Management of Venous Leg Ulcers

Venous leg ulcers arise from sustained venous hypertension and valvular incompetence in the lower limb, leading to skin breakdown and chronic wounds. Management encompasses accurate diagnosis, wound bed preparation, infection control, and restoration of venous return. Compression therapy remains the foundational treatment, improving microcirculation and reducing oedema, often supplemented by debridement to remove devitalised tissue and maintain a moist healing environment. Adjunctive measures include patient education on limb elevation and tailored exercise to enhance calf muscle pump function, alongside topical or systemic agents to address microbial colonisation. In selected cases, surgical or endovenous interventions targeting superficial venous reflux can reduce recurrence rates. Multidisciplinary care pathways integrating nursing, vascular and primary care services optimise resource utilisation and patient adherence. Globally, standardising evidence-based protocols and overcoming barriers to compression use are critical to reducing healing times, preventing complications and alleviating the burden on health systems.

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Management of Venous Leg Ulcers publication trend

The graph below shows the total number of articles in management of venous leg ulcers across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic venous insufficiency: Sustained dysfunction of venous valves and outflow leading to hypertension in leg veins.

Compression therapy: Use of graded external pressure, often via bandages or hosiery, to improve venous return and reduce oedema.

Debridement: Removal of non-viable or necrotic tissue to promote granulation and prepare the wound bed for healing.

Calf muscle pump: The mechanism by which contraction of the calf muscles propels venous blood proximally, aiding circulatory return.

Ankle–brachial pressure index (ABPI): Ratio of ankle to brachial systolic blood pressure used to assess peripheral arterial supply before applying compression.

References

1. Treating Infected Non-Healing Venous Leg Ulcers with Medical-Grade Honey: A Prospective Case Series. Antibiotics (2024).
2. Active legs: Impact of physical activity as an adjuvant treatment in the healing of venous ulcers in primary care: a RCT protocol study. BMC Nursing (2023).
3. Bacterial Species Involved in Venous Leg Ulcer Infections and Their Sensitivity to Antibiotherapy—An Alarm Signal Regarding the Seriousness of Chronic Venous Insufficiency C6 Stage and Its Need for Prompt Treatment. Microorganisms (2024).