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Treatment of hard-to-heal leg ulcers with hyaluronic acid, sodium alginate and negative pressure wound therapy

02 September 2020
Volume 4 · Issue 4



Hard-to-heal lower extremity ulcer is a common healthcare problem and can lead to a poor quality of life (QoL). Despite the advances in wound care, conventional therapies, such as necrotic tissue debridement, cleansing, treatment of infection and local treatment with dressing application are still considered the standard of care in patients with hard-to-heal leg ulcers. However, managing hard-to-heal ulcers that do not respond well to these methods has led to new treatment strategies. In this study, the effects of hyaluronic acid (HA) and sodium alginate (SA), combined with negative pressure wound therapy (NPWT), in patients with hard-to-heal leg ulcers are evaluated.


Patients with hard-to-heal lower extremity ulcers were treated with HA-SA combined with NPWT (HA-SA-NWPT, n=11), or conventional therapy (n=14), between June 2014 and September 2015. Demographics, comorbidities, time to complete healing and change in wound area were recorded and compared.


A total of 25 patients took part. Complete healing was achieved in 63.6% (n=7) of the patients in the HA-SA with NPWT group, compared with 14.3% (n=2) of the patients in the conventional therapy group (p=0.017). The mean decrease in wound size was significantly higher in the HA-SA-NPWT group than in the conventional therapy group (73.8% versus 34.8%, respectively, p=0.029). Despite a shorter healing period in the HA-SA-NPWT group than in the conventional group, no statistically significant difference was found between groups for time to complete healing (37 days versus 55 days, respectively).


These results demonstrate that the combination of HA-SA-NPWT is a promising treatment for decreasing the healing time and increasing the success rate by their synergistic effect on wound healing in hard-to-heal lower extremity ulcers. However, further studies with a larger number of patients are needed to confirm the results.

Hard-to-heal lower extremity ulcers are a major healthcare problem worldwide, with high amputation rates. They usually occur in patients with vascular disease or diabetes and are attributed to chronic venous insufficiency, arterial micro- or macro-angiopathy, mechanical trauma or neuropathy.1,2 These ulcers tend to become hard-to-heal due to excessive or prolonged inflammation, persistent infections, the formation of drug-resistant microbial biofilms, and the inability of the tissue to respond to reparative stimuli, which delays the healing process.1,3 In addition, hard-to-heal leg ulcers not only impact patients' quality of life (QoL) but also result in an enormous financial burden for patients and the healthcare system.4,5 Despite the advances in wound care, hard-to-heal lower extremity ulcers and the healing process continue to be subjects engaging researchers.

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