Lower extremity ulcers: Own treatment protocol [Ulcere cutanee a carico degli arti inferiori: Il nostro protocollo di trattamento]

Lower extremity ulcers are a cronic, common and inhabilitant pathology from a clinical and economical point of view. Our therapeutic alghorytm includes firstly an accurate clinical examination and then a study of blood supply to the limb in order to understand the arterial or venous nature of ulcers. If it's possible to operate the patient, firstly we perform a necrectomy followed by an istological exam of the specimen of the ulcer (a neoplastic degeneration is always possible); then we perform a split thickness skin graft. If a deep substance loss is present, it's possible to realize a microsurgical flap because of its better vascular support for the recipient site. In spite of all these treatments, sometimes it's not possible to obtain a complete riepitelization of the injuried area. In the last years, ulcers treatment have been progressed a lot because of the development of tissue enginearing and growth factors. If it is not possible to operate the patient, the only fruitful procedure is daily dressing of the injuries: it includes chemical and mechanical debridement and covering of ulcers with antibiotical and antiseptic oinments; this is just to avoid the enlargement and especially the infection of the ulcers.