It is very important for the treatment the diferencial diagnosis. 

- they are current of the sistemic hypertension of the superficial veined plexo, provoking deficiency of the veined return, 
- it corresponds at 60 to 80% of the ulcers of the inferior members, 
- they are frequent in the 1/3 medium-distal of the leg and with larger incidence on the bony prominences, particularly the maleoluos mediates, 
- it is generally superficial, irregular and multiple and it has aspect of plate eritematosa, surround of the borders, eczema and hiperpigmentation of adjacent areas. 
- the oedema is always present, pulses pediais generally tangible, 
- it is not very painful. 
- it presents recorrence in 70% of the cases. 

- it accompanies history of intermittent claudication, 
- to the clinical exam it presents absence of pulses in the extremities and cold, pale cutis or cianotic, 
- they are deep lesions, involving muscles and tendons, 
- larger frequency 1/3 distal of the leg and smaller incidence on the bony prominences, 
- they are generally more painful, 
- it presents smaller recorrence index.

It is important to define the dominant factor for we could choose the treatment.

Basically it should improve the drainage and to maintain the bed of the humid wound through the use of appropriate topical products. 

1. Rest: It is fundamental the rest and the elevation of the inferior members (position of Trendelenburg). Socioeconomic and family problems can impede this recommendation. The ideal would be to create systems of attendance domiciliar, with the support of the public system of health. 

2. Diet: balanced for patients' control with systemic arterial hypertension and accentuated obesity.

3. Veined Ulcers Compression: In the treatment of the veined ulcers the external compression is indicated. This proceeding besides facilitating the veined return reducing the o edema, it tends to balance the inadequacy valvular and to decrease the pain. The compression method will depend on the need, of the acceptance on the part of the customer and of the amount of secretion of the wound.

The objective is to maintain the clean and humid wound and the wash should be made with physiologic saline solution (0,9%) in jets. 
As the bed of the wound is generally covered by necrotic and fibrinous slough areas the application of chemical debridement is recommended, as well as, when necessary to the association of the mechanical desbridement.

The indication of the topical product to be used will depend:
a) healing phase of the lesion,
b) amount of necrotic and fibrinous slough areas,
c) readiness of the product in the service of health of reference and/or of the possibility of acquisition of the same on behalf of the patient.

The ideal would be that the team interdisciplinary went experienced and it disposed of several of these resources using them according to the need of the case, as: silver
sulfadiazine and cerio nitrate, enzymatic ointment (collagenase, fibrolynosin), hydrocoloide, hydrogel, linoleic acid, ricinoleic acid, bioperoxoil, Aloe vera, elicine, papain, albumin, non adherent gauzes, calcium and sodium alginate etc. 
The change period will depend on the chosen product. 

It is another resource that can be associated in the treatment of this ulcers. Hyperbaric oxygentherapy  (HBO) improves the oxigenated of the extremities of the limbs and consequently of every affected area, accelerating the formation of tissue cicatricial and collaborating in the control of the infection, because potencialition the effect of the antibiotic.

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Hyperbaric Oxygentherapy

DRESSING and COVERINGS

  

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It Consults the Feridologo's Book - 2006
Santos - São Paulo - Brazil.