Chronic venous leg ulcers markedly influence the physical, financial, and psychologic wellbeing of patients and result in an estimated 2 million lost workdays annually. Despite a wide variety of therapeutic options, venous leg ulcers remain a substantial management challenge to health care professionals. Although no consensus on compression therapy exists, it remains a primary treatment of edema and ulceration secondary to venous disease. Recently, biotechnology-derived skin substitutes have been developed to help stimulate local wound healing. These range in composition from an epidermal or dermal layer to a complete, bilayered living skin construct. This review focuses on nonoperative treatment options for venous ulcers, particularly the evolving roles of newer treatment options including skin substitutes and growth factor/cytokine preparations. The development and characteristics of these emerging therapies as well as clinical experience with and options for their use in the treatment of chronic venous ulcers are reviewed.
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