**5.1 Local VLUs therapy**

Local VLUs therapy is based on the application of the TIME treatment principle [27]:


Chronic wounds can traditionally be bandaged with gauze, antiseptics, topical antibiotics and adsorbents. This type of therapy requires daily bandaging, making the treatment expensive and ineffective [28].

By wound cleaning, we mean the removal of necrosis, fibrin or other deposits. Necrotic tissue can be removed surgically or treated with an enzymatic wound cleanser. The wound cleans itself by autolysis, if none of these methods is chosen. When performing surgical debridement of ulceration, debridement should be performed to avoid damage to healthy tissue [29]. Antiseptics such as povidone-iodine, chlorhexidine, acetic acid etc. are often used today in the VLUs treatment.

The use of dressings in the treatment of VLUs is efficient and pharmacoeconomically justified. The use of dressings in the treatment of VLUs has shown a significant advantage over the classic gauze bandage in a large number of studies. The advantages of dressing applying in the treatment of VLUs are reflected in [30]:


Dressings are divided into primary and secondary. Primary dressings are in direct contact with the wound surface, while secondary dressings have the role of fixing and holding the primary dressing, which also protects the wound surface from the external environment. Today, dressings have the role of both primary and secondary [31, 32].


#### **Table 2.**

*Type and mode of dressings action.*

The division of dressings according to the mode of action on wound healing is shown in **Table 2**.

#### **5.2 Compression therapy in the treatment of VLUs**

Compression therapy is the most effective form of VLUs conservative treatment. The advantage of this therapy is that it is used on an outpatient basis, patients are able to work during treatment and it is also cheaper compared to surgical treatment [33]. This method of treatment can be applied continuously or intermittently. Before applying the compression bandage, it is necessary to perform local treatment of the ulcer surface, cover the ulcer surface with sterile gauze, after which a compressive bandage is placed. The application of external compression reduces transmural pressure and improves skin changes. Compression bandage compresses the extremities, thus reducing the effect of venous hypertension. Depending on the stage of the vein disease, different degrees of compression therapy are applied.

Compression therapy can be achieved with short-elastic and long-elastic bandages, as well as various compression systems (compression gloves, socks and clothing) [34]. The materials used to make compressive agents have different extensibility, and create different pressures under the applied compressive agents both at rest and while walking.

In relation to the degree of compression, compression means are divided into four classes (**Table 3**) [35].

These compression values refer to in vivo measurements in the medial B1 area (end of the Achilles tendon / calf muscle insertion) measured while lying down [36].

Compression systems may contain elastic and inelastic materials. Multilayer systems (two-layer and four-layer) function as inelastic systems even if they contain mainly elastic components. An inelastic bandage is known to have high stiffness compared to an elastic bandage. The stiffness of the compression therapy system can be determined by determining the static stiffness index (SSI). This index is determined by measuring the values of the pressure between the compression system and the patient's skin (subband pressure). Pressure is measured first when the patient is lying down and then in a standing position. The difference between these two measurements is SSI. If SSI is >10, the compression system is characterized as inelastic, while if SSI is <10, the compression system is marked as elastic [37].

Compression therapy systems in which SSI is high (inelastic or multilayer compression system) give higher pressure during standing and lower pressures when the patient is lying down compared to a system with lower SSI (elastic compression system).

*Perspective Chapter: Diagnosis and Treatment of Venous Leg Ulcer DOI: http://dx.doi.org/10.5772/intechopen.105676*


#### **Table 3.**

*Levels of compression and indications.*


#### **Table 4.**

*Absolute and relative contraindications for the application of compressive therapy.*

Contraindications to the use of compression therapy are shown in **Table 4** [38]: The use of compression therapy may be associated with the appearance of certain signs and symptoms that indicate the appearance of complications. The most common complications of compression therapy are necrosis, skin trauma, discoloration, pain, paresthesia, burning sensation, etc. [39].

#### **5.3 Surgical treatment**

Surgical treatment of VLUs is one of the types of treatment. Today, surgical procedures are performed on the superficial venous system, deep venous system and venous perforators. It should also be noted that surgical procedures on these three venous systems can be combined [40]. One of the ways of VLUs surgical treatment is the Vigoni-Schmeller procedure. This method involves excision of ulcers and surrounding altered tissue with removal of compartment syndrome of the lower leg by the Hach method [41].
