Treatment of the underlying disease
Diagnosis of the underlying disease
Before actual wound treatment can be initiated, it is necessary to clarify the underlying disease which led to the skin defect after an initial anamnesis, recording of findings and evaluation of the wound. The most frequent causes of chronic wounds are:
- Chronic venous insufficiency
- Arterial occlusive disease
- Chronic pressure loading/decubitus
- Diabetes mellitus, angiopathy, neuropathy
Treatment of the underlying disease
For patients with chronic wounds, efficient causal treatment of the underlying disease is mostly just as important as the actual local wound treatment for healing. The goal is to improve the disrupted micro- and macrocirculation in the skin. A diagnostic clarification of the causes of chronic wounds is, therefore, the first and basic step enabling effective treatment of the patient.
Ulcus cruris venosum (venous leg ulcer)
In patients whose chronic wound is of venous origin, venous congestion in the legs must be reduced. This can be achieved by a compression treatment concomitant to wound treatment as well as regular movement or physiotherapy which activates the muscular venous pump. An operation on the venous system can also possibly be indicate
Ulcus cruris arteriosum (arterial leg ulcer)
Measures which promote circulation in the leg are necessary for a purely arterial ulcer. They can include for instance walking exercise for revascularization, vascular operations and/or medicinal therapies.
Decubital ulcers
For causal treatment of decubital ulcers, the patient’s existing ulcers or vulnerable parts of the skin should be relieved for instance by a special decubitus mattress and regular change of position.
Diabetic ulcers/diabetic foot
The basic prerequisite for successfully treating diabetic ulcers is optimal metabolic control. This is also the best therapy for neuropathy. Additionally, the affected foot should be relieved of pressure with special orthopedic shoes.
