Materiały źródłowe

• #1

  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. […] In some clinics, specialist teams are using new alternatives to compression bandages, such as special stockings or other compressive devices. […] 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. […] If your ulcer becomes infected, it should be cleaned and dressed as usual. […] The aim of antibiotic treatment is to clear the infection. But antibiotics do not heal ulcers and should only be used in short courses to treat infected ulcers. […] The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed.

• #2

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

  Most venous leg ulcers heal within 6 months if they’re treated by a healthcare professional trained in compression therapy for leg ulcers. […] Treatment usually involves: cleaning and dressing the wound, using compression, such as bandages or stockings, to improve the flow of blood in the legs. […] Antibiotics may also be used if the ulcer becomes infected, but they do not help ulcers heal. […] But unless the underlying cause of the ulcer is addressed, there’s a high risk of a venous leg ulcer coming back after treatment. […] Underlying causes could include immobility, obesity, previous DVT or varicose veins.

• #3

  https://www2.hse.ie/conditions/venous-leg-ulcer/treatment/

  With appropriate treatment, most venous leg ulcers heal within 3 to 4 months. […] Treatment should always be carried out by someone trained in compression therapy for leg ulcers. This will usually be a practice nurse. […] Your nurse will apply a firm compression bandage over the affected leg. This is to improve vein function in your legs and treat swelling. […] The application of a compression bandage is a skilled procedure. It should only be done by trained healthcare staff. […] Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema). This swelling is caused by fluid. This can be controlled by compression bandages. […] Sometimes an ulcer can become infected. It will produce a large amount of discharge and become more painful. There may also be redness around the ulcer.

• #4 Diagnosis and Treatment of Venous Ulcers | AAFP

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

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. […] Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures. […] Compression therapy has been proven beneficial for venous ulcer treatment and is the standard of care. […] Leg elevation minimizes edema in patients with venous insufficiency and is recommended as adjunctive therapy for venous ulcers. The recommended regimen is 30 minutes, three or four times per day. […] Dressings are beneficial for venous ulcer healing, but no dressing has been shown to be superior.

• #5 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. […] Treatment options for venous ulcers include conservative management, mechanical modalities, medications, advanced wound therapy, and surgical options.

• #6 Venous leg ulcer | Mölnlycke Advantage

  https://www.molnlycke.ae/education/wound-areas/vlu/venous-leg-ulcer/

  Venous leg ulceration and chronic venous insufficiency represent a significant health problem throughout the world. The key to successful management lies in the use of compression therapy. […] Compression treatment is used to treat lower limb venous insufficiency. […] There are several guidelines and consensus recommendations for the management of venous leg ulcers. Some documents focus on compression therapy. […] Compression therapy is widely recognized as key to the management of venous leg ulcers, it increases healing rates in comparison with no compression therapy, and, after healing, reduces recurrence rates. […] The effective management of wound exudate has been shown to reduce time to ulcer healing, to reduce the risk of skin damage and infection, and to enhance patient quality of life and improve healthcare clinical and cost efficiency.

• #7 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. […] 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. […] Exercises to stimulate the calf-muscle pump: […] Ankle range of motion exercise: Passive: patient is assisted by caregivers or assistive devices (i.e., using a rolled towel to pull toes upward towards body), Active: done by the patient; options: going from standing flat-footed to standing on toes, pulling toes upward to feel the stretch in the calf.

• #8 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

  A practical guideline incorporating analytical and non-analytical processes of clinical reasoning, which may be called strategic clinical reasoning, would therefore be useful in the primary care management of chronic leg ulcers, 90% of which are due to venous and/or arterial causes. […] This practical guideline, using the A2BC2D approach incorporating the TIME concept of wound bed preparation, is intended for GPs and practice nurses in a busy clinic. It is a short, evidence-based practical guide covering examination, diagnosis and initial management of chronic venous leg ulcers, which are the most common entity. […] The application of a graduated compression bandage (two, three or four layers) or stockings after ensuring that there is adequate arterial supply has been proven to be the most effective management of chronic venous leg ulcers.

• #9 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. […] 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. […] Exercises to stimulate the calf-muscle pump: […] Ankle range of motion exercise: Passive: patient is assisted by caregivers or assistive devices (i.e., using a rolled towel to pull toes upward towards body), Active: done by the patient; options: going from standing flat-footed to standing on toes, pulling toes upward to feel the stretch in the calf.

• #10 How to Heal a Chronic Venous Leg Ulcer and Keep it Healed

  https://inoviavein.com/how-to-heal-leg-ulcers/

  Compression helps to reduce swelling and improve blood flow in the legs, which can then promote healing of the ulcer. […] If the leg is very swollen and if the wound is messy, velcro wraps are a type of compression wrap that can be particularly effective for managing venous ulcers early on. […] An additional proven step is ablation of the superficial venous reflux using office based procedures such as Radiofrequency Ablation (RFA) of the great saphenous vein and sclerotherapy of the branch veins going to the ulcer bed. […] Using Wound Care and Compression before RFA Radiofrequency ablation (RFA) is a proven approach to get wound closed and to help them stay closed for longer. […] After the RFA procedure once the wound is healed, compression therapy will continue to be important components of the long term management.

• #11 Optimal Diagnosis and Therapy of Venous Ulcer

  https://www.annphlebology.org/journal/view.html?pn=search&uid=134&vmd=Full

  Compression therapy with higher compressive force is more effective than lower compressive force and using several overlapping layers of bandage is more effective than using a single layer for treating venous ulcer. […] Therefore, compression therapy is recommended for patients with venous ulcer and as an adjuvant therapy to superficial phlebectomy to reduce the risk of ulcer recurrence. […] The wound should be kept moist at all times by using occlusive dressings. […] Because venous ulcer is an inflammatory response attributed to venous hypertension, the goal of pharmacologic therapy in venous ulcer cases is treating CVI. […] Pentoxifylline has also been found to improve venous ulcer healing rate. Accordingly, its use, along with compression therapy, is recommended for treatment of CVI. […] The fundamental goal of surgical and interventional treatment for venous ulcer is to achieve venous healing and prevent recurrence. […] Surgery on superficial veins can be effective for ulcer healing and is recommended even in patients comorbid with deep vein thrombosis.

• #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. […] In some clinics, specialist teams are using new alternatives to compression bandages, such as special stockings or other compressive devices. […] 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. […] If your ulcer becomes infected, it should be cleaned and dressed as usual. […] The aim of antibiotic treatment is to clear the infection. But antibiotics do not heal ulcers and should only be used in short courses to treat infected ulcers. […] The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed.

• #13

  https://www2.hse.ie/conditions/venous-leg-ulcer/treatment/

  With appropriate treatment, most venous leg ulcers heal within 3 to 4 months. […] Treatment should always be carried out by someone trained in compression therapy for leg ulcers. This will usually be a practice nurse. […] Your nurse will apply a firm compression bandage over the affected leg. This is to improve vein function in your legs and treat swelling. […] The application of a compression bandage is a skilled procedure. It should only be done by trained healthcare staff. […] Venous leg ulcers are often accompanied by swelling of your feet and ankles (oedema). This swelling is caused by fluid. This can be controlled by compression bandages. […] Sometimes an ulcer can become infected. It will produce a large amount of discharge and become more painful. There may also be redness around the ulcer.

• #14 Leg ulcer care | Te maimoatanga o te kōmaoa o te waewae (Frailty care guides 2023) | Te TāhÅ« Hauora Health Quality & Safety Commission

  https://www.hqsc.govt.nz/resources/resource-library/leg-ulcer-care-te-maimoatanga-o-te-komaoa-o-te-waewae-frailty-care-guides-2023/

  Leg ulcers tend to start with trauma but are a result of underlying damage to veins, arteries or both. Venous leg ulcers are the most common (4085 percent) followed by those with arterial aetiology (530 percent), mixed venous and arterial ulcers (1020 percent) and other causes (525 percent). […] The gold standard treatment for venous leg ulcers is compression therapy. Before that can occur, a full diagnostic work-up is required. Only health professionals with specialist knowledge and skills should apply full compression therapy. […] For venous leg ulcers and some mixed ulcers, compression therapy is the gold standard treatment. This requires specialist assessment and training. Do not use compression therapy without a formal assessment from an appropriately qualified wound specialist; it could increase risk of ischaemia.

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

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

  Venous ulcers are sores that take weeks, or sometimes months, to heal. They can worsen quickly, putting you at risk for complications that cause some people to lose their limbs. With successful treatment, you can avoid these issues. […] Venous ulcers dont heal on their own. The longer you live with them, the greater the likelihood of permanent tissue damage. The damage can spread or cause infections that can become life- or limb-threatening, such as gangrene. […] Timely care from an experienced wound care provider significantly lowers this risk. […] 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.

• #16 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. […] 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.

• #17 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.

• #18 Venous leg ulcer | NHS inform

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

  Most venous leg ulcers heal within 6 months with treatment. […] The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal. […] To improve vein circulation in your legs and treat swelling, your nurse will apply a firm compression bandage over the affected leg. These bandages are designed to squeeze your legs and encourage blood to flow upwards, towards your heart. […] 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. […] If your ulcer becomes infected, it should be cleaned and dressed as usual. […] The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed.

• #19 Diagnosis and Treatment of Venous Ulcers | AAFP

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

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. […] Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures. […] Compression therapy has been proven beneficial for venous ulcer treatment and is the standard of care. […] Leg elevation minimizes edema in patients with venous insufficiency and is recommended as adjunctive therapy for venous ulcers. The recommended regimen is 30 minutes, three or four times per day. […] Dressings are beneficial for venous ulcer healing, but no dressing has been shown to be superior.

• #20 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.

• #21 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. […] A wide range of dressings are available, including hydrocolloids, foams, hydrogels, pastes, and simple nonadherent dressings. […] Topical negative pressure, also called vacuum-assisted closure, has been shown to help reduce wound depth and volume compared with a hydrocolloid gel and gauze regimen for wounds of any etiology. […] Pentoxifylline (400 mg three times per day) has been shown to be an effective adjunctive treatment for venous ulcers when added to compression therapy.

• #22 Diagnosis and Treatment of Venous Ulcers | AAFP

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

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. […] Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures. […] Compression therapy has been proven beneficial for venous ulcer treatment and is the standard of care. […] Leg elevation minimizes edema in patients with venous insufficiency and is recommended as adjunctive therapy for venous ulcers. The recommended regimen is 30 minutes, three or four times per day. […] Dressings are beneficial for venous ulcer healing, but no dressing has been shown to be superior.

• #23 Local treatment of venous leg ulcers – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/local-treatment-of-venous-leg-ulcers/

  Although topical treatment is an important aspect of wound care, it should always be considered secondary to the choice of a compression strategy. Generally, the choice of dressing is guided by the ulcer characteristics (for example, wound drainage absorption), patient requirements (ease of application, comfort), and expense. […] Skin grafts used for venous leg ulcers are most commonly pinch grafts, but split-thickness skin meshed grafts may also be performed on larger wounds. There are no specific indications for when skin grafting for venous leg ulcers should be used, but grafting should be considered for large or refractory ulcers, when the venous hypertension is well controlled and when the ulcer bed is clean with healthy granulation tissue. […] Apligraf is a living bi-layered bioengineered skin substitute. It was approved by the FDA in 1998 for the treatment of leg ulcers of greater than one-month duration that have not adequately responded to conventional therapy. Used with compression, Apligraf heals venous leg ulcers more effectively than simple dressings and compression.

• #24 Diagnosis and Treatment of Venous Ulcers | AAFP

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

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. […] Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures. […] Compression therapy has been proven beneficial for venous ulcer treatment and is the standard of care. […] Leg elevation minimizes edema in patients with venous insufficiency and is recommended as adjunctive therapy for venous ulcers. The recommended regimen is 30 minutes, three or four times per day. […] Dressings are beneficial for venous ulcer healing, but no dressing has been shown to be superior.

• #25 Diagnosis and Treatment of Venous Ulcers | AAFP

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

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. […] Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures. […] Compression therapy has been proven beneficial for venous ulcer treatment and is the standard of care. […] Leg elevation minimizes edema in patients with venous insufficiency and is recommended as adjunctive therapy for venous ulcers. The recommended regimen is 30 minutes, three or four times per day. […] Dressings are beneficial for venous ulcer healing, but no dressing has been shown to be superior.

• #26 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. […] 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. […] Exercises to stimulate the calf-muscle pump: […] Ankle range of motion exercise: Passive: patient is assisted by caregivers or assistive devices (i.e., using a rolled towel to pull toes upward towards body), Active: done by the patient; options: going from standing flat-footed to standing on toes, pulling toes upward to feel the stretch in the calf.

• #27 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.

• #28 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.

• #29 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. […] 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. […] Exercises to stimulate the calf-muscle pump: […] Ankle range of motion exercise: Passive: patient is assisted by caregivers or assistive devices (i.e., using a rolled towel to pull toes upward towards body), Active: done by the patient; options: going from standing flat-footed to standing on toes, pulling toes upward to feel the stretch in the calf.

• #30 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. […] Leg elevation can increase deep venous flow and reduce venous pressure, leg elevation added to compression may not improve ulcer healing. […] A systematic review evaluating progressive resistance exercise, resistance exercise plus prescribed physical activity, only walking, and only ankle exercises found that progressive resistance exercise with prescribed physical activity may result in an additional nine to 45 venous ulcers healed per 100 patients. […] Topical antiseptics, including cadexomer iodine (Iodosorb), povidone-iodine (Betadine), peroxide-based preparations, honey-based preparations, and silver, have been used to treat venous ulcers.

• #31 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. […] A wide range of dressings are available, including hydrocolloids, foams, hydrogels, pastes, and simple nonadherent dressings. […] Topical negative pressure, also called vacuum-assisted closure, has been shown to help reduce wound depth and volume compared with a hydrocolloid gel and gauze regimen for wounds of any etiology. […] Pentoxifylline (400 mg three times per day) has been shown to be an effective adjunctive treatment for venous ulcers when added to compression therapy.

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

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

  Pain control: pharmacological or non-pharmacological options, dressing selection to decrease pain. […] Co-morbidity management: diabetes, heart disease, respiratory diseases, obesity. […] Medications impacting healing: there is evidence that pentoxifylline can improve venous leg ulcer healing. […] Nutrition and hydration: wounds with a large amount of drainage lose proteins and nutrients from wound drainage. […] Mobility and range of motion (ROM): physiotherapy may be indicated for clients to increase ROM to support the activation of the calf muscle pump. […] Psychosocial support/needs: the psychosocial impact of having a VLU needs to be considered and interventions may be required (i.e., patient can be referred to social work).

• #33 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. […] Treatment options for venous ulcers include conservative management, mechanical modalities, medications, advanced wound therapy, and surgical options.

• #34 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. […] A wide range of dressings are available, including hydrocolloids, foams, hydrogels, pastes, and simple nonadherent dressings. […] Topical negative pressure, also called vacuum-assisted closure, has been shown to help reduce wound depth and volume compared with a hydrocolloid gel and gauze regimen for wounds of any etiology. […] Pentoxifylline (400 mg three times per day) has been shown to be an effective adjunctive treatment for venous ulcers when added to compression therapy.

• #35 Diagnosis and Treatment of Venous Ulcers | AAFP

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

  Like pentoxifylline therapy, aspirin (300 mg per day) combined with compression therapy has been shown to increase ulcer healing time and reduce ulcer size, compared with compression therapy alone. […] Human skin grafting may be used for patients with large or refractory venous ulcers. […] The role of surgery is to reduce venous reflux, hasten healing, and prevent ulcer recurrence.

• #36 Optimal Diagnosis and Therapy of Venous Ulcer

  https://www.annphlebology.org/journal/view.html?pn=mostdownload&uid=134&vmd=Full

  Elastic compression therapy offers the advantage of maintaining compression both at rest and during activities according to changes in leg size. […] Compression therapy with higher compressive force is more effective than lower compressive force and using several overlapping layers of bandage is more effective than using a single layer for treating venous ulcer. […] The wound should be kept moist at all times by using occlusive dressings. […] Because venous ulcer is an inflammatory response attributed to venous hypertension, the goal of pharmacologic therapy in venous ulcer cases is treating CVI. […] Pentoxifylline has also been found to improve venous ulcer healing rate. Accordingly, its use, along with compression therapy, is recommended for treatment of CVI. […] The fundamental goal of surgical and interventional treatment for venous ulcer is to achieve venous healing and prevent recurrence. […] The role of saphenous vein stripping in venous ulcer was assessed in the ESCHAR study. […] Therefore, surgery on superficial veins can be effective for ulcer healing and is recommended even in patients comorbid with deep vein thrombosis.

• #37

  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. […] In some clinics, specialist teams are using new alternatives to compression bandages, such as special stockings or other compressive devices. […] 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. […] If your ulcer becomes infected, it should be cleaned and dressed as usual. […] The aim of antibiotic treatment is to clear the infection. But antibiotics do not heal ulcers and should only be used in short courses to treat infected ulcers. […] The most effective method of preventing this is to wear compression stockings at all times when you’re out of bed.

• #38

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

  Most venous leg ulcers heal within 6 months if they’re treated by a healthcare professional trained in compression therapy for leg ulcers. […] Treatment usually involves: cleaning and dressing the wound, using compression, such as bandages or stockings, to improve the flow of blood in the legs. […] Antibiotics may also be used if the ulcer becomes infected, but they do not help ulcers heal. […] But unless the underlying cause of the ulcer is addressed, there’s a high risk of a venous leg ulcer coming back after treatment. […] Underlying causes could include immobility, obesity, previous DVT or varicose veins.

• #39

  https://www2.hse.ie/conditions/venous-leg-ulcer/treatment/

  Infections should be treated with an antibiotic. […] You should visit your nurse once a week to have your dressings and compression bandages changed. They’ll also check 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.

• #40 Diagnosis and Treatment of Venous Ulcers | AAFP

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

  Like pentoxifylline therapy, aspirin (300 mg per day) combined with compression therapy has been shown to increase ulcer healing time and reduce ulcer size, compared with compression therapy alone. […] Human skin grafting may be used for patients with large or refractory venous ulcers. […] The role of surgery is to reduce venous reflux, hasten healing, and prevent ulcer recurrence.

• #41 Diagnosis and Treatment of Venous Ulcers | AAFP

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

  Venous ulcer, also known as stasis ulcer, is the most common etiology of lower extremity ulceration, affecting approximately 1 percent of the U.S. population. […] Evidence-based treatment options for venous ulcers include leg elevation, compression therapy, dressings, pentoxifylline, and aspirin therapy. Surgical management may be considered for ulcers that are large in size, of prolonged duration, or refractory to conservative measures. […] Compression therapy has been proven beneficial for venous ulcer treatment and is the standard of care. […] Leg elevation minimizes edema in patients with venous insufficiency and is recommended as adjunctive therapy for venous ulcers. The recommended regimen is 30 minutes, three or four times per day. […] Dressings are beneficial for venous ulcer healing, but no dressing has been shown to be superior.

• #42 New Treatment Protocol for Venous Leg Ulcers Heals Faster and Is More Successful Long-Term: Vascular Specialists: Vascular Surgeons

  https://www.vascspecialists.org/blog/new-treatment-protocol-for-venous-leg-ulcers-heals-faster-and-is-more-successful-long-term

  Now, a new six-year study shows that aggressive ablation treatment earlier is much more effective in healing and in preventing recurrence. […] When patients with venous leg ulcers were quickly treated with endovenous ablation, ulcers healed 15% faster, with no scab or dressing requirements. […] Dr. Tanquilut agrees with these researchers recommendations to change the standards of venous leg ulcer care. If we can move from using compression stockings and conservative care to more frequent and faster use of endovenous ablation, we will help prevent infections, which helps avoid gangrene and amputations. Our patients will feel better faster, regain their mobility sooner and improve their quality of life.

• #43 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. […] Treatment options for venous ulcers include conservative management, mechanical modalities, medications, advanced wound therapy, and surgical options.

• #44 Venous Ulcers from Varicose Veins Signs & Treatments | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/venous-ulcer

  Endovenous ablation: This procedure can be done as an outpatient. A catheter is inserted into the great or small saphenous vein. After numbing medication is injected into the skin along the area of the vein to be treated, the vein is heated with radio waves or a laser. This heating process, or ablation, takes less than 10 minutes. The blood that used to pool in the treated superficial vein is naturally redirected into the deep vein system. Patients experience almost immediate relief. Patients are encouraged to walk immediately after the procedure. Pain, which is seldom severe, is managed with anti-inflammatory medications such as ibuprofen. A follow-up visit within a week after the procedure will check for any blood clots and medication may be prescribed to manage a clot. […] Ambulatory phlebectomy: This procedure to treat branch varicose veins can be performed in an office or as an outpatient. Patients are asked to stand for several minutes to allow the veins to fill, and the doctor marks the veins that are to be removed. Once the veins are marked and confirmed by the patient, numbing medication is injected into the skin along the course of the veins to be treated. Very small incisions, or nicks, in the skin are made and the veins are removed using a small hook. These incisions are so tiny that no stitches are needed. A dressing is placed on the leg, and patients are allowed to walk immediately after the procedure. Most patients do not require any pain medication, but when they do, anti-inflammatory medication is sufficient. Patients can return to work within a day or so, depending on the extent of the phlebectomy.

• #45 Venous Ulcer Treatment in Los Angeles, CA | ProVascularMD

  https://provascularmd.com/venous-leg-ulcer-treatment/

  Superficial vein closure is the gold standard to treat varicose veins that are contributing to venous ulceration. […] Deep vein revascularization is an image-guided procedure in which blood flow obstructions in the deep veins are opened up to improve blood flow and circulation. […] Compression stockings are usually prescribed by general practitioners as a conservative, first-line therapy for venous insufficiency. […] Wound care consists of self-care techniques, special dressings / bandages, therapies, medications, and lifestyle adjustments that keep the venous ulcer clean and promote healing of the skin.

• #46 Venous Ulcers from Varicose Veins Signs & Treatments | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/venous-ulcer

  Sclerotherapy: This procedure to treat branch varicose veins can be performed in an office or as an outpatient. Smaller veins are injected using a tiny needle containing a liquid that scleroses, or closes down, the vein. This treatment does not require any anesthesia or numbing medicine. Smaller veins (also known as spider veins) are best treated with this type of procedure.

• #47 Venous Leg Ulcers – Vein and Laser Center of Elgin Cardiac Surgery

  https://www.vlecs.com/services/vein-vascular-conditions/venous-leg-ulcers/

  There are several methods to treat venous leg ulcers, depending on their severity and how long they have been a problem. Apart from keeping the wounds clean and preventing infection, it is necessary to improve circulation in the legs. This may be done by elevating the legs above the heart, wearing compression stockings and exercising, especially walking. […] Some types of treatment for this condition include: Sclerotherapy, Endovenous Laser Treatment, or EVLT, Radiofrequency Ablation, Subfascial endoscopic perforator surgery, or SEPS, Ligation and stripping of veins.

• #48 Venous Ulcers from Varicose Veins Signs & Treatments | Baptist Health

  https://www.baptisthealth.com/care-services/conditions-treatments/venous-ulcer

  Endovenous ablation: This procedure can be done as an outpatient. A catheter is inserted into the great or small saphenous vein. After numbing medication is injected into the skin along the area of the vein to be treated, the vein is heated with radio waves or a laser. This heating process, or ablation, takes less than 10 minutes. The blood that used to pool in the treated superficial vein is naturally redirected into the deep vein system. Patients experience almost immediate relief. Patients are encouraged to walk immediately after the procedure. Pain, which is seldom severe, is managed with anti-inflammatory medications such as ibuprofen. A follow-up visit within a week after the procedure will check for any blood clots and medication may be prescribed to manage a clot. […] Ambulatory phlebectomy: This procedure to treat branch varicose veins can be performed in an office or as an outpatient. Patients are asked to stand for several minutes to allow the veins to fill, and the doctor marks the veins that are to be removed. Once the veins are marked and confirmed by the patient, numbing medication is injected into the skin along the course of the veins to be treated. Very small incisions, or nicks, in the skin are made and the veins are removed using a small hook. These incisions are so tiny that no stitches are needed. A dressing is placed on the leg, and patients are allowed to walk immediately after the procedure. Most patients do not require any pain medication, but when they do, anti-inflammatory medication is sufficient. Patients can return to work within a day or so, depending on the extent of the phlebectomy.

• #49 Venous Ulcers – Novus Spine & Pain Center

  https://novusspinecenter.com/pain-conditions/venous-ulcers

  In treating venous ulcers, it is essential to keep the site infection-free. Special medication may be applied under the bandages or stockings to help during the healing process. […] If a venous ulcer becomes infected by bacteria, the doctor may prescribe antibiotics to kill the infection. A moist dressing may be used to help the ulcer heal more quickly. […] If the ulcers do not heal, surgery may be necessary to improve blood circulation. If surgery is necessary, the doctor may recommend subfascial endoscopic perforator surgery. This minimally-invasive procedure uses an endoscope (a small, flexible tube with a light) to clip and tie off the perforator veins in the calf. Doing so allows blood to drain into healthy veins and improves ulcer healing. […] Most venous ulcers heal after 3 or 4 months of treatment. However, some can take longer or require a skin graft to close up the opening in the skin. Some may never clear up completely.

• #50 Venous Leg Ulcers – Vein and Laser Center of Elgin Cardiac Surgery

  https://www.vlecs.com/services/vein-vascular-conditions/venous-leg-ulcers/

  There are several methods to treat venous leg ulcers, depending on their severity and how long they have been a problem. Apart from keeping the wounds clean and preventing infection, it is necessary to improve circulation in the legs. This may be done by elevating the legs above the heart, wearing compression stockings and exercising, especially walking. […] Some types of treatment for this condition include: Sclerotherapy, Endovenous Laser Treatment, or EVLT, Radiofrequency Ablation, Subfascial endoscopic perforator surgery, or SEPS, Ligation and stripping of veins.

• #51 Optimal Diagnosis and Therapy of Venous Ulcer

  https://www.annphlebology.org/journal/view.html?pn=mostdownload&uid=134&vmd=Full

  Elastic compression therapy offers the advantage of maintaining compression both at rest and during activities according to changes in leg size. […] Compression therapy with higher compressive force is more effective than lower compressive force and using several overlapping layers of bandage is more effective than using a single layer for treating venous ulcer. […] The wound should be kept moist at all times by using occlusive dressings. […] Because venous ulcer is an inflammatory response attributed to venous hypertension, the goal of pharmacologic therapy in venous ulcer cases is treating CVI. […] Pentoxifylline has also been found to improve venous ulcer healing rate. Accordingly, its use, along with compression therapy, is recommended for treatment of CVI. […] The fundamental goal of surgical and interventional treatment for venous ulcer is to achieve venous healing and prevent recurrence. […] The role of saphenous vein stripping in venous ulcer was assessed in the ESCHAR study. […] Therefore, surgery on superficial veins can be effective for ulcer healing and is recommended even in patients comorbid with deep vein thrombosis.

• #52 Local treatment of venous leg ulcers – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/local-treatment-of-venous-leg-ulcers/

  Skin grafting should be considered for large or refractory ulcers, when the venous hypertension is well controlled and when the ulcer bed is clean with healthy granulation tissue. […] Topical negative pressure seems to prepare chronic wounds more rapidly for secondary closure surgery, but its clinical value in venous leg ulcers is still debated. More recently, local alternative treatments such as biological dressings and tissue-engineered products have been developed. These products may have the property of interacting directly with the wound, in order to speed the healing process and decrease the time to complete healing. But there is not yet any clear evidence for the efficacy of most of them. […] Venous ulcers are characterized by a cyclical pattern of healing and recurrence. The current standard of care for chronic venous ulcers involves the use of compression bandages as a means to reduce ambulatory venous pressure, control edema, and improve venous return. Dressings are applied beneath the compression and are used to control the exudates and to maintain the wound in a moist environment.

• #53 Diagnosis and Treatment of Venous Ulcers | AAFP

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

  Like pentoxifylline therapy, aspirin (300 mg per day) combined with compression therapy has been shown to increase ulcer healing time and reduce ulcer size, compared with compression therapy alone. […] Human skin grafting may be used for patients with large or refractory venous ulcers. […] The role of surgery is to reduce venous reflux, hasten healing, and prevent ulcer recurrence.

• #54 Local treatment of venous leg ulcers – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/local-treatment-of-venous-leg-ulcers/

  Although topical treatment is an important aspect of wound care, it should always be considered secondary to the choice of a compression strategy. Generally, the choice of dressing is guided by the ulcer characteristics (for example, wound drainage absorption), patient requirements (ease of application, comfort), and expense. […] Skin grafts used for venous leg ulcers are most commonly pinch grafts, but split-thickness skin meshed grafts may also be performed on larger wounds. There are no specific indications for when skin grafting for venous leg ulcers should be used, but grafting should be considered for large or refractory ulcers, when the venous hypertension is well controlled and when the ulcer bed is clean with healthy granulation tissue. […] Apligraf is a living bi-layered bioengineered skin substitute. It was approved by the FDA in 1998 for the treatment of leg ulcers of greater than one-month duration that have not adequately responded to conventional therapy. Used with compression, Apligraf heals venous leg ulcers more effectively than simple dressings and compression.

• #55 Local treatment of venous leg ulcers – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/local-treatment-of-venous-leg-ulcers/

  Although topical treatment is an important aspect of wound care, it should always be considered secondary to the choice of a compression strategy. Generally, the choice of dressing is guided by the ulcer characteristics (for example, wound drainage absorption), patient requirements (ease of application, comfort), and expense. […] Skin grafts used for venous leg ulcers are most commonly pinch grafts, but split-thickness skin meshed grafts may also be performed on larger wounds. There are no specific indications for when skin grafting for venous leg ulcers should be used, but grafting should be considered for large or refractory ulcers, when the venous hypertension is well controlled and when the ulcer bed is clean with healthy granulation tissue. […] Apligraf is a living bi-layered bioengineered skin substitute. It was approved by the FDA in 1998 for the treatment of leg ulcers of greater than one-month duration that have not adequately responded to conventional therapy. Used with compression, Apligraf heals venous leg ulcers more effectively than simple dressings and compression.

• #56 Venous Ulcers: Diagnosis and Treatment | AAFP

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

  Venous ulcers that do not improve within four weeks of standard wound care should prompt consideration of adjunctive treatment options. […] Skin grafting should be considered as primary therapy only for large venous ulcers (larger than 25 cm2 [3.9 in2]), in which healing is unlikely without grafting. […] Like conservative therapies, the goal of operative and endovascular management of venous ulcers (i.e., endovenous ablation, ligation, subfascial endoscopic perforator surgery, and sclerotherapy) is to improve healing and prevent ulcer recurrence. […] The recurrence rate of venous ulcers has been reported as high as 70%.

• #57 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.

• #58 New Treatment for Leg Ulcers (2024)

  https://cacvi.org/new-treatment-for-leg-ulcers/

  Negative Pressure Wound Therapy (NPWT) […] NPWT uses a vacuum device to create negative pressure over the wound. This removes excess fluid from the sores, reduces swelling, and increases blood flow to the area. Together, these create an optimal environment for faster healing. […] The recent progress in new treatment for leg ulcers represents a significant advancement in medical science, offering hope to millions of patients suffering from this chronic condition. […] New treatments for leg ulcers often involve advanced therapies that target the underlying causes of the ulcers more directly than conventional treatments. For instance, a new treatment might utilize bioengineered tissue products, growth factor therapies, or stem cell applications. […] The mechanism of action for these new treatments differs significantly from previous methods in various ways. When the growth factor comes into play, this treatment involves applying proteins that promote cell growth and division directly to the wound. This accelerates the healing process and prompts full wound closure.

• #59 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  Ultrasound therapy (UT) is pointed as one of the adjunctive treatments used in venous leg ulcers therapy. A mechanical effect is the major result of ultrasound use. […] Electromagnetic therapy (EMT) is used as an additional treatment supporting wound healing including venous leg ulcers. […] Photobiomodulation (PBM) or low-level light therapy (LLLT), as a variant of phototherapy, is another, promising venous leg ulcer healing technology. […] Oxygen therapy (OT) increases oxygen delivery to wounds, accelerates their healing, and does not reveal relevant cell damage risk. […] Negative pressure wound therapy (NPWT) accelerates the healing process of venous leg ulcers with several mechanisms such as local edema reduction, reduction in bacteria, inflammatory mediators, and wound exudate.

• #60 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://www.mdpi.com/2227-9059/9/11/1569

  Inflammation prolongs the healing process of wounds, which is why VLUs with clinical signs of infection should be treated with antibiotics according to the culture results. Depending on the severity of symptoms, systemic antibiotics or topical antimicrobials can be applied. […] Negative pressure wound therapy (NPWT) is a technology supporting the standard of care in VLUs. NPWT accelerates the healing process of venous leg ulcers with several mechanisms such as local edema reduction, reduction in bacteria, inflammatory mediators, and wound exudate. Moreover, NPWT provides angiogenesis induction, promotes tissue perfusion, stimulates tissue granulation, causes wound shrinking, and contraction of its edges. These mechanisms improve topical wound state and facilitate the healing process. […] Clinical trials confirmed that TOT could influence venous leg ulcers area reduction, pain relief, or decrease ulcer recurrence rate. On the other hand, the poor quality of current evidence requires clinical confirmation in the future. Some clinical data suggest that topical oxygen diffuse is too superficial and the oxygen amount absorbed by the wound is insufficient. That is why there are authors who claim that TOT should not be applied nowadays beyond clinical trials.

• #61 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  Platelet-rich plasma (PRP) or autologous platelet-rich plasma is platelet suspension extracted from whole blood. […] Biologics are mainly monoclonal antibodies that target specific parts of the immune system by blocking proteins or cell receptors. […] Stem cells release growth factors, correct weakened signaling growth factor pathways, and provide significant cytokines and chemokines. […] Other advanced therapies and new technologies can influence the individual aspects of the TIME wound bed preparation.

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

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

  Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. […] 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.

• #63 New Treatment for Leg Ulcers (2024)

  https://cacvi.org/new-treatment-for-leg-ulcers/

  For faster results, advanced treatments like stem cell therapy may be recommended to enhance tissue regeneration. However, these newer methods are not as accessible because of the high costs associated with them. […] These new methods aim to directly address the underlying causes of leg ulcers, such as poor circulation, chronic inflammation, or defective tissue repair mechanisms. The development of new treatments is rooted in extensive scientific research and clinical trials. […] Gene Therapy […] This approach introduces genes that stimulate growth factors like vascular endothelial growth factor (VEGF) to promote blood vessel formation and tissue repair. By doing so, gene therapy helps to heal ulcers more effectively. […] Stem Cell Therapy […] This treatment used the patient’s stem cells to regenerate damaged tissue and improve blood flow. Stem cells have the unique ability to transform into various cell types, making them ideal for repairing skin and vascular tissues affected by ulcers.

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

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

  Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. […] 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.

• #65 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://www.mdpi.com/2227-9059/9/11/1569

  Clinical data has revealed that stem cell therapy (SCT) fostered the healing process in each wound repair phase. Clinical trials proved the improvement of chronic venous ulcer healing as a result of the SCT use, with a crucial decrease of wound surface and high-quality tissue regeneration. SCT is a novel treatment method for VLUs and future trials will determine what significance that option will have. There is insufficient data on long-term results of skin wound treatment using such therapy and broader studies are required. […] Biologics were a breakthrough in the treatment of many auto-inflammatory diseases, such as psoriasis, psoriatic arthritis, rheumatoid arthritis, or ankylosing spondylitis. If future trials confirm the clinical efficacy of biologics in the treatment of VLUs, this therapy may significantly accelerate the wound healing process.

• #66 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  Platelet-rich plasma (PRP) or autologous platelet-rich plasma is platelet suspension extracted from whole blood. […] Biologics are mainly monoclonal antibodies that target specific parts of the immune system by blocking proteins or cell receptors. […] Stem cells release growth factors, correct weakened signaling growth factor pathways, and provide significant cytokines and chemokines. […] Other advanced therapies and new technologies can influence the individual aspects of the TIME wound bed preparation.

• #67 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://www.mdpi.com/2227-9059/9/11/1569

  Clinical data has revealed that stem cell therapy (SCT) fostered the healing process in each wound repair phase. Clinical trials proved the improvement of chronic venous ulcer healing as a result of the SCT use, with a crucial decrease of wound surface and high-quality tissue regeneration. SCT is a novel treatment method for VLUs and future trials will determine what significance that option will have. There is insufficient data on long-term results of skin wound treatment using such therapy and broader studies are required. […] Biologics were a breakthrough in the treatment of many auto-inflammatory diseases, such as psoriasis, psoriatic arthritis, rheumatoid arthritis, or ankylosing spondylitis. If future trials confirm the clinical efficacy of biologics in the treatment of VLUs, this therapy may significantly accelerate the wound healing process.

• #68 New Treatment for Leg Ulcers (2024)

  https://cacvi.org/new-treatment-for-leg-ulcers/

  For faster results, advanced treatments like stem cell therapy may be recommended to enhance tissue regeneration. However, these newer methods are not as accessible because of the high costs associated with them. […] These new methods aim to directly address the underlying causes of leg ulcers, such as poor circulation, chronic inflammation, or defective tissue repair mechanisms. The development of new treatments is rooted in extensive scientific research and clinical trials. […] Gene Therapy […] This approach introduces genes that stimulate growth factors like vascular endothelial growth factor (VEGF) to promote blood vessel formation and tissue repair. By doing so, gene therapy helps to heal ulcers more effectively. […] Stem Cell Therapy […] This treatment used the patient’s stem cells to regenerate damaged tissue and improve blood flow. Stem cells have the unique ability to transform into various cell types, making them ideal for repairing skin and vascular tissues affected by ulcers.

• #69 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  The prevalence of venous leg ulcers (VLUs) differs between 1.5% and 3% in the general population. The challenge in treating VLUs is common recurrence. Moreover, VLUs can be resistant to healing, despite appropriate treatment. In these cases, advanced wound therapies should be considered. The number of new technologies, applied in VLUs treatment, has increased in the last years. These therapies include biophysical interventions such as ultrasound therapy, electrical stimulations, electromagnetic therapy, or phototherapy. Furthermore, stem cell therapies, biologic skin equivalents, platelet-rich plasma therapy, oxygen therapies, anti-TNF therapy, or negative pressure wound therapy are advanced venous ulcer therapeutic methods that may support the standard of care. […] Standard care in VLU treatment consists of local wound management and compressive therapy. Correction techniques of pathological venous flow as a part of surgical and endovascular venous procedures are also included in the main therapeutic variants. Patients education on self-care, which includes wound care, physical exercise, and diet, are an important part of treatment that leads to therapeutic success. Pharmacological, systemic treatment improving blood circulation, rheological properties of blood, and the local wound environment, such as pentoxifylline, sulodexide, or nutrition supplements are effective when linked with other standard wound treatment methods. The gold standard of VLU treatment is currently the usage of a combination of methods mentioned above.

• #70 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  Ultrasound therapy (UT) is pointed as one of the adjunctive treatments used in venous leg ulcers therapy. A mechanical effect is the major result of ultrasound use. […] Electromagnetic therapy (EMT) is used as an additional treatment supporting wound healing including venous leg ulcers. […] Photobiomodulation (PBM) or low-level light therapy (LLLT), as a variant of phototherapy, is another, promising venous leg ulcer healing technology. […] Oxygen therapy (OT) increases oxygen delivery to wounds, accelerates their healing, and does not reveal relevant cell damage risk. […] Negative pressure wound therapy (NPWT) accelerates the healing process of venous leg ulcers with several mechanisms such as local edema reduction, reduction in bacteria, inflammatory mediators, and wound exudate.

• #71 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  Despite appropriate treatment, the average time for healing VLUs varies from 6 to 12 months, and one-fifth of VLU cases do not heal within 24 months. If standard treatment fails, advanced therapy methods should be taken into consideration that can be applied as adjuvants to conventional treatment. Another challenge in VLU treatment is frequent recurrence. Relapse after recovery within 5 years is high and reaches almost 70%. Furthermore, VLUs can be resistant to treatment. […] New therapies for chronic venous ulcers are still expected and the number of new wound management techniques increased in the last years and are sequentially being refined. […] Electrical stimulation (ES) induces angiogenesis by stimulating a signaling pathway of the mitogen-activated protein kinase (MAPK) and increasing the vascular endothelial growth factor (VEGF). Additionally, ES stimulates the signaling of VEGF receptors and therefore induces VEGF secretion and endothelial cells migration. Consequently, ES increases blood perfusion in the area of the ulcer.

• #72 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  Ultrasound therapy (UT) is pointed as one of the adjunctive treatments used in venous leg ulcers therapy. A mechanical effect is the major result of ultrasound use. […] Electromagnetic therapy (EMT) is used as an additional treatment supporting wound healing including venous leg ulcers. […] Photobiomodulation (PBM) or low-level light therapy (LLLT), as a variant of phototherapy, is another, promising venous leg ulcer healing technology. […] Oxygen therapy (OT) increases oxygen delivery to wounds, accelerates their healing, and does not reveal relevant cell damage risk. […] Negative pressure wound therapy (NPWT) accelerates the healing process of venous leg ulcers with several mechanisms such as local edema reduction, reduction in bacteria, inflammatory mediators, and wound exudate.

• #73 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  Ultrasound therapy (UT) is pointed as one of the adjunctive treatments used in venous leg ulcers therapy. A mechanical effect is the major result of ultrasound use. […] Electromagnetic therapy (EMT) is used as an additional treatment supporting wound healing including venous leg ulcers. […] Photobiomodulation (PBM) or low-level light therapy (LLLT), as a variant of phototherapy, is another, promising venous leg ulcer healing technology. […] Oxygen therapy (OT) increases oxygen delivery to wounds, accelerates their healing, and does not reveal relevant cell damage risk. […] Negative pressure wound therapy (NPWT) accelerates the healing process of venous leg ulcers with several mechanisms such as local edema reduction, reduction in bacteria, inflammatory mediators, and wound exudate.

• #74 Leg ulcers | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/leg-ulcers

  Medical treatment aims to improve blood flow to the area and promote healing of the ulcer. […] Treatment options include compression bandages, medication, surgery and (more recently) hyperbaric oxygen therapy. […] Treatment for chronic venous leg ulceration includes: cleaning the wound using wet and dry dressings and ointments, or surgery to remove the dead tissue […] specialised dressings a whole range of products are available to help the various stages of wound healing. […] occlusive (air- and water-tight) dressings ulcers heal better when they are covered. […] compression treatment boosts internal pressure, using either elasticised bandages or stockings. […] medication includes pain-relieving medication and oral antibiotics if infection is present […] supplements there is evidence that leg ulcers may heal faster with mineral and vitamin supplements, but only if the person suffers from a deficiency. […] skin graft is a surgical procedure, where healthy skin is grafted onto the prepared wound site […] hyperbaric oxygen this is now an accepted treatment for ulcers that resist other methods of healing, such as diabetic ulcers.

• #75 Venous leg ulcers | Healthify

  https://healthify.nz/health-a-z/v/venous-leg-ulcers

  If your ulcer is infected your healthcare provider may prescribe an antibiotic by mouth. […] Your healthcare provider may consider referring you to a vascular surgeon to discuss a minimally invasive procedure for varicose veins. This will reduce the risk of ulcers coming back repeatedly. […] Other treatments may be tried if your ulcer doesn’t improve. One possible treatment is hyperbaric oxygen therapy where you breathe in pure oxygen in a special pressurised environment. […] Signs that a venous leg ulcer may need treatment with antibiotics include increasing swelling, redness and warmth around the wound, increasing pain, the wound getting larger, more green and smelly discharge (pus) from the wound, a fever (high temperature). […] After your ulcer has healed you should wear compression stockings that have been specially fitted for you to help reduce the risk of another ulcer developing.

• #76 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  Ultrasound therapy (UT) is pointed as one of the adjunctive treatments used in venous leg ulcers therapy. A mechanical effect is the major result of ultrasound use. […] Electromagnetic therapy (EMT) is used as an additional treatment supporting wound healing including venous leg ulcers. […] Photobiomodulation (PBM) or low-level light therapy (LLLT), as a variant of phototherapy, is another, promising venous leg ulcer healing technology. […] Oxygen therapy (OT) increases oxygen delivery to wounds, accelerates their healing, and does not reveal relevant cell damage risk. […] Negative pressure wound therapy (NPWT) accelerates the healing process of venous leg ulcers with several mechanisms such as local edema reduction, reduction in bacteria, inflammatory mediators, and wound exudate.

• #77 Leg ulcers | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/leg-ulcers

  Medical treatment aims to improve blood flow to the area and promote healing of the ulcer. […] Treatment options include compression bandages, medication, surgery and (more recently) hyperbaric oxygen therapy. […] Treatment for chronic venous leg ulceration includes: cleaning the wound using wet and dry dressings and ointments, or surgery to remove the dead tissue […] specialised dressings a whole range of products are available to help the various stages of wound healing. […] occlusive (air- and water-tight) dressings ulcers heal better when they are covered. […] compression treatment boosts internal pressure, using either elasticised bandages or stockings. […] medication includes pain-relieving medication and oral antibiotics if infection is present […] supplements there is evidence that leg ulcers may heal faster with mineral and vitamin supplements, but only if the person suffers from a deficiency. […] skin graft is a surgical procedure, where healthy skin is grafted onto the prepared wound site […] hyperbaric oxygen this is now an accepted treatment for ulcers that resist other methods of healing, such as diabetic ulcers.

• #78 Venous Ulcers: Diagnosis and Treatment | AAFP

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

  Venous ulcers that do not improve within four weeks of standard wound care should prompt consideration of adjunctive treatment options. […] Skin grafting should be considered as primary therapy only for large venous ulcers (larger than 25 cm2 [3.9 in2]), in which healing is unlikely without grafting. […] Like conservative therapies, the goal of operative and endovascular management of venous ulcers (i.e., endovenous ablation, ligation, subfascial endoscopic perforator surgery, and sclerotherapy) is to improve healing and prevent ulcer recurrence. […] The recurrence rate of venous ulcers has been reported as high as 70%.

• #79 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  Despite appropriate treatment, the average time for healing VLUs varies from 6 to 12 months, and one-fifth of VLU cases do not heal within 24 months. If standard treatment fails, advanced therapy methods should be taken into consideration that can be applied as adjuvants to conventional treatment. Another challenge in VLU treatment is frequent recurrence. Relapse after recovery within 5 years is high and reaches almost 70%. Furthermore, VLUs can be resistant to treatment. […] New therapies for chronic venous ulcers are still expected and the number of new wound management techniques increased in the last years and are sequentially being refined. […] Electrical stimulation (ES) induces angiogenesis by stimulating a signaling pathway of the mitogen-activated protein kinase (MAPK) and increasing the vascular endothelial growth factor (VEGF). Additionally, ES stimulates the signaling of VEGF receptors and therefore induces VEGF secretion and endothelial cells migration. Consequently, ES increases blood perfusion in the area of the ulcer.

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

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

  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. […] Sometimes surgery for varicose veins or other vein problems is advised after an ulcer has healed, in order to help prevent a recurrence.

• #81 Symptoms of a Venous leg ulcers – why is my leg ulcer not healing?

  https://legsmatter.org/information-and-support/types-of-ulcers/venous-leg-ulcers/

  It is important to see your GP / Practice Nurse / District Nurse as soon as possible to get an assessment, diagnosis and have a compression garment prescribed. […] Compression garments are essential for when you sit, stand or walk. Strong evidence shows that compression garments and / or venous surgery are the only way to heal VLUs and to keep them healed. […] Surgery to remove the damaged vein can improve healing and also reduce the risk of venous ulcers coming back. […] In addition to the compression, your nurse should also advise you on wound care and dressings to keep your wound healthy. […] Venous ulcers can recur if the damaged vein is not supported or removed. Therefore, compression garments should be worn even when the ulcer has healed to stop it coming back. […] Venous leg ulcers can heal well with the right compression garments. Compression supports the veins and stop them leaking and allow the body to heal the wound. Continuing to wear them when your venous leg ulcer has healed can help reduce the risk of the wound coming back.

• #82 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.

• #83 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. Also, check your feet and legs every day: the tops and bottoms, ankles, and heels. Look for cracks and changes in skin color. 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.

• #84 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.

• #85 Leg Ulcers: What Is It, Treatments, Causes and Types

  https://my.clevelandclinic.org/health/diseases/23329-leg-ulcers

  Leg ulcers commonly open up again after healing. These steps can lower the risk of getting a leg ulcer or a wound recurrence: Elevate your legs above your heart when youre sitting or sleeping. Maintain a healthy weight and stay physically active. Manage health conditions that affect blood circulation, including diabetes, high blood pressure, high cholesterol and Raynauds syndrome. Quit smoking and using tobacco products. Talk with your healthcare provider about ways to stop smoking. Use gentle (nondrying) cleansers, and apply moisturizing lotion to prevent dry skin. Wear compression stockings or bandages for an hour each day to improve blood flow to the legs. […] Chronic leg ulcers need specialized wound care to prevent infection and aid healing. Your healthcare provider may recommend other treatments like medicines or procedures to improve blood flow to the leg. Even after they heal, leg ulcers can break open again. Your provider can offer suggestions on how to prevent a wound recurrence.

• #86 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.

• #87 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. Also, check your feet and legs every day: the tops and bottoms, ankles, and heels. Look for cracks and changes in skin color. 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.

• #88

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

  Most venous leg ulcers heal within 6 months if they’re treated by a healthcare professional trained in compression therapy for leg ulcers. […] Treatment usually involves: cleaning and dressing the wound, using compression, such as bandages or stockings, to improve the flow of blood in the legs. […] Antibiotics may also be used if the ulcer becomes infected, but they do not help ulcers heal. […] But unless the underlying cause of the ulcer is addressed, there’s a high risk of a venous leg ulcer coming back after treatment. […] Underlying causes could include immobility, obesity, previous DVT or varicose veins.

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

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

  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. […] Sometimes surgery for varicose veins or other vein problems is advised after an ulcer has healed, in order to help prevent a recurrence.

• #90 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.

• #91 Evaluation and management of chronic venous insufficiency including venous leg ulcer – UpToDate

  https://www.uptodate.com/contents/evaluation-and-management-of-chronic-venous-insufficiency-including-venous-leg-ulcer

  Chronic wounds are characterized as those that are „refractory and do not heal in the projected time frame, often physiologically impaired due to an underlying pathology” as compared with acute wounds that undergo a process of predicted wound healing. Venous leg ulcer (VLU) is the most common chronic wound, accounting for approximately 70 percent of lower extremity wounds. […] The evaluation and management of CVI, including VLUs, are reviewed. […] Venous hypertension, the underlying cause of CVI and VLUs, can be due to intravascular and/or extravascular etiologies. […] The prevalence of VLU is estimated to be about 4 percent of the population. VLUs are associated with prolonged disability, burdened socioeconomic impact, and significant psychosocial morbidity due to recurrence rates as high as 66 percent at five years.

• #92 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.

• #93 Dr Johan Blignaut | Venous Ulcers

  https://www.veinsurgery.co.za/venous-ulcers.html

  Venous leg ulcers are a consequence of venous hypertension that develops because of an inadequate calf muscle pump action and venous valve failure. […] The treatment of these ulcers are very different and a detailed examination and duplex scan is required to assess your legs prior to any treatment. […] Treatment of venous leg ulcers have been revolutionized over the past few years. It is no longer neccessary or indicated to condemn a patient to wearing compression stockings or bandages every day for life. Advanced endovenous techniques employed by Dr Blignaut yields excellent results in ulcer healing. […] Actual ulcer treatment consists of an in-depth consultation, wound examination and treatment, colour duplex doppler scanning of the superficial and deep venous systems of the legs, treatment plan that includes the procedure(s) to be carried out, medication and wound management plan. […] Venous ulcers can only be prevented by having venous reflux treated. The current treatment of choice in patients with superficial vein reflux is endovenous ablation by radio frequency catheter.

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

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

  Pain control: pharmacological or non-pharmacological options, dressing selection to decrease pain. […] Co-morbidity management: diabetes, heart disease, respiratory diseases, obesity. […] Medications impacting healing: there is evidence that pentoxifylline can improve venous leg ulcer healing. […] Nutrition and hydration: wounds with a large amount of drainage lose proteins and nutrients from wound drainage. […] Mobility and range of motion (ROM): physiotherapy may be indicated for clients to increase ROM to support the activation of the calf muscle pump. […] Psychosocial support/needs: the psychosocial impact of having a VLU needs to be considered and interventions may be required (i.e., patient can be referred to social work).

• #95 Symptoms of a Venous leg ulcers – why is my leg ulcer not healing?

  https://legsmatter.org/information-and-support/types-of-ulcers/venous-leg-ulcers/

  It is important to see your GP / Practice Nurse / District Nurse as soon as possible to get an assessment, diagnosis and have a compression garment prescribed. […] Compression garments are essential for when you sit, stand or walk. Strong evidence shows that compression garments and / or venous surgery are the only way to heal VLUs and to keep them healed. […] Surgery to remove the damaged vein can improve healing and also reduce the risk of venous ulcers coming back. […] In addition to the compression, your nurse should also advise you on wound care and dressings to keep your wound healthy. […] Venous ulcers can recur if the damaged vein is not supported or removed. Therefore, compression garments should be worn even when the ulcer has healed to stop it coming back. […] Venous leg ulcers can heal well with the right compression garments. Compression supports the veins and stop them leaking and allow the body to heal the wound. Continuing to wear them when your venous leg ulcer has healed can help reduce the risk of the wound coming back.

• #96

  https://www2.hse.ie/conditions/venous-leg-ulcer/treatment/

  Infections should be treated with an antibiotic. […] You should visit your nurse once a week to have your dressings and compression bandages changed. They’ll also check 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.

• #97 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. […] A malodorous exudate can be managed with a combination of adequate debridement, a short course of antibiotics (topical or systemic) and dressings. […] 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.

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

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

  Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. […] 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.

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

  https://www.wjgnet.com/2307-8960/full/v8/i21/5070.htm

  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.

• #100 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8615583/

  The prevalence of venous leg ulcers (VLUs) differs between 1.5% and 3% in the general population. The challenge in treating VLUs is common recurrence. Moreover, VLUs can be resistant to healing, despite appropriate treatment. In these cases, advanced wound therapies should be considered. The number of new technologies, applied in VLUs treatment, has increased in the last years. These therapies include biophysical interventions such as ultrasound therapy, electrical stimulations, electromagnetic therapy, or phototherapy. Furthermore, stem cell therapies, biologic skin equivalents, platelet-rich plasma therapy, oxygen therapies, anti-TNF therapy, or negative pressure wound therapy are advanced venous ulcer therapeutic methods that may support the standard of care. […] Standard care in VLU treatment consists of local wound management and compressive therapy. Correction techniques of pathological venous flow as a part of surgical and endovascular venous procedures are also included in the main therapeutic variants. Patients education on self-care, which includes wound care, physical exercise, and diet, are an important part of treatment that leads to therapeutic success. Pharmacological, systemic treatment improving blood circulation, rheological properties of blood, and the local wound environment, such as pentoxifylline, sulodexide, or nutrition supplements are effective when linked with other standard wound treatment methods. The gold standard of VLU treatment is currently the usage of a combination of methods mentioned above.

• #101 Venous Leg Ulcers: Advanced Therapies and New Technologies

  https://www.mdpi.com/2227-9059/9/11/1569

  The prevalence of venous leg ulcers (VLUs) differs between 1.5% and 3% in the general population. The challenge in treating VLUs is common recurrence. Moreover, VLUs can be resistant to healing, despite appropriate treatment. In these cases, advanced wound therapies should be considered. The number of new technologies, applied in VLUs treatment, has increased in the last years. These therapies include biophysical interventions such as ultrasound therapy, electrical stimulations, electromagnetic therapy, or phototherapy. Furthermore, stem cell therapies, biologic skin equivalents, platelet-rich plasma therapy, oxygen therapies, anti-TNF therapy, or negative pressure wound therapy are advanced venous ulcer therapeutic methods that may support the standard of care. […] Standard care in VLU treatment consists of local wound management and compressive therapy. Correction techniques of pathological venous flow as a part of surgical and endovascular venous procedures are also included in the main therapeutic variants. Patients’ education on self-care, which includes wound care, physical exercise, and diet, are an important part of treatment that leads to therapeutic success. Pharmacological, systemic treatment improving blood circulation, rheological properties of blood, and the local wound environment, such as pentoxifylline, sulodexide, or nutrition supplements are effective when linked with other standard wound treatment methods. The gold standard of VLU treatment is currently the usage of a combination of methods mentioned above.

• #102 Compression therapy for preventing venous leg ulcers returning | Cochrane

  https://www.cochrane.org/CD002303/WOUNDS_compression-therapy-preventing-venous-leg-ulcers-returning

  A high level of compression may be more effective for preventing ulcers returning than a lower level of compression or no compression. […] Compression with bandages or hosiery (stockings, socks, tights) can help heal most venous ulcers. However, venous leg ulcers can come back (recur) after they have healed, or new ulcers can develop in a different location. Continued use of compression therapy after healing may reduce the chance of ulcers recurring. […] European class 3 compression stockings may reduce the likelihood of ulcer recurrence compared with no compression. For every 1000 people using European class 3 compression stockings, 210 may have ulcer recurrence, compared with 457 of every 1000 people who use no compression. […] UK class 3 compression hosiery may be better than UK class 2 compression hosiery for preventing ulcer recurrence. For every 1000 people using UK class 3 compression hosiery, 342 may have ulcer recurrence, compared with 530 of every 1000 people using UK class 2 compression hosiery.

• #103 Venous Stasis Ulcers – UF Health

  https://ufhealth.org/conditions-and-treatments/venous-stasis-ulcers

  Surgery may be necessary to treat venous stasis ulcers. Surgery may be used to remove damaged tissue or to repair or remove damaged veins. […] It is important to work closely with our vascular experts to develop a treatment plan tailored to your specific needs and condition. Treatment for venous stasis ulcers may take time, and it is important to be patient and consistent with treatment to achieve the best possible outcome.

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