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
...agnosis...
Table 1. Standardized Venous Anatomy Nom...
...2. Standardized Venous Anatomy Nomen...
...inition
...suggest use of a standard definition...
...us Anatomy and Pathophysiol...
...NomenclatureWe recommend use of the International...
...Leg Ulcer PathophysiologyWe recommend a basic...
...ical Evaluation...
We recommend that for all patients with suspected...
...s of Leg UlcersWe recommend identifi...
...tationWe recommend serial venous leg ulce...
...e suggest against routine culture of venous...
...syWe recommend wound biopsy for leg...
...valuationWe suggest laboratory evaluation...
...gWe recommend arterial pulse exami...
...ulation AssessmentWe suggest against routine micro...
...ous Duplex UltrasoundWe recommend comprehensive v...
...ographyWe suggest selective use of venous pleth...
...us ImagingWe suggest selective computed tom...
...e ClassificationWe recommend that all p...
...ural Outcome AssessmentWe recommend ven...
.... Diagnosis of Peripheral Arterial Diseas...
...e 4. Basic Clinical Class, Etiology, Anatomy, an...
...sed Venous Clinical Severity Scoring...
Treatment
Treatme...
...ound Ca...
...ound Cleanse...
...t that venous leg ulcers be cleansed in...
...ridement
...nd that venous leg ulcers receive...
...hat additional maintenance débrid...
...t that the health care provider choose from a n...
...nesthesia for Surgical Débridemen...
...that local anesthesia (topical or...
...gical Débridem...
...ommend that surgical débridement be perfo...
...rgical Débridement...
...osurgical débridement as an alternati...
...onic Débridement...
...st ultrasonic débridement over surgical...
...tic Débridement...
...atic débridement of venous leg ulcers when...
...t enzymatic débridement over surgical...
Biologic Débridem...
...uggest that larval therapy for venous leg u...
...anagement of Limb Cellu...
...nd that cellulitis (inflammation and infection...
...und Colonization and Bacterial Biofi...
...uggest against systemic antimicrobial tre...
...t of Wound Infection
...st that venous leg ulcers with >106 colo...
...t antimicrobial therapy for virulent or difficult...
...bination of mechanical disruption and ant...
...ystemic Antibi...
...d that venous leg ulcers with clinical...
...tics are preferred initially, and the du...
...iotics for Infected Wounds...
...st against use of topical antimicr...
...l Dressing Selection...
...applying a topical dressing that will manage ve...
...election of a primary wound dressing that...
...ressings Containing Antimicrobia...
...ommend against the routine use of top...
...er Skin Managemen...
...ggest application of skin lubricants underneath c...
...ses of dermatitis associated with venous leg ul...
...inflammatory Therapie...
...inst use of anti-inflammatory therapies for...
...ons for Adjuvant Therapies...
...djuvant wound therapy options for v...
...hickness Skin Grafting...
...gainst split-thickness skin grafting as prim...
...t split-thickness skin grafting with co...
...ellular Thera...
...e suggest the use of cultured allogenei...
...ation for Cellular Therapy
We suggest a therapeutic trial of appropriate co...
...mend that adequate wound bed preparation, in...
...recommend additional evaluation and management...
...of Cellular Therapy Application...
...reapplication of cellular therapy as long as the...
...ue Matrices, Human Tissues, or Other...
...the use of a porcine small intestinal su...
...Pressure Therapy
...ainst routine primary use of negative pr...
...lectrical Stimulation...
...uggest against electrical stimulation therapy...
...trasound Ther...
...gainst routine ultrasound therapy for v...
Compression
Compression–Ulcer...
...a patient with a venous leg ulcer, we rec...
...n–Ulcer Recurrence...
...with a healed venous leg ulcer, we sugge...
Multicomponent Compression Bandage
We suggest the use of multicomponent...
...on–Arterial Insufficiency...
...atient with a venous leg ulcer and underlying arte...
...ntermittent Pneumatic Compression
...se of intermittent pneumatic compression when oth...
...eneral Categories of Wound Therapy for VLUsWou...
...ative/Endovascular Managemen...
...rficial Venous Reflux and Active V...
...nt with a venous leg ulcer (C6) and i...
...ficial Venous Reflux and Active Venous L...
...ith a venous leg ulcer (C6) and incompe...
...l Venous Reflux and Healed Venous Le...
...atient with a healed venous leg ulcer (C5)...
...perficial Venous Reflux With Skin C...
...nt with skin changes at risk for venous...
...d Superficial and Perforator Venous Reflux Wi...
In a patient with a venous leg ulcer (...
...ficial and Perforator Venous Reflux With or...
...nt with skin changes at risk for venous leg...
...he incompetent perforating veins can be performed...
...thologic Perforator Venous Reflux...
...a patient with isolated pathologic p...
Treatment Alternatives for Pathologic Per...
...or those patients who would benefi...
...guinal Deep Venous Obstruction and Sk...
...ient with infrainguinal deep venou...
...s Reflux With Skin Changes at Risk for...
...a patient with infrainguinal deep v...
...p Venous Reflux With Skin Changes at Risk for V...
...t with infrainguinal deep venous reflux and...
...ep Venous Reflux With Skin Changes at...
...ent with infrainguinal deep venous reflux and ski...
Deep Venous Reflux With Skin Chang...
...patient with infrainguinal deep venous refl...
...ximal Chronic Total Venous Occlusion/S...
...patient with inferior vena cava or iliac vein c...
...ic Venous Occlusion/Severe Stenosis (Bilate...
...a patient with inferior vena cava or iliac vein...
...iofemoral Venous Occlusion/Severe...
...with unilateral iliofemoral venou...
...nic Total Venous Occlusion/Severe S...
...r those patients who would benefit from a...
...igure 1. Treatment Al...
Ancillary Mea...
...Assessment and Managemen...
...at nutrition assessment be performed in a...
...stemic Drug Ther...
...ing or large venous leg ulcer, we recommend...
Physiother...
...st supervised active exercise to improve m...
...Lymphatic Drainage...
...est against adjunctive lymphatic dr...
Balneotherapy
...eotherapy to improve skin trophic changes...
...raviolet light
We suggest against use of ultraviole...
...ry Prevention...
...y Prevention–Clinical CEAP C3-4 Primary Veno...
...tients with clinical CEAP C3-4 dis...
...mary Prevention–Clinical CEAP C1-4 P...
...th clinical CEAP C1-4 disease related to pr...
...line 8.3. Primary Prevention–Acute DVT T...
...rombotic syndrome is a common preceding event...
...se of low-molecular-weight heparin over vitamin...
...suggest catheter-directed thrombol...
...ry Prevention–Education M...
...patients with C1-4 disease, we su...
...ry Prevention–Operative Therapy
...ients with asymptomatic C1-2 disease from either...