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
...rdized Venous Anatomy Nomenclature...
...dized Venous Anatomy Nomenclature of the Leg...
...Definition...
...st use of a standard definition of venou...
...Venous Anatomy and Pat...
...tomy NomenclatureWe recommend use of the Int...
...us Leg Ulcer PathophysiologyWe recommend...
...recommend that for all patients with su...
...nous Causes of Leg UlcersWe recommend identificati...
Wound DocumentationWe recommend serial...
...ultureWe suggest against routine c...
...d BiopsyWe recommend wound biopsy for leg ulc...
...valuationWe suggest laboratory evalu...
...terial TestingWe recommend arterial pulse exam...
...culation AssessmentWe suggest against rout...
...UltrasoundWe recommend comprehensive...
...hysmographyWe suggest selective use of...
...ous ImagingWe suggest selective computed tomogr...
...s Disease ClassificationWe recommend tha...
...ous Procedural Outcome AssessmentW...
...Diagnosis of Peripheral Arterial Diseas...
...ic Clinical Class, Etiology, Anatomy, and P...
...evised Venous Clinical Severity Sco...
Treatment
...Treatment...
Wound Car...
...Wound Cleansers...
...that venous leg ulcers be cleansed initially...
...Débridement...
...mend that venous leg ulcers receive...
...e suggest that additional maintenance débridement...
...uggest that the health care provider...
...Anesthes...
...ecommend that local anesthesia (to...
...Surgical Déb...
We recommend that surgical débridement be p...
...Hydrosu...
...ydrosurgical débridement as an alternati...
...Ult...
...suggest against ultrasonic débridement...
...Enzymatic Débridement...
...zymatic débridement of venous leg ulcers...
...NOT suggest enzymatic débridement over sur...
...Biologic Débrid...
...larval therapy for venous leg ulce...
...Managemen...
...at cellulitis (inflammation and infectio...
...Wound Colonization and Bacte...
...st systemic antimicrobial treatment of v...
...Tre...
...t that venous leg ulcers with >106 colony-form...
We suggest antimicrobial therapy for virulent or d...
...uggest a combination of mechanical disruptio...
...Systemic Antibi...
...d that venous leg ulcers with clinica...
...antibiotics are preferred initially, and t...
...Topical Anti...
...inst use of topical antimicrobial a...
...Topical Dressing Sel...
...est applying a topical dressing tha...
...ggest selection of a primary wound dressing th...
...Topi...
...commend against the routine use of topical...
...Periulcer Sk...
...ication of skin lubricants underneath compr...
...n severe cases of dermatitis assoc...
...Anti-inflamm...
...gainst use of anti-inflammatory therapies...
...Indications for Adjuva...
...mmend adjuvant wound therapy options for venous...
...Split-thickn...
...ainst split-thickness skin grafting as...
...e suggest split-thickness skin grafting with co...
...Cellular Therapy...
...suggest the use of cultured allogeneic bilay...
...Preparation for...
...est a therapeutic trial of appropriate compressi...
...end that adequate wound bed prepar...
...itional evaluation and management of increased...
...ggest reapplication of cellular therapy as...
...Tissue Matric...
We suggest the use of a porcine sma...
...Negative Pressu...
...e suggest against routine primary...
...Electrical Stimulation...
...t against electrical stimulation therapy for v...
...Ultras...
...against routine ultrasound therapy...
...Compres...
...Compression–Ul...
...th a venous leg ulcer, we recommend compres...
...Compression–Ulcer Rec...
...nt with a healed venous leg ulcer,...
...Multicomponent Co...
...est the use of multicomponent compression ba...
...Compression–Arterial...
...ient with a venous leg ulcer and underlying arteri...
...Intermi...
...t use of intermittent pneumatic compres...
...able 7. General Categories of Wound Therapy for...
...Operative/Endovascular...
...Superf...
...patient with a venous leg ulcer (C6) and incompe...
...Superficial Venou...
...with a venous leg ulcer (C6) and incompetent s...
...Superficial Venous Reflux...
...th a healed venous leg ulcer (C5) and incom...
...Superf...
...h skin changes at risk for venous leg ulce...
...Combined Superficial and Pe...
...patient with a venous leg ulcer (C6) and...
...Combined Supe...
...ent with skin changes at risk for venous...
...of the incompetent perforating veins...
...Pat...
...tient with isolated pathologic perforat...
...Treatment Alt...
...ts who would benefit from pathologic perforator v...
...I...
...a patient with infrainguinal deep venous obstru...
...De...
...h infrainguinal deep venous reflux and skin...
...Deep Venous Reflux With...
...a patient with infrainguinal deep v...
...Deep Venous Reflux With S...
...ent with infrainguinal deep venous reflux and...
In a patient with infrainguinal deep venous...
...Proximal Chr...
...atient with inferior vena cava or...
...Proximal Chroni...
...nt with inferior vena cava or iliac vein ch...
...Unilateral Ili...
...tient with unilateral iliofemoral...
...Proximal Chronic Total...
...patients who would benefit from an open...
...1. Treatment Algorithm...
...Ancilla...
...Nutriti...
...ommend that nutrition assessment be pe...
...Syste...
...ing or large venous leg ulcer, we recom...
...Physiotherapy...
...gest supervised active exercise to im...
...Manual Lymphatic Drain...
...st against adjunctive lymphatic dr...
...Balneotherapy...
...t balneotherapy to improve skin trophic changes...
...Ultraviolet...
...uggest against use of ultraviolet light for the t...
...Primary Prevention...
...Primary Preventi...
...ith clinical CEAP C3-4 disease due to prim...
...Primary Prev...
In patients with clinical CEAP C1-4...
...Guideline 8.3. Pri...
...post-thrombotic syndrome is a common pr...
...se of low-molecular-weight heparin...
...atheter-directed thrombolysis in patients with...
...Primary P...
...ients with C1-4 disease, we suggest pa...
...Primary Preventi...
...with asymptomatic C1-2 disease from either prima...