What is the best treatment for skin ulcers?

Best Treatment for Skin Ulcers

The best treatment for skin ulcers involves sharp debridement to remove necrotic tissue and slough, appropriate dressing selection based on exudate control, and standard of care that addresses the underlying cause of the ulcer. 1

Initial Assessment and Standard of Care

• Identify the underlying cause of the ulcer (e.g., diabetic, pressure, venous) as treatment success depends on addressing the primary etiology 2, 3
• Remove slough, necrotic tissue, and surrounding callus with sharp debridement as the preferred method, considering contraindications such as pain or severe ischemia 1
• Select dressings primarily based on exudate control, comfort, and cost rather than specific advanced materials 1

Dressing Selection Based on Wound Characteristics

• For necrotic ulcers: Use hydrogel or hydrocolloids to promote autolytic debridement 4
• For heavily exuding wounds: Use alginate or hydrofiber dressings to manage excess moisture 4
• For granulating wounds: Consider polyurethane foam dressings 4
• Do not use antimicrobial dressings (containing silver, iodine, etc.) with the sole aim of accelerating healing 1
• Do not use honey or bee-related products for wound healing 1
• Do not use collagen or alginate dressings specifically for the purpose of wound healing 1

Adjunctive Therapies for Difficult-to-Heal Ulcers

• Consider sucrose-octasulfate impregnated dressings for non-infected, neuro-ischemic diabetic foot ulcers that haven't responded to standard care for at least 2 weeks 1
• Consider protein or amino acid supplementation to improve wound healing, particularly in patients with pressure ulcers 1
• Consider hyperbaric oxygen therapy as an adjunctive treatment for non-healing ischemic diabetic foot ulcers when standard care has failed 1
• Consider topical oxygen therapy where standard care has failed and resources exist to support this intervention 1
• Consider electrical stimulation as adjunctive therapy for pressure ulcers to accelerate wound healing 1

Therapies to Avoid

• Do not use growth factors, autologous platelet gels (except autologous leucocyte, platelet, and fibrin patch), bioengineered skin products, ozone, topical carbon dioxide, or nitric oxide 1
• Do not use negative pressure wound therapy for non-surgical diabetic foot ulcers 1
• Do not use topical phenytoin or herbal remedies for wound healing 1
• Do not use physical therapies such as electricity, magnetism, ultrasound, or shockwaves 1
• Do not use interventions aimed at correcting nutritional status with the sole aim of improving healing 1

Special Considerations

• For post-surgical diabetic foot wounds, consider negative pressure wound therapy as an adjunct to standard care 1
• For pressure ulcers, air-fluidized beds may be superior to standard hospital beds for reducing ulcer size 1
• For venous ulcers, compression therapy is essential alongside appropriate wound care 4
• Hydrocolloid dressings are superior to gauze dressings for reducing wound size in pressure ulcers 1

Potential Complications and Monitoring

• Monitor for skin irritation, inflammation, tissue damage, and maceration with various dressings 1
• Be aware that frail elderly patients may experience more adverse events with electrical stimulation 1
• For surgical interventions, monitor for dehiscence, which is more common when bone is removed during surgery 1

The treatment of skin ulcers requires addressing the underlying cause while providing appropriate local wound care. Sharp debridement and proper dressing selection form the foundation of treatment, with adjunctive therapies considered for ulcers that fail to respond to standard care.