Selecting a dressing for chronic lower leg ulcers

Regular debridement and pressure offloading have a basic role in wound care in diabetic foot disease. Also, the use of compression bandages is an essential component to manage venous ulceration. There are many types of dressing available for lower leg ulcers. The ideal dressing for wound healing has several features, including the ability to absorb wound exudate, impermeability to water and bacteria and avoidance of wound trauma on dressing removal. The modern wound dressing has not shown a dramatic effect in clinical studies on patients with chronic lower leg ulcers. The choice of dressings remains controversial due to the lack of any large well-controlled comparative studies. Broadly, films can be used for superficial wounds; foams for protection, padding, and absorbency; hydrogels for debriding and rehydrating; hydrocolloids for debriding and protection; alginates for absorbing and in some cases as hemostatic agents. More recently, silver-based dressings are being used to reduce the bioburden in infected wounds. Consequently, many dressings (foam, film, hydrocolloid, gauze, and Hydrofiber) have now incorporated a silver component. A bioengineered bilayered skin substitute remains extremely costly compared with conventional wound care methods. Preliminary data demonstrate faster healing. Vacuum-assisted closure may also hold promise for the treatment of diabetic foot ulcers.