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Leg ulcer - venous - Management
How should I clean a venous ulcer?

  • Irrigate the ulcer at each dressing change with warm tap water or saline, then dry. A strict aseptic technique is not required.
  • Debridement is not usually necessary: any slough, or necrotic, fibrous, or excess granulation tissue should be removed by gentle washing. If debridement is being considered, the procedure should be carried out by a trained healthcare professional.
  • Consider using a potassium permanganate 0.01% soak if the ulcer is malodorous.
Clarification / Additional information
  • Debridement techniques include mechanical, autolytic, chemical, bio-surgical (maggots), or enzymatic methods. However, there is consensus that chemical agents such as iodine, acetic acid, hydrogen peroxide, or hypochlorite should not be used.
  • Sharp debridement (at the bed side) should only be carried out by a trained healthcare professional and a topical anaesthetic (e.g. EMLA® cream) is normally used to reduce pain.
Basis for recommendation
  • These recommendations are based on clinical guidelines: The nursing management of patients with venous leg ulcers published by the Royal College of Nursing (RCN) [RCN, 2006], and the Scottish Intercollegiate Guidelines Network (SIGN) clinical guideline Management of chronic venous leg ulcers [SIGN, 2010], together with the best available trial evidence, informed expert opinion, and current good clinical practice.
  • Irrigation:
    • The aim is not to remove surface bacteria, but rather to avoid cross-infection from contamination.
    • The SIGN guideline recommends washing ulcerated legs normally in tap water and drying carefully.
    • The RCN guideline found no trials comparing aseptic with clean techniques for cleaning leg ulcers. A systematic review (search date May 2001, six randomized controlled trials [RCTs], n = 1864) suggested there was a lack of evidence for or against cleaning leg ulcers versus not cleaning, cleaning with tap water versus cleaning with saline, and cleaning with antiseptics [RCN, 2006].
  • Debridement:
    • Sharp mechanical debridement (with a scalpel or sharp blade) should only be undertaken by an appropriately trained healthcare professional [SIGN, 2010], and may delay healing because of the risk of damaging healthy tissue and underlying blood vessels [Briggs and Nelson, 2003].
    • The SIGN guideline found a double blind placebo controlled trial of 69 people using EMLA® as a topical anaesthetic for the repeated mechanical debridement of venous ulcers. It found that wounds were cleaned faster and pain relief was better, but no comparisons were made with other therapies. This is an off-label indication for the use of EMLA® cream [SIGN, 2010].
    • The RCN guideline reviewed one systematic review (search date October 1997) and three subsequent RCTs, and concluded there is no clear evidence as to the optimal method for debridement. It is not clear whether debridement speeds up ulcer healing compared with no debridement [RCN, 2006; SIGN, 2010].
  • Potassium permanganate soaks are helpful for malodorous ulcers because they have antiseptic and astringent properties [Bell, Personal Communication, 2008].

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