Treatment modalities for the management of nonhealing wounds in patients with chronic venous insufficiency

The healing of wounds in patients with chronic venous insufficiency can be complex and benefit from multiple synergistic therapies, both to reduce venous hypertension and to treat the wounds themselves. Exercise therapy and compression can reduce venous stasis and edema. Pentoxifylline may provide some benefit. All patients should be evaluated for arterial and deep venous pathology that may be contributing; they should also be continuously reassessed for possible wound infection. Debridement of various types can help maintain a clean wound and speed healing. While many dressings may be beneficial, only hydrogels have demonstrated benefit over basic contact dressings. Some skin substitute products may improve the rate of wound healing. A vascular specialist committed to healing wounds associated with venous insufficiency should be familiar with all of these options; ongoing research is needed to help practitioners know when to use each.