Phase 1: Wound cleansing

As a result of the chronic weakness of the leg veins, the leg ulcer wound is generally surrounded by hardened connective tissue which needs to be removed. Alternatively, ointments can be used to loosen or soften this layer and cleanse it. Special non-woven materials swell up in the moist wound and absorb the wound secretion. Dressings containing silver particles that disinfect the wound are used for those wounds infected with bacteria.

Phase 2: Formation of new connective tissue

In the second phase of wound healing, the body attempts to fill the gap in the skin. Flat dressings (hydrocolloid and hydropolymer dressings) are applied to support the growth of connective tissue. These dressings stimulate the production of connective tissue and keep the wound moist.

Phase 3: Formation of new skin

In the third phase of wound healing, the wound contracts and skin cells grow from the margins of the wound inwards, in order to close the wound. The first two phases of wound healing are severely disrupted in chronic leg vein weakness and therefore most leg ulcers will not usually reach the third phase without supportive wound treatment. Even in this last phase, a balanced amount of moisture must be present in the wound area and adhesion of the dressing to the delicate new skin must be avoided. Thin flat hydrocolloid or hydropolymer dressings are usually used for this purpose.

In order to shorten this phase, an operation (in some cases under local anaesthesia) may also be performed on a wound showing good granulation to cover it with thin autologous skin. There are a number of possible surgical techniques by which either small islands of skin can be transplanted or thin flaps or lattices of skin can be placed on the wound.