1: Wound Cleansers

• We suggest that venous leg ulcers be cleansed initially and at each dressing change with a neutral, nonirritating, nontoxic solution, performed with a minimum of chemical or mechanical trauma (Grade 2, Level C).

2: Débridement

• We recommend that venous leg ulcers receive thorough débridement at their initial evaluation to remove obvious necrotic tissue, excessive bacterial burden, and cellular burden of dead and senescent cells (Grade 1, Level B).
• We suggest that additional maintenance débridement be performed to maintain the appearance and readiness of the wound bed for healing (Grade 2, Level B).
• We suggest that the health care provider choose from a number of débridement methods, including sharp, enzymatic, mechanical, biologic, and autolytic. More than one débridement method may be appropriate (Grade 2, Level B).

3: Anesthesia for Surgical Débridement

• We recommend that local anesthesia (topical or local injection) be administered to minimize discomfort associated with surgical venous leg ulcer débridement. In selected cases, regional block or general anesthesia may be required (Grade 1, Level B).

4: Surgical Débridement

• We recommend that surgical débridement be performed for venous leg ulcers with slough, nonviable tissue, or eschar. Serial wound assessment is important in determining the need for repeated débridement (Grade 1, Level B).

5: Hydrosurgical Débridement

• We suggest hydrosurgical débridement as an alternative to standard surgical débridement of venous leg ulcers (Grade 2, Level B).

6: Ultrasonic Débridement

• We suggest against ultrasonic débridement over surgical débridement in the treatment of venous leg ulcers (Grade 2, Level C).

7: Enzymatic Débridement

• We suggest enzymatic débridement of venous leg ulcers when no clinician trained in surgical débridement is available to débride the wound (Grade 2, Level C).
• We do not suggest enzymatic débridement over surgical débridement (Grade 2, Level C).

8: Biologic Débridement

• We suggest that larval therapy for venous leg ulcers can be used as an alternative to surgical débridement (Grade 2, Level B).