Skip to main content
  • 261 Accesses

Abstract

Leg ulcers can be defined as any wound located above the foot and under the knee. There are a large number of diseases that can induce a leg ulcer: malignancies, vascular, dermatological, metabolic, haematological or infectious diseases. Treatment of leg ulcers is based on two pillars:The first comprises treatment of underlying disease ,and the second encompasses local wound care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ABI or ABPI:

Ankle-brachial pressure index

DVT:

Venous thrombosis

ESWT:

Extracorporeal shock wave therapy

MPFF:

Micronised purified flavonoid fraction

NPWT:

Negative-pressure wound therapy

PAOD:

Peripheral arterial occlusive disease

PG:

Pyoderma gangrenosum

VAC:

Vacuum-assisted closure

VAD:

Venoactive drugs

wIRA:

Water-filtered infrared A

References

  • Barwell JR, Davies CE, Deacon J, Harvey K, Minor J, Sassano A, Taylor M, Usher J, Wakely C, Earnshaw JJ, Heather BP, Mitchell DC, Whyman MR, Poskitt KR. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet. 2004;363:1854–9.

    Article  PubMed  Google Scholar 

  • Brooklyn TN, Dunnill MG, Shetty A, Bowden JJ, Williams JD, Griffiths CE, Forbes A, Greenwood R, Probert CS. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut. 2006;55(4):505–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chaby G, Senet P, Vaneau M, Martel P, Guillaume JC, Meaume S, Téot L, Debure C, Dompmartin A, Bachelet H, Carsin H, Matz V, Richard JL, Rochet JM, Sales-Aussias N, Zagnoli A, Denis C, Guillot B, Chosidow O. Dressings for acute and chronic wounds: a systematic review. Arch Dermatol. 2007;143(10):1297–304.

    Article  PubMed  Google Scholar 

  • Coleridge-Smith P, Lok C, Ramelet AA. Venous leg ulcer: a meta-analysis of adjunctive therapy with micronized purified flavonoid fraction. Eur J Vasc Endovasc Surg. 2005;30:198.

    Article  CAS  PubMed  Google Scholar 

  • Cullen B, Smith R, McCulloch E. Mechanism of action of Promogran, a protease modulating matrix, for the treatment of diabetic foot ulcers. Wound Repair Regen. 2002;10(1):16–25.

    Article  PubMed  Google Scholar 

  • Duffy A, Schurr M, Warner T, Chen H. Long-term outcomes in patients with calciphylaxis from hyperparathyroidism. Ann Surg Oncol. 2006;13:96–102.

    Article  PubMed  Google Scholar 

  • Dumville JC, Worthy G, Soares MO, Bland JM, Cullum N, Dowson C, Iglesias C, McCaughan D, Mitchell JL, Nelson EA, Torgerson DJ, VenUS II team. VenUS II: a randomised controlled trial of larval therapy in the management of leg ulcers. Health Technol Assess. 2009;13(55):1–182.

    Article  CAS  PubMed  Google Scholar 

  • Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Glovicski P, Kistner RL, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40:1248–52.

    Article  PubMed  Google Scholar 

  • Eming S, Krieg T, Davidson J. Gene therapy and wound healing. Clin Dermatol. 2007;25:79–92.

    Article  PubMed  PubMed Central  Google Scholar 

  • European Wound Management Association (EWMA). Position document: wound bed preparation in practice. London: MEP Ltd; 2004.

    Google Scholar 

  • Falanga V, Margolis D, Alvarez O, Auletta M, Maggiacomo F, Altman M, Jensen J, Sabolinski M, Hardin-Young J. Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent. Human Skin Equivalent Investigators Group. Arch Dermatol. 1998;134(3):293–300.

    Google Scholar 

  • Falanga V, Iwamoto S, Chartier M, et al. Autologous bone marrow-derived cultured mesenchymal stem cells delivered in a fibrin spray accelerate healing in murine and human cutaneous wounds. Tissue Eng. 2007;13:1299–312.

    Article  CAS  PubMed  Google Scholar 

  • Guilhou JJ, Dereure O, Marzin L, et al. Efficacy of Daflon 500 mg on venous ulcer healing: a double blind randomized placebo controlled trail. Angiology. 1997;48:77.

    Article  CAS  PubMed  Google Scholar 

  • Kerk N, Goerge T. Livedoid vasculopathy – current aspects of diagnosis and treatment of cutaneous infarction. J Dtsch Dermatol Ges. 2013;11:407–10.

    PubMed  Google Scholar 

  • Miller DR, Enoch S, Williams DT, Price PE, Harding KG. Value of wound biopsy in chronic venous ulceration. Phlebology. 2004;19:65–8.

    Article  Google Scholar 

  • Moffat CJ, Franks PJ, Doherty DC, Martin R, Blewett R, Ross F. Prevalence of leg ulceration in a London population. QJM. 2004;97:431–7.

    Article  Google Scholar 

  • Neumann M, Cornu-Thénard A, Jünger M, Mosti G, Munte K, Partsch H, Rabe E, Albert-Adrien Ramelet AA, Streit M. Evidence based (S3) Guidelines for diagnostics and treatment of venous leg ulcers. European Dermatology Forum, Update 2014. http://www.euroderm.org/edf/index.php/edf-guidelines/category/5-guidelines-miscellaneous.

  • O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012;(11):CD000265.

    PubMed  Google Scholar 

  • O’Meara S, Martyn-St James M. Alginate dressings for venous leg ulcers. Cochrane Database Syst Rev. 2013a;(4):CD010182.

    Google Scholar 

  • O’Meara S, Martyn-St James M. Foam dressings for venous leg ulcers. Cochrane Database Syst Rev. 2013b;(5):CD009907.

    Google Scholar 

  • Ortega-Zilic N, Hunziker T, Läuchli S, Mayer DO, Huber C, Baumann Conzett K, Sippel K, Borradori L, French LE, Hafner J. EpiDex® Swiss field trial 2004–2008. Dermatology. 2010;221(4):365–72.

    Article  PubMed  Google Scholar 

  • Palfreyman S, Nelson E, Lochiel R, Michaels J. Dressings for healing venous leg ulcers. Cochrane Database Syst Rev. 2006;19, CD001103.

    Google Scholar 

  • Rabe E, Pannier-Fischer F, Bromen K, Schuldt K, Stang A, Poncar C, Wittenhorst M, Bock E, Weber S, Jöckel KH. Bonner Venenstudie für die Deutsche Gesellschaft für Phlebologie. Phlebologie. 2003;32:1–14.

    Article  Google Scholar 

  • Reichrath J, Bens G, Bonowitz A, Tilgen W. Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients. J Am Acad Dermatol. 2005;53(2):273–83.

    Article  PubMed  Google Scholar 

  • Roztocyl K, Stvrtinová V, Strejcek J. Efficacy of a 6-month treatment with Daflon 500 mg in patients with venous leg ulcers associated with CVI. Int Angiol. 2003;22:1.

    Google Scholar 

  • Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, Romanelli M, Stacey MC, Teot L, Vanscheidt W. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11 Suppl 1:S1–28.

    Article  PubMed  Google Scholar 

  • Sherman RA. Maggot versus conservative debridement therapy for the treatment of pressure ulcers. Wound Repair Regen. 2002;10(4):208–14.

    Article  PubMed  Google Scholar 

  • Sherman RA. Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy. Diabetes Care. 2003;26(2):446–51.

    Article  PubMed  Google Scholar 

  • Stieger M, Schmid JP, Bajrami S, Hunziker T. Extracorporeal shock wave therapy as a treatment of a non-healing chronic leg ulcer. Hautarzt. 2013;64(6):443–6.

    Article  CAS  PubMed  Google Scholar 

  • Storm-Versloot MN, Vos CG, Ubbink DT, Vermeulen H. Topical silver for preventing wound infection. Cochrane Database Syst Rev. 2010;(3):CD006478.

    Google Scholar 

  • Sunderkotter C, de Groot K. Therapie von Vaskulitiden und Vaskulopathien. Hautarzt. 2008;59:382–93.

    Article  CAS  PubMed  Google Scholar 

  • Tausche AK, Skaria M, Böhlen L, Liebold K, Hafner J, Friedlein H, Meurer M, Goedkoop RJ, Wollina U, Salomon D, Hunziker T. An autologous epidermal equivalent tissue-engineered from follicular outer root sheath keratinocytes is as effective as split-thickness skin autograft in recalcitrant vascular leg ulcers. Wound Repair Regen. 2003;11(4):248–52.

    Article  PubMed  Google Scholar 

  • Veves A, Falanga V, Armstrong DG, Sabolinski ML, Apligraf Diabetic Foot Ulcer Study. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. Diabetes Care. 2001;24(2):290–5.

    Article  CAS  PubMed  Google Scholar 

  • Vojtassák J, Danisovic L, Kubes M, et al. Autologous biograft and mesenchymal stem cells in treatment of the diabetic foot. Neuro Endocrinol Lett. 2006;27 Suppl 2:134–7.

    PubMed  Google Scholar 

  • Weenig RH, Sewell LD, Davis MD, McCarthy JT, Pittelkow MR. Calciphylaxis: natural history, risk factor analysis, and outcome. J Am Acad Dermatol. 2007;56:569–79.

    Article  PubMed  Google Scholar 

  • Widmer LK, Wandeler JM. Leg complaints and peripheral venous disorders. In: Widmer LK, editor. Peripheral venous disorders (Basle study III). Bern: Hans Huber; 1978. p. 33–42.

    Google Scholar 

  • Wieman TJ, Smiell JM, Su Y. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers. A phase III randomized placebo-controlled double-blind study. Diabetes Care. 1998;21(5):822–7.

    Article  CAS  PubMed  Google Scholar 

  • Wright DD, Franks PJ, Blair SD, et al. Oxerutins in the prevention of recurrence in chronic venous ulceration: a randomized controlled trial. Br J Surg. 1991;78:1269.

    Article  CAS  PubMed  Google Scholar 

Further Readings

  • Araya CE, Fennell RS, Neiberger RE, Dharnidharka VR. Sodium thiosulfate treatment for calcific uremic arteriolopathy in children and young adults. Clin J Am Soc Nephrol. 2006;1:1161–6.

    Article  CAS  PubMed  Google Scholar 

  • Auböck J. Synthetic dressings. Curr Probl Dermatol. 1999;27:26–48.

    Article  PubMed  Google Scholar 

  • Bettens S, Delaere B, Glupczynski Y, Schoevaerdts D, Swine C. Ecthyma gangrenosum in a non-neutropenic, elderly patient: case report and review of the literature. Acta Clin Belg. 2008;63:394–7.

    Article  CAS  PubMed  Google Scholar 

  • Binamer Y, Sowerby L, El-Helou T. Treatment of ulcerative necrobiosis lipoidica with topical calcineurin inhibitor: case report and literature review. J Cutan Med Surg. 2012;16(6):458–61.

    Article  PubMed  Google Scholar 

  • Caputo WJ, Beggs DJ, DeFede JL, Simm L, Dharma H. A prospective randomised controlled clinical trial comparing hydrosurgery debridement with conventional surgical debridement in lower extremity ulcers. Int Wound J. 2008;5(2):288–94.

    Article  PubMed  PubMed Central  Google Scholar 

  • Conrad C, Trüeb RM. Pyoderma gangrenosum. J Dtsch Dermatol Ges. 2005;3:334–42.

    Article  PubMed  Google Scholar 

  • Daniel BS, Borradori L, Hall 3rd RP, Murrell DF. Evidence-based management of bullous pemphigoid. Dermatol Clin. 2011;29:613–20.

    Article  CAS  PubMed  Google Scholar 

  • Darvay A, Acland KM, Russell-Jones R. Persistent ulcerated necrobiosis lipoidica responding to treatment with cyclosporin. Br J Dermatol. 1999;141(4):725–7.

    Article  CAS  PubMed  Google Scholar 

  • Dissemond J, Körber A, Grabbe S. Differential diagnosis of leg ulcers. J Dtsch Dermatol Ges. 2006;4:627–34.

    Article  PubMed  Google Scholar 

  • Enoch S, Miller DR, Price PE, Harding KG. Early diagnosis is vital in the management of squamous cell carcinomas associated with chronic non healing ulcers: a case series and review of the literature. Int Wound J. 2004;1:165–75.

    Article  PubMed  PubMed Central  Google Scholar 

  • Falanga V. Wound bed preparation: science applied to practice. In: European Wound Management Association (EWMA), editor. Position document: wound bed preparation in practice. London: MEP Ltd; 2004.

    Google Scholar 

  • Greene SL, Su WP, Muller SA. Ecthyma gangrenosum: report of clinical, histopathologic, and bacteriologic aspects of eight cases. J Am Acad Dermatol. 1984;11:781–7.

    Article  CAS  PubMed  Google Scholar 

  • Guillevin L, Lhote F. Classification and management of necrotizing vasculitis. Drugs. 1997;53:805–16.

    Article  CAS  PubMed  Google Scholar 

  • Hafner J, Schaad I, Schneider E, Seifert B, Burg G, Cassina PC. Leg ulcers in peripheral arterial disease (arterial leg ulcers): impaired wound healing above the threshold of chronic critical limb ischemia. J Am Acad Dermatol. 2000;43:1001–8.

    Article  CAS  PubMed  Google Scholar 

  • Hafner J, Nobbe S, Partsch H, Läuchli S, Mayer D, Amann-Vesti B, Speich R, Schmid C, Burg G, French LE. Martorell hypertensive ischemic leg ulcer: a model of ischemic subcutaneous arteriolosclerosis. Arch Dermatol. 2010;146:961–8.

    Article  PubMed  Google Scholar 

  • Hairston BR, Davis MD, Gibson LE, Drage LA. Treatment of livedoid vasculopathy with low-molecular-weight heparin: report of 2 cases. Arch Dermatol. 2003;139:987–90.

    Article  PubMed  Google Scholar 

  • Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor Jr LM, White CJ, White J, White RA, Antman EM, Smith Jr SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B, American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, ACC/AHA Task Force on Practice Guidelines. ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease) – summary of recommendation. J Vasc Interv Radiol. 2006;17:1383–97.

    Article  PubMed  Google Scholar 

  • Howard DPJ, Howard A, Kothari A, Wales L, Guest M, Davies AH. The role of superficial venous surgery in the management of venous ulcers: a systematic review. Eur J Vasc Endovasc Surg. 2008;36:458–65.

    Article  CAS  PubMed  Google Scholar 

  • Jones V, Grey JE, Harding KG. Wound dressings. BMJ. 2006;332(7544):777–80.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kirtschig G, Middleton P, Bennett C, Murrell DF, Wojnarowska F, Khumalo NP. Interventions for bullous pemphigoid. Cochrane Database Syst Rev. 2010;(10):CD002292.

    Google Scholar 

  • Lazarus GS, Cooper DM, Knighton DR, Margolis DJ, Pecoraro RE, Rodeheaver G, Robson MC. Definitions and guidelines for assessment of wounds and evaluation of healing. Arch Dermatol. 1994;130:489–93.

    Article  CAS  PubMed  Google Scholar 

  • Leaper DJ, Schultz G, Carville K, Fletcher J, Swanson T, Drake R. Extending the TIME concept: what have we learned in the past 10 years? Int Wound J. 2012;9 Suppl 2:1–19.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lehnen M, Kohaus S, Körber A, Hillen U, Grabbe S, Dissemond J. Contact allergies in patients with chronic wounds: results of a study from 1999 to 2004. Hautarzt. 2006;57(4):303–6.

    Article  CAS  PubMed  Google Scholar 

  • Meissner M, Gille J, Kaufmann R. Calciphylaxis: no therapeutic concepts for a poorly understood syndrome? J Dtsch Dermatol Ges. 2006;4:1037–44.

    Article  PubMed  Google Scholar 

  • Meurer M. Immunosuppressive therapy for autoimmune bullous diseases. Clin Dermatol. 2012;30:78–83.

    Article  PubMed  Google Scholar 

  • Moffatt C, Morison MJ, Pina E. Wound bed preparation for venous leg ulcers. In: European Wound Management Association (EWMA), editor. Position document: wound bed preparation in practice. London: MEP Ltd; 2004.

    Google Scholar 

  • Monney P, Nguyen QV, Perroud H, Descombes E. Rapid improvement of calciphylaxis after intravenous pamidronate therapy in a patient with chronic renal failure. Nephrol Dial Transplant. 2004;19:2130–2.

    Article  PubMed  Google Scholar 

  • Mumcuoglu KY, Ingber A, Gilead L, Stessman J, Friedmann R, Schulman H, Bichucher H, Ioffe-Uspensky I, Miller J, Galun R, Raz I. Maggot therapy for the treatment of intractable wounds. Int J Dermatol. 1999;38(8):623–7.

    Article  CAS  PubMed  Google Scholar 

  • Nguyen K, Washenik K, Shupack J. Necrobiosis lipoidica diabeticorum treated with chloroquine. J Am Acad Dermatol. 2002;46(2 Suppl Case Reports):S34–6.

    Article  PubMed  Google Scholar 

  • Partsch H. Current problems in dermatology, vol. 27. Basel: Karger; 1999.

    Google Scholar 

  • Patel GK, Harding KG, Mills CM. Severe disabling Koebnerizing ulcerated necrobiosis lipoidica successfully managed with topical PUVA. Br J Dermatol. 2000;143(3):668–9.

    Article  CAS  PubMed  Google Scholar 

  • Ramelet AA. Phlebology, the guide. Paris: Elsevier; 1999.

    Google Scholar 

  • Ramelet AA. Dermatol Surg. 2002;28:6–10.

    CAS  PubMed  Google Scholar 

  • Rey S, Sparsa A, Durox H, Allot V, Pommepuy I, Salem A, Roux C, Labrousse F, Bonnetblanc JM. Calciphylaxis treated by cinacalcet: a medical alternative to parathyroidectomy. Rev Med Interne. 2009;30:186–9.

    Article  Google Scholar 

  • Robson MC. Wound infection. A failure of wound healing caused by an imbalance of bacteria. Surg Clin North Am. 1997;77(3):637–50.

    Article  CAS  PubMed  Google Scholar 

  • Robson M, Mannari R, et al. Maintenance of wound bacterial balance. Am J Surg. 1999;178:399–402.

    Article  CAS  PubMed  Google Scholar 

  • Schliep S, Schuler G, Kiesewetter F. Successful treatment of calciphylaxis with pamidronate. Eur J Dermatol. 2008;18:554–6.

    CAS  PubMed  Google Scholar 

  • Schumann H, Calow T, Weckesser S, Müller ML, Hoffmann G. Water-filtered infrared A for the treatment of chronic venous stasis ulcers of the lower legs at home: a randomized controlled blinded study. Br J Dermatol. 2011;165(3):541–51.

    Article  CAS  PubMed  Google Scholar 

  • Schuren J, Becker A, Sibbald RG. A liquid film-forming acrylate for peri-wound protection: a systematic review and meta-analysis (3M Cavilon no-sting barrier film). Int Wound J. 2005;2(3):230–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Scola N, Gäckler D, Stücker M, Kreuter A. Complete clearance of calciphylaxis following combined treatment with cinacalcet and sodium thiosulfate. J Dtsch Dermatol Ges. 2011;9:1030–1.

    PubMed  Google Scholar 

  • Shiraishi N, Kitamura K, Miyoshi T, Adachi M, Kohda Y, Nonoguchi H, Misumi S, Maekawa Y, Murayama T, Tomita M, Tomita K. Successful treatment of a patient with severe calcific uremic arteriolopathy (calciphylaxis) by etidronate disodium. Am J Kidney Dis. 2006;48:151–4.

    Article  PubMed  Google Scholar 

  • Stöberl C. Komprimieren: Wann, wie, wozu? In: Partsch H, editor. Phlebologiekurs II. Wien: Facultas Universitätsverlag; 1990. p. 178–88.

    Google Scholar 

  • Streit M, Mayer D, Traber J. Definitionen und Arten von Wunden: Akute und chronische Wunden. Wund Manage. 2012;3:4–10.

    Google Scholar 

  • Suárez-Amor O, Pérez-Bustillo A, Ruiz-González I, Rodríguez-Prieto MA. Necrobiosis lipoidica therapy with biologicals: an ulcerated case responding to etanercept and a review of the literature. Dermatology. 2010;221(2):117–21.

    PubMed  Google Scholar 

  • Tan E, Patel V, Berth-Jones J. Systemic corticosteroids for the outpatient treatment of necrobiosis lipoidica in a diabetic patient. J Dermatolog Treat. 2007;18(4):246–8.

    Article  CAS  PubMed  Google Scholar 

  • Torregrosa JV, Durán CE, Barros X, Blasco M, Arias M, Cases A, Campistol JM. Successful treatment of calcific uraemic arteriolopathy with bisphosphonates. Nefrologia. 2012;32:329–34.

    PubMed  Google Scholar 

  • Trémezaygues L, Schmaltz R, Vogt T, Reichrath J. Management of pyoderma gangrenosum. An update on clinical features, diagnosis and therapy. Hautarzt. 2010;61(4):345–53.

    Article  PubMed  Google Scholar 

  • von Felbert V, Schumann H, Mercer JB, Strasser W, Daeschlein G, Hoffmann G. Therapy of chronic wounds with water-filtered infrared-A (wIRA). GMS Krankenhhyg Interdiszip. 2008;2(2):Doc52.

    Google Scholar 

  • Wenzel J, Gerdsen R, Phillipp-Dormston W, Bieber T, Uerlich M. Topical treatment of pyoderma gangrenosum. Dermatology. 2002;205:221–3.

    Article  CAS  PubMed  Google Scholar 

  • Williams D, Enoch S, Miller D, Harris K, Price P, Harding KG. Effect of sharp debridement using curette on recalcitrant nonhealing venous leg ulcers: a concurrently controlled, prospective cohort study. Wound Repair Regen. 2005;13(2):131–7.

    Article  PubMed  Google Scholar 

  • Winter GD. Formation of the scab and the rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature. 1962;193:293–4.

    Article  CAS  PubMed  Google Scholar 

  • Zitt E, König M, Vychytil A, Auinger M, Wallner M, Lingenhel G, Schilcher G, Rudnicki M, Salmhofer H, Lhotta K. Use of sodium thiosulphate in a multi-interventional setting for the treatment of calciphylaxis in dialysis patients. Nephrol Dial Transplant. 2013;28:1232–40.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Markus Streit .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Streit, M., Blazek, C. (2015). Leg Ulcers. In: Katsambas, A.D., Lotti, T.M., Dessinioti, C., D’Erme, A.M. (eds) European Handbook of Dermatological Treatments. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45139-7_49

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-45139-7_49

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-45138-0

  • Online ISBN: 978-3-662-45139-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics