Conclusion and References

Conclusion

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.

Key Takeaways

  • 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

References

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

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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

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