More effective cell-based therapy through biofilm suppression

Consensus on the diagnosis and management of chronic leg ulcers - Brazilian Society of Dermatology

BACKGROUND

Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution.

OBJECTIVE

To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers.

METHODS

Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence.

RESULTS

The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology.

CONCLUSION

This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.

[Research progress of chronic wound debridement]

Objective

To review the research progress of chronic wound debridement.

Methods

The recent related literature concerning the mechanisms, advantages, limitations, and indications of the technologies of chronic wound debridement was extensively consulted, reviewed, and summarized.

Results

Debridement is essential for chronic wound healing, which includes autolytic debridement, enzymatic debridement, biodebridement, mechanical debridement, sharp/surgical debridement, ultrasound debridement, hydrosurgery debridement, and coblation debridement. Each technique has its own advantages and disadvantages.

Conclusion

There are many types of technologies of chronic wound debridement, which can be chosen according to clinical conditions. It is showed there are more significant advantages associated with the technique of coblation debridement relatively, which also has greater potential. Further study is needed to improve its efficacy.