The Role of Complex Treatment in Mixed Leg Ulcers – A Case Report of Vascular, Surgical and Physical Therapy


  • Uwe Wollina Städtisches Klinikum Dresden, Department of Dermatology and Allergology, 01067 Dresden
  • Birgit Heinig Städtisches Klinikum Dresden - Center of Physical and Rehabilitative Medicine, Dresden
  • Christian Stelzner Stadtisches Klinikum Dresden - Department of Internal Medicine II, Angiology Unit, Dresden, Sachsen
  • Gesina Hansel Städtisches Klinikum Dresden - Department of Dermatology and Venerology, Dresden, Sachsen
  • Jacqueline Schönlebe Städtisches Klinikum Dresden - Institute of Pathology "Georg Schmorl", Dresden
  • Georgi Tchernev Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, and Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia
  • Torello Lotti Università Degli Studi "G. Marconi”, Rome



Leg ulcer, Mixed vascular type, Sandwich transplantation, Percutaneous transluminal angioplasty, Transdermal CO2, Surgery


BACKGROUND: Leg ulcers are a burden to patients, their families and society. The second most common cause of chronic leg ulcers is the mixed arterio-venous type. An 80-year-old female patient presented to our department due to painful enlarging chronic leg ulcer of mixed arteriovenous origin on her left lower leg. She suffered from peripheral arterial occlusive disease stage I and chronic venous insufficiency Widmer grade IIIa, and a number of comorbidities.

AIM: The aim of our ulcer treatment was a complete and stable wound closure that was hampered by arterial occlusion, exposed tendon, and renal insiffuciency.

CASE REPORT: To improve the prognosis for ulcer surgery, we performed percutaneous transluminal angioplasty, transcutaneous CO2 and deep ulcer shaving. The wound was closed by sandwich transplantation using elastin-collagen dermal template and meshed split skin graft. She had a 100% graft take with rapid reduction of severe wound pain.

CONCLUSION: Complex approaches are necessary, to gain optimum results in leg ulcer therapy in mixed leg ulcers. Therapeutic nihilism should be abandonend.


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How to Cite

Wollina U, Heinig B, Stelzner C, Hansel G, Schönlebe J, Tchernev G, Lotti T. The Role of Complex Treatment in Mixed Leg Ulcers – A Case Report of Vascular, Surgical and Physical Therapy. Open Access Maced J Med Sci [Internet]. 2018 Jan. 1 [cited 2024 Jun. 17];6(1):67-70. Available from:

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