Local treatment procedures
Overview: Local treatment of lower leg ulcers involves maintaining a moist environment or sharp debridement for healable wounds and managing infection, exudate, or odor for maintenance and non-healable wounds.
Wound Cleansing and Debridement: Systematic reviews reveal that there is insufficient evidence to support the use of specific solutions like aqueous oxygen peroxide or propyl betaine over sterile water or other cleansing solutions.
Key Studies:
- McLain et al. found no significant difference in ulcer size reduction when comparing various cleansing solutions.
- Gethin et al. highlighted that dextranomer beads and hydrogel were more effective in debridement compared to other methods.
Purpose: Wound dressings support the healing process by promoting an optimal environment.
Wound dressings
Comparative Effectiveness:
- Alginate Dressings: No significant difference found between alginate dressings and hydrocolloid or plain non-adherent dressings.
- Hydrogel Dressings: Evidence is inconclusive regarding the effectiveness of hydrogel dressings compared to other types such as gauze, alginate, or manuka honey.
Use of antimicrobials and topical agents
Systematic and Topical Antibiotics: Evidence suggests systemic antibiotics like levamisole may improve healing, but routine use is not supported due to insufficient evidence.
Topical Agents: Studies on the use of honey-based products, silver-impregnated dressings, and povidone-iodine show no significant differences in healing outcomes.
Pain management
Topical Pain Relief:
- Lidocaine Cream (EMLA): Effective for pain relief during debridement.
- Ibuprofen Dressings: Mixed evidence on their effectiveness for persistent VLU pain.
Alternative treatments
- Autologous Platelet-Rich Plasma (PRP): Unclear if PRP affects healing of VLUs.
- Ultrasound Therapy: Low-quality evidence on the effectiveness of high and low-frequency ultrasound in improving VLU healing.
- Electromagnetic Therapy (EMT): Limited and unclear evidence on the impact of EMT on VLU healing.
- Protease Modulating Matrix (PMM) Treatments: Uncertainty remains about the effectiveness of PMM treatments in healing VLUs, requiring more robust clinical trials.
