Adequate treatment of chronic ulcers is critical to promote healing and minimize the risk for complications. Treatment interventions include management of conditions that give rise to chronic wounds of different origin. Guidelines present a synthesis of evidence-based recommendations for the diagnosis and treatment of chronic (non healing) wounds.
Decongestive therapy in accordance with international guideline is considered the mainstay of chronic wound treatment.
The value of a guideline is that it provides consistency among treatment protocols given to patients, resulting in improved efficacy and the quality of care and of resources, so
that an agreed on “best practice” algorithm can maximize the quality and effectiveness of care while minimizing cost and resource use.

Prevalence of chronic venous insufficiency (CVI) in the western world is 17-40 %. The most severe complication associated with CVI is leg ulcer, which develops in 1% of the population. Altered haemodynamics, vein wall damage, and vein valve damage play the main role in the development of the disease. The most commonly used classification of CVI is the CEAP classification, that describes the clinical symptomes of the disease (C), the etiology (E), the anatomical localisation (A), and the pathophysiology (P). The most useful
diagnostic method is the color doppler ultrasonography.
The treatment depends on the stage of the disease. When ulcer develops, the treatment becomes more difficult, and more expensive. Patient education and compliance are crucial for succesful treatment.

This review outlines the relationship between chronic wounds and (lymph)edema and asserts that proper wound care demands attention to the evacuation of concomitant chronic edema and the improvement of lymphatic insufficiency. Compression therapy represents the cornerstone of all therapeutic modalities and the principles of compression are discussed
didactically. However there are currently a wide variety of materials and systems available, inelastic bandages or multicomponent systems should be used in the initial decongestion phase, ulcer stocking systems are rather recommended for the subsequent maintenance phase. Adaptive velcro bandage-stocking systems are adequate alternatives of compression
stockings but can also replace bandages in the intensive decongestion. Classic medical compression stockings have proven particularly beneficial in the prevention of ulcer recurrence. The large number of treatment options currently available enables therapists to develop therapeutic concepts geared towards their patients’ individual needs and abilities, thus resulting in good acceptance, adherence and concordance.

Pressure ulcer is caused by permanent pressure resulting in damage of different layers of the skin and the subcutaneous tissue. The hip and pelvis region are the most commonly affected areas. Different risk assessment methods can be used to select the endangered patients. In prevention, it is important to care for significantly limited mobility patients with regular repositioning and use of antidecubitus devices. In addition to local treatment of decubitus, attention has to be paid to the general condition of the patients too. Complications may develop and practitioners have to be prepared for their
professional care. Effective treatment of pressure ulcer can be achieved by the coordinated activity of the practioners.

Diabetic foot syndrome is one of the most severe and expensive chronic complication of diabetes mellitus. The pathogenesis is complex, the contributing factors are peripheral neuropathy, peripheral vascular disease, foot deformities, external trauma, infections and peripheral oedema. The rate of major amputation in diabetic patients in Hungary substantially
exceeds the international average, due to lack of coordinated care as developed for other acute and chronic diabetic complications. Integrated healthcare providing screening and preventive care for the patients, fast and effective multidisciplinary treatment of the complications has shown to reduce the amputation rate by 50% or more according to the international experience. The high number of patients who need screening and preventive care, the involvement of newly certified health care professionals (podiatrist, foot care specialist nurse) might provide the basis for a cost-effective care.

Wound management is a complex, coordinated effort that tends to utilize numerous new achievements in order to gain a more rational and effective treatment approach. Adherence to basic wound healing protocols is mandatory. Errors unfortunately do happen during therapy, some of which may pose a risk even to the success of the whole process. The paper is going to introduce some of the recently introduced therapeutic tools with a potential to transform the way we treat wounds. You will also get an overview of the most commonly made rule-breaking mistakes during wound management. The paper is based on the presentation held at the Dermatological Residents’ Course in 2017.