Conclusion and References
Venous leg ulcer management can be very challenging representing a high socioeconomic burden but also have a high incidence of recurrence. A systematic approach to management of venous leg ulcers offers clinicians a way to improve wound healing outcomes and reduce the incidence of recurrence. It is incumbent on the treating clinicians to educate patients regarding the need for lifelong compression therapy.
- Risk factors for arterial disease should be evaluated in the history and physical examination
- An ABPI between 0.5-0.7 indicates mild to moderate disease and a referral to a vascular surgeon for a more comprehensive assessment is recommended
- The audible handheld Doppler ultrasound is proven to be a reliable, simple, rapid, and inexpensive bedside exclusion test of peripheral arterial disease in diabetic and nondiabetic patients
- Multiphasic audible handheld Doppler sounds (biphasic and triphasic) indicate adequate blood supply to heal. The monophasic wave form indicates inadequate blood supply, requiring a vascular consultation
- When patients receive adequate compression therapy, they are likely to have wound closure by week 12
- Patient adherence to compression therapy is the cornerstone for venous leg ulcer management
- Patient education on the concept of “compression-for-life” is key to venous leg ulcer reoccurrence
Alavi et al. (2015). Audible handheld Doppler ultrasound determines reliable and inexpensive exclusion of significant peripheral arterial disease. Vascular https://wound.echoontario.ca/wp-content/uploads/2019/05/Alavi-2015-Doppler-Perpherial.pdf
Evans, R et al. Best Practice Recommendations for the Prevention and Management of Venous Leg Ulcers. A supplement of Wound Care Canada; [2019, November]: pp 1-70. Available [on-line]: https://www.woundscanada.ca/index.php?option=com_content&view=article&id=110&catid=12&Itemid=724#how-to-cite-a-bprs
Hofman D, Ryan TJ, Arnold F, Cherry GW, Lindholm C, Bjellerup M, et al. Pain in venous leg ulcers. J Wound Care. 1997;6(5):222–224.
Mariani, F. The Compression Therapy Study Group. Compression: Consensus document based on scientific evidence and clinical experiences. 2009 13:978-88-7711-650-5 [Available on-line]: https://www.researchgate.net/publication/304624717_Compression
Merriman L, Greaves M. Testing for thrombophilia: an evidence-based approach. Postgrad Med J. 2006;82:(973)699-704. [PMID 17099087]
Meulendijks AM, de Vries FMC, van Dooren AA, Schuurmans MJ, Neumann HAM. A systematic review on risk factors in developing a first-time Venous Leg Ulcer. J Eur Acad Dermatol Venereol. 2019 Jul;33(7):1241-1248. doi: 10.1111/jdv.15343. Epub 2019 Apr 1. PMID: 30422345.
Murphy, C. et al. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: ‘wound hygiene’. Journal Of Wound Care Vol 28, No. 12, December 2019 https://www.magonlinelibrary.com/action/doSearch?AllField=wound+cleansing&ContentGroupKey=10.12968%2Fjowc.2019.28.issue-12
Musil, D. What’s new in the 2020 update of the CEAP classification system of chronic venous disease? Vnitr Lek Summer 2021;67(3):143-148. https://pubmed.ncbi.nlm.nih.gov/34171953/
Nicolaides. A. The Most Severe Stage of Chronic Venous Disease: An Update on the Management of Patients with Venous Leg Ulcers. Adv Ther. 2020 Feb;37(Suppl 1):19-24. doi: 10.1007/s12325-020-01219-y. Epub 2020 Jan 22. https://pubmed.ncbi.nlm.nih.gov/31970660/
O’Donnell TF Jr, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, et al. Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2014;60(Suppl 2):3S–59S.
Parker CN, Finlayson KJ, Edwards HE. Predicting the likelihood of delayed venous leg ulcer healing and recurrence: Development and reliability testing of risk assessment tools. Ostomy Wound Manag. 2017;63(10):16–33. Assessment Tools and Clinical Guidelines. On-line available https://painbc.ca/health-professionals/assessment-tools
Sibbald, RG, Cameron, J. Dermatologic aspects of wound care. In: Krasner D, Sibbald RG. Chronic Wound Care: A Clinical Source Book for Healthcare Professionals. 4th ed. Malvern, PA: HMP Communications; 2007. pp. 221–232.
Woodcock TE, Woodock TM. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. British journal of Anaesthesia. 2012. 108 (3), 384-394