Recent progress in the understanding of the pathogenesis of venous ulcers and in the biology of healing allows us to formulate a therapeutic strategy for patients with venous ulcerations. Systemic evaluation and local considerations of the ulcerated areas are important in the management of these patients. Occlusive therapy, made easier by new and more effective dressings, relieves pain, leads to better and faster healing in a moist environment, and facilitates treatment in the ambulatory setting. Fibrinolytic therapy, aimed at reducing pericapillary fibrin and restoring proper physiologic exchanges between blood and tissues, may benefit some patients with extensive and nonhealing ulcers.