The Royal Music & Ar Group

Venous Leg Ulcer Treatment: Innovations & Evidence-Based Care

Introduction

Venous leg ulcers (VLUs) are chronic wounds that result from venous insufficiency—frequently around the ankles—and profoundly impact quality of life. Globally, about 1 % of people develop VLUs, with higher rates in older adults and women. Advances in wound care, diagnostic technology, and therapy have paved new pathways in both healing and prevention.

Foundational Treatments: Compression & Debridement

Compression therapy remains the cornerstone of VLU management. Graduated, multilayer bandaging or high-compression stockings (typically 35–40 mmHg at the ankle) significantly improves venous return, reduces edema, and accelerates ulcer closure—especially when the ankle–brachial pressure index (ABPI) is 0.8 or higher.

Debridement, including mechanical cleansing by trained practitioners or use of agents like cadexomer iodine, helps manage bioburden and stimulates healing in non-healing wounds.

Adjunctive Medical Therapies

Micronized Purified Flavonoid Fraction (MPFF)—a plant-derived compound—reduces inflammation and capillary filtration. Multiple randomized trials show it speeds healing when added to compression treatment.

Sulodexide, combining anticoagulant and profibrinolytic effects, has shown promise in controlled trials for improving VLU healing rates, though evidence quality remains moderate and further study is advised.

Pentoxifylline improves microcirculation and reduces oxidative stress. Reviews suggest benefit, particularly alongside compression, but results vary across studies.

Advanced Dressings & Bioengineered Skin Substitutes

Bioengineered skin equivalents—such as bilayered living cellular constructs or acellular dermal matrices—are increasingly adopted. Evidence shows they significantly enhance healing and tissue regeneration versus standard dressings when used with compression.

Hydrogel and antimicrobial dressings, including silver- or nanoparticle-enhanced materials, combine moisture regulation with infection control. While results remain mixed, they offer comfort, facilitate granulation, and reduce exudate.

Next-Generation Technologies & Regenerative Strategies

Stem cell therapy, especially using adipose-derived or mesenchymal stem cells, is being explored in early-phase trials. These therapies may accelerate healing, angiogenesis, and collagen deposition—but require further large-scale studies and standardization.

Transdermal continuous oxygen therapy (TCOT) delivers low-flow oxygen directly over the wound bed 24/7. It is distinct from intermittent topical treatments and especially suited to chronic ulcers such as VLU.

Negative-pressure wound therapy (NPWT)—or vacuum-assisted closure—removes excess fluid, increases blood flow, and promotes granulation. NPWT devices, increasingly portable, show efficacy for select chronic wounds including VLUs, yet evidence remains limited and context-specific.

Neuromuscular electrostimulation (Muscle Pump Activator devices) activate the calf-muscle pump to enhance venous return and reduce edema, and may benefit patients with limited mobility.

Minimally Invasive Venous Interventions

For patients with superficial venous reflux, endovenous treatments—including laser ablation, radiofrequency, foam sclerotherapy, or TRLOP—combined with compression, demonstrate better healing rates and lower ulcer recurrence compared to compression alone.

CLaCS (Cryo-Laser and Cryo-Sclerotherapy)—a newer modality combining cooled laser ablation and sclerotherapy—offers a less invasive alternative for smaller varicosities and may enhance both healing and cosmetic outcomes.

Holistic Measures for Recurrence Prevention

Once an ulcer heals, consistent use of below-knee graduated compression stockings (25–35 mmHg) is critical to prevent recurrence. Long-term compression combined with surgical correction of venous insufficiency yields the best outcomes.

Lifestyle modifications—such as leg elevation, calf muscle exercises, nutrition optimization, weight management, smoking cessation, and psychosocial support—also contribute to healing and recurrence prevention.

Digital Innovation & Personalized Care

Recent market-driven trends highlight AI-powered wound measurement and predictive analytics, smart compression garments, and remote wound monitoring apps as disruptors in VLU management. AI models based on ultrasound or imaging help clinicians track healing trajectories and adjust treatments earlier.

Telemedicine platforms paired with smart dressings and wearable compression devices empower patients to participate in care at home and support clinician-guided personalized care plans.