Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Leg ulcer - venous - Management
How do I manage a person after their venous leg ulcer has healed?

  • Educating and encouraging the individual to adopt a lifestyle to prevent ulcer recurrence is vital. The advice should be personalized, repeated on a regular basis.
  • Explain the importance of:
    • Wearing the appropriate grade and type of compression stockings, ideally for a minimum of 5 years (although life long usage is preferable).
    • Putting compression stockings on first thing in the morning before getting out of bed.
    • Adhering to lifestyle measures.
  • Encourage the person to attend a healthy leg club — for more information, see the website www.legclub.org.
  • Follow up the person on a regular basis (every 6–12 months) to identify risk factors that may result in further skin breakdown and ulceration, such as poor skin care, worsening leg oedema, varicose veins, and leg trauma.
  • Ideally, Doppler studies should be carried out every 6 months, or sooner if clinically indicated. However, in practice the frequency of Doppler assessment will be guided by local availability and resources.
Clarification / Additional information
  • Class III (high) compression stockings should be advocated for most people but, if not tolerated, class II (medium) stockings may be considered.
  • Graduated compression stockings should ideally be used for at least 5 years after ulcer healing. Lifelong use of compression stockings may be considered in people with recurrent venous ulcers, if acceptable to the person.
Basis for recommendation
  • These recommendations are based on clinical guidelines: The nursing management of patients with venous leg ulcers published by the Royal College of Nursing (RCN) [RCN, 2006], Management of chronic venous leg ulcers published by the Scottish Intercollegiate Guidelines Network (SIGN) [SIGN, 2010], together with the best available trial evidence, informed expert opinion, and current good clinical practice.
  • The SIGN guideline highlights that chronic leg ulcers almost always recur unless measures to prevent ulcer recurrence are implemented, and it recommends the use of below-knee graduated compression hosiery where leg ulcer healing has been achieved. It recommends that compression will be required indefinitely [SIGN, 2010].
  • Twelve-month recurrence rates vary widely between different studies, from 26–69% [Nelson et al, 2000].
  • Stockings: the RCN guideline reviewed the evidence which included one systemic review (two randomized controlled trials [RCTs]) comparing different types of stockings (socks, stockings, or tights), and a subsequent RCT (n = 153) comparing class III stockings with no stockings. The subsequent RCT showed that class III stockings significantly reduce ulcer recurrence at 6 months, compared with no stockings. In the systematic review one RCT showed class III stockings to be more effective than class II stockings, although they were less well tolerated. The second RCT in the review showed no difference between two types of UK class II stockings in recurrence rates. However, wearing no stockings was associated with a higher recurrence of ulcers [Nelson et al, 2000; RCN, 2006; Rajendran et al, 2007].
  • Leg clubs: the SIGN guideline recommends leg clubs that offer support to people with venous leg ulcers, and can improve compliance with treatment regimes for some people [SIGN, 2010].

© NHS Institute for Innovation and Improvement