A long term chronic and recurring condition. Assessment of foot pulses and ankle brachial pressure index as is useful to determine suitability for compression therapy.
- Venous ulcerations are the most common type of ulcer affecting the lower extremities.
- Venous leg ulcers can develop after a minor injury
- Venous ulcers are secondary to venous stasis
- There is chronic stretching vessel of the superficial veins walls.
- Due to improper functioning of venous valves, usually of the legs
- These eventually become thinner and ulcerate.
- Increasing age, Previous DVT
- Obesity, Lower limb fracture, surgery or injury
- Immobility, HTN, Prolonged upright posture
- Multiple previous pregnancies, Varicose veins
- Avoid steroids. Nicorandil has been associated with ulcers
- Chronic full-thickness skin loss on the lower leg
- Shallow, medial, superficial often with exudate
- Chronic brownish discolouration, Dermatitis, Thick toenails
- Traumatic or arterial ulceration
- Pyoderma gangrenosum
- FBC, U&E: Dehydration may impair healing
- ESR/CRP - may suggest infection of elevated
- Albumin: low suggests protein loss and malnutrition, which may delay healing.
- Check Doppler's and ABPI (ankle-brachial pulse index) prior to compression.
- HbA1c: to assess for diabetes mellitus.
- Duplex USS can confirm venous obstruction or valve incompetence
- Bacteriological swabs should only be taken where there is clinical evidence of infection
- Manage any oedema and infection. Keeping wounds clean. Weight reduction. Elevated leg above heart height when possible.
- Only effective treatment is to compress the superficial venous using a four-layer compression bandage. Compression (eg, four-layer elastic bandaging) helps heal venous ulcers, limits leg swelling and provides symptomatic relief. Compressive dressings or devices should not be applied if the arterial circulation is impaired.
- Debridement is used to remove dead tissue along the borders of the wound and excessive slough from the wound bed.
- Skin grafting may be required for stable, uninfected, large venous ulcers that have not shown improvement with other measures.