Venous Leg Ulcers
Key Points
Key Points
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...
...rdized Venous Anatomy Nomenclature of the Pelv...
...tandardized Venous Anatomy Nomenclature of the...
...inition...
...ggest use of a standard definition...
...Anatomy and Pathophysiology...
...y NomenclatureWe recommend use of th...
...cer PathophysiologyWe recommend a b...
...cal Evaluation...
...that for all patients with suspected leg...
Nonvenous Causes of Leg UlcersWe re...
...umentationWe recommend serial venous le...
...reWe suggest against routine culture...
...syWe recommend wound biopsy for le...
...ratory EvaluationWe suggest laboratory evaluatio...
...ingWe recommend arterial pulse examination and m...
...ocirculation AssessmentWe suggest again...
...UltrasoundWe recommend comprehensi...
...graphyWe suggest selective use of venous...
...e suggest selective computed tomogr...
...se ClassificationWe recommend that all patien...
...Procedural Outcome AssessmentWe recommend veno...
...3. Diagnosis of Peripheral Arterial Di...
...le 4. Basic Clinical Class, Etiology, Anatomy...
...evised Venous Clinical Severity Scoring (VCSS)...
Treatment
...reatment
...ound Ca...
...Cleansers...
...e suggest that venous leg ulcers be cleanse...
...ridement...
...e recommend that venous leg ulcers receive thor...
...uggest that additional maintenance débridement...
...ggest that the health care provider...
...for Surgical Débridement...
...ecommend that local anesthesia (topical or loc...
...gical Débridem...
...that surgical débridement be performed fo...
...rgical Débridemen...
...surgical débridement as an alternative to standa...
...asonic Débridem...
...st against ultrasonic débridement...
...tic Débridement...
...zymatic débridement of venous leg ulcers when n...
...t enzymatic débridement over surgical dé...
...gic Débridement...
...suggest that larval therapy for venous l...
...agement of Limb Cellulitis...
...nd that cellulitis (inflammation and infection of...
...nization and Bacterial Biofilms...
...t against systemic antimicrobial tre...
...of Wound Infection...
...suggest that venous leg ulcers with >106 co...
...antimicrobial therapy for virulent...
...suggest a combination of mechanical dis...
Systemic Antibio...
...that venous leg ulcers with clinic...
...l antibiotics are preferred initially, an...
...ntibiotics for Infected Wounds...
...inst use of topical antimicrobial agents...
...Dressing Selection...
We suggest applying a topical dres...
...est selection of a primary wound dressing that...
...cal Dressings Containing Anti...
...nd against the routine use of topical antimicro...
...riulcer Skin Management
...ication of skin lubricants underneath compress...
...severe cases of dermatitis associated with veno...
...ti-inflammatory Therap...
...e suggest against use of anti-inflammato...
...cations for Adjuvant Th...
...juvant wound therapy options for venous leg ulcers...
...hickness Skin Grafting...
...uggest against split-thickness skin grafting as...
...split-thickness skin grafting with conti...
...llular Thera...
...suggest the use of cultured alloge...
...reparation for Cellular Th...
...herapeutic trial of appropriate compression and...
...recommend that adequate wound bed prepara...
...itional evaluation and management of inc...
Frequency of Cellular Therapy...
...st reapplication of cellular therapy...
...ices, Human Tissues, or Other Skin Substitutes...
...e suggest the use of a porcine small intesti...
Negative Pressure The...
...st routine primary use of negative pres...
Electrical Stimulation
...st electrical stimulation therapy for venous le...
...ltrasound Ther...
...gest against routine ultrasound therapy...
...ompression...
...mpression–Ulcer Healing
...patient with a venous leg ulcer, we recommend com...
...ompression–Ulcer R...
...patient with a healed venous leg ulcer, we...
...component Compression Banda...
...st the use of multicomponent compression...
...ion–Arterial Insufficiency...
...ent with a venous leg ulcer and under...
...termittent Pneumatic Compres...
...e suggest use of intermittent pneumatic...
...neral Categories of Wound Therapy f...
...ative/Endovascular Mana...
...us Reflux and Active Venous Leg Ulcer–Ulce...
In a patient with a venous leg ulcer (C6) a...
...l Venous Reflux and Active Venous Leg Ulcer...
...patient with a venous leg ulcer (C6) and incompe...
...icial Venous Reflux and Healed Venous Leg...
...th a healed venous leg ulcer (C5) and...
...ial Venous Reflux With Skin Changes at Ris...
...a patient with skin changes at risk for ven...
...rficial and Perforator Venous Reflux Wi...
...patient with a venous leg ulcer (C6)...
...Superficial and Perforator Venous Reflux With o...
...h skin changes at risk for venous...
...the incompetent perforating veins can be performed...
...gic Perforator Venous Reflux in the Absence of...
...patient with isolated pathologic perforator ve...
...tment Alternatives for Pathologic Pe...
...se patients who would benefit from pathologic pe...
...eep Venous Obstruction and Skin Changes at Risk f...
...ent with infrainguinal deep venous...
...lux With Skin Changes at Risk for V...
In a patient with infrainguinal deep venous ref...
...ous Reflux With Skin Changes at Risk for Venous Le...
...ient with infrainguinal deep venous reflux and ski...
...flux With Skin Changes at Risk for V...
...a patient with infrainguinal deep venous reflux...
...p Venous Reflux With Skin Changes at Risk...
...ith infrainguinal deep venous refl...
...ic Total Venous Occlusion/Severe Stenosis With...
...n a patient with inferior vena cava...
...ximal Chronic Venous Occlusion/Severe Stenosi...
...atient with inferior vena cava or il...
Unilateral Iliofemoral Venous Occlusion/Severe St...
...a patient with unilateral iliofemoral...
...l Chronic Total Venous Occlusion/Severe Stenosis...
...ose patients who would benefit from an open...
...e 1. Treatment Algorithm
...cillary Measures
...utrition Assessment and M...
...t nutrition assessment be performed...
...emic Drug Therapy
...long-standing or large venous leg ulcer, we recom...
...iotherapy...
...gest supervised active exercise to improv...
...l Lymphatic Drainage...
...t against adjunctive lymphatic drainage for heali...
...eotherapy
...balneotherapy to improve skin trophic...
...raviolet ligh...
...suggest against use of ultraviole...
...ry Prevention
...ion–Clinical CEAP C3-4 Primary Venous...
...clinical CEAP C3-4 disease due to primary...
...ention–Clinical CEAP C1-4 Post-thromboti...
...with clinical CEAP C1-4 disease rel...
...8.3. Primary Prevention–Acute DV...
...rombotic syndrome is a common preceding event for...
...use of low-molecular-weight heparin over vita...
...st catheter-directed thrombolysis in p...
Primary Prevention–Educa...
...ts with C1-4 disease, we suggest patient and famil...
Primary Prevention–Operative...
...with asymptomatic C1-2 disease from...