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Clinical
Quick Reference Guide
Recommendations for Practice: Prevention & Treatment of Venous
Leg Ulcers
- Obtain a careful history to determine the venous characteristics
and rule out other diagnoses. Assess pain and identify the systemic
and local factors that may impair wound healing.
- Determine the cause(s) of chronic venous insufficiency (CVI) based
on etiology: abnormal valves (reflux), obstruction, or calf muscle pump
failure.
- Perform the ankle-brachial pressure index (ABPI) test on all patients
with venous ulcers to help rule out significant arterial disease.
- Implement high compression bandaging for the management of venous
edema if the ABPI is > 0.8.
- Use graduated compression stockings to manage and prevent venous leg
edema. Wearing stockings to decrease the frequency of ulcer recurrence
is important.
- Implement intermittent pneumatic compression therapy and/or elevation
of the leg as an added benefit in managing venous edema and venous leg
ulcers.
- Consult with rehabilitation experts to maximize activity and mobility.
Consider appropriate adjunctive therapies.
- Assess for infection and treat if indicated.
- Optimize the local wound healing environment: debridement, bacterial
balance, and moisture balance. Use biological agents when the cause
has been corrected and healing does not proceed at an expected rate.
- Implement medical therapy if indicated for CVI (superficial and deep
thrombosis, woody fibrosis).
- Consider surgical management if significant superficial or perforator
vein disease exists in the absence of extensive deep disease.
- Communicate with the patient, the family, and the caregivers to establish
realistic expectations for (non)healing. The presence or absence of
a social support system is important for treatment and prevention of
venous leg ulcers.
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