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

...gnosis...

...1. Standardized Venous Anatomy Nomenclature...


...ndardized Venous Anatomy Nomenclature of the Le...


...finition...

...se of a standard definition of venou...


...tomy and Pathophysiology...

...Anatomy NomenclatureWe recommend us...

...s Leg Ulcer PathophysiologyWe recommend...


Clinical Evalua...

...ecommend that for all patients with s...

...onvenous Causes of Leg UlcersWe recomm...

...tionWe recommend serial venous leg ulcer wound m...

Wound CultureWe suggest against routine cu...

...BiopsyWe recommend wound biopsy for l...

...y EvaluationWe suggest laboratory evaluation...

...tingWe recommend arterial pulse examinatio...

...ion AssessmentWe suggest against routin...

...ltrasoundWe recommend comprehensive venous d...

...enous PlethysmographyWe suggest selec...

Venous ImagingWe suggest selective computed tom...

...enous Disease ClassificationWe recommend t...

...s Procedural Outcome AssessmentWe reco...


...Diagnosis of Peripheral Arterial Disease (PAD)...


...Clinical Class, Etiology, Anatomy,...


...able 5. Revised Venous Clinical Sev...


Treatment

...eatment

Wound C...

...nd Cleansers...

...at venous leg ulcers be cleansed initially...

...©bridement...

...mend that venous leg ulcers receive thor...

...hat additional maintenance débridement b...

...that the health care provider choose...

Anesthesia for Surgical DĂ©bride...

...d that local anesthesia (topical or local...

...al DĂ©bridement...

...hat surgical débridement be performed for v...

...surgical DĂ©bridement...

...ggest hydrosurgical débridement as an a...

...asonic DĂ©bridement...

...st against ultrasonic débridement over surgi...

...matic DĂ©bridement...

...st enzymatic débridement of venous leg ulcer...

...OT suggest enzymatic débridement over surg...

...gic DĂ©bridement...

...at larval therapy for venous leg ulcers can b...

...nagement of Limb Cellulitis

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

...lonization and Bacterial Biofilms...

...inst systemic antimicrobial treatment o...

...nt of Wound Infection...

...uggest that venous leg ulcers with...

...microbial therapy for virulent or dif...

...combination of mechanical disruptio...

Systemic Antibiot...

...that venous leg ulcers with clinical...

...biotics are preferred initially, a...

...cal Antibiotics for Infecte...

...nst use of topical antimicrobial agents...

...pical Dressing Selection...

...pplying a topical dressing that will mana...

...st selection of a primary wound dressing tha...

...essings Containing Antimicrobials...

...ecommend against the routine use of topical antimi...

...cer Skin Manageme...

...st application of skin lubricants underneath...

...ere cases of dermatitis associated with veno...

Anti-inflammatory Therapies

...nst use of anti-inflammatory therapies for the tre...

...cations for Adjuvant Therapies...

...djuvant wound therapy options for venous leg ulc...

...plit-thickness Skin Graftin...

...suggest against split-thickness sk...

...lit-thickness skin grafting with c...

...ular Therap...

...the use of cultured allogeneic bilayer ski...

...reparation for Cellular Thera...

We suggest a therapeutic trial of appropriat...

...e recommend that adequate wound bed preparation,...

...additional evaluation and manageme...

...f Cellular Therapy Application...

...est reapplication of cellular therapy as lo...

Tissue Matrices, Human Tissues, or Ot...

...se of a porcine small intestinal submucosal ti...

...ive Pressure Therap...

...e suggest against routine primary...

...ical Stimulation...

...ggest against electrical stimulation ther...

...sound Therapy...

...ainst routine ultrasound therapy for ve...


...pression...

...ompression–Ulcer Healin...

...atient with a venous leg ulcer, we recommend c...

...sion–Ulcer Recurre...

...with a healed venous leg ulcer, we suggest compre...

...nent Compression Bandage...

We suggest the use of multicomponent comp...

...pression–Arterial Insuffici...

...t with a venous leg ulcer and underl...

Intermittent Pneumatic Compres...

...use of intermittent pneumatic compression wh...


...le 7. General Categories of Wound Therapy f...


...tive/Endovascular Management...

...icial Venous Reflux and Active Venous Leg...

...ith a venous leg ulcer (C6) and in...

...nous Reflux and Active Venous Leg Ulcerâ...

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

...perficial Venous Reflux and Healed Venous Leg Ulc...

In a patient with a healed venous leg...

...Venous Reflux With Skin Changes at Risk for...

...t with skin changes at risk for ven...

...mbined Superficial and Perforator Venous...

...ith a venous leg ulcer (C6) and incomp...

...ficial and Perforator Venous Reflux With...

...patient with skin changes at risk fo...

...t of the incompetent perforating veins can be pe...

...gic Perforator Venous Reflux in the Absence of Su...

...t with isolated pathologic perforator veins (...

...natives for Pathologic Perforator Veins...

...tients who would benefit from pathologic p...

...nguinal Deep Venous Obstruction and Skin Changes...

...tient with infrainguinal deep venous obstruction a...

...Reflux With Skin Changes at Risk f...

In a patient with infrainguinal deep venous r...

Deep Venous Reflux With Skin Changes...

...n a patient with infrainguinal deep venous...

...ux With Skin Changes at Risk for Venous L...

...ient with infrainguinal deep venous reflux...

...eep Venous Reflux With Skin Changes...

...with infrainguinal deep venous ref...

...ic Total Venous Occlusion/Severe Stenosis With...

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

...roximal Chronic Venous Occlusion/Sever...

...n a patient with inferior vena cava or iliac v...

...ofemoral Venous Occlusion/Severe Stenosis...

...ith unilateral iliofemoral venous occl...

...al Chronic Total Venous Occlusion/Severe S...

...or those patients who would benefi...


...1. Treatment Algorithm...


...lary Measure...

...trition Assessment and Mana...

...hat nutrition assessment be perform...

...ic Drug Therapy...

...r long-standing or large venous leg ulcer, we reco...

...ysiotherapy...

We suggest supervised active exercise t...

...Lymphatic Drainage...

...suggest against adjunctive lymphati...

...alneotherapy...

...otherapy to improve skin trophic changes and qua...

...raviolet light...

...against use of ultraviolet light for the tre...


Primary Preventio...

...ry Prevention–Clinical CEAP C3-4 P...

...ients with clinical CEAP C3-4 disease due...

...Prevention–Clinical CEAP C1-4 Post-thro...

In patients with clinical CEAP C1-4 disease relate...

...3. Primary Prevention–Acute DVT Treat...

...ic syndrome is a common preceding...

...f low-molecular-weight heparin over vitamin K ant...

...suggest catheter-directed thrombolysis in pati...

...vention–Education Measures...

...tients with C1-4 disease, we suggest...

...mary Prevention–Operative Therapy...

...atients with asymptomatic C1-2 dise...