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Leg ulcers – the „open leg“

As the colloquial name already suggests, the wound is an open, usually exuding wound on the lower leg. The course shows no improvement over a long period of time and very often ends in a chronic wound. The type of wound is often attributed to an underlying disease, such as chronic venous insufficiency or peripheral arterial disease. The underlying disease diabetes complicates the therapy and healing opportunities. Very often, the trigger is a small wound that does not heal due to supply problems and further worsens the condition of the surrounding tissue. Inflammation and siege by bacteria are usually further characteristics. There are many more causes. With TIVITA® Tissue it is possible for the first time to monitor the oxygen supply to the surrounding and affected tissue.

Venous leg ulcers
The venous leg ulcer is a substance defect with pathologically altered lower leg tissue due to chronic venous insufficiency (CVI). The muscle-vein pump in combination with intact venous valves ensure a safe blood flow back to the heart and prevent a backflow or a stagnation of the blood in the veins. CVI patients suffer from non-intact venous valves, connective tissue weaknesses disturb the function of the venous valves, which can lead to impaired blood flow and congestion in the extremities. Permanent problems with the removal of blood lead to wounds, the course of which is usually chronic. In addition, affected patients usually suffer from water retention in the legs (edema), which further complicates the backflow of the blood.

Regular exercise activates the muscle-vein pump, but only to a limited extent in the advanced stage of the disease. Only by a compression therapy can the stored water displace and improve the blood flow, which also positively influences the healing of already formed wounds by the increase of the oxygen saturation. The assessment of the correct compression is very subjective. The removal of tissue water in the leg is improved, but many wounds continue to show increased water content to the surrounding tissue, which can block healing.

A healing of the wound can only be guaranteed if the water content in the affected limb and the wound itself is reduced. For this an objective, multi-parameter assessment of the wound is of great advantage. Furthermore, according to the course of the wound, the therapy can be individually adapted and optimized to the needs. Aiming to reduce the water content in the wound may be liquid-absorbent pads in combination with the proper compression. In compression therapy, it can happen that there is too much constriction in certain tissue areas, which is a source of danger for other wounds. This can also be detected early by the novel diagnostics and prevented accordingly. The following is a meaningful case study.

The patient has two large and deep wounds on the leg at the start of treatment. The orange arrows on the left indicate areas in the wound that mark areas under 30 (%) (blue areas) in the parameter screens StO2 and NIR Perfusion. These indicate a lack of perfusion and are considered to be critical for wound healing. The high THI (tissue hemoglobin content, green arrow) indicates that the wound is open. The TWI (blue arrow) shows that the whole lower leg has a very high water content. During the course of the treatment, it can be seen that the perfusion increased (orange arrows on the right) and the water content in the lower leg (blue center arrow) could be reduced. The still high THI indicates that the wound closes only slowly. Due to the still high water content within the wound, the treatment was modified and a liquid-absorbent wound dressing was consulted. The THI at the end of the documentation (green arrow on the right), shows a closing of the wound.

Course of a chronic wound under treatment

Overall, the oxygen saturation (StO2) increases continuously in the course of the wound treatment, which speaks for an improvement of the wound state. The compression causes a reduction in the water content in the leg, but not in the wound. After 11.05. a condition is added to the therapy, which withdraw water, which is understood in the further course. At the same time, it can be seen from the THI that the red area is shrinking, which indicates a wound closure. The data conclude that it is the combined therapy that leads to wound closure.