Treatment options	Comments	References
Conservative management
Compression therapy (inelastic, elastic, intermittent pneumatic)	Standard of care; proven benefit (benefit of intermittent pneumatic therapy is less clear); associated with decreased rate of ulcer recurrence	2, 7, 10, 22–26
Leg elevation	Standard of care when used with compression therapy; minimizes edema; recommended for 30 minutes, three or four times a day	27
Dressings	No one type of dressing is superior	28, 29
Mechanical treatment
Topical negative pressure (vacuum-assisted closure)	No robust evidence regarding its use for venous ulcers	30
Medications
Pentoxifylline (Trental)	Effective when used with compression therapy; may be useful as monotherapy	31
Aspirin	Effective when used with compression therapy; dosage of 300 mg once per day	32
Iloprost	Intravenous administration (not available in the United States) may be beneficial, but data are insufficient to recommend its use; high cost limits use	33
Oral zinc	Not shown to be beneficial	34
Antibiotics/antiseptics	Oral antibiotic treatment is warranted in cases of suspected cellulitis; routine use of systemic antibiotics provides no healing benefit; benefit of adding the topical antiseptic cadexomer iodine (not available in the United States) is unclear	1
Hyperbaric oxygen therapy	No proven benefit	35
Surgical management
Debridement	More studies needed to establish benefit	36–40
Human skin grafting	More studies needed to establish benefit	41
Artificial skin (human skin equivalent)	May be beneficial when used with compression therapy; concern about infection transmission	42
Surgery for venous insufficiency	May be beneficial for severe or refractory cases; associated with decreased rate of ulcer recurrence	19, 35, 40, 42–44