GUIDELINES FOR THE ASSESSMENT AND MANAGEMENT OF LEG ULCERS
VENOUS
DVT/PE
Family history
Varicose veins
ARTERIAL
Venous ulcers
Phlebitis
Leg fracture
Pregnancies
Previous venous surgery
TIA
CVA
MI
OTHERS
Hypertension
Claudication
Arterial surgery
Rheumatoid arthritis
Diabetes
Malignancy (ulcer associated)
Examination of foot and leg (disease indicators)
Varicose veins
Ankle flare
Brown pigmentation
Woody, indurated skin
Eczema
Shiny/thin/hairless skin
Skin cold/blue/white
Poor capillary filling
Night pain relieved when
leg dependent
Joint abnormalities
Evidence of Neuropathy
Examination of ulcers
Gaiter region / internal & external malleolus
Sloping edge / irregular margin
On foot or anywhere on lower limb
Deep and punched out
Investigations
Doppler, BP, Blood sugar, HB/FBC, ESR,
if available BMI, Urinalysis, Swab if clinically infected
Identify cause of ulcer.
ABPI 0.8 – 1.29
Evidence of Venous Disease
Treat as Venous Ulcer
- Apply compression
- Keep dressing simple
Surrounding skin
Healthy, Oedematous, Red, Macerated
Eczematous / Contact dermatitis
Treat wound according to guidelines.
High on calf /on foot
Rolled edge
Pain
Assess using pain scale
Treat underlying cause
ABPI 0.6 – 0.79
With evidence
of venous disease
ABPI < 0.6
ABPI > 1.3
with evidence of diabetes, RA
or Arterial Disease
Evidence of Vasculitis,
Malignancy or Contact
Dermatitis
Refer to TVN / Routine
Vascular referral –apply
reduced compression
Vascular Referral
(URGENT if <0.5) –
No compression
Refer to TVN / Vascular
Referral
No compression
Refer to TVN
Dermatology Referral
Reassessment at 12 weeks
Healed
After care
Doppler 3-6 monthly
Definite signs of healing
Continue treatment and reassess every week.
No signs of healing at 12-16 weeks
Refer to Community leg ulcer clinic or TVN.
Seek advice from TVN for referral to Combined leg
ulcer clinic at Addenbrooke’s Hospital.
TVN January 07 These recommendations are for guidance only. Based on Royal College of Nursing (2006) Clinical Practice Guidelines: The Management of Patients with Venous Leg Ulcers.
RCN, London.