I frequently use Unna boots or DuoDerm or Vigilon dressings to treat chronic leg/foot ulcers. While these treatments eventually work most of the time, is there a more efficient approach?
—CORBIN ROGERS, MHS, PA-C, Denver
Tailoring the treatment to the cause and etiology of the leg ulcer is the most important step in wound therapy. Malnutrition should be excluded in elderly patients and those dependent on help for eating. Treatment approaches can include simple gait training for patients with peripheral arterial occlusive disease and chronic venous insufficiency, relief of pressure in patients with diabetic foot ulcers, reduction of lymphedema with physiotherapy, and possible surgical intervention (e.g., vein stripping, stenting in peripheral arterial occlusive disease). Optimal application of compression therapy (with either compression bandages or hosiery) and a simple adherent dressing (to control exudate, provide comfort, and aid in healing) is the main treatment for leg ulcers secondary to chronic venous insufficiency. For more information, see J Dtsch Dermatol Ges. 2008;6:389-401 and Br J Nurs. 2007;16:S6-S14).
—Philip R. Cohen, MD (125-5)