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Enzymatic Débridement
➤ We suggest enzymatic débridement of venous leg ulcers when no
clinician trained in surgical débridement is available to débride the
wound. (2-C)
➤ We do NOT suggest enzymatic débridement over surgical
débridement. (2-C)
Biologic Débridement
➤ We suggest that larval therapy for venous leg ulcers can be used as an
alternative to surgical débridement. (2-B)
Management of Limb Cellulitis
➤ We recommend that cellulitis (inflammation and infection of the skin
and subcutaneous tissue) surrounding the venous leg ulcer be treated
with systemic gram-positive antibiotics. (1-B)
Wound Colonization and Bacterial Biofilms
➤ We suggest against systemic antimicrobial treatment of venous leg
ulcer colonization or biofilm without clinical evidence of infection.
(2-C)
Treatment of Wound Infection
➤ We suggest that venous leg ulcers with >10
6
colony-forming units per
gram of tissue (CFU/g) and clinical evidence of infection be treated
with antimicrobial therapy. (2-C)
➤ We suggest antimicrobial therapy for virulent or difficult to eradicate
bacteria (such as beta-hemolytic streptococci, pseudomonas, and
resistant staphylococcal species) at lower levels of CFU/g. (2-C)
➤ We suggest a combination of mechanical disruption and antibiotic
therapy as most likely to be successful in eradicating venous leg ulcer
infection. (2-C)
Systemic Antibiotics
➤ We recommend that venous leg ulcers with clinical evidence of
infection be treated with systemic antibiotics guided by sensitivities
performed on wound culture. (1-C)
➤ Oral antibiotics are preferred initially, and the duration of antibiotic
therapy should be limited to 2 weeks unless persistent evidence of
wound infection is present. (1-C)
