What is the treatment for venous stasis ulcers?

From the Guidelines

The primary treatment for venous stasis ulcers is compression therapy, which involves the use of multilayer bandages, compression stockings (30-40 mmHg), or pneumatic compression devices to reduce edema and improve venous return, as recommended by the most recent study 1.

Key Components of Treatment

• Compression therapy:
  • Minimum pressure of 20 to 30 mm Hg is recommended, with pressures of 30 to 40 mm Hg advised for more severe disease 1
  • Inelastic compression is better than elastic bandaging for wound healing, with velcro inelastic compression being as good as 3- or 4-layer inelastic bandages 1
• Wound care:
  • Regular cleansing with normal saline, debridement of necrotic tissue when necessary, and application of appropriate dressings such as hydrocolloids, foams, or alginates depending on wound characteristics 1
  • Infection should be treated with topical antimicrobials like silver-containing dressings or systemic antibiotics if cellulitis is present
• Additional measures:
  • Pentoxifylline (400 mg three times daily) can be prescribed to improve microcirculation and healing, often in combination with compression therapy, as shown to be effective in a meta-analysis 1
  • Leg elevation above heart level for 30 minutes several times daily helps reduce edema
  • For recalcitrant ulcers, skin grafting or biological dressings may be considered

Prevention of Recurrence

Prevention of recurrence requires ongoing compression therapy, regular skin care, and possibly surgical interventions like endovenous ablation or sclerotherapy to address underlying venous insufficiency, as these treatments work by improving venous return, reducing venous hypertension, and creating an optimal environment for wound healing 1.

From the Research

Treatment Options for Venous Stasis Ulcers

• Compression therapy is a mainstay of conservative treatment for venous stasis ulcers, as noted in studies 2, 3, 4, 5.
• Additional treatment modalities that have shown effectiveness in healing venous ulcers include pentoxyphylline and bilayered living-cell therapy 2.
• Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures 3, 6.
• New minimally invasive techniques can be used to correct venous hypertension, which is a major cause of venous stasis ulcers 2.
• Combination therapy, such as compression therapy and pulsed radio frequency energy, may also be effective in healing venous stasis ulcers 4.

Surgical Intervention

• Surgical procedures to reduce venous hypertension do not accelerate healing of a chronic ulcer, but trials suggest a decreased rate of future recurrence after surgery 5.
• Patients with chronic or frequently recurring ulcers that are refractory to conservative treatment with compression bandages may be candidates for surgical intervention 6.
• Various therapeutic modalities, including surgical options, can be considered for venous ulcers resistant to compression therapy 6.

Topical Dressings and Other Treatments

• No single topical dressing has been shown to be superior for all wounds, and the choice of dressing may depend on the individual patient's needs 5.
• Other treatments, such as leg elevation, dressings, pentoxifylline, and aspirin therapy, may also be used to manage venous ulcers 3.