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The importance of pathogenic bacteria in venous leg ulcers was analysed in a randomized open trial divided into 2 parts. During the first 2-week period the effects of physiological saline and dextranomer beads were compared. During the following 8 weeks the effect of porcine skin, aluminium foil and a double layer bandage were compared. The assessment of the results of treatment was based on the area and volume of the ulcer measured by stereophotogrammetry and the bacteriological findings. Staphylococcus aureus was the commonest isolated species. Mixed cultures comprising Staph. aureus and gram-negative bacteria were the next commonest finding. There was a low frequency of isolation of anaerobic bacteria. The bacteriological findings were similar in the different treatment groups. The nature of the bacterial isolates and the colonization estimated by a contact-transfer procedure bore no relationship to the clinical assessment as to whether the ulcer was clean or purulent. Healing of the ulcer was not influenced by the bacteria present. The findings seem to indicate that as a rule the bacteria in the ulcers are saprophytic and will disappear when the favourable environment for their growth is lost.

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