Ulcus cruris – causes, connection with CVI and comprehensive therapeutic approaches

What is a leg ulcer?

The leg ulcer is a chronic wound on the lower leg that is difficult to heal and is usually due to impaired circulation. In around 80 % of cases, it is a Ulcus cruris venosumwhich is caused by venous circulatory disorders. Other forms, such as the Ulcus cruris arteriosum (due to arterial disorders) or the ulcus cruris mixtum (a combination of venous and arterial causes) also occur, but are rarer.

Anatomical basics

Blood circulation in the legs works via a network of superficial and deep veins that transport blood back to the heart against the force of gravity. When the Venous valves do not close properly, the blood can flow back and accumulate in the veins. This condition is known as venous insufficiency and leads to a chronic increase in pressure in the veins, which can ultimately lead to a leg ulcer.

Causes of venous leg ulcers

The main cause of a venous leg ulcer is chronic venous insufficiency (CVI)a disease in which the venous valves lose their function and the blood is no longer transported efficiently to the heart. The persistent backlog of blood in the leg veins leads to permanent overstretching of the vein walls and damages the surrounding tissue. The most important risk factors include

• Varicose veins (varicosis)These dilated veins prevent the smooth flow of blood and increase the pressure in the veins.
• Chronic venous insufficiency (CVI)The main cause of venous leg ulcers, which is caused by dysfunction of the venous valves.
• Deep vein thrombosis (DVT)A previous thrombosis in the deep veins can permanently damage venous valves and lead to venous congestion.
• Being overweightExcessive body weight increases the pressure on the leg veins, which impedes the return flow of blood.
• Standing or sitting for long periodsOccupational groups who spend long periods of time in one position have an increased risk of CVI and leg ulcers.

What is chronic venous insufficiency (CVI)?

The chronic venous insufficiency (CVI) is a chronic venous disease in which the venous valves venous valves in the leg no longer function properly. The blood no longer flows effectively back to the heart and builds up in the veins, which in the long term leads to Swelling, skin changes and ulcers like the ulcus cruris can lead to a CVI. CVI is diagnosed on the basis of CEAP classification is divided into different degrees of severity:

• C1Spider veins or reticular veins
• C2: Visible varicose veins
• C3: Swelling (edema) in the legs
• C4a: Skin changes such as pigmentation disorders and eczema
• C4b: Hardening of the tissue (lipodermatosclerosis)
• C5Healed leg ulcer
• C6Active, open leg ulcer

The treatment of CVI is crucial to prevent the development of a leg ulcer or to heal an existing wound.

Ulcus cruris in connection with other diseases

Although the CVI is the main cause of venous leg ulcer there are several other conditions that can influence the development or healing of leg ulcers:

• Diabetes mellitusPoor blood circulation and wound healing disorders in diabetes make those affected more susceptible to chronic wounds.
• Arterial occlusive disease (AVD)Patients with arterial circulatory disorders are more likely to develop ulcus cruris arteriosumwhich is caused by a lack of oxygen in the tissue.
• Rheumatoid arthritisChronic inflammation weakens the tissue and can lead to the development of ulcers.
• Heart failurePatients with chronic heart failure are prone to swelling and fluid accumulation in the legs, which favors the development of leg ulcers.

How are venous leg ulcers treated?

The treatment of a venous leg ulcer requires a comprehensive and long-term approach that addresses both the causes of the disease and the wound itself. The main therapeutic approaches include compression therapymodern wound care, surgical interventions and innovative procedures such as VenaSeal and radiofrequency ablation.

1. compression therapy

Compression therapy is the basis for the treatment of venous leg ulcers. It improves venous return and reduces the pressure in the veins, which supports the healing of the wound. Elastic bandages or medical compression stockings are used for this purpose. Common methods include

• Short-stretch bandagesThese provide high pressure at rest and lower pressure when moving, which is particularly helpful for acute wounds.
• Medical compression stockingsThese must often be worn long-term to prevent the ulcus cruris from recurring.

2. wound care

Modern wound care plays a decisive role in the treatment of leg ulcers. A thorough Wound cleansing and the use of special wound dressings promote healing. The most commonly used materials include

• Hydrocolloid dressingsThese keep the wound moist and promote the formation of new tissue.
• Antimicrobial dressingsThese are useful if the wound is infected or there is a high risk of infection.

3. VenaSeal: A minimally invasive treatment method

VenaSeal is one of the most modern and effective treatments for eliminating varicose veins and improving venous circulation. In this procedure, a special medical Vein glue is injected into the diseased vein, which closes the affected vein and prevents the blood from flowing back. This minimally invasive technique does not require anesthesia, is virtually painless and enables a quick return to normal activities. VenaSeal is particularly advantageous as it does not require the use of heat or large incisions, which reduces the risk of post-operative complications.

4. radiofrequency ablation (RFA)

The radiofrequency ablation is another modern and effective method for treating varicose veins that contribute to the development of leg ulcers. A thin probe is inserted into the affected vein, which emits high-frequency radio waves. These waves heat and seal the vein, diverting the blood flow into healthy veins. This procedure is minimally invasive, requires only local anesthesia and enables a quick recovery.

5 Surgical treatment

In advanced cases, surgical intervention may be necessary, especially if conservative measures are not sufficient. Surgical procedures include

• Vein operationsRemoval or sclerotherapy of diseased veins to improve blood flow.
• Skin graftsIn the case of large wounds, a skin graft may be necessary to close the wound and promote healing.

Prevention and aftercare

The avoidance of risk factors and consistent follow-up care are crucial to prevent the recurrence of leg ulcers. leg ulcer to prevent. These include:

• Regular exercise: Promotes blood circulation and reduces the risk of venous congestion.
• Weight reductionObesity puts pressure on the leg veins and increases the risk of CVI.
• Wearing compression stockingsThese should be worn for the rest of the patient’s life to prevent recurrence of the disease.

Conclusion

The treatment of venous leg ulcer requires an individually adapted, holistic therapy that includes both conservative and modern minimally invasive approaches such as VenaSeal and radiofrequency ablation includes. Early treatment of the underlying chronic venous insufficiency is the key to avoiding serious complications. Patients should also be monitored regularly by a doctor and, if necessary, preventive measures should be taken to minimize the risk of recurrence.