Internationally, the NPIAP, EPUAP and Pan Pacific<unk>  Injury Alliance, together with wound organizations from 15 countries around the world<unk> blished updated their international evidence-based clinical practice guideline in 2019. The 2019 guideline was developed by an international team of over 180 clinical specialists and updates the 2009 EPUAP/NPUAP clinical guideline and the 2014 NPUAP/EPUAP/PPPIA clinical guideline. The guideline includes recommendations on strategies to treat<unk> s, including the use of bed rest,<unk>  redistributing support surfaces, nutritional support, repositioning, wound care (e.g. debridement, wound dressings) and biophysical agents (e.g. electrical stimulation). Reliable scientific evidence to support the use of many of these interventions, though, is lacking. More research is needed to assess how to best support the treatment of<unk> s, for example by repositioning. A 2020 Cochrane systematic review of randomized controlled trials concluded that more research is needed to determine whether or not electrical stimulation is an effective treatment for<unk> s. In addition, the benefit of using systemic or topical antibiotics in the management of<unk>  is still unclear. Debridement Necrotic tissue should be removed in most<unk> s. The heel is an exception in many cases when the limb has an inadequate blood supply. Necrotic tissue is an ideal area for bacterial growth, which has the ability to greatly compromise wound healing. There are five ways to remove necrotic tissue. # Autolytic debridement is the use of moist dressings to promote autolysis with the body's own enzymes and white blood cells. It is a slow process, but mostly painless, and is most effective in individuals with a properly functioning immune system. # Biological debridement, or maggot debridement therapy, is the use of medical maggots to feed on necrotic tissue and therefore clean the wound of excess bacteria. Although this fell out of favor for many years, in January 2004, the FDA approved maggots as a live medical device. # Chemical debridement, or enzymatic debridement, is the use of prescribed enzymes that promote the removal of necrotic tissue. # Mechanical debridement, is the use of debriding dressings, whirlpool or ultrasound for slough in a stable wound. # Surgical debridement, or sharp debridement, is the fastest method, as it allows a surgeon to quickly remove dead tissue. Dressings A 2017 Cochrane review found that it was unclear whether one topical agent or dressing was better than another for treating<unk> s. Protease-modulating dressings, foam dressings or collagenase ointment may be better at healing than gauze. The wound dressing should be selected based on the wound and condition of the surrounding skin. There are some studies that indicate that antimicrobial products that stimulate the epithelization may improve the wound healing. However there is no international consensus on the selection of the dressings for<unk> s. Cochrane reviews summarise evidence on alginate dressings, foam dressings, and hydrogel dressings. Due to a lack of robust evidence, the benefits of these dressings over other treatments is unclear. Some guidelines for dressing are: Condition Cover dressing None to moderate exudates Gauze with tape or composite Moderate to heavy exudates Foam dressing with tape or composite Frequent soiling Hydrocolloid dressing, film or composite Fragile skin Stretch gauze or stretch net Other treatments Other treatments include anabolic steroids, negative<unk>  wound therapy, phototherapy, support surfaces, reconstructive surgery, ultrasound, topical phenytoin and<unk>  relieving devices. There is little or no evidence to support or refute the benefits of most of these treatments compared to each other and placebo. When selecting treatments, consideration should be given to patients' quality of life as well as the interventions' ease of use, reliability, and cost.
Pressure ulcer
Venous ulcer
Arterial insufficiency ulcer
Hair loss
Linguatulosis
Gangrene
Diabetic foot ulcer
Veinoplus