What are your preferred treatment options for patients with chronic non-healing leg ulcers?

In addition to all the typical things (decreasing edema with meds, compression, etc + treating superinfection, critical colonization, or debriding eschars), there is some evidence for pentoxifylline 400 mg TID or 800 BID in ulcerations of any etiology. There is also newer evidence for using topical timolol as well. I personally like to throw the kitchen sink at ulcers since they can be so difficult (always best to biopsy and make sure there's nothing atypical going on before adding all these adjunctive therapies).

While the approach will differ depending on the underlying wound etiology, some basic principles are applicable across wound types. Compression can help heal all lower extremity wounds, with the exception of moderate to severe peripheral arterial disease. Compression is not just for venous leg ulcers. If distal pulses are not palpable, consider getting an ABI. Dressings should be selected to maintain a moist wound healing environment. Typically, foams, alginates, and gelling fiber dressings (i.e., Aquacel) are most useful for chronic leg wounds, depending on exudate level. Regular sharp debridement has also been shown to speed healing across wound types, with the caveat being arterial ulcers and pyoderma gangrenosum due to the risk of pathe...