Venous Leg Ulcers

Publication Date: August 1, 2014

Key Points

Key Points

Venous leg ulcers (VLUs) are the most common ulceration on the lower extremity, accounting for 70% of all leg ulcers with a prevalence ranging between 0.06% and 2%.

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

...Di...

...tandardized Venous Anatomy Nomenclature of the P...


...le 2. Standardized Venous Anatomy Nomencl...


...Definition...

...e of a standard definition of venous ulc...


Venou...

...my NomenclatureWe recommend use of the I...

...PathophysiologyWe recommend a basic practica...


...Clinical Evaluati...

...hat for all patients with suspected leg ulcers fit...

...venous Causes of Leg UlcersWe recommend iden...

...umentationWe recommend serial venous leg ulc...

...suggest against routine culture of venous leg u...

...psyWe recommend wound biopsy for leg ulcers...

...y EvaluationWe suggest laboratory evalua...

...erial TestingWe recommend arterial...

...on AssessmentWe suggest against routine...

...s Duplex UltrasoundWe recommend comprehensi...

...ographyWe suggest selective use of venous...

...nous ImagingWe suggest selective computed tomogra...

...Disease ClassificationWe recommend that all pat...

...dural Outcome AssessmentWe recommend ve...


...3. Diagnosis of Peripheral Arterial...


...4. Basic Clinical Class, Etiology...


...ised Venous Clinical Severity Scoring (VCS...


Treatment

...Treatment...

...Wound Ca...

...Wound Clean...

...that venous leg ulcers be cleansed initiall...

...Débridement...

...that venous leg ulcers receive thorough débridem...

...ggest that additional maintenance d...

...suggest that the health care provider ch...

...Anesthesia...

...nd that local anesthesia (topical or loca...

...Surgical...

...mend that surgical débridement be perform...

...Hydrosurg...

We suggest hydrosurgical débridement as...

...Ultrasonic Déb...

...against ultrasonic débridement over su...

...Enz...

...st enzymatic débridement of venous leg ulce...

...suggest enzymatic débridement over...

...Biologic Débri...

...that larval therapy for venous leg ulcers can be...

Managemen...

...that cellulitis (inflammation and infection...

...Wound Colonizati...

...uggest against systemic antimicrobial...

...Treatme...

...t venous leg ulcers with >106 colony-formi...

...e suggest antimicrobial therapy fo...

...bination of mechanical disruption...

...Systemic Antibiotics...

...at venous leg ulcers with clinical evidence of in...

...ral antibiotics are preferred initially, a...

...Topical Antibi...

...st against use of topical antimicrobial...

...Topical Dressi...

...ing a topical dressing that will manage venous le...

...e suggest selection of a primary wound...

...Topical Dressings...

...d against the routine use of topical an...

...Periulcer Skin Manageme...

...ication of skin lubricants underneath compression...

...ses of dermatitis associated with venous...

...uggest against use of anti-inflammatory therap...

...Indic...

...adjuvant wound therapy options for venous...

...Split-thickness Skin Gr...

...est against split-thickness skin grafting...

...plit-thickness skin grafting with continued...

...Cellular Thera...

...suggest the use of cultured allogeneic bil...

...Preparation for Cellular The...

...uggest a therapeutic trial of appr...

...at adequate wound bed preparation, including...

...nd additional evaluation and management of increas...

...Frequency of Cellular...

...uggest reapplication of cellular th...

...Tissue Matrice...

We suggest the use of a porcine small int...

...Negative Pre...

...e suggest against routine primary use of...

...inst electrical stimulation therapy for venou...

...Ultrasound Therapy...

...uggest against routine ultrasound therapy for...


...Compres...

...Comp...

...ient with a venous leg ulcer, we recommend com...

...Compressi...

...atient with a healed venous leg ulcer,...

...Multicomp...

...ggest the use of multicomponent com...

...Compression...

...with a venous leg ulcer and underlyi...

...Intermittent...

...e suggest use of intermittent pneumatic comp...


...al Categories of Wound Therapy for VLUsWound...


...Operative/Endov...

...Superficial Venou...

...nt with a venous leg ulcer (C6) and i...

...Supe...

...with a venous leg ulcer (C6) and incompetent supe...

...Superficia...

...nt with a healed venous leg ulcer...

...Superfici...

...nt with skin changes at risk for venous leg u...

Combine...

...with a venous leg ulcer (C6) and incompetent super...

...Combined...

...with skin changes at risk for venous leg...

...of the incompetent perforating veins can be p...

...Pathologic Perf...

In a patient with isolated patholog...

...hose patients who would benefit from path...

...Infrainguinal Deep Venou...

...h infrainguinal deep venous obstruction and...

...Deep Venous Re...

...ent with infrainguinal deep venous re...

...Deep Venous Reflux...

...patient with infrainguinal deep venous reflux and...

...Dee...

In a patient with infrainguinal deep veno...

...Deep Venous Reflux Wit...

...with infrainguinal deep venous reflux and skin ch...

...Proximal C...

...tient with inferior vena cava or i...

...Proximal Chronic Veno...

...tient with inferior vena cava or iliac vei...

...with unilateral iliofemoral venous oc...

...Proximal Chro...

...ts who would benefit from an open...


...Treatment Algorithm...


Ancillar...

...Nutrition Assessment...

...mmend that nutrition assessment be perfo...

...Systemic Drug The...

...-standing or large venous leg ulcer,...

...Physiotherapy...

...vised active exercise to improve muscle pum...

...Manual Lymphatic...

...gest against adjunctive lymphatic draina...

...gest balneotherapy to improve skin tr...

...Ultraviolet...

...t against use of ultraviolet light for...


...Primary Pr...

...with clinical CEAP C3-4 disease due to primary...

...Primary Pre...

...tients with clinical CEAP C1-4 disease related...

...Guideline 8.3. Primary Prev...

...-thrombotic syndrome is a common pre...

...e suggest use of low-molecular-weight...

...st catheter-directed thrombolysis in patients w...

Primary Pre...

...h C1-4 disease, we suggest patient and family educ...

...Primary Prevention...

...patients with asymptomatic C1-2 disease fr...