Standard, Appropriate, and Advanced Care and Medical-Legal Considerations: Part Two -- Venous Ulcerations

William J. Ennis, DO, MBA, FACOS, Patricio Meneses, PhD

Disclosures

Wounds. 2003;15(4) 

In This Article

Modalities

There are many treatment modality options for the treatment of chronic wounds including venous ulcers. These include but are not limited to ultrasound, electrical stimulation, laser light, warming therapy, radio frequency, pulsed short wave diathermy, and hyperbaric oxygen. These modalities are well described in the literature and textbooks.[163,164] Several ongoing trials may help identify the roles of these treatment options in the near future. Electrical stimulation has been recently shown in a meta-analysis to provide significant benefit for healing chronic wounds of many etiologies including venous ulcers and at this point has the most literature-based support.[165] As described in the section on bioengineered tissue, modalities have a definite role in the treatment of venous ulcers but a question still remains: Which modality, what combination, and when during the course of therapy should they be used? Once again the identification of a recalcitrant patient might lead a clinician to use a modality earlier in the treatment plan. In addition, many of these modalities aid in microcirculation support, and, therefore, patients identified with deficits in tissue oxygen or laser Doppler wound bed microcirculatory flow should be considered candidates for these techniques.

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