Thanks for sharing this case. It seems like the ulcer has been reducing in size, which is great. As for your question regarding other suggestions, our colleagues might have additional thoughts, but wondering what kind of assessment/workup has been done to identify the underlying causes and comorbidities that might be impeding healing. It'd be important to make sure that underlying causes of the ulcer and comorbidities that might be impeding healing have been thoroughly addressed.
If despite treating the cause of the ulcer, addressing comorbidities affecting healing and implementing proper local wound care, the ulcer does not improve according to expected
benchmarks, re-evaluation of the patient and wound should be performed before consideration of adjuvant therapies. Re-evaluation should be performed to rule out other differential diagnoses, ensure that interventions are adequately addressing the cause(s) of the ulcer, local wound care has been adequate, bio-burden and exudate are well managed, and factors impeding healing are not present or under control.
Reassessment would include a comprehensive history and physical exam, assessment of any poorly controlled systemic disease, history of autoimmune disease, inflammatory bowel disease, arthritis, and myeloproliferative disorder nutrition, medications that might be impeding healing, objective assessment of adequate blood supply to heal the ulcer, venous/lymphatic status, etc. A biopsy would be helpful in assessing differential diagnosis as well.