Assessing and managing leg ulcers
Once they have been assessed, the management of arterial and venous leg ulcers differs.
ASSESSING LEG ULCERS
A careful history must be obtained to determine whether the cause of ulceration is either arterial or venous. The location and appearance of the ulcer, history of ulcer formation and existence of any other conditions should be noted. The Ankle-brachial pressure index test, to rule out significant arterial disease, is important because the use of high compression therapy on a leg with arterial disease may adversely affect blood flow and worsen any ischemia1.
Sustained, graduated compression is the mainstay of venous leg ulcer management. Various compression bandage systems are available, but all “must create a pressure gradient from ankle to knee”2. Debridement may speed healing of ulcers and any infection should be treated appropriately3.
Where possible the aim of managing arterial leg ulcers is to revascularize the limb. Unlike venous ulcers, compression therapy is not suitable. Any infection should be addressed to prevent rapid deterioration of the ulcer. Debridement is not appropriate with arterial ulcers as this may cause further ischemia3.
References [+]
- Clinical Practice Guidelines. The nursing management of patients with venous leg ulcers. Recommendations. Royal College of Nursing, 2006. Available to download at: http://www.library.nhs.uk. Accessed 16/10/07.
- Kunimoto B, Cooling M, Gulliver W, Houghton P, Orsted H, Sibbald RG. Best practices for the prevention and treatment of venous leg ulcers. Ostomy/Wound Man 2001;47(2):34-50
- Grey JE, Enoch S and Harding KG. ABC of Wound Healing: Venous and arterial leg ulcers. BMJ