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Cellular Therapy
➤ We suggest the use of cultured allogeneic bilayer skin replacements
(with both epidermal and dermal layers) to increase the chances for
healing in patients with difficult to heal venous leg ulcers in addition
to compression therapy in patients who have failed to show signs of
healing after standard therapy for 4–6 weeks. (2-A)
Preparation for Cellular Therapy
➤ We suggest a therapeutic trial of appropriate compression and wound
bed moisture control before application of cellular therapy. (2-C)
➤ We recommend that adequate wound bed preparation, including
complete removal of slough, debris, and any necrotic tissue, be
completed before the application of a bilayered cellular graft. (1-C)
➤ We recommend additional evaluation and management of increased
bioburden levels before the application of cellular therapy. (1-C)
Frequency of Cellular Therapy Application
➤ We suggest reapplication of cellular therapy as long as the venous
leg ulcer continues to respond on the basis of wound documentation.
(2-C)
Tissue Matrices, Human Tissues, or Other Skin Substitutes
➤ We suggest the use of a porcine small intestinal submucosal tissue
construct in addition to compression therapy for the treatment of
venous leg ulcers that have failed to show signs of healing after
standard therapy for 4–6 weeks. (2-B)
Negative Pressure Therapy
➤ We suggest against routine primary use of negative pressure wound
therapy for venous leg ulcers. (2-C)
Electrical Stimulation
➤ We suggest against electrical stimulation therapy for venous leg
ulcers. (2-C)
Ultrasound Therapy
➤ We suggest against routine ultrasound therapy for venous leg ulcers.
(2-B)
