We present a patient with a large, chronic, unhealing crural ulcer of mixed etiology. The patient was diagnosed with a chronic venous insufficiency of highest grade as well as a substantial ischemic disease of lower limb.
Following a careful considering of diagnostic strategy we indicated a complex treatment consisting of systemic pharmacotherapy, local pharmacotherapy, local nursing and surgical treatment. In the surgical part of the treatment we eliminated the factor of venous insufficiency by a correction of insufficient superior venous system and we simultaneously performed a surgical arterial revascularization. The careful ulcer nursing with modern tools followed. It resulted in a cessation of ischemic claudication and the defect was healed during next three months after the surgery. In conclusion, we point out the importance of the careful diagnosis and assessment of chronic ulcer etiology. We implement the principles of complex treatment of chronic wounds. The simulta­neous surgical treatment of venous insufficiency and ischemia represents one treatment option in defects of mixed etiology.
Good patient’s collaboration and education in the wound care is essential.

Key words: crural ulcer, mixed etiology, complex treatment

Good patient’s nutrition status is one of the preconditions of a successful healing of different types of wounds – both acute and difficultly healing. Nutrition screening is aimed to select patients who are in bad nutrition status and who can have complications including a prolonged wound healing. During the screening patients are classified according to their nutrition risk. There are many different screening tools available. The mostly included data are the weight, BMI (Body Mass Index), unwanted weight loss in time period and restriction of food intake. Our summary itemizes the tools recommended by international professional societies for clinical nutrition (ESPEN, BAPEN, ASPEN) – MUST (Malnutrition Universal Screening Tool), NRS 2002 (Nutritional Risk Screening 2002), MNA (Mini Nutritional Assessment), SGA (Subjective Global Assessment) and questionnaires (Nottingham questionnaire). The summary is supplemented by a pediatric nutritional score made up by the workgroup of Faculty Hospital Motol. In some patients with large wounds (bedsores, bed-dependent patients) the ability to measure the height and weight is limited; therefore we add alternative methods of measurement.

Key words: nutrition screening, risk of malnutrition, nutrition status, screening tools, plan of nutritional care, alternative methods of measurement

Good nutritional status providing adequate amount of substrates for the process of regeneration is the essential precondition for wound healing. The integral part of the wound care must include the diagnosis of malnutrition and adequate treatment of nutrition disorders.

Key words: wound healing, malnutrition, enteral nutrition, parenteral nutrition