Dear Patricia Nyathi

The non-pharmacological treatment for infected leg ulcers could be as follows.

1. Electrical stimulation therapy helps in stimulating the healing response in the skin and underlying tissues.

The electric current has been shown to increase the migration of neutrophils and macrophages, increase the local blood flow and stimulate the fibroblasts as well. Electrical stimulation treatment methods range from high voltage to low voltage currents, pulsed to non-pulsed, and alternating to direct currents.

You may want to refer to the articles attached below for more information.

Article Treatment of a Large Infected Thoracic Spine Wound Using Hig...

Article Electric stimulation of protein and DNA synthesis in human fibroblasts

2. Hyperbaric oxygen therapy will help to get more oxygen into the blood and speed healing.

The proposed mechanism of action of hyperbaric oxygen in management of leg ulcers is through its anti-inflammatory as well as antibacterial effects. Increase in the oxygen concentration during this treatment is supposed to help in neutrophil dependent microbial killing, collagen cross-linking as well as neovascularization.

Hyperbaric oxygen therapy can be administered in two different ways.

One of these is to make the patient breathe 100% oxygen, while exposed to increased atmospheric pressure. The treatment is carried out in chambers meant for single or multiple persons. Exposure is continued for about 1.5-2 h, depending on the indication and the treatment is performed 1-3 times a day.

Another method of administering hyperbaric oxygen therapy is by exposing only the affected limb to high oxygen concentration under pressure.

You may want to refer to the articles attached below for more information.

Article Systematic review of hyperbaric oxygen in the management of ...

Article Hyperbaric Oxygen Therapy for Wound Healing and Limb Salvage...

3. Vacuum assisted closure (VAC) therapy employs negative pressure to improve blood flow, decrease local tissue edema, and remove the excessive fluid from the ulcer bed.

VAC is supposed to assist the formation of healthy granulation tissue and remove the bacterial load from the wound bed. Another hypothesis proposed is that negative pressure, when used cyclically, alters the cytoskeleton of the cells in the ulcer bed and this triggers the formation of healthy granulation tissue.

Vacuum assisted closure therapy is administered by means of special devices that generate a negative or sub-atmospheric pressure gradient over the area to be treated. Negative pressure is applied either in a continuous or intermittent fashion and the optimal negative pressure employed is in the range of 75-125 mmHg. Depending upon the size of the ulcer to be treated, negative pressure can be applied in a continuous fashion for the first 48 h to remove larger amounts of fluid.

You may want to refer to the articles attached below for more information.

Article Vacuum-Assisted Closure: A New Method for Wound Control and Treatment

Article Use of vacuum-assisted wound closure in three chronic wounds

4. Electrotherapy modalities using electrical devices applied by trained professionals to an injury site in effort to enhance, expedite, or improve the treatment plan and recovery process. There are a wide range of electrotherapy modalities used in physical therapy. Conventionally, they are used for pain management, reducing swelling, increasing local blood flow, and breaking down scar tissue and can be applied across various stages of injury recovery.

One of the common electrotherapy modalities is laser therapy. However, the mechanism of action of lasers is not yet known. The hypothesis that has been postulated are improved metabolism of the affected tissue, stimulation of the tissue repair and increased collagen synthesis.

You may want to refer to the articles attached below for more information.

Article Low intensity laser therapy: Still not an established clinical tool

Article Abergel RP, Lyon RF, Castel JC, Dwyer RM, Uitto LLBiostimula...

Please note: Based on the highest level of evidence found in the data, recommendations are provided and graded according to the following categories:

Level A—Recommendations are based on good and consistent scientific evidence.

Level B—Recommendations are based on limited or inconsistent scientific evidence.

Level C—Recommendations are based primarily on consensus and expert opinion.

Electrical stimulation therapy comes under Level B, while Hyperbaric oxygen therapy, Vacuum assisted closure and Laser therapy come under Level C.

Best.

Laser therapy and ultrasound devices