Assessing and managing leg ulcers

 

 

Once arterial and venous leg ulcers have been assessed, their management 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 ischaemia1.

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 revascularise 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 ischaemia3.


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