Chirurgische Aspekte der neuen Leitlinie zum Ulcus cruris venosum

This review article summarizes the most important recommendations of the new guidelines of the Association of Scientific Medical Societies in Germany (AWMF) on the diagnostics and treatment of venous leg ulcers. The comprehensive clinical and timely duplex sonographic diagnostics are decisive for the identification of the causes of ulcers and the initiation of a targeted treatment. The individually adapted and as painless as possible wound treatment with consistent medical compression treatment are the basic measures which should be initiated without delay. These are supplemented by a causal treatment, whereby open surgical and endovascular procedures are applied. When an epifascial reflux is established as the main cause of a venous leg ulcer, a timely cleansing of the superficial venous system should be carried out. When an occlusion of the deep venous system is present an endovascular revascularization can be considered after exhaustion of the conservative measures. In cases of firmly attached deposits and necrosis with fascial dermatoliposclerosis, a surgical debridement or shave therapy is necessary, whereby a simultaneous defect coverage with split-skin transplantation represents the standard treatment.