Only follow if full leg assessment and Leg Ulcer Management Doppler have been done to establish the aetiology Leg Ulcer Type Indicator/Descriptor Management Aims Treatment Options Other Considerations edges, usually with higher Reduce oedema Reduce formulary for choice of that the ulcer is a symptom of VENOUS the underlying condition. In systems levels of exudate pressure in the order for successful healing to Dressing selection; e.g. superficial venous ABPI greater than 0.8 occur it is necessary to treat Usually low adherent or foam the underlying cause (i.e. system gaiter venous or arterial problems) Usually requiring Aid venous return by area redressing weekly Pain control is an important increasing velocity flow in Full compression Shallow factor in obtaining patient therapy, 40mmHg deep veins concordance. Careful sloping It is important to note pressure; refer to consideration should be Never attempt compression bandaging unless aetiology appropriate prescription of assured and competent in application analgesia. The aim should be to given to managing pain and an MIXED AETIOLOGY from both aetiologies Reduce pain Prevent Dressing selection; keep Good nutritional status is essential it simple e.g. low Doppler assessment; infection for wound healing to take place adherent or foam ABPI between 0.6 and Patient education 0.8 For appropriate dressing selection according to assessment of the wound and surrounding skin characteristics refer to Any part of the leg or No compression Classification of Wounds Reduce pain Prevent Keep it simple; patients with Wound management as foot history of leg ulceration have high infection indicated within Usually small ‘punched incidence of sensitivities formulary ARTERIAL Vascular investigation out’ defined edge Management of pain For venous ulceration; when the Prevent maceration ulcer has healed wearing Mixture of both Refer to vascular ABPI less than 0.6 compression hosiery reduces venous surgeon Apply reduced recurrence rates and arterial and compression therapy Increase venous return maximise patient comfort and therefore signs at 15-25mmHg Reduce oedema adherence to treatment Linked information: Leg ulcer guideline Refer to Classification Of Bandages for optimum compression levels and choice of therapy
Leg Ulcer Management Only follow if full leg assessment and Doppler have been done to establish the aetiology Leg Ulcer Type Indicator/Descriptor Management Aims Treatment Options Other Considerations VENOUS Usually gaiter area Shallow sloping edges, usually with higher levels of exudate ABPI greater than 0.8 Aid venous return by increasing velocity flow in deep veins Reduce oedema Reduce pressure in the superficial venous system Full compression therapy, 40mmHg pressure; refer to formulary for choice of systems Dressing selection; e.g. low adherent or foam Usually requiring redressing weekly It is important to note that the ulcer is a symptom of the underlying condition. In order for successful healing to occur it is necessary to treat the underlying cause (i.e. venous or arterial problems) Pain control is an important factor in obtaining patient concordance. Careful consideration should be Never attempt compression bandaging unless aetiology assured and competent in application given to managing pain and an appropriate prescription of analgesia. The aim should be to MIXED AETIOLOGY ARTERIAL Mixture of both venous and arterial and therefore signs from both aetiologies Doppler assessment; ABPI between 0.6 and 0.8 Any part of the leg or foot Usually small ‘punched out’ defined edge ABPI less than 0.6 Increase venous return Reduce oedema Reduce pain Prevent infection Reduce pain Prevent infection Vascular investigation Prevent maceration Apply reduced compression therapy at 15-25mmHg Dressing selection; keep it simple e.g. low adherent or foam No compression Wound management as indicated within formulary Management of pain Refer to vascular surgeon maximise patient comfort and adherence to treatment Good nutritional status is essential for wound healing to take place Patient education For appropriate dressing selection according to assessment of the wound and surrounding skin characteristics refer to Classification of Wounds Keep it simple; patients with history of leg ulceration have high incidence of sensitivities For venous ulceration; when the ulcer has healed wearing compression hosiery reduces recurrence rates Refer to Classification Of Bandages for optimum compression levels and choice of therapy Linked information: Leg ulcer guideline