Aim. The objective of the present study was to analyze the results of the combined step-by-step treatment of the patients presenting with venous trophic ulcers (VTU) on the lower extremities. Material and methods. We undertook the analysis of results of the treatment of 68 patients including 52 (75.4%) ones with varicose veins and 17 (24.6%) patients suffering from post-thrombotic disease. The history of venous trophic ulcers in the participants of the study ranged from 3 to 64 months in duration. Wound dressings were applied to treat local lesions whereas autodermoplasty was used to close large ulcers. In 35 (50.7%) cases, the latter technique was employed in the combination with the surgical interventions designed to eliminate either horizontal or vertical reflux. Autodermoplasty alone, without the surgical intervention on the venous system, was used to treat 11 (10.6%) patients. To facilitate the cleansing of large ulcers and their preparation for subsequent autodermoplasty, vacuum-therapy, ultrasound therapy, and a hydrosurgical system were employed. In 39 (58%) patients with varicose veins, vertical reflux was eliminated by classical phlebectomy whereas echophlebosclerotherapy had to be employed to get rid of horizontal reflux in 15 (21,7%) other patients. Results. Cutaneous flap engraftment and ulcer closure were achieved in 33 of the 35 (90,4%) patients who underwent simultaneous elimination of venovenous refluxes. A recurrent VTU developed in one patient of this group. The closure of the trophic ulcers was successfully performed in 7 (63.3%) of the eleven patients whose venous blood flow remained uncorrected. In 3 (27,3%) patients of his group the ulcer recurred within 1.5 and 2.0 years after the treatment. Conclusion. In order to obtain good results of the treatment in the patients presenting with venous trophic ulcers, especially large ones, it is necessary to use the surgical methods designed to eliminate both horizontal and vertical venous blood reflux in the combination with autodermoplasty.