Materiały źródłowe

• #1 Venous ulcer care: prompt, proper care reduces complications

  https://www.myamericannurse.com/venous-ulcer-care/

  Venous ulcers are the most common lower extremity wounds in the United States. Patients experience poor quality of life as a result of pain and immobility, and they require advanced levels of wound care. Any delay in care increases the risk of infection, sepsis, amputation, skin cancers, and death. […] Targeted nursing education is essential to improve the assessment and management of venous leg ulcers. In addition, empowering patients to care for themselves can help bridge care gaps. […] Venous ulcer management varies depending on severity and whether the current wound is a recurrence. Treatment options include conservative management and advanced therapy. The main goal of treatment for any stage of venous ulcer is healing, but preventing recurrence and reducing edema also are important.

• #2 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. […] Current evidence supports treatment of venous ulcers with compression therapy, exercise, dressings, pentoxifylline, and tissue products. […] Compression therapy is beneficial for venous ulcer treatment and is the standard of care. […] Dressings are recommended to cover venous ulcers and promote moist wound healing. […] Pentoxifylline is effective when used as monotherapy or with compression therapy for venous ulcers. […] Early endovenous ablation to correct superficial venous reflux improves ulcer healing rates. […] Venous ulcers are open skin lesions that occur in an area affected by venous hypertension. […] Treatment options for venous ulcers include conservative management, mechanical modalities, medications, advanced wound therapy, and surgical options.

• #3 Practice Nursing – Recurrent venous leg ulcers: management in general practice

  https://www.practicenursing.com/content/clinical-focus/recurrent-venous-leg-ulcers-management-in-general-practice/

  Despite improved healing rates, however, recurrence rates are depressingly high. Around 6070% of all VLUs are reported to recur after healing, with the highest recurrence rate within 3 months and the majority recurring within 12 months. A quarter of all patients will experience in excess of 10 episodes of active ulceration in their lifetime.

• #4 Nursing Care Plan for Leg Ulcers – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-leg-ulcers/

  Leg ulcers pose significant challenges in healthcare, requiring comprehensive nursing care to promote healing, prevent infection, alleviate pain, and enhance the patients quality of life. […] As a nurse, providing evidence-based care and support to individuals with leg ulcers is crucial. […] This article presents nursing care guidelines for leg ulcers, encompassing assessment, therapeutic interventions, patient education, and preventive measures to ensure optimal management and successful wound healing. […] Venous leg ulcers are the most common type and occur due to impaired venous circulation, leading to increased pressure and inflammation in the lower legs. […] Nurses play a pivotal role in assessing leg ulcers, ensuring a comprehensive understanding of the wounds characteristics, patient history, and vascular status.

• #5 Nursing Care Plan for Leg Ulcers – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-leg-ulcers/

  Nurses gather a detailed medical history, including information on previous ulcers, chronic conditions, lifestyle factors, and medications, to identify potential risk factors and guide the assessment process. […] Nurses conduct a thorough assessment of the ulcer site, examining the size, depth, surrounding skin condition, presence of infection, and any signs of complications such as cellulitis or osteomyelitis. […] Nurses assess the lower extremities arterial and venous blood flow to determine the underlying circulatory issues contributing to the ulcer development. […] Accurate diagnosis is vital for tailoring appropriate care plans for leg ulcers. […] Nurses work closely with physicians, wound care specialists, and vascular surgeons to ensure accurate diagnosis and appropriate treatment plans.

• #6 Wound Care Today | May 2025

  https://www.woundcare-today.com/journals/issue/wound-care-today/article/differential-diagnosis-leg-ulcers-focus-atypical-ulcers

  Most leg ulcers seen in practice are venous in aetiology. […] Venous leg ulcers are reported as the most common form of leg ulcer, accounting for around 80% of all cases while arterial leg ulcers account for approximately 15% of cases. […] A leg ulcer is a symptom of another condition and therefore it is important for nurses to ascertain the cause by implementing differential diagnostic procedures. […] Patients presenting with venous leg ulcers may give a history of previous varicose veins, deep vein thrombosis (DVT), leg surgery and trauma. […] Leg ulcers that are venous in origin are often relatively easy to diagnose with tell-tale signs of varicose veins, haemosiderin staining, lipodermatosclerosis, atrophie blanche, ankle flare, and eczema. […] Treatment involves compression of the leg and a wound dressing appropriate for the ulcer.

• #7 Wound Care Today | May 2025

  https://www.woundcare-today.com/journals/issue/wound-care-today/article/differential-diagnosis-leg-ulcers-focus-atypical-ulcers

  The patients medical history and comorbidities, such as cardiovascular disease, venous insufficiency, chronic kidney disease, autoimmune disorders and inflammatory bowel disease can provide clues as to the aetiology and are particularly pertinent to atypical ulcers, which have no significant venous or arterial involvement. […] The patients mobility and ankle movement should also be noted. […] A structured wound assessment tool such as TIME can aid diagnosis of the ulcer. […] A thorough assessment should allow the leg ulcer diagnosis to be noted and treatment started, or the patient referred on for further investigations and specialist treatment. […] When leg ulcers fail to respond to treatment or heal in an orderly manner despite optimal therapy, nurses should reconsider the diagnosis and, where necessary, refer on for specialist advice and management.

• #8 A new district nursing model improves venous leg ulcer healing rates :: Cambridge Media Journals

  https://journals.cambridgemedia.com.au/wpr/volume-29-number-4/new-district-nursing-model-improves-venous-leg-ulcer-healing-rates

  A new district nursing model improves venous leg ulcer healing rates. The predominant aetiology of lower leg ulcers (VLU) are caused by venous insufficiency. The specialist nurses provided district nurse education on leg ulcers and conducted vascular assessments to identify venous ulcer aetiology, enabling early compression therapy to increase healing rates and prevent wound chronicity. A nurse-led model facilitated early diagnosis and treatment of VLUs to reduce healing time. A venous leg ulcer (VLU) is defined as an open skin lesion affecting the leg or foot that is affected by venous hypertension; these ulcers account for 70% of all lower leg ulcers. VLUs have high recurrence rates and can lead onto chronic wounds if not managed appropriately; hence early identification to treat and prevent these is essential for a persons quality of life, and to reduce the financial burden on the person and healthcare system. The Capital Coast District Health Board (CCDHB) serves an estimated population of 324,000 in the lower half of the North Island in New Zealand. A previous 52-week retrospective audit involving 288 patients enrolled with the district nursing service from May 2015 to May 2016 showed VLUs had an average heal time of 27 weeks. Additionally, recurrent ulcers took 45 weeks to heal which was 1.7 times longer than new ulcer presentations. Previous to this audit the wound clinical nurse specialist (WCNS) had identified the need for early VLU diagnosis and treatment and submitted a successful proposal to the CCDHB for a specialist wound care team (SWCT) in March 2016. The SWCT then implemented a VLU training program for 70 district nurses; Doppler assessment was included for approximately 20 of the district nurses with practice supported by the SWCT. In accordance with the ANZ guideline and CCDHB protocol, all non-healing lower leg wounds, or patients who had an ABPI reading below 0.8 or above 1.2, were referred onto the specialist vascular team. Patients diagnosed with a VLU (ABPI 0.81.2) received compression bandaging. All patients received written information sheets on the importance of skin care and compression hosiery post-healing. The primary objective was to determine if newly referred patients with lower leg wounds received early diagnosis and treatment. The secondary aim was to determine VLU healing rates using compression therapy. A total of 219 (89%) patients had healed wounds at the end point of data analysis; healing time ranged from less than 1 week to 43 weeks. The average healing rate for VLUs using compression therapy was 11.82 weeks which is within the UK 12-week healing target for simple VLUs. The audit data supports that our new nursing model did, in most cases, provide earlier leg ulcer assessment and diagnosis and did improve healing rates for new and recurrent leg ulcers, hence reducing the risk of chronic wounds developing.

• #9 Management of venous leg ulcers in general practice – a practical guideline

  https://www.racgp.org.au/afp/2014/september/management-of-venous-leg-ulcers-in-general-practic

  Chronic venous leg ulcers are the most common wounds seen in general practice. Their management can be both challenging and time-consuming. […] Effective management of chronic ulcers involves the assessment of both the ulcer and the patient. The essential requirements of management are to debride the ulcer with appropriate precautions, choose dressings that maintain adequate moisture balance, apply graduated compression bandage after evaluation of the arterial circulation and address the patients concerns, such as pain and offensive wound discharge. […] Most chronic venous leg ulcers can be managed effectively in the general practice setting by following the simple, evidence-based approach described in this article. […] Effective treatment of chronic venous leg ulcers is time-consuming and depends on appropriate assessment, which includes examination of the ulcer and the patient.

• #10 Venous ulcers – self-care: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000744.htm

  Venous ulcers (open sores) can occur when the veins in your legs do not push blood back up to your heart as well as they should. Blood backs up in the veins, building up pressure. If not treated, increased pressure and excess fluid in the affected area can cause an open sore to form. […] Most venous ulcers occur on the leg, above the ankle. This type of wound can be slow to heal. […] Your health care provider will show you how to care for your wound. The basic instructions are: Always keep the wound clean and bandaged to prevent infection. Your provider will tell you how often you need to change the dressing. Keep the dressing and the skin around it dry. Try not to get healthy tissue around the wound too wet. This can soften the healthy tissue, causing the wound to get bigger. Before applying a dressing, cleanse the wound thoroughly according to your provider’s instructions. Protect the skin around the wound by keeping it clean and moisturized. You will wear a compression stocking or bandages over the dressing. Your provider will show you how to apply the bandages.

• #11 Venous ulcers – self-care Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/selfcare-instructions/venous-ulcers-self-care

  Venous leg ulcers – self-care; Venous insufficiency ulcers – self-care; Stasis leg ulcers – self-care; Varicose veins – venous ulcers – self-care; Stasis dermatitis – venous ulcer […] Your health care provider will show you how to care for your wound. The basic instructions are: […] Always keep the wound clean and bandaged to prevent infection. […] Your provider will tell you how often you need to change the dressing. […] Keep the dressing and the skin around it dry. Try not to get healthy tissue around the wound too wet. This can soften the healthy tissue, causing the wound to get bigger. […] Before applying a dressing, cleanse the wound thoroughly according to your provider’s instructions. […] Protect the skin around the wound by keeping it clean and moisturized. […] You will wear a compression stocking or bandages over the dressing. Your provider will show you how to apply the bandages.

• #12

  https://www.nhs.uk/conditions/leg-ulcer/treatment/

  With appropriate treatment, venous leg ulcers often heal within 6 months. […] Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers. This will usually be a practice or district nurse. […] The application of a compression bandage is a skilled procedure and should only be done by trained healthcare staff. […] It’s important to wear your compression bandage exactly as instructed. If you have any problems, it’s usually best to contact your nurse instead of trying to remove it yourself. […] Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema), which is caused by fluid. This can be controlled by compression bandages. […] The following advice may help your ulcer heal more quickly. […] If your ulcer becomes infected, it should be cleaned and dressed as usual.

• #13

  https://www.nhs.uk/conditions/leg-ulcer/treatment/

  You’ll see your nurse at least once a week at the start of your treatment to have your dressings and compression bandages changed. They’ll also monitor the ulcer to see how well it’s healing. […] The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed.

• #14 Venous ulcer care: prompt, proper care reduces complications

  https://www.myamericannurse.com/venous-ulcer-care/

  Conservative treatment consists of compression therapy, dressings, debridement, and medication. […] Medical compression therapy (compression garments, containment devices, Velcro systems, and short and long stretch-fiber compression wraps) is the standard treatment for initial and long-term venous ulcer management in patients without arterial disease. […] Covering the wound with a dressing is recommended to promote moist wound healing. […] Removing necrotic tissue by debridement may help expedite wound healing, but it requires a provider who is experienced with the procedure. […] Pentoxifylline (400 mg three times daily) may be used to increase microcirculation and oxygenation. […] Encouraging an hour of leg elevation daily may reduce the risk of venous ulcer recurrence. Also, mild exercise (such as walking and progressive resistant exercises) in conjunction with compression therapy may aid healing.

• #15 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Compression therapy is a standard treatment modality for initial and long-term treatment of venous ulcers in patients without concomitant arterial disease. […] Goals of compression therapy include reduced edema and pain, improved venous reflux, and enhanced healing. […] Although leg elevation can increase deep venous flow and reduce venous pressure, leg elevation added to compression may not improve ulcer healing. […] Dressings should be chosen based on wound location, size, depth, moisture balance, presence of infection, allergies, comfort, odor management, ease and frequency of dressing changes, cost, and availability. […] Venous intervention and long-term use of compression stockings are important for preventing recurrence, and leg elevation can be beneficial when used with compression stockings.

• #16 Chronic Venous Insufficiency (Venous Stasis Ulcer) Interventions for Nursing RN

  https://www.picmonic.com/pathways/nursing/courses/standard/medical-surgical-nursing-pathophysiology-296/vascular-disorders-1405/chronic-venous-insufficiency-venous-stasis-ulcer-interventions_2037

  Compression stockings are essential for chronic venous insufficiency treatment. These come in various forms, including elastic support bandages, velcro wraps, sequential compression devices, and multilayer compression bandages. Be sure to assess the peripheral pulses prior to applying any type of compression therapy. […] Use of proper wound dressings helps to heal these ulcers and prevents their recurrence. These can be antimicrobial dressings, but can be hydrocolloid dressings, or dressings that are applied with hydrogel. […] Patients should have proper foot and leg care to avoid additional trauma. Lotions should be applied to moisturize the skin, which also helps to prevent itching and cracking of the skin. Clean dressings should be used, and products with additives should be avoided in order to prevent venous dermatitis.

• #17 Managing leg ulcers in primary care | Nursing in Practice

  https://www.nursinginpractice.com/clinical/managing-leg-ulcers-in-primary-care/

  Compression bandaging for venous leg ulcers must aim to deliver 40mmHg by the ankle. […] In addition to bandaging or compression in general, patients should be encouraged to exercise more than once a day. […] Pain should be assessed using a validated assessment chart and appropriate action taken. […] The type of dressing used on a venous ulcer has little influence on healing when adequate compression is achieved. […] Diagnosing and treating the underlying cause is the key to successful treatment.

• #18 Leg ulcers (and disorders of venous insufficiency)

  https://www.pcds.org.uk/clinical-guidance/leg-ulcers

  Leg ulcers are of huge socio-economic importance. Approximately over 500,000 people live with a form of venous ulceration in the UK, this has doubled in the last 10 years. A leg ulcer is not a diagnosis; it is a manifestation of an underlying disease process and so the concept should be of the patient with the leg ulcer. […] The cornerstones of wound management are: Define and treat underlying causes. […] Compression therapy where appropriate. […] For venous leg ulcers provide a patient information leaflet. […] Compression therapy is the most important step in the management of venous leg ulcers, and sometimes those with mixed vascular disease. […] In the best hands 70% of venous ulcers can be healed in compression bandaging within three months. […] All bandages must be applied from toe to knee with the foot flexed at 90 degrees.

• #19 Leg ulcers (and disorders of venous insufficiency)

  https://www.pcds.org.uk/clinical-guidance/leg-ulcers

  Following application, if the patient shows signs of pain, reduced colour or numbness on their extremities, the bandage must be removed immediately. […] Referral must be considered in the following cases: Venous ulcers failing to progress at three months or which have not healed by twelve months. […] Most patients needing referral should be directed to community leg ulcer (tissue viability) clinics or dermatology departments.

• #20 The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection – Wounds International

  https://woundsinternational.com/journal-articles/the-impact-of-venous-leg-ulcers-on-a-patients-quality-of-life-considerations-for-dressing-selection/

  Although dressings do not play a direct role in this aspect of VLU management, it is important that clinicians select dressings that (i) have been designed and tested to confirm that their performance is not adversely affected by the mechanical forces imparted by the compression systems and (ii) do not interfere with the delivery of compression to the lower limbs. […] It is important to view these patients as challenges, rather than non-compliant, and attempt to find an effective level of compression. […] Dressings play an important role in the management of excess exudate. […] In doing so, they should be (i) able to handle exudate and its components through absorption, moisture vapour loss and retention, even when working against gravitational forces and the mechanical forces applied by compression systems, (ii) capable of reducing the risk of leakage and spread of exudate onto the periwound region (reducing the risk of maceration and skin erosion) and, (iii) act as a barrier against the invasion of microorganism.

• #21 Venous Leg Ulcers, the 4Ds and Expected Healing Outcomes – Sanara MedTech

  https://sanaramedtech.com/blog/venous-leg-ulcers-and-expected-healing-outcomes/

  Venous leg ulcers are some of the most common lower extremity ulcers. They result as a late indicator of chronic venous insufficiency and venous hypertension. […] For all leg ulcers, a reliable diagnosis and evaluation of the underlying factors for non-healing are essential. […] Periwound skin care is perhaps most challenging in patients with venous leg ulcers. […] Compression is the mainstay of management of venous leg ulcers, together with skin and local wound care. […] Venous leg ulcers have highly proteinaceous exudate and tend to build up with fibrinous debris. […] Timely and effective interventions are needed to support a healing environment. […] Expected Healing Outcomes for Venous Leg Ulcers […] These findings underscore is the importance of timely care and the need to refer to a wound care specialist if the aforementioned predictors are identified.

• #22 Venous Leg Ulcer and Compression Therapy – Skin and Wound Care – LibGuides at Nova Scotia Health

  https://library.nshealth.ca/WoundCare/VenousLegUlcer

  Compression therapy helps reduce the ambulatory venous pressure; it improves the calf-muscle pump function and decreases reflux in the malfunctioning veins, reducing edema. […] As edema is reduced in legs, a new compression system may be required based on size of limb; do not fit for a compression garment until compression wraps have been used to decrease edema. […] Cleansing: Wash both legs with pH-balance soap and water every time compression wrap is removed, or instruct patient to cut off compression wrap and have a shower in which they wash leg prior to homecare visit. […] After washing legs, moisturize legs with unscented or perfumed moisturizer. […] Debridement: Removal of necrotic tissue from wound bed; select the debridement method most appropriate for the patient, situation and environment of care. […] Moisture balance: select a dressing that will be able to absorb the exudate from the ulcer; venous ulcers typically have high levels of exudate.

• #23 Venous Ulcer: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/23165-venous-ulcer

  The therapies that are best for you depend on the location and severity of the ulcer. Care typically includes frequent follow-up appointments to ensure treatments are working. […] Venous ulcer treatments often include: Antibiotics if theres an infection. Compression bandages or stockings to improve circulation. Ointments that protect against germs. Pain relievers and other therapies to quiet overactive nerves. Procedures (debridement) to remove debris and dead tissue. Referrals to specialists if you need help managing chronic conditions, such as diabetes. Special bandages and dressings to keep the ulcer covered. Wound cleaning daily to flush out bacteria and remove dead tissue. […] Preventive care can help you avoid a venous stasis ulcer. If youve had one in the past, these steps can lower the risk of ulcers recurring (returning) after treatment.

• #24 Understanding Venous Ulcers And The Best Dressing Methods

  https://www.thewoundpros.com/post/understanding-venous-ulcers-and-the-best-dressing-methods

  Keeping the ulcer moist helps the skin heal faster and more efficiently. […] Antimicrobial dressings are crucial if a venous ulcer shows signs of infection (e.g., increased pain, foul odor, or pus). […] Dressing changes should be done based on the amount of drainage and the condition of the wound, typically every 1 to 3 days. […] By combining the right dressing techniques with supportive therapies like compression, elevation, and exercise, venous ulcers can heal more efficiently, reducing pain and the likelihood of recurrence. […] Proper care is critical to ensure lasting results and a healthier quality of life. […] Proper wound care may prevent healing and complications from a leg ulcer, including compression therapy, moist wound dressings, and antimicrobial treatments. […] Early venous ulcer treatment significantly improves healing outcomes and minimizes the risk of infection or recurrence.

• #25 Venous ulcers – self-care: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000744.htm

  To help treat a venous ulcer, the high pressure in the leg veins needs to be relieved. Wear compression stockings or bandages every day as instructed. They help prevent blood from pooling, reduce swelling, help with healing, and reduce pain. Put your feet above your heart as often as possible. For example, you can lie down with your feet propped up on pillows. Take a walk or exercise every day. Being active helps improve blood flow. Take medicines as directed to help with healing. […] If ulcers do not heal well, your provider may recommend certain procedures or surgery to improve blood flow through your veins. […] If you are at risk for venous ulcers, take the steps listed above under Wound Care. Also, check your feet and legs every day: the tops and bottoms, ankles, and heels. Look for cracks and changes in skin color.

• #26 Venous Leg Ulcer and Compression Therapy – Skin and Wound Care – LibGuides at Nova Scotia Health

  https://library.nshealth.ca/WoundCare/VenousLegUlcer

  Elevation can mobilize fluid out of the legs. During elevation the feet must be above the hip joint to be adequate to mobilize fluid, for patients who can tolerate that position. […] Frequent 20-30 minute episodes of elevation throughout the day are recommended. […] As with all wounds, the whole patient must be considered and interventions must be in place to support the management of any patient factor that could impact wound healing: Pain control: pharmacological or non-pharmacological options, dressing selection to decrease pain. […] Co-morbidity management: diabetes, heart disease, respiratory diseases, obesity.

• #27 Venous ulcers – self-care Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/selfcare-instructions/venous-ulcers-self-care

  To help treat a venous ulcer, the high pressure in the leg veins needs to be relieved. […] Wear compression stockings or bandages every day as instructed. They help prevent blood from pooling, reduce swelling, help with healing, and reduce pain. […] Put your feet above your heart as often as possible. For example, you can lie down with your feet propped up on pillows. […] Take a walk or exercise every day. Being active helps improve blood flow. […] Take medicines as directed to help with healing. […] If ulcers do not heal well, your provider may recommend certain procedures or surgery to improve blood flow through your veins. […] If you are at risk for venous ulcers, take the steps listed above under Wound Care. […] Lifestyle changes can help prevent venous ulcers. The following measures may help improve blood flow and aid healing.

• #28 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  Compliance is essential to achieve a successful outcome. […] Patients should be educated because VLUs are chronic processes that require lifelong evaluation and care, even after wound closure. […] An interprofessional team approach is fundamental for a thorough evaluation and treatment strategy.

• #28 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  Venous leg ulcers are chronic wounds that result from prolonged venous insufficiency, primarily affecting older adults. […] The condition requires careful management, including proper diagnosis, wound care, and prevention strategies to avoid recurrence. […] The treatment plan becomes more holistic and evidence-based by involving specialists from various fields, such as dermatology, wound care, vascular surgery, and nursing. […] The standard of care for VLUs relies on 2 strategies: compression therapy and direct wound management. […] Compression therapy is the most practical, effective, and cost-conscious intervention for the treatment of VLUs. […] Direct ulcer interventions involve cleansing, debridement, infection control, and applying dressings and topical substances. […] Although VLUs are often colonized, frank infections are less common.

• #29 4. Venous Insufficiency Ulcers | ATrain Education

  https://www.atrainceu.com/content/4-venous-insufficiency-ulcers

  Compression wraps are typically done weekly by a trained clinician in order to provide accurate compression. […] Compression stockings must be worn daily to help prevent further wound development by reducing swelling. […] The goals for venous insufficiency patients are to maintain intact skin, reduce pain if present, and reduce edema with effective lifestyle changes to prevent future complications. […] Encourage patient compliance by discussing the benefits of edema control with wound healing and that we must reduce the swelling. […] Topical wound care is performed according to the wound bed appearance, with treatment that will be best for the patient and caregiver to perform effectively. […] Involvement of the patient and caregiver in the treatment process can encourage confidence in future self-management and prevention measures.

• #30 Personalised self-care for people with venous leg ulcers: a toolkit for change – Wounds UK

  https://wounds-uk.com/best-practice-statements/personalised-self-care-for-people-with-venous-leg-ulcers-a-toolkit-for-change/

  The guidance in this document aims to empower patients and improve outcomes, by equipping clinicians with a toolkit to effectively advocate for the inclusion of self-care, while potentially helping healthcare services to reduce the burden of wounds. […] Self-care is the ability of individuals to care for themselves, allowing them to take an active role to achieve, maintain or optimise their health and wellbeing. […] It is evident that a change to the model of care provision for people with VLUs is needed, and self-care needs to be encouraged and promoted as early in the treatment journey as possible. […] Moreover, compression therapy (leg ulcer hosiery kits and adjustable compression wraps) is considered the gold standard for treatment of VLUs, and can be supplied to patients to self-care for their own wounds.

• #31 Personalised self-care for people with venous leg ulcers: a toolkit for change – Wounds UK

  https://wounds-uk.com/best-practice-statements/personalised-self-care-for-people-with-venous-leg-ulcers-a-toolkit-for-change/

  The aim of this meeting and the resulting document was to learn from shared experiences and provide guidance on patient suitability and best practice, to reduce the pressure on all clinicians and healthcare providers working with VLUs, and ensure that all patients receive the appropriate level of support. […] Clarify individual patient considerations and guide clinicians on assessing patient suitability, capacity and willingness to be involved in self-care. […] Emphasise the importance of effective communication to optimise self-care, and provide a Dialogue Tool to support clinicians to promote self-care in the clinical setting. […] Focus on self-care in the context of VLUs and compression therapy.

• #32 Venous ulcers – self-care: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000744.htm

  Lifestyle changes can help prevent venous ulcers. The following measures may help improve blood flow and aid healing. Keep the skin of your lower legs well moisturized. Quit smoking. Smoking is bad for your blood vessels. If you have diabetes, keep your blood sugar level under control. This will help you heal faster. Exercise as much as you can. Staying active helps with blood flow. Eat healthy foods and get plenty of sleep at night. Lose weight if you are overweight. Manage your blood pressure and cholesterol levels.

• #33 Venous ulcers – self-care Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/selfcare-instructions/venous-ulcers-self-care

  Keep the skin of your lower legs well moisturized. […] Quit smoking. Smoking is bad for your blood vessels. […] If you have diabetes, keep your blood sugar level under control. This will help you heal faster. […] Exercise as much as you can. Staying active helps with blood flow. […] Eat healthy foods and get plenty of sleep at night. […] Lose weight if you are overweight. […] Manage your blood pressure and cholesterol levels. […] Contact your provider if there are any signs of infection, such as: […] Redness, increased warmth, or swelling around the wound […] More drainage than before or drainage that is yellowish or cloudy […] Bleeding […] Odor […] Fever or chills […] Increased pain.

• #34 Venous Leg Ulcers: Causes, Symptoms and Treatment

  https://patient.info/heart-health/varicose-veins-leaflet/venous-leg-ulcers

  Venous leg ulcers are common in older people. The most important part of treatment is for compression bandages to be applied correctly by a nurse. […] The ulcer is dressed in a similar way to any other wound. Typically, a nurse will do this every week or so. […] Wearing a compression bandage is the most important part of treatment. The aim is to counteract the raised pressure in the leg veins. […] When you are resting, if possible, try to keep your leg raised higher than your hip. […] Venous leg ulcers commonly come back (recur) after they have healed. To prevent this, you should wear a support (compression) stocking during the daytime for at least five years after the ulcer has healed. […] A leg ulcer is much less likely to recur if you wear compression stockings regularly.

• #35 What are Venous Leg Ulcers? Most Common Questions and Answers | Richardson Healthcare

  https://richardsonhealthcare.com/what-are-venous-leg-ulcers/

  It is critical to notify your clinician of any signs of infection. This is because infection can lead to an increase in pain and discomfort as well as a range of more serious complications. […] The best way to minimise the risk of developing a leg ulcer is to reduce venous pressure. […] The most effective preventative measure you can take is to wear your compression hosiery and bandages consistently.

• #36 Management of venous leg ulcers in general practice – a practical guideline

  https://www.racgp.org.au/afp/2014/september/management-of-venous-leg-ulcers-in-general-practic

  The most common concern that patients express is pain during change of dressings or at night. This is followed by the offensive odour from the wound exudate, which often leads to social isolation. […] A malodorous exudate can be managed with a combination of adequate debridement, a short course of antibiotics (topical or systemic) and dressings. […] Documentation of the examination findings, wound scores and management plan for future reference is the final step of the consultation process. […] Finally, specialist referral should be considered when there is suspicion of malignancy, there are clinical features of peripheral arterial disease, there is an atypical leg ulcer, an ulcer does not improve or increases in size despite management in the primary care setting, TIME-H score is 6, or a patient with a venous ulcer is unable to tolerate compression due to pain.

• #37 Venous ulcer care: prompt, proper care reduces complications

  https://www.myamericannurse.com/venous-ulcer-care/

  If a venous ulcer is unresponsive after 4 weeks of conservative therapy or does not respond to conventional therapy, advanced therapies are recommended. […] Improving venous ulcer care requires increasing nurse wound care knowledge across settings and ensuring nurses work at the top of their scope of practice. […] The Centers for Medicare Medicaid Services has paved the way for using telehealth during the pandemic, making it an ongoing viable option for helping patients adhere to treatment recommendations. […] As more nurses who are inexperienced in wound care are required to care for venous ulcers, they should participate in additional continuing education, including online programs, to help improve decision-making during assessment and care.

• #38 Strategies and challenges in the treatment of chronic venous leg ulcers

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7674718/

  Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. […] When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs.

• #39 Strategies and challenges in the treatment of chronic venous leg ulcers

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7674718/

  Wound care, debridement, bed rest with leg elevation, and compression are basic therapies for chronic venous leg ulcers (CVLUs). Ablation of the great saphenous veins help heal some ulcers. Negative pressure wound therapy, autologous split-thickness skin grafting, autologous platelet-rich plasma, and administration of adipose tissue or placenta-derived mesenchymal stem cells are effective approaches for wound healing. […] There are little data to support the efficacy of silver-based dressings in the healing of CVLUs. Hydrogen peroxide is harmful to the growth of granulation tissue in CVLUs. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.

• #40 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Understanding the molecular pathways underlying VLU has led to new lines of therapy with significant promise including biologics such as bilayer living skin construct, fibroblast derivatives, and extracellular matrices and non-biologic products such as poly-N-acetyl glucosamine, human placental membranes amnion/chorion allografts, ACT1 peptide inhibitor of connexin 43, sulodexide, growth factors, silver dressings, MMP inhibitors, and modulators of reactive oxygen and nitrogen species, the immune response and tissue metabolites. […] Preventive measures including compression therapy and venotonics could also reduce the risk of progression to chronic venous insufficiency and VLU in susceptible individuals.

• #41 Venous Leg Ulcers Treatment in Portland, OR and Vancouver, WA

  https://inoviavein.com/venous-leg-ulcers/

  At Inovia Vein Specialty Centers, we specialize in Venous Stasis Ulcer Treatment and we have the diagnostic tools and experience needed to help make an accurate diagnosis and develop a definitive short-term and long-term treatment plan. […] Studies have shown that the sooner one sees a vascular or vein specialist and the sooner the patient is treated, when indicated, with endovenous ablation, the faster the wound heals. […] Most venous leg ulcers will heal with consistent and adequate control of the swelling, proper wound care and endovenous ablation of the varicose veins contributing to the ulcer. […] Yes. Studies have shown that the sooner a patient with a venous leg ulcer is referred to a vascular specialists, the sooner the ulcer can be treated so it will heal faster. […] Treating a venous leg ulcer entirely at home is not recommended.

• #42 The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection – Wounds International

  https://woundsinternational.com/journal-articles/the-impact-of-venous-leg-ulcers-on-a-patients-quality-of-life-considerations-for-dressing-selection/

  Prevention of infection in VLUs is, therefore, of paramount importance. […] If infection does occur, then it should be treated according to clinical guidelines (e.g. topical antimicrobials versus systemic antibiotics). […] As well as being challenging clinically and economically, VLUs cause patients a wide range of psychosocial issues including depression, anxiety and social isolation. […] While the underlying causes of VLUs can be effectively addressed with the use of compression therapy, it is equally or more important for clinicians to provide appropriate local ulcer management to minimise the impact that high exudation (e.g. leakage and maceration), malodour, pain and frequent dressing changes can have on the health-related QoL of patients.

• #43

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abr7909

  A venous skin ulcer is a shallow wound that develops when the leg veins do not move blood back to the heart normally. […] The first sign of a venous skin ulcer is skin that turns dark red or purple over the area where the blood is leaking out of the vein. […] Follow your doctor’s instructions on how to clean the ulcer and change the bandage. […] If your doctor prescribed antibiotics, take them as directed. […] Lift your legs above the level of your heart as often as possible. […] Wear compression stockings or bandages. They help the blood circulate in your legs. […] After your ulcer has healed, continue to wear compression stockings. […] Walk daily. Walking helps your blood circulation. […] Call your doctor or nurse advice line now or seek immediate medical care if you have symptoms of infection, such as increased pain, swelling, warmth, or redness. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if your ulcer is not healing.

• #44 The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection – Wounds International

  https://woundsinternational.com/journal-articles/the-impact-of-venous-leg-ulcers-on-a-patients-quality-of-life-considerations-for-dressing-selection/

  Leakage and malodour cause considerable distress to patients and their carers. […] This was explored in a mixed method study, in which both quantitative (Hospital Anxiety Depression Scale and qualitative (interviews) data were analysed to investigate the link between depression and VLU-associated exudate and malodour. […] In a later study which was undertaken to understand the personal impact of VLUs from the perspective of patients, the impact of exudate (e.g. leakage) and malodour was described as devastating, causing embarrassment, shame and stress. […] Wound-related pain is multidimensional; it integrates the experience of chronic wound pain (i.e. the persistent pain that is usually associated with the underlying wound aetiology) with cyclic acute pain (i.e. the periodic pain that is induced by repeated interventions such as recurring dressing changes) and non-cyclic acute pain (i.e. single-episode pain arising from procedures such as sharp debridement). […] For example, in a survey involving over 2,000 patients from 15 countries, over 40% of respondents revealed that pain at dressing change was the worst part of living with a wound.

• #45 Nursing Care Plan for Leg Ulcers – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-leg-ulcers/

  Nurses carefully evaluate the characteristics of the leg ulcer. […] Nurses may assist in obtaining wound culture specimens to identify the presence of infection and guide antibiotic therapy if necessary. […] Effective planning is crucial to optimize the management of leg ulcers. […] Follow evidence-based practice guidelines for wound dressing selection, considering factors such as wound characteristics, moisture balance, and the patients condition. […] For venous leg ulcers, implement compression therapy as prescribed to improve venous return, reduce edema, and promote ulcer healing. […] Develop a comprehensive pain management plan, combining pharmacological interventions and non-pharmacological approaches. […] Nurses ensure strict adherence to infection control protocols. […] Nurses develop and implement pain management strategies.

• #46 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  Compliance is essential to achieve a successful outcome. […] Patients should be educated because VLUs are chronic processes that require lifelong evaluation and care, even after wound closure. […] An interprofessional team approach is fundamental for a thorough evaluation and treatment strategy.

• #47 Diagnosis and Treatment of Venous Ulcers | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0415/p989.html

  Pentoxifylline (Trental) is effective when used with compression therapy for venous ulcers, and may be useful as monotherapy. […] Aspirin (300 mg per day) is effective when used with compression therapy for venous ulcers. […] Compression therapy is the standard of care for venous ulcers and chronic venous insufficiency. […] Leg elevation when used in combination with compression therapy is also considered standard of care. […] Dressings are often used under compression bandages to promote faster healing and prevent adherence of the bandage to the ulcer. […] Overall, acute ulcers (duration of three months or less) have a 71 to 80 percent chance of healing, whereas chronic ulcers have only a 22 percent chance of healing after six months of treatment. […] Given the poor healing rates associated with chronic ulcers, surgical evaluation and management should be considered in patients with venous ulcers that are refractory to conservative therapies.

• #48 Practice Nursing – Interventions in infected venous leg ulceration in clinical practice

  https://www.practicenursing.com/content/clinical-focus/interventions-in-infected-venous-leg-ulceration-in-clinical-practice/

  Annemarie Brown explores the vital role practice nurses play in caring for patients with infected venous leg ulcers. […] This article aims to inform practice nurses of the management of infection in venous leg ulcers which they may encounter in clinical practice. […] Careful observation and a timely response to subtle signs can prevent a systemic wound infection developing. […] In order to achieve this, it is helpful for health professionals to be familiar with the continuum of wound infection and to be able to intervene appropriately before a systemic wound infection develops. […] No treatment is necessary but frequent observation and on-going reassessment is required.

• #49 Venous leg ulcer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/venous-leg-ulcer/

  The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed. […] A venous leg ulcer can develop after a minor injury if there’s a problem with the circulation of blood in your leg veins. […] Many factors can increase your risk of developing a venous leg ulcer, including: obesity or being overweight this increases the pressure in the leg veins. […] There are ways to help prevent venous leg ulcers. For example, you could: wear compression stockings this may be recommended by your GP.

• #50 Venous leg ulcer prevention 1: identifying patients who are at risk | Nursing Times

  https://www.nursingtimes.net/tissue-viability-and-wound-care/venous-leg-ulcer-prevention-1-identifying-patients-who-are-at-risk-28-05-2019/

  Ulceration of the lower limbs results in painful and often debilitating leg wounds that can have a profound effect on patients physical, social and psychological wellbeing. […] All nurses have a vital role in identifying patients at risk of ulceration and supporting them to take preventative action to prevent skin breakdown. […] Nurses should be aware of the risk factors such as lower-limb oedema, skin changes and varicose veins and actively assess patients risk of developing ulceration before implementing prevention strategies. […] Nurses need to spot the early signs of venous leg ulceration and take preventative action, such as using compression therapy. […] Compression therapy has an important role to play in the prevention of leg ulceration but a greater emphasis on prevention is needed if the considerable burden of managing leg ulceration is to be reduced.

• #51 NHS England » Improving venous leg ulcer healing in the community

  https://www.england.nhs.uk/atlas_case_study/improving-venous-leg-ulcer-healing-in-the-community/

  Tissue Viability Nurses at Nottinghamshire Healthcare NHS Foundation Trust led on the development and implementation of a new standardisation approach to venous leg ulcers within the community. This programme of work has addressed unwarranted variation in venous leg ulcer treatment and management in order to deliver better outcomes, experience and use of resources within the organisation. […] The Tissue Viability Nurses undertook a review of existing service provision and clinical practice in order to establish a baseline as well as to identify areas for development and improvement. This review highlighted that practice differed between the Trusts services and that knowledge regarding best practice with venous leg ulcers varied between practitioners. This provided an opportunity to standardise training, clinical pathways and support available to staff to ensure they delivered high quality leg ulcer care.

• #52 NHS England » Improving venous leg ulcer healing in the community

  https://www.england.nhs.uk/atlas_case_study/improving-venous-leg-ulcer-healing-in-the-community/

  The immediate impact of the change has been measured in a number of ways including through venous leg ulcer healing rate data, clinical audits of practice and feedback from patients receiving care and clinicians providing care. […] Since the implementation of the new standardised approach to venous leg ulcers, the Trust has seen improvements in the support available to staff, healing rates and referral rates. In excess of 90% of leg ulcers heal within the 20 week period. […] The new approach has led to increased consistency in venous leg ulcer care across the Trust and improved healing rates have meant a reduction in time under services for a number of patients with leg ulcers. It is anticipated that the Trust will save in excess of 19000 annually following the implementation of the online training packages.

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