subject: VENOUS LEG ULCERATION CLINICAL FEATURES AND MANAGEMENT [print this page] VENOUS LEG ULCERATION CLINICAL FEATURES AND MANAGEMENT
Management Patients with venous leg ulcers often have other disorders,correction of which facilitates healing. These include nutritional deficiency, anaemia, diabetes, obesity, hypertension,cardiac and renal disease, myxoedema, and any diseasecausing immobility. It is most important to assess the arterialsystem in the legs, as the compression that is valuablefor venous insufficiency can be harmful if there is a poorarterial inflow. A simple Doppler device should be used,and if the ratio of inflow pressure in the ankle or foot tothat in the arm is less than 0.8, compression should not beused without a vascular surgical assessment.Raised venous pressure can be counteracted by elevationof the legs at night and for periods during the day, andby careful use of compression bandages combined withexercise. If the ulcer is due to incompetent superficial orcommunicating veins rather than to deep vein thrombosis,surgical treatment may be indicated. Numerous treatmentsare available for the ulcer itself, and in most circumstancesmaterials that do not contain potential sensitizers andmaintain a moist surface should be used. Desloughing isoften best achieved with a hydrocolloid dressing. Cellulitisrequires systemic antibiotics.When venous ulceration has healed, the patient shouldcontinue to exercise and maintain compression withsuitable stockings indefinitely.
