Aim. The objective of the present study was to analyze the results of the treatment of trophic venous ulcers in elderly patients. Materials and methods. The study included 186 patients of advanced age varying from 75 to 90 years presenting with trophic venous ulcers. All the patients underwent clinical examination, laboratory and ultrasound studies, evaluation of microcirculation, cytological and planimetric studies. The patients were allocated to two groups one of which (main) was comprised of 86 patients while the other (control) consisted of 100 patients. Those in the main group were treated with the use of actovegin before and after the surgical intervention whereas the patients of the control group did not receive actovegin. Results. The patients in both groups were matched in terms of the size of the trophic ulcers, cytogram patterns, the histological picture, and the microbial paysage. The cytograms of wound images obtained from the patients of the main group within 10 days after the surgical intervention showed up the signs of inflammatory and inflammatory-regenerative processes in 31 (36%) and 37 (43%) cases respectively. The similar patterns on the cytograms from the control patients began to prevail only by day 15. On day 7, the ulcers in the patients of the main group were cleared from fibrous-necrotic and fibrous- leukocytic debris; simultaneously, the granulation tissue was formed. Similar changes in the patients of the control group were documented on days 10—12. The patients of the main group showed a tendency toward the enhancement of the volumetric microcirculatory blood flow in the resting state. Transplantation with the application of a split cutaneous flap was performed in 32 (37,2%) patients of the main group and in 42 (42%) ones in the control group. The excellent engraftment was achieved in 24 (75%) patients of the main group and in 34 (81%) patients of the control group (p=0,577). 72 (84%) patients of the main group and 79 (79%) ones in the control group were discharged from the hospital with the completely healed ulcers (р=0,456). None of the patients in the main group presented with a relapse of the ulcers during the follow-up period of 6—12 months whereas relapses developed in 5% of the patients in the control group (p=0,062). Conclusion. The preoperative conservative treatment of venous ulcers in the elderly patients with the use of a medication for metabolic therapy results in a substantial improvement of microcirculation, acceleration of the formation and maturation of granulation tissue. These effects facilitate preparation of the patients for the surgical intervention.