Chronic wounds are important because of their frequency, their chronicity and high costs of treatment. However, there are few primary data on the cost-of-illness in Germany. The aim was to determine the cost-of-illness of venous leg ulcers (VLU) in Germany. Prospective cost-of-illness study was performed in 23 specialised wound centres throughout Germany. Direct, medical, non medical and indirect costs to the patient, statutory health insurers and society were documented. Thereover, health-related quality of life (QoL) was recorded as intangible costs using the Freiburg quality of life assessment for wounds (FLQA-w, Augustin). A total of 218 patients (62.1% female) were recruited consecutively. Mean age was 69.8 +/- 12.0 years. The mean total cost of the ulcer per year and patient was 9569 euros, [8658.10 euros (92%) direct and 911.20 euros (8%) indirect costs]. Of the direct costs, 7630.70 euros was accounted for by the statutory health insurance and 1027.40 euros by the patient. Major cost factors were inpatient costs, outpatient care and non drug treatments. QoL was strikingly reduced in most patients. In Germany, VLU are associated with high direct and indirect costs. As a consequence, there is a need for early and qualified disease management. Deeper-going cost-of-illness-studies and cost-benefit analyses are necessary if management of chronic wounds is to be improved.