The main aim of the treatment is to create such an environment that allows skin to grow across an ulcer. In the majority of cases this requires finding and treating underlying<unk>  reflux. The National Institute for Health and Care Excellence (NICE) recommends referral to a vascular service for anyone with a leg ulcer that has not healed within 2 weeks or anyone with a healed leg ulcer. Most<unk> s respond to patient education, elevation of foot, elastic compression, and evaluation (known as the Bisgaard regimen). Exercise together with compression stocking increases healing. There is no evidence that antibiotics, whether administered intravenously or by mouth, are useful. Silver products are also not typically useful, while there is some evidence of benefit from cadexomer iodine creams. There is a lack of quality evidence regarding the use of medical grade honey for<unk>  leg ulcers. The recommendations of dressings to treat<unk> s vary between the countries. Antibiotics are often recommended to be used only if so advised by the physician due to emergence of resistance of bacteria to antibiotics. This is an issue on<unk> s as they tend to heal slower than acute wounds for example. Natural alternatives that are suitable for the longer term use exists on the market such as honey and resin salve. These products are considered as Medical Devices in EU and the products have to be CE marked. There is uncertain evidence whether alginate dressing is effective in the healing of<unk>  when compared to hydrocolloid dressing or plain non-adherent dressing. It is uncertain whether therapeutic ultrasound improve the healing of<unk> . Compression therapy Non-elastic, ambulatory, below knee (BK) compression counters the impact of reflux on<unk>  pump failure. Compression therapy is used for<unk>  leg ulcers and can decrease blood vessel diameter and pressure, which increases their effectiveness, preventing blood from flowing backwards. Compression is also used to decrease release of inflammatory cytokines, lower the amount of fluid leaking from capillaries and therefore prevent swelling, and prevent clotting by decreasing activation of thrombin and increasing that of plasmin. Compression is applied using elastic bandages or boots specifically designed for the purpose. A 2021 systematic review found that compression dressings probably reduce pain and help ulcers to heal more quickly (usually within 12 months) and may also improve quality of life. However, it is not clear whether or not compression bandages have any unwanted effects or if the potential health benefits of using compression outweigh its costs. It is not clear whether non-elastic systems are better than a multilayer elastic system. Patients should wear as much compression as is comfortable. In treating an existing ulcer, the type of dressing applied beneath the compression does not seem to matter, and hydrocolloid is not better than simple low adherent dressings. Good outcomes in ulcer treatment were shown after the application of double compression stockings, e.g. ulcer stockings. These systems contain two different stockings, one often of white colour. This one is to be put on first, is also worn overnight and exerts a basic pressure of 20 mmHg or less. Also it keeps the wound dressing in place. A second stocking, often brown, sometimes black, achieves a pressure of 20–30 mmHg and is applied over the other stocking during the daytime. Intermittent pneumatic compression devices may be used, but it is not clear that they are superior to simple compression dressings. It is not clear if interventions that are aimed to help people adhere to compression therapy are effective. More research is needed in this field. Medications Pentoxifylline is a useful add on treatment to compression stockings and may also help by itself. It works by reducing platelet aggregation and thrombus formation. Gastrointestinal disturbances were reported as a potential adverse effect. Sulodexide, which reduces the formation of blood clots and reduces inflammation, may improve the healing of<unk> s when taken in conjunction with proper local wound care. Further research is necessary to determine potential adverse effects, the effectiveness, and the dosing protocol for sulodexide treatment. An oral dose of aspirin is being investigated as a potential treatment option for people with<unk> s. A 2016 Cochrane systematic review concluded that further research is necessary before this treatment option can be confirmed to be safe and effective. Oral zinc supplements have not been proven to be effective in aiding the healing of<unk> s, however more research is necessary to confirm these results. Treatments aimed at decreasing protease activity to promote healing in chronic wounds have been suggested, however, the benefit remains uncertain. There is also lack of evidence on effectiveness on testing for elevated proteases in<unk> s and treating them with protease modulating treatment. There is low certainty evidence that protease modulating matrix treatment is helpful in the healing of<unk> . Flavonoids may be useful for treating<unk> s but the evidence needs to be interpreted cautiously. Wound Cleansing Solutions There is insufficient evidence to determine if cleaning wounds is beneficial or whether wound cleaning solutions (polyhexamethylene biguanide, aqueous oxygen peroxide, etc.) are better than sterile water or saline solutions to help<unk>  leg ulcers heal. It is uncertain whether the choice of cleaning solution or method of application makes any difference to<unk>  leg ulcer healing. Skin grafts and artificial skin Two layers of skin created from animal sources as a skin graft has been found to be useful in<unk>  leg ulcers. Artificial skin, made of collagen and cultured skin cells, is also used to cover<unk> s and excrete growth factors to help them heal. A systematic review found that bilayer artificial skin with compression bandaging is useful in the healing of<unk> s when compared to simple dressings. Surgery A randomized controlled trial found that surgery "reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time". Local anaesthetic endovenous surgery using the thermoablation (endovenous laser ablation or radiofrequency), perforator closure (TRLOP) and foam sclerotherapy showed an 85% success rate of healing, with no recurrence of healed ulcers at an average of 3.1 years, and a clinical improvement in 98% in a selected group of<unk>  leg ulcers. No studies are found on the effect of endovenous thermal ablation on ulcer healing, recurrence, and quality of life. The use of subfascial endoscopic perforator surgery is uncertain in the healing of<unk> . Dressings It is not certain which dressings and topical agents are most effective for healing<unk>  leg ulcers. Silver-containing dressings may increase the probability of healing for<unk>  leg ulcers. A clinical trial was successfully performed with a mixture of 60% sugar or glucose powder and 40% vaseline. A 2013 Cochrane systematic review aimed to determine the effectiveness of foam dressings for helping to heal<unk>  leg ulcers. The authors concluded that is uncertain whether or not foam dressings are more effective than other dressing types and that more randomized controlled trials are needed to help answer this research question. However, there is some evidence that ibuprofen dressings may offer pain relief to people with<unk>  leg ulcers.
Venous ulcer
Arterial insufficiency ulcer
Callous ulcer
Pressure ulcer
Buruli ulcer
Varicose veins
Genital ulcer
Cushing ulcer