8.1 Chronic leg ulcers

Chronic leg ulcers can be divided into three types; venous, arterial and mixed aetiology.

Venous leg ulcers
Venous leg ulcers occur due to long-term increased pressure in the venous system. It is a consequence of impaired valve function, venous obstruction or failure of the calf muscle pump function in the leg. Wounds often return because the of the chronic nature of the condition.

Patients with venous leg ulcers often have a history of varicose veins, DVT, trauma, surgery of the lower limb, aching and swollen legs. The wound is often located over the medial malleaolus, the lateral malleolus, and the gaiter area of the leg.

Venous ulcers are shallow, have diffuse edges and are variable in size. The wound bed may be covered by yellow fibrin or red granulation. There is production of wound exudate which can be of a moderate to an excessive amount. Black necrosis might be present, and there can be an offensive odour. The skin around the wound is pigmented. The limb may be oedematous with signs of atrophe.

The best treatment for venous leg ulcers is a moist wound environment and compression. Assessment of the wound provides the basis for an individual wound care plan. It is important to dress a moist wound with a dressing that can manage the amount of exudates from the wound. A barrier film should be applied around the wound edges to prevent maceration from the exudates.

An assessment of the ankle brachial index (ABI) is always necessary before compression therapy is commenced.