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 To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?'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
Overview of management

  • All people with venous leg ulcers should be managed by a healthcare professional trained in leg ulcer management. Most venous leg ulcers can be managed in primary care.
  • Referral is usually considered if there is an uncertain diagnosis, treatment failure, or if complications develop.
  • All people with venous leg ulcers should be assessed for arterial insufficiency by Doppler studies, oedema, venous eczema, and examined for signs of infection.
  • Manage an uncomplicated venous leg ulcer by cleaning with tap water (or saline), dressing with a simple low-adherent dressing, and applying a 4-layer or 2-layer compression bandage.
  • Manage an infected venous leg ulcer by first cleaning the wound and taking a swab. Then apply a simple low-adherent dressing and prescribe an empirical course of antibiotics (flucloxacillin). Do not use compression bandaging until the infection has resolved.
  • Advise people about adopting a lifestyle that encourages healing and prevents recurrence of the ulcer.
  • When the ulcer has healed, people should be encouraged to wear below knee class III graduated compression stockings if they are not contraindicated and can be tolerated, to prevent ulcer recurrence. This should be encouraged for a minimum of 5 years (although life long usage is preferable).
  • If the ulcer fails to heal and complications have been excluded in secondary care, aim to improve the person's quality of life rather than heal the ulcer, as healing of the ulcer may not be an achievable outcome.
  • Manage associated pain with simple analgesia, encourage leg elevation to reduce oedema, and use regular emollients plus a low-potency topical corticosteroid (after exclusion of cellulitis) for venous eczema.
  • Exclude contact dermatitis related to dressings if skin rash worsens when applying dressings at any stage of treatment, and refer to Dermatology for consideration of patch testing.
  • Follow up an infected ulcer daily or every other day until the infection has resolved. Weekly to monthly reviews are then appropriate for uncomplicated venous ulcers until the ulcer heals. During follow up look for possible complications related to the ulcer and treatment. Assess the impact that symptoms are having on the person's quality of life and look for risk factors and comorbidities which need treatment or referral.

© NHS Institute for Innovation and Improvement