Definition

The term ulcus cruris (ulcer "ulcer" and cruris "lower leg") refers to a substance disorder of the skin on the lower leg. Which typically develops as a result of venous drainage, arterial inflow disorders, or a mixture of both. Other causes are rare. Colloquially, the ulcus cruris is also called "open leg".

Epidemiology

The prevalence of leg ulcers is strongly age-dependent; leg ulcers hardly ever occur before the age of 40, and the incidence rises rapidly from the age of 75.

There are no reliable data on the incidence, and the number of people affected who do not consult a doctor or do so very late is probably high.

Pathophysiology

Both venous and arterial ulcers represent the most severe stage of their underlying disease, i.e., chronic venous 

insufficiency and peripheral arterial occlusive disease.

In terms of form, both venous and arterial ulcers differ (Table 1).

Mixed leg ulcers are a special form of leg ulcer, since both underlying diseases can influence the form and appearance of the ulcer(s) to different degrees.

Diagnostics

The focus of ulcer diagnostics is to clarify the underlying disease.

If none of the common causes of the ulcer(s) can be identified, or if the ulcer(s) show no healing tendency despite efficient cause-related therapy, other diseases with the same or similar symptoms must be sought.

Therapy

Of essential and fundamental importance for the healing of vascular ulcerations, is the efficient treatment of the underlying disease. For the treatment of venous causes, the focus is on compression therapy; for arterial causes, the focus is on increasing walking conduction or surgically improving blood flow.

In addition, local therapeutic measures are necessary for existing ulcers. These measures should be based on the current state of knowledge of wound treatment and individually adapted to the wound situation.

Above all, the necroses (mummified avital tissue) that occur in arterial leg ulcers must be treated dry; the "transformation" of a necrosis into a gangrene increases the risk of infection and even sepsis.