Treatment
12
Wound Care
Wound Cleansers
➤ We suggest that venous leg ulcers be cleansed initially and at each
dressing change with a neutral, nonirritating, nontoxic solution,
performed with a minimum of chemical or mechanical trauma. (2-C)
Débridement
➤ We recommend that venous leg ulcers receive thorough débridement
at their initial evaluation to remove obvious necrotic tissue, excessive
bacterial burden, and cellular burden of dead and senescent cells.
(1-B)
➤ We suggest that additional maintenance débridement be performed to
maintain the appearance and readiness of the wound bed for healing.
(2-B)
➤ We suggest that the health care provider choose from a number
of débridement methods, including sharp, enzymatic, mechanical,
biologic, and autolytic. More than one débridement method may be
appropriate. (2-B)
Anesthesia for Surgical Débridement
➤ We recommend that local anesthesia (topical or local injection) be
administered to minimize discomfort associated with surgical venous
leg ulcer débridement. In selected cases, regional block or general
anesthesia may be required. (1-B)
Surgical Débridement
➤ We recommend that surgical débridement be performed for venous
leg ulcers with slough, nonviable tissue, or eschar. Serial wound
assessment is important in determining the need for repeated
débridement. (1-B)
Hydrosurgical Débridement
➤ We suggest hydrosurgical débridement as an alternative to standard
surgical débridement of venous leg ulcers. (2-B)
Ultrasonic Débridement
➤ We suggest against ultrasonic débridement over surgical débridement
in the treatment of venous leg ulcers. (2-C)
