Venous Leg Ulcers
Key Points
Key Points
It has been estimated that approximately 2.5 million people suffer from chronic venous insufficiency in the United States, and of those, about 20% develop venous ulcers.
Diagnosis
...agnosi...
...dardized Venous Anatomy Nomenclature of the Pelvi...
...le 2. Standardized Venous Anatomy Nomenclature...
...efiniti...
...use of a standard definition of venous u...
...omy and Pathophysiology...
...natomy NomenclatureWe recommend use of th...
...Leg Ulcer PathophysiologyWe recommend...
...linical Evaluatio...
...commend that for all patients with suspect...
...onvenous Causes of Leg UlcersWe recommend ident...
...und DocumentationWe recommend serial venous...
...ound CultureWe suggest against routine cu...
...und BiopsyWe recommend wound biopsy fo...
...aboratory EvaluationWe suggest laboratory eva...
Arterial TestingWe recommend arterial pulse e...
...culation AssessmentWe suggest agains...
Venous Duplex UltrasoundWe recommend comprehen...
...nous PlethysmographyWe suggest selective...
...e suggest selective computed tomography venog...
...nous Disease ClassificationWe recommend that all...
...edural Outcome AssessmentWe recommend venous...
...able 3. Diagnosis of Peripheral Ar...
...ble 4. Basic Clinical Class, Etiology, Anatomy, a...
...able 5. Revised Venous Clinical Severity...
Treatment
Treatmen...
...und Care
...ound Cleansers...
...venous leg ulcers be cleansed initially an...
...ébrideme...
...end that venous leg ulcers receive...
...at additional maintenance débridement...
...the health care provider choose from a numb...
...esia for Surgical Débrideme...
...mmend that local anesthesia (topical or local i...
...urgical Débride...
...e recommend that surgical débride...
...urgical Débridement
...surgical débridement as an alternative to st...
...onic Débridement...
...against ultrasonic débridement over surg...
Enzymatic Débridement
...enzymatic débridement of venous leg ulcers when...
...e do NOT suggest enzymatic débridement ov...
...iologic Débridement
...suggest that larval therapy for venous...
...anagement of Limb Cellul...
...mend that cellulitis (inflammation and infection...
...ation and Bacterial Biofilms...
...ggest against systemic antimicrobial treatment of...
...t of Wound Infection...
...that venous leg ulcers with >106 colony-for...
...st antimicrobial therapy for virule...
...uggest a combination of mechanical...
...stemic Antibio...
...ecommend that venous leg ulcers wit...
Oral antibiotics are preferred initia...
...pical Antibiotics for Infec...
...t against use of topical antimicrobial...
...Dressing Selection...
...uggest applying a topical dressing that will...
...election of a primary wound dressing that...
...ressings Containing Antimicrobials...
...mend against the routine use of to...
...cer Skin Management...
...application of skin lubricants underneath comp...
...cases of dermatitis associated with venous...
Anti-inflammatory Th...
...uggest against use of anti-inflammatory therapies...
...ns for Adjuvant Therapies...
...e recommend adjuvant wound therapy options for ve...
...lit-thickness Skin Graf...
...nst split-thickness skin grafting as primary the...
...suggest split-thickness skin grafting wit...
...ellular The...
...est the use of cultured allogeneic bilayer skin r...
...ion for Cellular Thera...
...suggest a therapeutic trial of appropriate...
...hat adequate wound bed preparation, including...
...ecommend additional evaluation and manage...
Frequency of Cellular Therapy App...
...st reapplication of cellular therap...
...rices, Human Tissues, or Other Skin Substitutes...
...se of a porcine small intestinal submucosal tis...
...e Pressure Therapy
...ainst routine primary use of negative...
...ical Stimulation...
...inst electrical stimulation therapy for venous l...
...rasound Therapy...
...nst routine ultrasound therapy for venou...
...mpressio...
...pression–Ulcer Heal...
...h a venous leg ulcer, we recommend c...
...ion–Ulcer Recurrence...
...n a patient with a healed venous leg ulcer, we s...
...lticomponent Compression Ba...
...suggest the use of multicomponent...
...pression–Arterial Insuf...
...a patient with a venous leg ulcer and underlying...
...tent Pneumatic Compress...
...use of intermittent pneumatic compress...
...7. General Categories of Wound Therapy for VLUs...
...ative/Endovascular Managem...
Superficial Venous Reflux and Activ...
...ient with a venous leg ulcer (C6) and...
...us Reflux and Active Venous Leg Ulcer–Pre...
...with a venous leg ulcer (C6) and i...
...rficial Venous Reflux and Healed Venous Leg...
...a patient with a healed venous leg ulcer (...
...l Venous Reflux With Skin Changes at Ris...
...ith skin changes at risk for venous...
...Superficial and Perforator Venous Reflux Wi...
...nt with a venous leg ulcer (C6) and inco...
...ombined Superficial and Perforator Venous Reflux...
...nt with skin changes at risk for venous leg ulcer...
...he incompetent perforating veins can be performed...
Pathologic Perforator Venous Reflux in the...
...a patient with isolated pathologic...
...tment Alternatives for Pathologic Pe...
...nts who would benefit from pathologic p...
...frainguinal Deep Venous Obstruction and Skin...
...t with infrainguinal deep venous obstruction and s...
...s Reflux With Skin Changes at Risk for Ven...
...n a patient with infrainguinal deep ven...
...flux With Skin Changes at Risk for Venous Leg...
...ent with infrainguinal deep venous...
...Venous Reflux With Skin Changes at Risk f...
...t with infrainguinal deep venous ref...
...Venous Reflux With Skin Changes at Risk for Venou...
...ith infrainguinal deep venous reflux and...
...ximal Chronic Total Venous Occlusion/Seve...
...tient with inferior vena cava or i...
...Chronic Venous Occlusion/Severe Stenosis (Bil...
...ient with inferior vena cava or iliac vein c...
...liofemoral Venous Occlusion/Severe...
...a patient with unilateral iliofemo...
Proximal Chronic Total Venous Occlu...
...ts who would benefit from an open venous by...
...e 1. Treatment Algor...
...ary Measures...
...n Assessment and Management
...t nutrition assessment be performed in any patient...
...c Drug Therapy...
...nding or large venous leg ulcer, we recommend...
...iotherapy...
...st supervised active exercise to improve m...
...al Lymphatic Drainage...
...ggest against adjunctive lymphatic dr...
...eotherapy...
...st balneotherapy to improve skin trophic...
...traviolet ligh...
We suggest against use of ultraviolet light for...
...imary Preventi...
...ary Prevention–Clinical CEAP C3-4 P...
...atients with clinical CEAP C3-4 disease due...
...rimary Prevention–Clinical CEAP C1...
...ts with clinical CEAP C1-4 disease...
...8.3. Primary Prevention–Acute DVT Tre...
...tic syndrome is a common preceding event for venou...
...use of low-molecular-weight hepari...
...suggest catheter-directed thrombolysi...
...ention–Education Measures...
...patients with C1-4 disease, we suggest pati...
Primary Prevention–Operative Therapy
...patients with asymptomatic C1-2 d...