[Management of leg ulcers]

Abstract

This review discusses current therapeutic options for leg ulcers. Compression therapy remains the first-line treatment for venous ulcers, with the use of an external pressure of 30 to 40 mmHg at the ankle (0.8 < ABPI < 1.3). Superficial vein surgery does not improve healing rates of venous ulcers; however it has been shown to reduce ulcer reoccurrence in the context of a competent deep venous system. In cases of severe arterial insufficiency, lower limb revascularization should be considered if possible. Wounds cleansing does not require antiseptics. Wound debridement is an accepted practice but no studies have been performed evaluating its effectiveness on leg ulcers. No systemic treatment has been given any indication in the treatment or prevention of ulcers. Systemic antibiotics should be considered only if the ulcer presents clinically significant infection (spreading erythema, cellulitis, purulent exudates and fever). Choose a type of dressing depending on the phase of healing and on particulars situations (infection, hemorrhagic, malodorous wounds, dermatitis of surrounding skin). In addition to conventional therapeutic options, patient education and lifestyle interventions should not be forgotten.