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Leg ulcer - venous - Management
How should I dress a venous leg ulcer?

  • Dressings and compression therapy should be applied by a healthcare professional trained in venous ulcer management.
  • Wound dressing: apply a low-adherent dressing and replace weekly:
    • If the wound has a heavy exudate, more frequent bandage changes may be required.
    • Alternative dressings may be considered to help with pain (hydrocolloid), heavy exudate (alginate), or slough (hydrogels).
  • Compression therapy: measure the person's ankle circumference and apply below-knee, graduated multi-layer high compression bandaging and replace weekly:
    • For people who are immobile, 4-layer or 3-layer bandaging is more suitable.
    • For people who are mobile, 2-layer bandaging is more practical.
    • Do not use compression therapy if Doppler studies show an ankle brachial pressure index of 0.8 or less, or there is active phlebitis, deep vein thrombosis, or cellulitis.
    • Do not routinely use intermittent pneumatic compression, either as a replacement for, or an adjunct to, compression bandaging.
Clarification / Additional information
  • Wound dressings that create and maintain a clean, moist microenvironment are optimal for wound healing.
  • Compression bandaging is the gold standard treatment for venous leg ulcers. The bandage types are classified depending on the degree of sub-bandage pressure they exert on the limb. A constant tension is needed when applying the bandaging, to create a sub-bandage pressure gradient; the highest pressure is at the ankle, and progressively reduces towards the knee and thigh. Careful attention is needed to avoid the risk of pressure ulceration over bony points.
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], and the Scottish Intercollegiate Guidelines Network (SIGN) clinical guideline Management of chronic venous leg ulcers [SIGN, 2010],together with the best available trial evidence, informed expert opinion, and current good clinical practice.
  • Wound dressings aid healing, improve comfort, and control exudate, and are needed to prevent a bandage or compression hosiery from adhering to the wound [SIGN, 2010]. Their role in maintaining moisture facilitates autolytic debridement and promotes healing [Jones et al, 2006]. There is insufficient evidence to show that any wound dressing is better than simple low-adherent dressings for the healing of venous leg ulcers [Palfreyman et al, 2006; RCN, 2006; SIGN, 2010].
  • Graduated compression reduces venous reflux and ankle oedema and increases venous blood flow, thus improving the microcirculation and encouraging the healing process [Rajendran et al, 2007].
    • The RCN guidelines reviewed the available evidence. The trials included were small and considered to be of poor quality. There appeared to be no difference in healing rates between the different types of high compression multilayered systems (4-layered, 3-layered, short-stretch bandages) [Nelson et al, 2006; RCN, 2006].
    • There is no clear evidence that intermittent pneumatic compression improves ulcer healing when compared with standard compression alone, or when added to standard compression regimens. Further research is needed [Mani et al, 2001; RCN, 2006].

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