Introduction to venous leg ulcers

Venous leg ulcers are the most common type of leg ulcer. Venous ulcers are caused by venous valve incompetence, venous obstruction and calf muscle pump insufficiency (either alone or in combination), resulting in venous stasis and venous hypertension. The impaired circulation increases the risk of an ulcer and reduces the ability to heal.

Determining the cause of a leg ulcer is essential to guide management; see c_lwg2-c10-s1.html#lwg2-c10-s1__tlwg2-c01-tbl1 for advice on determining the vascular cause of a leg ulcer. An overview of assessment and management of venous leg ulcers is provided in Overview of assessment and management of venous leg ulcers.

Patient education is an important part of management¹. Patients are more likely to participate in therapy if they understand why it is necessary. Patient education is also essential in preventing venous leg ulcer recurrence. Topics for education include:

• the pathophysiology of venous disease and venous leg ulceration
• leg ulcer assessment techniques
• the role of the foot and calf pump
• the role of compression therapy or biomechanical alternatives
• devices and appliances that can assist in the application and removal of compression garments
• skin care
• strategies to prevent recurrence (eg ongoing compression therapy, nutrition, leg elevation, exercise).

Patients with diabetes require early specialist involvement as they can deteriorate rapidly and standard assessment techniques may be unreliable.