Venous Leg Ulcer Standard Care

Venous ulcers are the most common cause of lower-extremity ulcers in the Western world,

and approximately 20% are caused by arterial insufficiency or mixed arteriovenous disease.¹

In this presentation, Tania J. Phillips, MD, FRCPC, FAAD, and Jimmy Lam, MD, from the Boston University School of Medicine, Boston, MA, discuss the standard care provided to patients with this condition. The pathophysiology of venous leg ulcers as well as wound assessment and venous/arterial assessment are discussed. Other topics include:

• Compression therapy,
• Debridement and local wound care,
• Surgical and medical treatment,
• Recurrence prevention,
• New therapies,
• Patient education,
• Guidelines published by the Association of Advanced Wound Care and Wound Healing Society,
• Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum,
• Cochrane Database of Systematic Reviews, and
• A literature review.

Regarding physical examination, the authors stress the importance of looking at the whole patient and the wound characteristics (gaiter area, shallow, irregularly shaped, shaggy border). Other findings also should be considered, including varicosities, venous flare, venous eczema, hemosiderosis, edema, and lipodermatosclerosis.² Diagnosis should be based on clinical findings, duplex ultrasound, and exclusion of arterial disease.

Best practices for wound documentation include number and location of wounds; wound size, depth; description of wound bed, amount and color of drainage; and ulcer tracings, planimetry, and photography. Wound documentation continues throughout treatment, the cornerstone of which is compression therapy.

The presentation also addresses factors that may delay wound healing (eg, infection/inflammation, moisture balance, wound edge, repair, and social factors) and provides a framework for managing hard-to-heal wounds.

References

1. Ruckley CV. Socioeconomic impact of chronic venous insufficiency and leg ulcers. Angiology. 1997;48(1):67­–69. doi:10.1177/000331979704800111.

2. Morton LM, Phillips TJ. Wound healing and treating wounds: differential diagnosis and evaluation of chronic wounds. J Am Acad Dermatol. 2016;74(4):589–606.