Skin Ulcers: Wound Management

For patients with chronic ulcers, the primary management goal, when possible, is complete wound healing. When this is not possible, palliative wound care provides a patient-centered alternative. Malnutrition is a risk factor for pressure ulcer development, but it is unclear whether interventions improve wound healing or other outcomes. Debridement is the removal of nonviable tissue, foreign bodies, and biofilm from the wound bed to eliminate physical and microbiologic impediments to healing. Nonsurgical debridement options include autolytic, enzymatic, biologic, and mechanical methods. The ideal dressing provides moisture to the wound and dryness to the periwound area. Choice of dressing is based primarily on exudate management properties. Pressure offloading is considered the primary therapy for pressure ulcers but strong evidence to support its use is lacking. For patients with venous leg ulcers (VLUs), unless contraindicated, compression therapy is a recommended component of the management plan. There is insufficient or poor-quality evidence supporting the effectiveness of negative pressure wound therapy and hyperbaric oxygen therapy in the management of pressure ulcers, VLUs, and arterial ulcers. Family physicians play a central role in the management of chronic ulcers, providing aggressive risk factor modification, control of chronic conditions, and prompt referral when indicated.