative and operative treatment

The trophic ulceration of the tibia is a complication of chronic venous insufficiency (CVI). This disease is secondary to venous hypertension caused by venous reflux and often partial obstruction of the deep veins. The main goal of the treatment is the successful correction of micro-and macrocirculation as well as the reduction of venous pressure of the leg. Moreover, the cause of venous ulcer should be diagnosed, the mapping should be performed, and the obstruction of venous flow should be removed. The complex wound care contains: wound cleansing and debridement as well as the use of moisture maintenance, closed dressings (e.g. hydrogel and bioactive dressing), pharmacotherapy (micronized diosmine and hesperdin, anticoagulants, antibiotics in compliance with antibiogram), compression therapy, ozone therapy, surgical procedures (endoscopic and cryosurgical methods with approach via healthy skin are preferred). The compression therapy adjusted to arterial supply of the leg, according to ankle-brachial index (ABI), is compulsory after surgery. The sclerotherapy, a technique based on the injection of an obliteration solution in the form of foam under ultrasound guidance is an important auxiliary method. The following surgical treatment is recommended when the conservative methods fail: classic methods (VSM and VSP stripping according to Dodd-Cockett), mini phlebectomy according to Muller, cryostripping, endoluminal lase-rotherapy and RF-therapy, subfascial endoscopic perforator surgery (SEPS), CHIVA method, venous valve plasty or implantation, narrowed or occluded iliac or femoral veins stenting, endovascular embolisation and targeted sclerotherapy, newer technique as growth-factors (i.e. becaplermin gel) or various skin substitutes i.e. graftskin). Each invasive procedure should be always followed by compression therapy, pharmacotherapy and the wound local therapy with bioactive dressing.