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Supraglottic ulcer — Clinical Guidelines

Overview

Supraglottic ulcers, often associated with hepatogenic ulcers, are characterized by ulceration in the supraglottic region, frequently linked to Helicobacter pylori infection and liver cirrhosis. 1

Diagnosis

Key Diagnostic Criteria: Presence of ulceration in the supraglottic region.

Recommended Tests: Helicobacter pylori testing (serology, urea breath test, stool antigen test).

Grading: Severity often correlates with complications of liver cirrhosis, such as esophageal varices grade. 1

Management

First-Line Treatments:

- Helicobacter pylori Eradication: Rabeprazole plus amoxicillin and levofloxacin regimen significantly improves healing rates compared to rabeprazole alone. 1

Adjunctive Treatments:

- Wound Dressings: Biosynthetic cellulose-based dressings (e.g., eiratex) show efficacy in healing chronic and acute ulcers. 3 - Skin Grafting: Punch skin grafting (PSG) may provide analgesic benefits for painful ulcers, though evidence is preliminary. 4

Special Populations

Comorbidities: Management considerations in patients with liver cirrhosis and associated complications like esophageal varices. 1

No Specific Guidance: Limited evidence addressing pediatrics, pregnancy, or elderly-specific management strategies.

Key Recommendations

Eradicate Helicobacter pylori in patients with hepatogenic ulcers to enhance ulcer healing. (Evidence: Strong 1)

Consider biosynthetic cellulose dressings for the management of nonhealing ulcers to promote healing. (Evidence: Moderate 3)

Evaluate the use of punch skin grafting for painful ulcers due to potential analgesic effects, though further evidence is needed. (Evidence: Weak 4)

Perioperative antibiotic use does not significantly impact graft success or infection rates in lower extremity ulcer grafting. (Evidence: Moderate 6)

Use iliofemoral pedicle flaps for complex cases of trochanteric trophic ulcers when conventional methods fail. (Evidence: Expert opinion 7)

Recommendations vary regarding the necessity of perioperative antibiotics in ulcer grafting 6 7.

References

1 Qiao G, Feng L, Wang M, Wang C, Li C, Han S et al.. Eradication of Helicobacter pylori that contributes to hepatogenic ulcer is beneficial to the healing of hepatogenic ulcer. BMC gastroenterology 2025. link 2 Lykov AP, Surovtseva MA, Poveshchenko OV, Bondarenko NA, Kim II, Yankaite EV. Evaluation of the Effect of Plasma from Patients with Trophic Ulcers on the Function of Dermal Fibroblasts, Mesenchymal Stem Cells, and Endothelial Cells. Bulletin of experimental biology and medicine 2020. link 3 Sivlér T, Sivlér P, Skog M, Conti L, Aili D. Treatment of Nonhealing Ulcers with an Allograft/Xenograft Substitute: A Case Series. Advances in skin & wound care 2018. link 4 Fourgeaud C, Mouloise G, Michon-Pasturel U, Bonhomme S, Lazareth I, Meaume S et al.. Interest of punch skin grafting for the treatment of painful ulcers. Journal des maladies vasculaires 2016. link 5 Gschwandtner ME, Ambrózy E, Marić S, Willfort A, Schneider B, Böhler K et al.. Microcirculation is similar in ischemic and venous ulcers. Microvascular research 2001. link 6 Bizer LS, Ramos S, Weiss PR. A prospective randomized double blind study of perioperative antibiotic use in the grafting of ulcers of the lower extremity. Surgery, gynecology & obstetrics 1992. link 7 Gulyás G, Kartik I. Repair of trochanteric trophic ulcer with bilateral iliofemoral pedicle flaps. Plastic and reconstructive surgery 1980. link

Supraglottic ulcer